We discuss in this interview:

• The benefits of exercising for people with inflammatory arthritis
• Carl’s activity on the Rheumatoid Support forum
• The role of muscles in regulating inflammation
• Resistance bands techniques and exercises
• Upper body strengthening
• The correct way to hold bands
• Mistakes to avoid when exercising

Clint – Welcome back to RheumatoidSolutions.com. Today, I’ve got the lights on me because it’s eight o’clock at night, in fact, it’s 8:30 Pm. I’ve got a guest today from South Africa so with the time zone, we’ve configured this so that he’s got nice lighting on him because he’s going to be demonstrating some exercises for us that we can be doing at home. Throughout the covid period, there’s been a massive shift away from gyms and yoga studios to doing workouts at home. This is certainly something that can be hugely beneficial if you have inflammatory arthritis, because some studies show that if you have ongoing inflammation, you are susceptible to muscle atrophy, meaning that you have some wastage of some of your muscle tissue. In addition to that, when we have inflammation in our joints we are reluctant to do exercise. In particular sort of resistance work because we feel that the discomfort in our joints means that, we’d prefer to avoid that discomfort, even if we intuitively know that better muscles and better strength can be helpful. Getting around the house, getting up off the toilet chairs, going up and downstairs and so on. Today’s guest is going to help us with that, he is Carl Reidar and he has a website that you can visit him on. It’s www.CarlReaderCoaching.com. He is a functional movement coach, and he has been on our show before and is now a member of Rheumatoid Support, which is a support forum, and home for all of the activities that we do. Where we interact and help each other, solve each other’s problems, and cheer each other on as we reverse inflammatory arthritis as a group. So, Carl, welcome back to the show, thanks for joining us.

Carl – Thanks for having me back again, and also enjoying being a member and engaging with all the guys. It’s been great.

Clint – Yeah, everyone has been very, very supportive and very engaged with you as our coach inside the group. What sort of questions have you been getting? Can you give us examples of some of the problems that you’ve helped people solve?

Carl – Yeah, a lot of questions are on, what are the best exercises to do for certain conditions, especially elbows. Also finding that a lot of the members are doing too much and things that they often have to cut back on the exercises and reduce the load. So the members are aware that exercises are so important, but sometimes we just naturally gravitate into that mindset of more is better. And so I’ve just found that quite is just to say let’s get this cut back a bit and space it out to move more often throughout the day than opposed to doing all the exercises all in one hour and then needing for the rest of the day. (inaudible) the typical type of questions we get.

The Importance Of Working With A Coach

Clint – And you’ve been developing your skills and honing your recommendations for rheumatoid arthritis, haven’t you? We were just chatting before we hit record here that as a result of some of the podcasts that we’ve done in the past and also as a result of the help that you do to our support forum members, that you do get contacted frequently outside of those platforms for personal one on one help and for coaching and so forth. So you’re building quite a repertoire of knowledge and tools to solve problems with RA, because it is challenging, isn’t it? You’ve got to be careful not to aggravate the joints.

Carl – And that’s why working with a coach like myself is so key just to guide them through the process, and just which we’ll discuss some of the stuff just now. Like some of the small tips that you miss out on when you try and do a lot of exercises by yourself. It’s not always a shortcut method, but it’s just saving you that may be a treatment to obtain in the long term. But, yeah, it’s been wonderful, I’m so fortunate to have great clients, a good relationship with them, and seeing them improve, so I’m really enjoying it.

Clint – Yes, and we’ve been very grateful as well to have you as a member. It’s only been a couple of months now, but it looks like you’re going to be staying with us long-term, and I know that our members are very, very grateful, And your thread, your coaching thread where people post questions to you is a very popular one. There’s always something happening in there, and I’ve learned a lot myself. I know that if I had someone like you working with me over the years, I could have saved myself a lot of time and reduced the duration of pain because I’ve made probably, I want to say probably 20 times more mistakes than what I have revelations at the gym. You try all these different things and so many things don’t work with RA. Just like the diet, it’s a narrow path to success. So thank you.

