Physical fitness is vital to maintaining professional longevity in the bodywork field. What exactly does fitness mean? The US Centers for Disease Control and Prevention define it as the “ability to carry out daily tasks with vigor and alertness, without undue fatigue, and with ample energy to enjoy leisure-time pursuits and respond to emergencies.”1 The National Strength and Conditioning Association simply calls it the “ability to perform important physical activities.”2
By anyone’s definition, the first step is to decide which tasks and activities are important for performing our jobs. Next, we must identify common issues or movement patterns that may be limiting our ability to carry out those tasks. Finally, we must seek out activities that help us maintain a healthy balance of flexibility, strength, and endurance so we can function optimally.

You Are What You Do
Our body adapts to how we use it. If more oxygen is needed on a consistent basis, the body builds more of the structures responsible for delivering oxygen to the cells. A helpful concept is the Specificity Principle: training is most effective when it is similar to the activity or skill we are trying to improve. When we spend time doing activities that require strength, the body realizes greater strength is called for, and it builds stronger muscles to generate force and fortifies the myofascial architecture that transmits that force.
It takes a lot of energy to maintain these adaptations. This is why we burn more calories when our bodies are physically fit. If we do not continue at a higher level of activity, the body will conserve energy by breaking down its previous adaptations. The notion of  “use it or lose it” is true­­—and we also lose physical ability much faster than we gain it, because the body prefers to conserve energy rather than expend it. We must continuously apply the specific stresses on the body necessary to achieve and maintain the desired results.
The body doesn’t discern if these changes are comfortable or support long-term health. It simply accommodates whatever activities you do on a regular basis, good or bad.
Now that we know the body is constantly changing to adapt to whatever it is doing, we can address some common problems faced by bodyworkers. By better understanding each issue, we may more effectively alter or balance the stresses in an effort to improve physical fitness.

Make the Change
PROBLEM:
Stiffness from Static Positioning
In our work, we sustain certain body positions for long periods of time. This may involve standing beside the massage table and applying pressure along a client’s spine, or sitting and supporting a client’s head with our palms. Our bodies function in a state of relaxed tension, maintaining proper posture and joint alignment while transferring our intention to a client’s body. We often move very slowly, smoothly navigating the landscape of a client’s body. To do this effectively and with directed contact, muscle tension is generated and maintained, often with little or no actual joint movement.
Our bodies are designed to function best when moving. When our bodies are in motion, circulation of blood and lymph increases, fascia becomes more fluid, joints are lubricated, and muscles are able to vary tension to sustain, overcome, or control resistance. Maintaining static positions for prolonged periods can lead to stagnancy of blood and lymph, fascial adhesions, joint stiffness, and dysfunctional muscle tone.

SOLUTION:
Restore Fluid Movement
To combat the impact of stasis, we need movement, not static stretching: large, fluid, full-body movements that include different positions and mindful activation and relaxation of major muscle groups. One activity I find really useful both before and after a long day at the office is the Sun Salutation: a series of yoga poses, or asanas, performed in succession.
When performed correctly, the poses promote coordinated effort of multiple body regions, specific muscle activation and elongation, proper joint positioning, and balance. Transitioning smoothly from one pose to the next rather than holding a given pose emphasizes circulation, fascial fluidity, and joint lubrication. Proper timing and focus of the breath supports and enhances movement while maximizing circulation of fluids, oxygenation of the blood, and overall muscle endurance.
One repetition of the Sun Salutation involves moving through all of the poses, starting and ending with Mountain Pose. It usually takes me about three repetitions to establish a smooth flow and feel the effects of the exercise. If I have time, I will do a couple more repetitions or add other poses to the flow, depending on how my body feels or what I need that day.

PROBLEM:
Overemphasis on Flexion
The issues of prolonged static positioning are compounded by our tendency to position into flexion.3 There are two unavoidable reasons for this tendency.
The first reason is anatomical. Our eyes are on the front of our head. This means we tend to use our arms and hands in front of the body so we can see what we are doing. Can you imagine trying to work on clients facing away from them with your hands behind your back? Working with our arms in front of us emphasizes rounding of the shoulders (scapular protraction, glenohumeral joint adduction, and medial rotation) as well as shoulder and elbow flexion.4 Our hands are also designed to close around objects, emphasizing flexion in the wrist and hand, typically combined with pronation of the forearm.
In addition to positioning the upper extremities in front of our bodies, we tend to lean into activities, creating an overflexion pattern in the spine and hips. This is often combined with a jutting or forward-head posture, especially when we are really focused or concentrating on a task. A seated position further emphasizes flexion patterns as both the hips and knees are flexed, typically to a 90-degree angle.
The second reason is gravity. Living in gravity further enhances flexion patterns because we must actively pull our shoulders back and down, lift the spine to maintain proper alignment and curvature, and extend the hips and knees to maintain our base of support over the feet in order to remain upright. The muscles responsible for maintaining posture against gravity, including the spinal extensors, rhomboids, middle and upper trapezius, gluteals, and hamstrings, can become dysfunctional if not properly conditioned. Activities emphasizing proper activation and endurance training for these anti-gravity muscles are essential for optimal posture and alignment, normal joint mechanics, and comfortable, efficient performance of physical activities.5

