Stair Training 101

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It's that time of year, again!  Time to stair train for the annual Climb to the Top for Multiple Sclerosis. I've previously written about this fundraiser here where I describe climbing New York's Rockefeller Center's 66 flights of stairs. This will be my fifth year participating with Team Kapniss - the Top Fundraising Team - in honor of my friend Leigh, who has MS.  Interested in donating? CLICK HERE.

Last year I completed the Climb in 23 minutes and 45 seconds and it is always my hope to do it faster than the previous year.  Over the past four years, I've cut seven minutes off my time, improving annually,  so now I've had four previous rounds of trying different training methods to see what has worked and what hasn't.  While everything has helped me improve - I think the biggest benefit has come from strength training - ie lifting weights - along with stair intervals and what helped the least was working on running endurance.  I had listed out in this blog post my 2018 training program - which was going really well until summer came and I just wanted to enjoy the sunshine and my kayak.  So now I'm back to developing my training program for this upcoming climb, mostly starting in a de-conditioned state, I'm definitely up in weight which will also be something that can slow me down.  I decided I'd use this opportunity to share more about the health benefits of stair training and discuss the ways I use stairs in patient care.

Livestrong.com has a nice article here that describes many of the health benefits of stair training.  It's cardiovascular exercise, so it helps build up your endurance and burns calories, but it also requires strength to propel yourself upwards against gravity!  Stair training is a difficult activity that can burn a lot of calories in a short time. Depending on how you're using the steps - you can target your aerobic or your anaerobic training systems using stairs.  If that's unfamiliar to you - a brief explanation is that your muscles make energy in different ways.  With long distance activities over a longer period of time, you will use oxygen to make the energy for your body to function - an aerobic activity.  For shorter bursts of energy, your body will make energy without using oxygen - an anaerobic training system.  (There are actually three systems the body uses for this, but for now - that's probably all we need to discuss).  Depending on your daily activity or the demands of a sport or activity you participate in, you may benefit from training aerobically or anaerobically or focusing on both of these systems.

In the clinic, I use step up and step down variations for numerous reasons.  We have steps of varying heights ranging from about 4 inches to metal boxes that are 18 inches high as well as a small stair case.  We use them to help with strengthening one leg at a time with optimal form. For example, someone who has knee pain or recently had surgery on their knee might not yet be strong enough to climb the stairs "normally."  But they may be able to go up and down a smaller height, so by practicing, they can improve their strength and form with the activity to progress up to higher steps until they are back to their usual level of function.

Stepping up onto one foot also challenges balance.  To stand on one foot on the ground requires control at the joints in your foot, ankle, knee, hip, pelvis, and core.  That's a lot of things to control!  Sometimes I work on balance from the ground-up... standing either on the floor on one foot or on various objects like a wobble board or bosu ball or airex pad. This makes you control all of those things at the same time, unless you're working on one of those activities sitting down and taking out the joints above the knee.  A step up exercise also works on balance from the ground up.  Sometimes I also train balance from the core/pelvis downwards - working in kneeling or quadruped (on hands and knees) positions so that you're taking the knee and foot out of the activity.  Either way, every time you go up a set of stairs, you're standing on one foot at a time and need to be able to balance and control all those joints - or you need to hold on to prevent yourself from falling over.

Recently I was working with someone who is recovering from an ACL reconstruction who is getting close to returning to soccer.  When thinking about soccer, it's easy to picture a lot of running and kicking, but people often forget about the amount of jumping that is involved.  You jump to head the ball or to kick the ball higher in the air or to change directions or to avoid an opponent. So we were working on some box jumps in the clinic.  With two feet, he could easily jump up onto the 12 inch box.  Piece of cake.  With his non-surgical leg, he could jump 12 inches on one foot.  But he couldn't get himself to jump up 12 inches on his surgical leg alone.  I've written about my own experience being unable to jump onto a 12 inch box before in that same post linked above - but watching a patient experience that block and then overcoming it was different than dealing with it myself.  We worked our way up to it two inches at a time, both jumping up and down, until he was able to jump that high.  Part of this is a confidence issue - where your brain doesn't think it can be successful, so it inhibits you from trying.  How cool is it that if your brain doesn't think you can land - it (usually) won't let you jump? By learning that he could land from a jump that high and from progressive heights below it, he was ultimately successful.  It was a big win for him and fun to see such a change in ten minutes in the clinic.   Even better was that he was still able to do it at his follow up visit - and right away!