Clint – Now let’s get into what we’ve set ourselves up to discuss today, which is resistance band training at home. I’ve set the scene with regards to the challenges, to muscle atrophy, and the reluctance to exercise with some joint pain. But if we’re successful at navigating past those issues and actually do these exercises, what benefits can people expect if they follow successfully what we’re about to learn today?

What To Expect In This Podcast

Carl – So, I mean, there’s just so many benefits to strengthening in terms of improved posture, joint stability. Also, we look at the muscle the same as in the past as just the things that move your bones, and now we know that they secrete things called cytokines, which are chemical signaling messages, and they regulate inflammation. So that’s very, very important just to get that resistance and to preserve the muscle, and we know sarcopenia, which is the breaking down a muscle as you get older. But the big thing for me is helping them regulate inflammation, I think it’s amazing how muscles are involved in regulating and helping avoid and treat inflammation. The anti-inflammatory effect of muscles, we can call it. So I’m excited to as a guy with the background sport as well, but I’m super excited to see how strength and exercises have such a profound effect on inflammation, and of course RA.

Clint – Yeah, fantastic. All right. Well, tell us what equipment we need and then we will we’ll get right into it.

Resistance Bands

Carl – So we’re looking at the resistance bands, you’ve got these typical type of resistance bands and you’ve also got these rubber shootings, and the other one is weights. And I think a lot of people start off with the resistance bands, and I think we should maybe just cover some of the tips in using resistance bands. Now, there’s a big difference between the resistance band and the weights in the sense that if you look at, if you were to hold a dumbbell and have the arm by the side, it’s easy in the beginning and it gets harder and harder and then it starts to get easier and easier. so the load follows sort of a bell curve. Where with resistance bands, it starts at nothing, low resistance to load. And as you increase the length of the band, you reach maximal load at the top of the joints, which you’ve got to be careful. So the first big tip with bands, especially for RA clients, is you want to be careful of holding the (inaudible) movements because you’ve got maximum load on the joints with maximum vulnerability. So like with a weight, if I do that now, I’ve got maximum range of the elbow, but the load is low. But if I’ve got the same thing with a band, the load is heavy. Does that make sense?

Clint – Yeah, absolutely. So if we were to give another example, just for me to gain clarity. If you were doing like a punching motion, as if you were like punching like a boxer, and the resistance band was attached to a tree behind you to run at the outermost punch point, you’re at maximum resistance. So you may be in a little bit of a vulnerable state at that point,

Carl – Correct. We want to talk about upper body strengthening exercises. And one of the powerhouse for your upper body is your pecs and your core. Now you’ve got your deltoids in your arm muscles, but not in comparison to the size of the pectoralis and your abdominals and that’s the powerhouse. Before we get into that, it’s very important that the members or people listening to the show, understand that because of poor posture or pain or just muscle imbalances or whatever, your muscles are not optimally firing. So in other words, they’re not functioning correctly or efficiently. So if you just go straight into exercises and let’s say you have one hundred muscle fibers, you’ve only got maybe twenty-five to thirty engaged, and it’s the same with the pecs. So if you’re doing a punching exercise or pull even a bicycle, that you actually start straining the joints because you haven’t got full use of the muscle. So one of the things you want to do is we want to activate the muscles. And I’m just going to show you a very simple exercise, especially for the pecs, which is really important. So keep in mind that, the pecs is where the power is. This is delivering power through the arm and through the elbow, which many people start RA up to the wrist. The power doesn’t come from the shoulder, it comes from the abdominals through the big powerful pecs through what we call, fascia lines. And then it’s distributed into the down the elbow and into the rest. It’s such a simple exercise that you can do what the sportsmen do. (Inaudible) bang their chest, bodies, and do these rubbing things. But you can just simply if you have relatively good posture, just literally just look right and allow your body to turn as well. You turn to the right and you turn to the left as comfortable as you can two times and then back. And if you put your hand on your chest now and just do even a little simple, like a like an uppercut, you should feel that the pecs actually feels like it’s more engaged. Can you feel it? It’s more pumped, isn’t it? You’ll feel more (inaudible) like what we call, a pump. First of all, it gets the blood flow there and second is the activation. In fact, if you do in which we’re getting (inaudible), one of the big exercises for the chest is push-ups. Now, the problem is for most people with R.A. in shoulders and elbows, doing push-ups is quite an advanced exercise, you need a degree of good core stability. And that makes the elbow punches with the elastic band, which I’ll give an example now. But if you were to do that with the band and just stay in the short range movement, don’t go full out. You’ll actually get tremendous pecs arthritis because of the pecs engagement, and as well as the arms, being strengthened as well.

