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Case Study: An Unfit Fitness Plan

Pradeep Carvalho walked towards his car in the parking bay of Purple Global School. At the exit reception he was joined by Dr Ved Bhuller who had analysed his son, Naitik’s case and given the school some sound advise about their sports programme.

Pradeep Carvalho walked towards his car in the parking bay of Purple Global School. At the exit reception he was joined by Dr Ved Bhuller who had analysed his son, Naitik’s case and given the school some sound advise about their sports programme.

Pradeep: Your clinic is nearby? I would like to consult you.

Dr Bhuller: Sure! For yourself?

Pradeep: I have a double condition of cervical spondylosis and maybe even a PIVD (prolapsed intervertebral disc). I am taking some ibuprofen… Have been dealing with some pain, but after hearing you in there, I am thinking you should check me…bhuller nodded. Everyone was becoming very knowledgeable these days; with Dr Google resident right on their keyboards, there were more doctors than patients to manage. Knowledge helped validate reports but it did not change behaviours. So, here was Pradeep saying, “I can’t hold my neck up, I can’t sit for long, I can’t drive. Within minutes I am in pain…” Bhuller had one assessment: Pradeep was in a high-stress job and did a lot of self-medication.

Not just the corporate folk, but business folk, lawyers, architects, doctors, students were all under stress. If it was not deadlines, it was goals, targets, competition, market fluctuations… Or if they are young lawyers or writers, they were spending some 15-16 hours a day on their chairs! The human body was not designed to be in a seated posture for that long; but when he told them that you should not be in one position for more than 20 minutes, they laughed quite heartily.

Nor standing that long. These days, security guards and sales staff stood for their entire 12-hour shift. ‘Wrong!’ thought Bhuller. His niece who taught at a school and hence stood for very long periods, had a faltering heart rate. He had her go for a full check-up and she was diagnosed with Chronic Venous Insufficiency (CVI) — where her veins were not sending enough blood to her heart. All at 33.

In Pradeep’s case, he was also looking at the computer screen in an awkward position including slouched on his bed and bending in the car to use the long ride effectively. “Neck pain is a function of not just posture, but your prolonged bad posture, for a long time and for many days. Add to that deadlines. Always navigating from one deadline to another.

Pradeep: How does deadline impact my neck pain!?

Bhuller: Stress! Stress causes the muscles of the neck and shoulder to tighten (the nape of the neck, the shoulder girdle) and it radiates to the upper back. And if these are allowed to continue, at some point it is going to reduce the motion in the spine. Then, it becomes a vicious cycle.

Pradeep also travelled a lot; many small flights within the country, fire-fighting breakdowns at different offices of his company, so that he travelled as much as 18 days a month. And now he proudly revealed, “Sometimes I cover short distances by road because going to the airport to get the flight takes just as long thanks to our great roads. So, Bombay-Pune, Bombay-Goa, Ahmedabad-Baroda, Chennai-Bangalore… I take the car.”

Bhuller noticed that Pradeep carried a backpack. A backpack was an unnatural weight on the back.

Bhuller: I am sure it also gets filled with books, papers, a set of clothes?

The modern managers usually didn’t even want the bother of waiting for checked-in baggage. So backpacks were getting bigger and more accommodating! Pradeep shrugged, “What to do. Some days the meetings are so back-to-back, your only chance is making a day trip.” This is what Bhuller meant: Google did not change behaviours. In fact, there was enough information on the Internet — but people read selectively.

Pradeep believed in a healthy lifestyle; he talked with agility about sprouts, wholegrains and probiotics. He even wore a fitness tracker, his phone had a fitness app. But he ended up eating at the airport and street stalls. His food was most often unhealthy.

So, the young corporate manager’s awareness grew with Google and an app. Like Pradeep, they would say, ‘Ok, so I have to join a gym’ and with that came a plethora of problems.

At the gym, there was pressure from so many machines staring at him. Pradeep, who sat for more than 12 hours a day, had not told the trainer about his lifestyle. Add to that, the trainer, looking all fit and flexible, whose vocation is body fitness, who spent his whole day staying fit, intimidated Pradeep.

Bhuller: You must tell a trainer everything about yourself. Absolutely everything. I don’t just mean diabetes or High BP, but poor digestion, acid reflux, how much you sit, how much you travel, I am anxious by nature…everything. He or she is not merely working with a body, but with a body with conditions. And what is your gym routine? Do you warm up before weights training?

Pradeep: I have done weights before in college, so it is not new to me. That way I am quite fit…

Bhuller: You are 39? You were in college 20 years ago.

So, here was the other set of problems. Regardless of whether it is weights or the treadmill, people carry the memory of what they could do at college. “I could run 10 km in one go!” But that was then, this is now.

Seeing Pradeep’s expression, Bhuller laughed, “No, I am not saying that it is about age; It is about how the body has been doing different things and has not been kept fit. So, have you stopped the gym for the time being?”