When training on stairs, you have to consider going both up and down.  So basically you're going to be using all the muscles in your legs and core - and if you use a hand rail or swing your arms - you're going to get the upper body and chest and back involved too!  All those joints I mentioned before that are involved in balancing - the muscles around those joints are needed to stabilize you and propel you up or control your descent.  The other thing to consider is that one leg is moving while the other is holding you up.  So it's a complicated activity that also requires coordination.

So, if you're looking for a new training activity to try out - stair climbing is an option you can consider.  Today I did a short training session of 450 stairs in 10 minutes on a stair climber machine and I'm convinced that the machine is considerably more difficult than being outside on the stairwell, but I didn't have to go back down when I ran out of stairs because on the machine, they just keep coming! 

Again - please consider a donation to the National MS Society in support of my Climb to the Top.  Link above.  And if you want to go climb some stairs around Seattle together, just let me know!

Climb to the Top for Multiple Sclerosis

Today I climbed to the top of Rockefeller Center for the fourth consecutive year. Why would I do such a thing? Because it’s a fundraiser for Multiple Sclerosis and that cause is important to me- and because I can!

View of NYC from the Top of the Rock

The Climb is 66 flights of stairs- 1215 steps- that today took me 23 minutes and 45 seconds. Those 24 minutes were grueling.  My legs started to feel like lead around the 10th flight and my lungs were gone around the 20th- not to recover for several hours because it’s pretty cold at the top and they burn as I tried to catch my breath. This year’s preparation included a lot more weight lifting along with regular stair training steady pace and intervals including at least 11,500 steps in the past 8 weeks.  I endured one ridiculous training session in an apocalyptic hail storm in Seattle just a few days ago.  There was some foam rolling - because #RecoveryDays.  There was biking and running and circuits.   Last year it took 26:05.  The year before that 28:13.  And the year before that, my first effort in 2015, it took me 30:59.  So, totaling up all the minutes of training, and all the minutes of climbing for these events - I've collectively suffered maybe one week’s worth of discomfort.  Perspective: my friend who has MS (who also makes this climb every year and rocks it!) deals with so much more and on such a larger scale. Every ache I've experienced for this is such a small reminder of a much greater cause- and motivates me to fundraise and train harder. 

Let me be clear - this event is not sad.  It's raising money for a serious health condition, Multiple Sclerosis, which a friend lives with every day.  Having sick family members and friends may be sad- but this event is not. It’s empowering! And it’s challenging It's a bit of a party with an MC and DJ and free t-shirts and Pom Poms. An indoor vertical 5-K road race with lots of bananas and granola bars and weird drinks to sample and pamphlets and tracking bibs and both a start and finish line. I love it.  I love flying to the East Coast to visit with my family and friends for the weekend.  I love that it is an annual event that I regularly train for and fundraise for.  I love that my friend has a huge group of people rallying with her and collectively climbing up those 1215 steps.   I love that it is something that benefits a serious health condition.  And I love that the event raises tons of money!  As my friend said when she greeted the team at brunch following the climb, “Let’s keep raising these funds every year until we no longer have to!” 