Clint – Okay. So if I was to be sort of creating a checklist here because I don’t know what you’re going to be delivering to us, I would write down the first thing is we want to probably warm-up before any upper body by moving.

Carl – Rotational.

Clint – Yeah like a talk, it would rotate. The people can’t see the video at the moment, you’re basically rotating on a vertical spine with your entire upper body. You’re twisting on your upper body. Okay, so we warm up doing that, what do we do next?

Strengthening The Pecs

Carl – So then is to then get into the right, depending on excising, you’re getting into the right posture. So I’ve got a really good exercise for the pecs. Now, some people are worried about strengthening their pecs because they may have what we call the rounded posture or forward posture. We’ve been trained and conditioned to stretch the pecs, open up the chest, which is correct. But remember, when I started this conversation that your picks are the powerhouse of the upper body. So if you’re just stretching them all the time and not actually strengthen them, you’re not getting the benefits. So we want to strengthen them in what we call a lengthened or isometric way. So that means that they’re working hard without contracting and training exercise for that and it’s very simple. I’ve got a band here that’s attached to a bar and I’m going to turn sideways so you can see it, and you hold the band in your hands like this. The idea here is that you’re sitting in a chair and you want to be sitting relaxed, upright, so not slouched, but not military. You can see my chest is sort of puffed up, so that’s not correct. You want to relax that into a relaxed, upright position that that gets the muscles to engage. The minute you sit upright, you disengage the stomach muscles, and it’s a very important point. So from here, we are pulling the band down towards our belly button. But I want you to keep in mind that the elbows must come next to the chest. So, you can see that my elbows are next to my body and that actively engages the pec muscle isometrically, which is what you want. You’re getting a core contraction and you’re getting a really good pec contraction. And what I do with some of my clients, I just get them to hold that, and then I can feel that working. But, that’s not working super hard, like a push-up. But you’re getting, especially for our RA clients, you’re getting a nice core and you’re getting rhomboids. The back muscles, trapezius back and you’re getting the pecs activated in a not a rounded position. Like if you are doing flies or those things in the gym and you’re getting a good call contraction, which is great from here. So that’s really simple and it’s one of my go-to for core exercises. But remember, we’re talking upper body now and that’s core and that’s the pec exercises. It’s important when you do this as well is to look straight ahead and don’t look down on the floor. OK, yeah,

Clint – Now with that one, I forget the term for this and I should know it, but the pecs are actually being used not in ascending, but the reverse. The pecs are being used as the muscle as the tension is released from the body, aren’t they?

Carl – Could it be concentric?

Clint – Yes, that’s it. Pecs is what we call it, it’s an adductor towards the midline. So people will be, how do the pecs works if you’re not doing any sort of these kinds of things? The key is as the arms come down close to the body, you’re creating adduction. And look, that’s almost like a push-up position. If you think about it, you’re doing a push-up, and then it’s an adductor. So as you release it, it would be on a push-up and you would be feeling that. But in this case, it’s not really and it’s more this action here, and it’s giving that the activation.

Clint – Okay, beautiful. Now, we’re going to now learn about some more upper body workouts.

