Woodard Wednesday: Watch your language

I am becoming increasingly convinced and irrefutably sold on the importance of language.  

And even if I just used the word “irrefutably” wrong, who cares?  It sounds cool when the first sentence is about language.  I needed a big word.

What I mean by that is not the particular language that we speak, but the language we use with ourselves.  And yes, in case you are wondering if this is going to be another Oprah-like blog entry, brace yourself for something AHHHH-MAAAAAA-ZIIIIIING!

I am a professor in a doctorate physical therapy program.  It is my honor to teach one of my favorite topics in the whole world, orthopedics.  Another name for the class: Evaluation and Treatment of the Musculoskeletal System.  In real person terms that means I teach about muscles and bones, and what to do with them when they say “ouch.”

On day one, I start with an activity that has nothing to do with muscles and bones, but also everything to do with muscles and bones.  Stay with me…

On that day I find the biggest muscle bound beau I can find in the class.  In PT school, there is usually one guy or gal that looks like they lift Volkswagen's for fun on the weekends.  I’m happy that my fitness capabilities give me the option to run away from them before being crushed or tossed about like a doll.

I ask that student to stand in front of the class and hold their arm out.  They are given the following information and instructions: “I am going to attempt to push your arm down several times.  I am asking you to not let me win at all and to use all your strength to keep your arm lifted as it is now.  No matter what, do not let me win.  Do you think you can do that?”

At this point, the class is interested to the point of visible salivation.  Look at how scrawny Dr. Woodard’s arms are.  This is going to be EPIC!  I’m convinced they are all planning my violent demise but just won’t admit to it.  This gives them a glimmer of joy, as surely the result of this contest will be a humiliating defeat for the guy grading their exams.

I now tell the student with his arm raised, “as we do this first test, I want you to think very clear thoughts.  Those thoughts need to be: ‘I am strong.  There is now way my arm is going to drop.  My muscles are huge and powerful.  I am a badass and can do anything.”

Without fail, I can hang from this outstretched arm, jump up and down on it, bite it, and absolutely not move the thing.

I then tell the student, “as we do this second test, I want you to think very clear thoughts again, but this time those thoughts need to be: ‘I am weak.  Even though I am going to try to hold my arm up, I will fail.  My strength is not enough to hold up to this challenge.”  I remind them they are not supposed to let me win and push their arm down, but to think those negative thoughts.

Without fail, I can break their position using 2 fingers.

Naturally, the class is devastated that I was not humiliated.  Vultures…

Did this super muscly weight-lifting student just get less strong?  Did his muscle atrophy and shrink?  Why did he get weaker, just by thinking weak thoughts?

The answer: our thoughts create more of a reality in our lives than another other force conceivable. 

That is true for this students shoulder and arm muscles; it is also true for every damn thing we do from moment to moment.  It is that simple. 

My question to you, and something I’d love to actually hear back about: what thoughts are you thinking that are making you weak?

“I’m too fat.  I hate my life.  The people at work are out to get me.  My boss is a douche and is trying to make me miserable.  I’ll be single forever.  I’ll never pay off my debt.  This race/run is going to be slow and painful.  I won’t qualify for Kona today.  That sushi last night gave me salmonella, or at least herpes.” 

You say those things, you are those things. 

Why are we so nasty?  Not to each other, but to ourselves?

Sports psychologists have known this since sports were invented.  When you have positive psychology, you perform better in sports.  Check out this link from the American Psychological Association: http://www.apa.org/helpcenter/sport-psychologists.aspx

So, how does this work?  The answer is clear.  It’s pixie dust…

The actual answer might be more complicated than that, but that chat could go on for chapters and chapters, and frankly, I should be working instead of writing this blog.  Ain’t got no time for that.

The simple answer: your body is under the control of your brain and nervous system.  Obviously for simple things like wriggling your toes, but also for the amount of force production and efficiency of movement.  The strength of a muscle contraction is directly controlled by how many neuromuscular junctions are firing per unit area of muscle and dumping excitatory chemicals into each other.  The more "happy juice" your brain squirts into a muscle, the stronger it will contract.  The happier your thoughts, the more "happy juice" you've got at your disposal.  See, biochemistry is actually not all that hard.  

You try to run a race saying internally that you suck the whole time, guess what?  You are going to suck.  You try being the student at the front of the class told to hold up their arm while thinking you are too weak to do so, your arm will fall. 

You try being a person living a happy and fulfilling life, but all the while repeating to yourself how miserable you are and how there is no hope, misery and hopelessness will continue.  This isn’t my opinion, it’s just a truth.