Pradeep: Sort of. We have a gym in our building so whenever have a short window, I do 20 minutes on the treadmill. At least, it increases my heart rate, which is good.

They know all the cool key words and terms but there is a method. You can’t decide to jack up your heart rate because you have 20 minutes. So, they do high speed, steep inclines on the treadmill, panting and suffering….. “I have an hour before I go for dinner, let me take up my heart rate…” Bhuller cringed; what a lot of damage that was doing to their bodies. Consequently they had knee problems, ankle problems, lower back problems because the pressure on the lower back on steep inclines was very intense. Some patients came with neck problems, which he had traced to walking at high speeds and steep inclines on the treadmill while they strongly grip and hang on to the side bars so that they don’t fall off.

The whole ‘gymming’ was based on a lot of imagery, which could not be the premise for ‘training to get fit’. Like Pradeep believed, that until you feel that burning sensation in the muscles you are not gaining strength or losing weight. ‘Burning hona chahiye!’ So, Pradeep had worked intensively on weights to feel the ‘burn’. Or how Sushant and Nagesh on his floor, did 150 on the bench press. Nagesh even took up his speed to 8.5 on the treadmill. But Pradeep had ended up with a strange clicking sensation in his right knee.

Sometimes the gyms were to blame, felt Bhuller. Many were promoted by non-professionals. Customers too were uninformed and bought ‘packages’ trading off wisdom for economy and a hollow ‘we promise you’. “No, they cannot promise anything. How can they?” said Bhuller, a trifle annoyed. “We are a biological system, and it is biology that dictates what you can do.”

So, it was a combination of what they recalled of their college-day-prowess and what was out in space as portrayed by film idols. But these same Pradeep-like managers forgot that those guys are in the business of body beautiful, they are dream merchants and their primary stock-in-trade is their body, which they have to keep looking beautiful to stay in business and to entertain your senses. “Like you read HBR to remain relevant!” said Bhuller, “They also have access to nips and cuts and tucks with which they edit their flaws, don’t forget!”

The trainer also marketed his gym or his training aggressively in some cases. Because it was going to take a while to bring on those biceps and packs, the trainer decides to enhance his impact by looking for ‘quick fixes’. One was ‘weights jyaada karo’. The more you do the better, he says. Bhuller’s patients had revealed the trainer's accent on ‘nutrition’ or what the trainer thought was nutrition: Supplements and anabolic steroids. And the younger they were the more easily they bought into this plan.

Bhuller: Anabolic steroids deliver results really fast, testosterone spike, muscle becomes large and buff. But side effects? It weakens tendons, weakens ligaments, weakens your tissue. Your trainers cannot/will not tell you that. Why? Because you and he are looking at output. Results. It is like a consultant who will project aggressive sales, ignoring the plant’s depreciated state.

Side effects? Apart from these some psychiatric reactions are talked about — mood swings, anger (called ‘roid’ rage) that leads to violence.

Then again, how much stress are we putting on the liver and kidney? They are having to metabolise all these ingredients you are ingesting. All those supplements you are gorging on, too have to be metabolised. (Sadly, all these are unregulated and available over the counter, thought Bhuller) They have side effects especially when taken along with other medication. So then, are you drinking enough water, for instance?

Mr Carvalho, you are educated in some very fine schools. You know enough about marketing and brands and promotions. These are the stuff of your life. How do you forget that these gyms when they promise you a six-pack, are merely only promoting? Isn’t that obvious?

Bhuller had spoken to them all who came to him with damaged body parts, groaning, wanting to be made good soon. Catching the damage early was possible only in some cases. Some came very quickly. Small sprain, cut, bruise, they landed at his clinic. There, he was able to correct the damage early. But some, like Pradeep, stuck on with his programme, despite his PIVD, “I thought because I was new, my body was complaining. My trainer told me pain is good. I thought the more I do the weights the better I will get. But now I am in really bad shape...”

But Pradeep also had a shoulder that was crying for attention. “We had an inter-office cricket match over the weekend and now my shoulder has packed up. I can’t believe this.”

Bhuller: You have not rotated your shoulder and arms to throw a ball in 20-25 years and now you are expecting to do the pace bowling that you used to do. Look at the bio-mechanics: the action of bowling involves the entire body. The arm is used as a sling, and the maximum power that is generated, is from the trunk and the leg. So, you have to combine the motion of the pivoting leg and the trunk, and then as we come towards the shoulder and the arm, it is the back that does the most work! In bowling, it is not speed, but how fast that kind of power can be generated, which depends on how quickly your muscles can lengthen and contract. If you are not generating the power from the proximal joints, then the muscles of the arm have to work harder. So, then the shoulder gives way. See, the shoulder joint is a mobile joint (at the cost of stability) and has to tolerate massive rotational forces during the bowling action, leading to injuries of the rotator cuff tendons. That is why they say that throwing is a whole body skill.