Upper Body Workout

Carl – Yes. Now, another really important point when you’re using Bandz is that you’ve got to hold it correctly. So the average person, when they take a band, is they grab it over the thumb if you can see like this and that’s just common sense. I learned this from sailing by the way and this is fantastic. But when you hold any band for any exercise either be bicycles, tricep pulldowns, and anything that uses resistance bands. This targets the upper chain muscles, your upper neck, your shoulders. And so you want to move away from that because it puts a lot of strain on the shoulder and the neck. So what you want to do is make sure you take your hand and then you grab it, and twist instead of the line of pull is going underneath or cross the small finger. Can you see that? So it’s not over the thumb and this makes a huge difference to the different muscles. It activates the core, the (inaudible), the pecs and it connects. So if you are going to do this, for example, like your punches. Although times like this, you could do that the same way here just with the band. And so I’ve got great contraction here, but I’m not going extra like that because now I’ve got maximum load on, on a vulnerable shoulder. So it’s just that action and that is fantastic for entry-level or even medium-level of pec exercises. It’s very good for the core and it replaces push ups. And I think for those who love doing push up, that’s fine. But for the average person struggling with elbow pains and shoulders, that’s a great alternative.

Clint – Elbow pumps are good and many people are already familiar with those. Yes, I’ve been doing those for 15 years. OK, and now we can add our bands to it. I used to add some light weights to it, but then I just moved away from doing that because I use it as a warm-up and a maintenance exercise. I thought, why do I want to start confusing the purpose of why I was doing it originally? It suits its purpose and then if I want to load and try and build strength with muscles, then I can do a different exercise. I don’t need to load my warm-up or my maintenance exercise. But yes, I don’t mean to contradict what that you’ve said. It’s a good idea just for me at the gym when I started doing it, I have been adding more and more weight until I realized, I’m getting away from what feels comfortable. And I was adding quite a little weight.

Carl – Ok, which of us with your weight to remember with the band you’re exercising in the line of resistance. Wherein, you put a weight in it and you just do the weights of pulling down. So you’re counterbalancing the weight and it puts tension on your neck and it actually can hurt the shoulders. So it’s actually a completely different exercise if you look at it like that.

Clint – Perfect. Okay, what else can we do?

Carl – The other one I really like for the upper body is what we call, internal rotation of the elbows. It’s for the ‘pecs again and remember we want to get that strong. So simply just again, you want to maybe have the line horizontal, which I can do. The idea is that you keep your elbow close to your shoulder and then just pull across then you got the pec working. And so that would be like sliding a door or closing a car door, and it’s very functional. It’s knock out like in front like this because that’s going to hit the shoulder. But keeping that elbow and you can see how my elbow is not chicken wing, it’s close to the body and I’m pulling it. And take note, I’m using the tummy muscles. You’ll notice as well when I do this, my upper body rotates. So we get into what we call these robotic movements which look like this. It’s a robotic sort of movement that would be just kind of moving the arm back and forth, and that takes away all the power. It’s that combination of allowing the upper body to rotate as well as you do this and it activates all the key core muscles. So those are three really simple exercises to get those pecs and upper body stronger. And there’s another one we can do, which is the pulldowns or the tricep pulls down and they are also very nice.

Clint – You should do those because over the years I’ve had times when I’ve had tendinitis in my elbows. And earlier in the chronological path, I had obviously a lot of synovitis, inflammation, and rheumatoid in my elbows as well. And what I find is that the first thing to go when that happens is your triceps strength. You can’t push down and get yourself up off the chair, or the bathroom, or off the toilet. You try and push down, but the pain is too great through your elbows. And so you stop using them, and then you try to roll forward and do like momentum, as we’ve talked about, off the toilet and stuff. And what happens is your triceps waste quickly, real quick.

Carl – It’s such an important message, like you said, getting up something, pushing yourself off the floor, and you are just reading (inaudible) that involves an extension on the elbow is compromised.

Clint – So let’s look at that.

Carl – With the triceps, the first thing you want to do, in my opinion, is you want to avoid doing the traditional tricep exercise because it puts the weight behind you.