I challenge each of you readers to do the following.  Every day, physically write down 3 quick things you are grateful for in your life, and then one short paragraph about something happening in the last 24 hours that made you happy.  If it takes more than 3-4 minutes, you are trying too hard.

Here is mine from today:

Grateful for:  1) my adorable dogs who slobber on my shoes 2) my career that I freakin’ love 3) people who take the time to read my blog

Happy moment in last 24 hours: today I made my students laugh.  During the course of an intense lecture with really heavy material, I got them to laugh at me or something I said.  I was able to share a sliver of knowledge to make them better healers someday, but I did so in a way that they were able to smile.  What a gift is that for me to have access to?  And even better, I got to laugh right with them.  They might have been miserable all day, but in those moments, we were all laughing.  We were happy together.  Because of their presence, I had joy.  And perhaps even momentarily, my presence brought joy back to them in kind.

That’s it.

There is a growing body of literature and science on this stuff.  The science of happiness and positivity.  You want to change your life, read this book: The Slight Edge by Jeff Olson http://www.amazon.com/The-Slight-Edge-Disciplines-Happiness/dp/1626340463

Go ahead, tell me I’m a hippie and smoked too much dope in college and have clearly shorted out my brain.  Tell me all this is crap and that thinking happy thoughts won’t make your life better.  Tell me about how miserable you are and there is no hope. 

Just don’t be upset that after you’re done telling me that, I smile at you so genuinely and purely that you are convinced I am mentally compromised. 

I am happy.  My life is unbelievably amazing.  I have everything.

Those things are true because I, you guessed it, tell myself they are true every damn day.  I do so without pause and without wavering conviction.  Why do I believe in it so much: because telling myself these things has manifested exactly what was promised: happiness, joy, contentment.  

I had a hard enough life in year's past.  I am grateful for those times as I learned the power of sadness and depression.  But I am more grateful to be what I am now: the thoughts in my head and absolutely nothing else.  

Thank you for reading...

Are there carbs in humble pie? My race report from IronMan Cozumel 2014

Another race report can only mean one thing: I did another race.  Aside from my incredulous powers of deductive reasoning, you'll be dazzled in the following paragraphs by the recounting of the kick in the crotch that was IronMan Cozumel 2014.  Read on, dear soul, read on.

First, may I take a moment to explain where my head was at while preparing for this race?  Since you can't answer, I'll just go ahead.

Either the sun was bright or I was channeling my inner pirate.  AAARRRGGGGHHHH!

I had just come off of what I thought to be a pretty good showing at IronMan Mont Tremblant, beating my previous years time at the same course by about 2 hours.  Boom.  This strong finish gave me a great sense of accomplishment and self-worth as an athlete.  This sense would be dashed in short order by the proverbial Mexican mariachi band that marched across my face.  Going into this course, I knew 3 things: 1. the ocean swim has a current in your favor but you'll probably get eaten by a shark, 2. the bike and run courses were reportedly a bit windy but flat as a tortilla, and 3. bean burritos should never be used for carb loading the night before an IronMan.  I was prepared.

The Swim
Let me preface by saying that I've only done one ocean swim for a race in my life.  During that swim, I got motion sickness and yacked 3 times, which is as lovely as it sounds, and thought I was legitimately having a stroke when my left eye went numb and cold.  Swims like that leave a certain mental marker on a guy, so getting ready for this second ocean swim in Cozumel had me gnawing my fingernails like they were electrolyte tablets.

The conditions of the water were not helping in the days leading up to the race.  The wind was so strong on Friday (race on Sunday) that during the ferry ride, the crew handed out barf-bags to the passengers because the sea was so rough.  The bags did not go unused.  Upon arrival to the island, the ocean was well decorated with white capped waves, signaling certain doom.  These facts, along with the joy of having hollywood worthy disaster scenes play out while sleeping about floods, drowning, and destruction by water, did not help ease my nerves before race day.  I was a mess... roadkill level mess.

Saturday morning, on a relatively empty belly, I got in the water for a practice swim.  The wind had really died down and with it, the tumultuous water conditions.  I swam about 200 yards out and back and was concerned with how I felt: happy.  That was stupidly beautiful.  It's pretty impossible to be concerned about much of anything when the show that has been playing out meters below you stars schools of tropical fish and a sting ray.  The water was warm and welcoming and the beauty was enough to settle my nerves.  For the first time in about 10 days, I wasn't dreading the swim.