Here are a few facts about Multiple Sclerosis (MS) from the National MS Society Website:
1) The cause of MS is unknown - but it is thought to be impacted by environmental factors.  It is more difficult to find a cure when a thorough understanding of a cause is unknown.
2) MS is an immune condition in which your body fights off it's own central nervous system.  The central nervous system includes your brain and spinal cord, so when this occurs, a variety of symptoms can occur depending on where the degeneration occurs.
3) MS is most often diagnosed in people between the ages of 20-50 and is two to three times more common in females. It is most common in caucasians with northern European descent.
4) According to this website, the Pacific Northwest has the highest rate of MS in the world.  There are studies looking at geography, vitamin D and environmental factors such as bacterial infections in an effort to determine the cause.
5) There are numerous types of MS.  Commonly, the condition is broken down into four types, but in actuality, because each person presents differently, there are many more than are generally outlined.
6) What can you do to help?  You can donate here to support further research, or you can join me to climb next year and raise money with me!

Overall- a successful training season with improved climb time compared to last year, much better fundraising, and a fun time had by all!

"If it ain't broke - don't fix it" - Workout Programming Edition

They tell you in PT School that you need to be able to properly demonstrate any activity you're going to have a patient or client do. I'm 5'5" and I was working with someone over 6' tall for return to sport after an ankle sprain.  I set up a series of objects to jump over or onto in various directions including a 12" box.  I went to demonstrate the obstacle course, but when I reached the base of the 12" box, I completely chickened out.  I was glued to the floor.  I then spent my lunch working on box jumps. (And yes, I nailed that 12" box jump, and yes, I made all my coworkers watch repeats as witnesses, and no, I can't do it again unless I work my way up from a 6" box - but at the end of the day, I still can do it!)

Being a physical therapist is an active and physically challenging job.  When I worked with the geriatric population, there were numerous times when I found myself holding up 200+ pound adults who thought they could stand, but ultimately could not.  When I'm working with basketball players, if I go to stretch someone, I'm lifting a leg that is solid muscle.  When I work with really little kids, I have to make it fun which often means ball activities with balance on various apparatuses and obstacle courses.  Not only do I need to be able to demonstrate, I also like seeing what my body is capable of and I like that I get to stay moving for my job.  I also need to work hard to keep myself healthy so I don't hurt myself.

One of the changes I made in 2017 was to program my own workouts and schedule them on my calendar leading up to a stair climb event I have in March 2018. This was the first time I have ever programmed for myself in such a manner and I really enjoyed the experience.

Here's what I learned:
1) Planning made me more compliant with my workouts.  I planned 3x/week over 6 months and when I looked back, I only missed four.  Not too shabby for someone who has previously struggled - A LOT - with workout consistency and rolling out of bed to put the work in.  And, though I was frustrated each of those times, I felt that the sickness I was feeling on 2 of those days and the snow on the ground for one of them were legitimate excuses for three out of the four.  But having a plan meant I was able to get back on track, quickly, and get over regretting missed workouts.
2) Scheduling workouts into my weeks eliminated daily early alarm clocks to see if I would, in fact, drag myself out of bed - because when a workout was scheduled - it happened.  I planned them at the times that appeared to be best for the week, mostly on a regular basis, with enough flexibility should something pop up during my usual time.  I stopped making myself feel guilty, because I wasn't missing workouts unless it was truly what my body needed.  On the few occasions I did miss, I knew I had another workout scheduled in about 48 hours to get right back on track.  Let it go.  Move on.
3) I also learned that I grossly over-estimated my ability to progress my endurance training activities.  Because endurance training is not something I enjoy and I'm not entirely sure my body is built to be running long distances, my program had me increasing mileage every 2 weeks but I was only running once per week so it was too fast of a progression.  It didn't mean I stopped running... it just meant that I had to revise my program early on because my targets weren't appropriate.