SOLUTION:
Extension Exercises
Stretching short muscles may not be enough to counteract our tendency toward flexed positions. We also need to wake up the extensor muscles and re-establish their ability to activate through a full range of motion.
In particular, I seek out exercises that emphasize hip extension, spinal extension, scapular retraction, shoulder extension, horizontal abduction, and external rotation. While the Sun Salutation on page 63 offers an opportunity to move into positions of extension, we may need to supplement this with specific exercises such as those shown here.

Bridging (beginner)
Lie on the floor face up with your knees bent and feet flat on the floor. Feet should be slightly apart and arms relaxed at your sides. Using your abdominal and buttock muscles, gently raise your hips off the floor until your shoulders, hips, and knees form a straight line. Lower your hips back to the floor. Repeat.

Prone Extension (beginner)
Lie prone over an exercise ball or with several pillows under your abdomen and hips. If over a ball, steady yourself with the balls of your feet. Relax your back and neck, allowing your body to curl around the ball or pillows. Now, actively engage your back muscles and buttocks, lifting your head and chest and slightly arching your back. Lower your chest and head. Repeat. Modification: extend your arms forward as far as you can during the lifting phase.

Sidelying Shoulder External Rotation (beginner)
Lie on your left side with your head supported and right elbow bent to 90 degrees. With or without a small weight in your hand (1–3 pounds maximum), rotate your shoulder, lifting your hand away from your body. Keep your trunk still, holding your elbow bent and against your side so your shoulder does the work to raise and lower your hand. Repeat. Turn onto your right side and repeat with your left arm.

Cervical Retraction (beginner)
Lie on your back with a towel roll under your neck. Nod your head and tuck your chin, keeping the back of your head in contact with the towel. Focus on elongating the back of your neck. Relax and repeat.

Prone Extension with Alternating Arms and Legs (intermediate)
Lie prone over an exercise ball or with several pillows under your abdomen and hips. If over a ball, steady yourself with the balls of your feet and the palms of your hands. Extend and lift your right arm as you extend and lift your left leg. Keep your weight even on your hips and tummy, not allowing your body to shift to one side or the other. Maintain this as you lower your right arm and left leg, then raise your left arm and right leg. Repeat.

Good Morning (advanced)
Stand up straight with feet slightly apart and knees slightly bent. You may or may not opt to support a weight on your shoulders. With knees kept slightly bent, bend at the waist until your upper body is parallel to the floor. Look ahead and keep your back flat throughout the movement. Repeat.

Prone Shoulder Horizontal Abduction (intermediate)
Lie prone with a towel roll under your forehead. Raise your arms straight out to the side as you squeeze your shoulder blades together. Keep your elbows straight and your thumbs pointed up as you lift your arms and lower them back to the starting position. Repeat.

Deadlift (advanced)
With or without weights in your hands, squat down until the weight touches the floor or your hands are even with the outside of your ankle. Look ahead, keep your back straight, and squeeze your shoulder blades together as you move into a standing position. Press through your heels and exhale as you rise up. Lower to the starting position, keeping your body weight on your heels, shoulders back, and spine straight. Repeat.

PROBLEM:
Overuse of Upper Extremities
When people learn what I do for a living, they often ask me, “Don’t your hands get tired?” I answer that if I am doing my work correctly, it’s my legs and feet that should be tired. Our bodies are designed to produce the greatest amount of force in the powerful muscles of our legs, hips, and trunk. Ideally, that force is then transferred through the shoulder, elbow, wrist, and hand where it is fine-tuned and applied in a specific direction.
An easy way to imagine how this kinetic chain works is when learning to throw a ball. At first, we just use our arm to hurl the ball forward. We soon learn that a twist of the trunk gives the throw more force and it travels further. Finally, stepping into the movement really gets that ball moving. We are now using the entire kinetic chain as it was intended, generating major forces in the lower body and trunk and directing them through the arm.
Improper utilization of the kinetic chain can contribute to overuse syndromes in the upper extremities. Bodyworkers are vulnerable to these pathologies and too often they are career ending. Thoracic outlet syndrome, rotator cuff tendinitis, medial and lateral epicondylitis, carpal tunnel syndrome, de Quervaine’s syndrome, and osteoarthritis in a multitude of locations in the wrist and hand are common.