Now on to race morning, we all squeezed ourselves into various garments of latex, rubber, and spandex.  It was basically a public service announcement for safe sex...in goggles.  The age group wave start is usually not my favorite for one primary reason: I'm slow.  This typically means that the fast swimmers in the groups released after me are tasked with climbing over the carcass that is my body in the water.  I feel badly that I'm in their way, and I'm frankly not in love with someone trying to swim on me.

This swim however was a complete surprise, in the good way.  Because it is point to point, the athletes were able to spread out quite a bit and find some room.  Translation: very little bumping and grinding.  I had a few little collisions but got through the entire portion without getting my clock cleaned by a flagrant elbow or angry calcaneous directed at my upper teeth.  Success!  And again, the spectacle that was going on below us was magnificent!  The water was crystal clear allowing viewing to the sea floor, which was teaming with fish and sea life.  Best distraction for a swim ever, except that time I did laps while listening to my underwater iPod at a geriatric nudist pool.  That was pretty distracting too.

As for the current, later discussion revealed that it wasn't very strong this year and didn't end up helping as much as we might have hoped.  That said, I pulled off a pretty good time for my standards and got out of the water feeling surprisingly at peace.  "This was going to be a great race," I foolishly mouthed.

Results: 1:23:23 which is about 10 minutes faster than what I would normally do.  185th place out of 466 in my age group.

There's me in the background, the one who is all wet

Transition 1 went off without any surprises either.  I rinsed off the salt water in the showers provided, and yes, I sang as one is obligated to do while showering, and grabbed my bike gear bag and made off for the changing tent.  After what I wrongly thought was an adequate coating of sunscreen application, I dashed off to my bike for a torrid love affair with the beast.  Time for T1: 8:44

The Bike
Before I tell you about my bike performance, a discussion about my training is warranted.  I actually spent a lot of time on my bike preparing for this race and came in pretty confidently.  The only problem was that all of the time I spent on my bike was done in 2 hour increments, indoors.  I'm not too proud to announce to the world that my longest outdoor ride was done during IM Mont Tremblant.  Actually, to be more accurate, my ONLY outdoor ride was Mont Tremblant.  Still I reasoned that this bike ride would be much easier than such a hilly course that I had done pretty well on just a few months prior.  What could go wrong?

I had done my power testing and found that my endurance zone range was about 155 Watts to 185 Watts.  We decided to play it safe and aim for my normalized power on the bike to be 160W.  Again, a refresher on the problem here is that I could hold 160W without any trouble at all...for 2 hours.  After that, it was a mystery.  Perhaps not the best training strategy?

I started the ride spectacularly, holding about 163W and passing people like I was getting paid for it.  "I am SO fast," I thought.  What a fool.  The first dose of reality came with a soft left turn about 10 miles into the ride.  What awaited us was a brilliant headwind reported to be sustained at 30mph.  Well, that slowed me down a notch or two.  But still, I am not a novice to this sport and know what I'm doing (reader: insert sarcastic face here if you wish).  I kept my cadence high and held my wattage like I knew I should.  Just stay in aero position and keep pedaling.

I had to admit that about an hour into the ride I felt like 160W was going to be too aggressive.  By hour 2, I was certain of the fact.  If this had been a half IronMan, I would have been golden.  But seeing that I had only completed my 1st of 3 loops of the bike course, I knew I was in trouble.  Try as I did, my wattage kept falling lower, and lower, and lower.  How lovely that the headwind on the back side of the island just got higher, and higher, and higher.

People had told me the wind was a major factor in the race.  They neglected to tell me that I should train inside a tornado to prepare.  I could not believe how strong the headwind was, and similarly, how crappy I was feeling.  I also hadn't trained to be in aero position for 6+ hours straight and my neck, back, and shoulders would scream every time I was there for longer than 10 minutes.  "Just sit up and take a break," you suggest?  Yeah, might as well have been riding the brakes while dragging a parachute behind me.  Sitting upright in that wind cuts your speed horrifically.

To sum up the bike ride, it was a battle.  I ended up with a normalized power of 138W which means somewhere about half way through, I officially tanked.  People talk about having a certain amount of matches to burn during one race.  My match box was a smoldering heap of mess.  That bike course spanked me like a bad, bad baby.

My hope for the bike ride was to hold 160W and finish with a time of 5:45 or better.  In reality I finished in 6:24:58, 124th in my age group.

Transition 2
This is usually a fast transition for me.  Not this time.  I was pretty shaken by that crushing blow from the bike and I just couldn't seem to rally.  I was dizzy, my legs were wobbly, and my belly was making a threatening gurgley noise, a triathletes worst nightmare.  "To hell with this," I thought.  I am a runner.  I will crush this flat course run.  I will still pull off my goal run time.  I WILL bend down to tie my shoe somehow.