Now I'm coming upon the end of my original six month program (5 weeks left) and have been doing some research on how to better write my program for the next period of time. I have a lot more learning to do in this area - definitely a weak spot of physical therapy education, but I consistently came across articles that outlined steps to writing a training program such as goal writing, determining your primary intent (increased muscle size/increased strength/increased endurance/weight loss), determining which exercises to include and at what volume (frequency/reps/sets). But this article on T Nation by Paul Carter had a sentence that really struck me: "You don't need to overhaul a program that's largely working... The worst thing you can do is overhaul an entire program that's producing results. Keep what's working and make minor adjustments to what's not."

I've been on the same program for six months: one day per week each of strength training, interval running, and stair training with the upcoming last four weeks a ramp up of the stair training leading to my event.  I like the variety, my body seems to be recovering from each workout pretty well, I can feel and see the changes, and I'm being consistent.  My primary goals for the last six months were to get into the habit of working out three days per week (not a focus on strength, weight loss, or any other physiological changes) and to be prepared for the stair climb in March.  Period. Since I'm still seeing progress in the physiological changes that weren't even my target - and I'm able to be consistent with the program - despite weeks of trying to more meticulously plan the next program - I'm sticking with it.  It ain't broke... so I'm not fixing it.

So - Step 1: Write Goals for 2018
1) Continue training three times per week.  Get the schedule onto my calendar.  We're forming a habit here. This is my top priority.  The other goals are either ways to try to spend my time to achieve this goal or hopeful side-effects of achieving this goal.
2) Cover 1000 miles for the year (tracker located on the right of this page - tracked by FitBit, updated when blogs are posted.)
3) Climb 75,000 stairs for the year (tracker located on the right of this page)
4) 60 second plank.  Because #core and #strengthgains
5) Of course I have a weight loss goal, as well - but this requires my training program combined with an eating plan which is an entirely different blog post.
Step 2: Volume: Continued plan of 3x/week.  Reps and sets to be planned ahead of time because this is what training looks like.  It's not an arbitrary workout where I get to the gym and think "what am I doing today?"  There's no guessing.
Step 3: Exercise components: The next six month cycle has been broken down into smaller pieces, unlike the last six months. Seattle summer is gorgeous and once the sun comes out, we only get about 90 days to enjoy it for the whole year so you won't likely find me lifting or on a treadmill once that happens.  Summer is for kayaking and hiking with my favorite hiking pal.  And my stairs are outside - so they get to stay in the program.  As long as there's an active activity 3x/week for more than 30 minutes - it'll be ok to skip the weight room if I'm kayaking.  Flexibility is permitted in the workout content as long as there is consistency.

The plan:
January through March 5th - completion of the previously planned cycle.  Includes ramping up stair training and endurance training for my annual Climb to the Top of Rockefeller Center fundraiser for Multiple Sclerosis.  Can't wait to see how this year's training pans out in comparison to previous years which weren't planned.  Goal time for completion is 25 mins.  If you want to donate to that cause, click here.

March:  Recovery from stair climb with more soft tissue work, lower volume of stairs, and lots of core/planking.

April through May: Ramp up strengthening days using this program from Bret Contreras, "The Glute Guy" that has consistently been kicking my butt (pun intended) along with cardio days of  running and stairs as I ramp back up for:

June: June is the Shoreline Stair Climb Challenge and I'll be aiming to climb 15,000 stairs during the month of June.  Last year I made it just past 10,000. Stairs will be supplemented by hiking and kayaking and sunshine.

July: Recovery again with increased soft tissue work and decreased volume with core and planking.

August through September: back to the progressed cycle.

That will bring me back to the time when I will determine if I'll be Stair Climbing again in 2019 and when I would start my training program/what it would look like as we enter the gray days of Seattle for winter.

Why would I share this?  First off - accountability.  Second - sometimes it helps others to plan their training program by seeing how someone else has structured it.  If you're hoping to increase your glute size or strength, you could review Bret's program that I've included. If you want to start a workout program for the first time in a long time - or ever, the ideas I've used to get into a routine may help you.  Or you can come join me on the stairs.  They never seem to get any easier but the view from the top is gorgeous.