Pradeep: Man! I actually know nothing!

Bhuller: Similarly with soccer. In soccer, the body balance is a critical component. You are running; then one either stops and kicks, or kick while running. In either case, you need excellent balance; fatigue anyway reduces your balance. Now, you try to overstretch or try a long kick, the fact is that you are putting a lot of strain on the joints of the whole body, but specifically those of the legs. Squash is another one. In corporate environment, squash, golf, are the ones to watch out for.

It’s not that you cannot be fit too. Of course, you can, but given that you have hibernated for 15-odd years, you need to give the body time.

Pradeep could not deny that those huge mirrors in the gym in front of which all weight training was done had led him to develop impatience. “You have to make me fit really fast!’ he had told the trainer. So, the trainer urged him to do more and more.

Bhuller: Whereas the trainer needed to have been more realistic, as nothing will happen in 10 sessions. The trainer has to say, “Look I have to prepare your body to get you to that level. So, let us start slow and then we pick up speed.” So, goal setting and expectations have to become more realistic on both sides.

Pradeep now sheepishly revealed that he had wanted to build a muscular body. So, the trainer put him on an intense strength training programme. However, the trainer did not warn him about aches and pains that follow intense training. In addition, his old back problem had reoccurred with a vengeance — a problem he had not told his trainer about....

Bhuller now saw that Pradeep’s pains and aches had a deeper story to tell. “I am sorry, but your back pain began with badly planned weight training. The trainer ought to have told you to strengthen your core first or use a posture that supports the spine prior to lifting weights. When you start to swing, there is the danger of shearing forces pulling on the spinal column. Hence this back pain.”

Continuing his assessment, Bhuller saw that Pradeep had the most common conditions — bicipital and rotator cuff tendonitis. He often saw that people who lifted weights ended up with tender and painful tendons. That also easily explained why Pradeep was unable to change gears without pain while driving.

Bhuller: Ok, straight off, stop lifting weights for some time. If and when you resume weights, you must work with a trainer who knows kinesiology. Why? Because he/she will be able advise you how to train safely using biomechanical principles.

Pradeep: Doc, this is India. Trainers are not so fancy.

Bhuller: Not so! Not so! Trainers that have attended physical education undergraduate programmes or credited certification programmes are trained for it. They have a subject called kine-siology. You need to appoint the right trainer.

Bhuller looked back to early 1990s, when with liberalisation came the fitness mantra starting with Reebok and then going to Kelloggs, which had the nerve to rubbish the 8 a.m. aloo paratha and with Reebok saying ‘Walking to the temple is not a fitness regime’. Both (and others who followed them) defined fitness for India.

Market gazers had pooh-poohed cereals entering the regime of the idlis and parathas. Some even swore by the 5,000-year-old Indian heritage in anxiety. But walking and running for fitness entered many lives; cereal boxes climbed the Indian kitchen shelves; people did surreptitiously look at their growing paunches and took strong decisions. India was a country of good people with good intentions. Fitness became religion.

But sadly this liberalisation was not channelled to add knowledge to growth. To add finesse to delivery. To add value to service. To improve the quality of life. Every car company came and sold their cars. Everybody set up pizza shops. Everybody became courier companies. Everybody set up gyms. Everybody called himself a trainer. In the interim, the average Indian forgot to stop and ask: ‘Where were we before 1995? Who trained us with the science, the skills…?’ From 24-hour delivery that courier was meant to be, it now took over eight days while Indian Postal Service continued to deliver consistently in four days for one-fifteenth the cost and to every nook of India.

He thought about people like Pradeep. When they moved up the ladder at work, they had access to medical check-ups and thus to specialist doctors like himself, albeit for his child. But they also had loosened their fists to enroll a trainer, but look at what they got! The gyms they went to for quick fixes at Rs 80,000 to Rs 100,000 per annum, had all the equipment but not trained trainers.

Bhuller knew that most trainers were not certified. Some were self-taught, and there lay the danger. Pradeep’s back was strained as was his shoulder right in the first month of gymming. This happened only when man and machine clashed without the interface of science.

Pradeep: My annual check-up declared I was not fit. So, I decided to join the gym…. Had I known… what should I do now?

Bhuller: Start with mild stretches — a regime of stretching exercises for the lower limbs, a flexibility programme for the structures of the lower limb and the upper limb. Then gently mobilise the back until the pain and stiffness settles down. Don’t over do the cardio programme as well — to begin with start with a 30-40 minute programme and progress gradually. More is not necessarily better…. Spread the cardio workouts through the week and choose different types of workouts — walking, swimming, cross trainer, etc.

Pradeep chuckled hearing all this. He was the IT resource for a key business and here he was completely clueless about the machinations of his own body. He decided to put himself onto a healing programme straightaway… for starters.

Read Case Analysis by Rahul S. Verghese
Read Case Analysis by Dr Raju K. Parasher

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