I somehow managed to get changed and ready for the run and went to look at my watch for my time.  Yeah, it wasn't there.  In my delirium and haste, I had managed to leave my watch face attached to the mount on my bike.  I took a moment considering my options: run back and see if they could somehow find my bike a get my watch for me, or just throw caution to the wind (no pun intended) and run based on feel.  I chose the later.  Bad move.

My time for T2 was a terrifically slow 11:39.

The Run
I started the run with what felt to be about an 8:30 pace, which was after all my goal.  That lasted no more than 200 yards before I simply had to stop and walk.  Confidence boost, it was not.  The gurgle of the belly was also becoming more angry and pronounced.  Oh boy.

After about a mile of pitiful jogging, desperate walking, and progressively impressive tummy gurgles, I decided to just suck it up and resign to walking and porto-potties for a while.  During each race, you have to accept where you are at that particular moment and manage it.  At that point of the run, I was a barely ambulatory troll with some unpleasant gastrointestinal goings-on.  "Manage the moment," was my mantra.

About a mile down the road I started to feel a little better.  I had picked up my pace and was feeling borderline good.  I have no idea what pace I was running, but it felt to be in the 8:30-8:45 range.  And I tell you, dear readers, that I so deeply tried to keep that pace.  But all the caffeine and simple sugar in the world can't help you when you start a marathon with so little left in the tank.

I ran some of the time, jogged when I just couldn't hold a strong pace, and walked more than I have in the past few races combined.  Having a lot of friends on the course helped spur me along at times, but the reality was that I was just having a terrible run for my level of run fitness (yes, I actually did train appropriately for the run!).  At least I managed to escape relatively unscathed, despite my poor gangly nasty toe.  Yes, it does feel great, thank you for asking.

My original goal for the marathon was to hold an 8:30 pace and finish in the neighborhood of 3 hours and 45 minutes.  In reality I turned in a time of 4:26:26.

Overall Thoughts
This race is spectacular and I can see beyond doubt why everyone I know who has raced it has come back with highest marks for the course.  The swim is breathtaking, the bike and run are challenging but interesting, and the local people are some of the warmest and most delightful folks you'll ever meet.  If that's not good enough, they have Mexican food everywhere, the equivalent of living a childhood Christmas morning at each meal.

I have now completed 5 full distance IronMan races and am always taken aback by how different each experience is and how very much I learn from all of them.  This race taught me more than I expected certainly, but probably the most of all my races.  I learned that ocean swimming can actually be quite pleasant if you don't eat 4 pounds of bananas immediately beforehand.  I learned that while indoor trainer workouts are extremely valuable, they will never fully replace the training you get on a long outdoor ride.  I learned that an IronMan course should never be taken lightly, even if it is the flattest on the circuit.  I learned that my mouth loves Snickers bars while biking but my belly feels differently later.  I was reminded that while these races always provide a nice heaping dose of pain and struggle, the feeling of crossing that finish line and hanging yet another medal on my wall brings me immense joy.

To answer the question posed in the title of this entry, yes there are carbs in humble pie, and boy did I have a nice slice of it.  I came into this race feeling pretty sure I was going to pull in a time under 11 hours.  With a total finishing time of 12:35:10, I was reminded that humility is as important a training tool as is the physical training itself.

There is no shame in my result, and in fact, I feel I am a much stronger athlete because of it instead of in spite of it.  Having a race beat you down like that will do one of two things: discourage you from the sport and make you see reason as to the madness of doing this voluntarily, or add fuel to the fire that is the desire to push yourself harder and return to the line more ready and triumphantly than before.  I'd wager you can guess which of those options I am feeling post-IMCOZ.

I got my ass handed to me.  But the silver lining of the story: after all that biking and running, my ass is looking pretty damn good.

When I see you on the road, say hello.  When I meet you at the starting line, return the polite nod.  When I celebrate the success of my next finish and the accomplishment of another seemingly impossible goal, join my celebration.

My sincere gratitude to you for reading and keeping me honest, as well as to the sport we call triathlon.

Why we run and how we run

I geek out so hard over this video!

Firstly, it all makes such perfect sense.  The next time I get a patient in my office that tells me, "my doctor told me it isn't good for me to run," I'll probably respond by saying, "THIS doctor said it is ok to run, and this video explains succinctly why."