Clint – Okay. I’m cringing because I caused myself a long-term injury by doing that before I had rheumatoid. So if people are not watching the video and they’re just listening to this, what we’re talking about here, is what not to do. Do not do when you raise the peak of your elbow to the top of your head, then dangle your arm down behind your shoulder blades and then use a weight to raise it up and down. And that is a tricep exercise that’s quite common but it’s called an open loop, isn’t it? In that situation, you can explain what that is and then also go on to show us the better way.

Carl – Well, it’s just, Grandage, like if your hands on the ground or sitting there. The thing is, it’s just all the load is distributed straight into the elbow. So you have no powerful muscles assisting the movement. So it’s very effective for straightening the triceps, but it’s always compromised as you experienced. There are good ones as well where you can sit on the edge of the chair, then put your legs on refining and you sort of trickle and tricep dips. They are effective, but you have also to be very careful. You got to have a certain degree of strength, then you’ve got to build the body and get used to it because you do that too early on as well if the load goes and the elbow. And that can cause pain effective for triceps strengthening and quite a functional aspect to it as well. But it’s something I would caution early inflammation, beginning stages, maybe second phase, introduction to triceps strengthening.

Clint – Let me give a personal experience on that. I have been through this a few times with my right elbow tendinitis. My go-to exercise when I get tendonitis in the right elbow, fortunately, it hasn’t been in there for over six months. I just sort of this out and I’ll just do what as you said, which is a dip set up position for a dip, but I don’t lower myself. I try and squeeze a lockout in the setup position, I do not lower, and I just hold it. Then it develops muscle in the connective tissue. The tendons at the joint engage them as they hang on for grim life to hold their position.

Carl – Very good, and that is isometric (inaudible) the tendon is being held in that position and I like that. And then you can hold it for a few seconds and then get out of it and you’re not risking that low, and then it can literally be the difference between excruciating pain.

Clint – When I started getting back into fixing this situation, my feet were touching the ground. I couldn’t hold my body weight in the dip set up because of the pain. Now I think the longest I’ve held that set up full body weight is I think seventy-two seconds. And now, I can hold in a dip setup position, which is significant for me because given that the significance of the tendonitis that I most recently had last year. So this works and that was one of the key things.

Carl – When someone doesn’t want to do that exercise, there is a good one for only ten minutes. If they maybe are in a chair, where they can’t get into that position with the legs out in front of them. By just sitting in a chair, you can put your hands by the side of your body on the chair, then almost try to lift yourself off gently and you’ll get the same sort of effects. So if you pushing down into the chair to almost lift your pelvis off the chair and pushing down into the same action. It’s something you can do in a wheelchair, you can (inaudible) sitting is easy.

Clint – If I may and I know that I’m laboring this point, but for me, I said I’ve probably done 20 things for every one thing that worked. And with that, I found that I only made progress when I started in the locked-out position. And if I try and push up, I was just I was too tender.

Carl – Too weak?

Clint – Yes, to hold and lock my body. So that was just my experience and for people who are going to try both, give it a go. But that was just my experience. So, give us these tricep fixes.

Tricep Exercises

Carl – So with the tricep, you want to make sure you attach your tubing. At least up in front of you, like six feet or two meters so that you can have the pull-down action. And the key with that is you want to bring the elbows by the side. So don’t keep them out and you want to keep them down. And then, what I like to do is to just keep my knees in a semi-relaxed position which gets the core. Remember, the core is what’s generating the parts. You don’t just want to be to upright and you just kind of pulling down with the triceps. We want to strengthen our triceps and we don’t want to just be isolating triceps. Does that make sense? We want to be using the whole chain and the triceps that happens to be the prime mover here. So very simply pulling down and then back up to comfortable. Now, this is not high enough just for the purpose of the video, but I would have this much more vertically.

Clint – Basically, the elbow should be coming down vertically and attach it maybe by closing a door on the band at the top, right? And you would stay up against the close to the door.

Carl – Correct. And you want to hold it again where your pinky finger is coming on the outside and I’m pulling down, it’s not on the thumb side. You’ll notice the difference in the neck muscles straight away when you do that. And you can hold that as well to get the isometric as you hold it. Make sure you feel that the core is working, always look up slightly at where the bands coming down. So maybe not up in the neck but, look forty-five degrees. Because what a lot of people do is they follow their hands, they look down and when you look down you put a strain on the nervous structures, the tissues, and that compromises the actual movement and the strengthening processes.