SOLUTION:
Proper Whole-Body Force Transfer
From a physical fitness perspective, we can help correct or prevent many of these issues by learning to utilize the whole body to generate force and transfer that force with proper mechanics through the upper extremities.
To improve force transfer for my job, I seek activities that include fundamental movements like lunging and twisting, and then add pushing and pulling. Each of these motions has a specific purpose and can be combined to create more complex movements. I like to start by mastering each individual component and then systematically combine them to create a smooth, efficient kinetic chain.
First, focus on establishing a strong, stable base of support with the lower body. Place feet shoulder-width apart in a staggered stance (one foot forward and one back) to create a stable base in all directions. When I am working, this stance allows me to position close to the table while bracing my front thigh for additional support. It also allows me to hinge at my hips when bending and reaching over the table, instead of rounding my spine.
Lunge exercises put this position into motion and improve strength and endurance in the lower body. I also like using a couple more yoga poses to improve function in the lower extremities. The sequence described on page 69 can be done as a stand-alone exercise or added to the Sun Salutation just after Downward Facing Dog.
The large muscles of the trunk, including the rectus abdominis and internal and external obliques, are prime movers, generating force to twist and pull the trunk forward. A layered network of smaller, deeper muscles positions and stabilizes the individual vertebrae and larger vertebral regions as forces move through the trunk. I often see trunk exercises performed lying down, which are effective in manipulating gravity for resistance, but may not be directly applicable to our work. Remember the Specificity Principle: we need to practice twisting motions while sitting and standing so the physical improvement we achieve is relevant to the way we do our job.
Sometimes the spine is particularly stiff or it is difficult to activate and control individual segments. If this is the case, start twisting exercises lying down or supported so the legs and hips can be fixed, minimizing compensation. Once mobility, proprioception, and muscle activation in the trunk improve, exercises are progressed to sitting, then standing.

Lunges
Stand up straight with feet slightly apart and hands at your sides, with or without weights. Keep your back straight and head up as you step forward with your right foot. Bend the leg until your thigh is parallel with the floor and your right knee is directly over your right foot. Return and repeat, stepping with your left foot.

Prone Trunk Rotation
Lie prone over an exercise ball and relax your back and neck, allowing your body to curl around the ball. Raise one arm as you rotate your head and shoulders toward the same side. Keep the front of your hips in firm and even contact with the ball. Return to center and then reach and rotate to the other side. Repeat.

Seated Spinal Twist
Sit tall and grasp an exercise band or pulley around your right shoulder. Brace your feet on the floor and hold your pelvis still as you engage your abdominals and twist your upper body to the right. Repeat until fatigued, then perform the same exercise on the other side.

Lawn Mower Pulls
Stand with feet shoulder-width apart and grasp an exercise band or pulley with both hands. Keep your feet planted and hips forward as you pull up and twist to the opposite side. Repeat until fatigued, then perform the same exercise on the other side.

Supine Trunk Rotation
Lie on the floor face up with your knees bent and feet flat on the floor. Keep your ankles, knees, and thighs together as you rotate your legs from side to side. Activate and control the motion with your abdominal muscles and do not let your shoulders rise off the floor. Repeat.

Wood Choppers
Stand with feet shoulder-width apart and grasp an exercise band or pulley with both hands. Keep your feet planted and hips forward as you pull down and twist to the opposite side. Repeat until fatigued, then perform the same exercise on the other side.

Summary
Because our body structures adapt to how we use them most frequently, we may develop dysfunctional or painful tension patterns. The good news is that we can alter those demands in order to achieve different structural results. We may not be able to change the nature of the work we do, or even the movement patterns required to do that work. Fortunately, we can seek out and perform other activities that alter or balance those currently creating dysfunctional patterns.

Christy Cael is a licensed massage therapist and certified strength and conditioning specialist. Her private practice focuses on injury treatment, biomechanical analysis, craniosacral therapy, and massage for clients with neurological issues. She is the author of Functional Anatomy: Musculoskeletal Anatomy, Kinesiology, and Palpation for Manual Therapists (Lippincott Williams & Wilkins, 2009). Contact her at functionalbook@hotmail.com.

Notes
1. US Centers for Disease Control and Prevention, “Physical Activity: Glossary of Terms,” accessed May 2014, www.cdc.gov/physicalactivity/everyone/glossary.
2. Roger W. Earle and Thomas R. Baechle, NSCA’s Essentials of Personal Training (Human Kinetics, 2004): 74.
3. P. Kolá, “Systemization of Muscular Imbalances From the Aspect of Developmental Kinesiology,” Rehabil. Fyz. Lék. 8, no. 4 (2001): 152–164.
4. Phil Page, The Janda Approach to Musculoskeletal Pain (The Hygenic Corporation, 2002). Author workbook for private seminar: 9–11.
5. Florence Peterson Kendall et al., Muscles: Testing and Function with Posture and Pain, 5th ed. (Lippincott Williams & Wilkins, 2005): 51–52.

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