Clint – OK, back in back. OK, so did you have anything else for us.

Carl – This last thing is as well with the bands I see this so often, especially with women, is the wrist. You can see how the wrist is bent and when they are pulling they do this just to keep that wrist straight. So when you are doing anything keep it straight. You can see in the video here, my wrist is straight, and like there’s a bent and that causes tendinitis. But it also shifts it and puts a strain on your elbow because it is also involved in the rotation. For example opening, closing, your hand supine and, opening up that movement. So be careful with that and keep your wrist stretch.

Clint – All right, so let me just summarize. I’ve just made some notes here on a piece of paper. We’re going to start by just getting some warm up by getting sitting up straight, but without really puffing our chest out. By just getting nice posture and then rotate our torso back and forth a few times. And that starts to activate some of the muscles in the upper body. Then we could do like seated rows, but we pull the band towards us with the bend coming out underneath. So that the pressure is on the bottom of our fist with the pinky. And that’ll work on the pecs and also work on some of the back muscles as well. So we’re getting a nice as you call it, functional movement there. And then we can do the elbow pumps and we can load them with a band if we’re finding that they’re pretty easy. And the flow then works nicely because of the way that the tension works with the bands. Then we can work with when you’re moving your fist towards your chest and you’re saying is bring it in with your elbow to your side. I’ve written down the internal rotator cuff movement.

Carl – Yes, it is a rotator cuff. But again, the power a lot of people are doing rotator cuff. They’re trying to focus on the rotator cuff. And it brings the attention that this is a (inaudible). There are many benefits to these exercises.

Clint – But that’s how I described it to myself. And then we’ve got the isometric dip or the symmetric dip set up, which we can do by putting our legs out straight in front of us and just holding our body weight with locked-out elbows. If our elbows are pretty good and we’re actually just trying to build strength, then we can actually do some little dips as well and go down a little bit, come back up. And that’s very effective for building triceps. And that’s probably one of the ones that we’ve listed and that’s the most challenging so far, wouldn’t it be? So if your elbows are good, you’re going to see some results from doing that for sure and get some soreness from doing that even after your first session within a day or two. The tricep pulldowns you have also outlined for us. The band should be right in front of us, attached to an overhead bar or more likely at home, run it through the door frame top and close the door on it. And then we’ve got to keep our wrists straight, always throughout the exercises. So what I’m going to do is, I’m going to have these drawn up as images and put them together on a PDF. I’ve got someone who I can ask to get that done for us. And if people want to go to rheumatoidsolutions.com and find this episode with Carl, you’ll be able to download that PDF with Carl’s exercises from today’s session and print that I’ll make. I’ll see if I can fit a mold of one or two pages and print that out and then you’ll be able to follow that along at home. And you’ve got yourself a nice band, work out to build some strength without blowing the joint. So, Carl, thanks very much. Did you want to add anything else to that?

Carl – I think that’s a great summary. It has the most important notes and not too much. Yeah, just stick to the program.

Clint – Well, let’s wrap there. If you would like to speak with Carl more, if you’ve got other questions that are pressing about your physical health and areas that need assistance, Carl does private coaching. You can go over to www.carlreadercoaching.com and you can follow the links and contact him. It’s very affordable as well and he is based in South Africa, if you’re wondering about time zones. You can also reach Carl inside rheumatoid support, our support forum,and as we talked about at the beginning of this conversation, he answers every question that is posted to his private coaching column. And you can just go and say to Carl, “this is what I’m dealing with.” And he gives you a comprehensive reply and in some instances, creates personalized videos that go along with his answers. So he’ll demonstrate those few and post them inside the support form. So thank you very much, Carl. I think this is going to be really well received. I believe we should set up another couple more of these sessions so that we can help people more with the physical movement and reduce joint inflammation.

Carl – Thanks Clint, always a pleasure.