I also love a point that isn't discussed by the scientist but really jumps out.  Look at the differences between the barefoot video and the shod (wearing shoes) video.  The exact same runner is a mid foot striker when barefoot but becomes a heel striker when wearing shoes.

An interesting point seeing that the anthropologist is saying we use the Achilles tendon as a spring...  Well, if he's landing on his heel while wearing those sneaks, he will no longer be using the Achilles tendon as a spring.

GOD that was great!  Ok...  off of my soap box now.

A run in solitude

As one of my 25 jobs I like to dabble in, I spend some of my life as a professor in a doctoral program for physical therapy.  Being a runner/triathlete/idiot myself, I took the initiative to start a running club with my student body.  What could be better for a group of future physical therapists aside from becoming, well, PHYSICAL?

Monday was our first night and I was so excited!  Things didn't go exactly as planned.  Below is an email I sent out immediately after the first meeting that I thought might resonate with some of my readers here:

Tonight's run was fantastic. A full loop of Central Park was taken on, and pretty fast I might add. The only trouble: I was the only one there. WHOMP!
Many of you have expressed interest in joining but raised concerns you wouldn't be able to keep up. Nonsense! 
Allow me to tell you how I started as a runner. The winter of 2009 I decided to sign up for my first marathon. To give you perspective, I had never at that point run more than a mile continuously. In middle school we had to run a mile as a fitness test; I came in dead last...and I cheated! I hated running, so why did I sign up for a 26.2 mile race? 
No clue. 
My first training run was 1 mile. I almost died. My long run for that first week was 3 miles. It was the saddest thing you've ever seen, I assure you. I ran when I could and walked when necessitated. It was all kinds of ugly but I got through it. 
So if you're worried you aren't fast enough, will feel embarrassed, will run like a cartoon version of yourself, or are afraid to start, please just picture me during my first week of training. You have nothing on the spectacle I created. No chance. 
For most journeys the hardest step is the first...
Great, now you've got me speaking in catch phrases worthy of bumper stickers. Who's embarrassed now?
If you've never run in your life aside from dashing to catch the train, you'll be fine. If you used to run but haven't laced up in 20 years, you'll be fine. If you're worried you'll get hurt, I know a terrific physical therapist. If you're faster than me, I'll be fine...mostly. 

I plan to be consistent and trust that I will eventually give the gift of running to some.  Only thing better than the feeling I get from running will be the feeling I get knowing I've shared it.

Onward!

Winter blues

Dear people of the warmer southern states, also substitutable with any warm client readers, you are turds for living in such a reasonably climate-influenced location.

There, I said it.  I am actually resentful that you were smart enough to live somewhere nice while my clearly questionable life choices have led me to a city where the temperature was in the teens this morning.  With wind, single digits.

Why am I whining so much you ask?  Well other than being so good at it (it's on my resume), I was scheduled to run this morning.  1 hour and 40 minutes of pure happiness.

What did I do instead?  Snuggled with my pups and caught up on The Voice.  It was just too cold out to be running and the thought of 1:40 on a treadmill makes me compulsively want to dig my liver out with a wooden spoon.  Damned if you do, damned if you do...

How then, I'd like to hear, do you all deal with the crappy season as an endurance athlete?  I can handle an indoor bike ride, and in some ways prefer it to outdoor riding, but the running is tough for me.

Do you just suck it up?  Do you have a brand of clothing you wear that actually works in these temps?  Do you preemptively light yourself on fire beforehand?

My first race is just over 5 weeks away and some running needs to happen.  While puppy-snuggles are truly superior to most other things in life, a better triathlete they will not make.

Pondering, shivering, scheming...

An article published on interconnectedness

Look how famous I am.  The following is an article I wrote that was published in the upcoming issue of OnFitness magazine (March/April 2014).  I hope the paparazzi doesn't start hounding me again…

Before getting into the definition and discussion of interconnected body regions, let’s first review situations or client experiences that proved to be especially challenging.
Have you ever had clients say things like, “this side of my body just doesn’t work and feel like the other side.”  Or perhaps you give them an exercise but regardless of all the cueing and imagery you can think to offer, their form remains poor.
At times, some clients will complain of discomfort with an exercise that seems mysterious.  Take planks for example.  Some clients complain of low back discomfort with planks that doesn’t improve with positional changes, form corrections, and so on.
Instead of assuming this person or client just shouldn’t do that exercise or eliminating certain movements from their program, consider the following.
When one portion of the body is out of alignment, or not in its neutral position, other parts of the body will have to compensate for that misalignment.
Take for example the foot.  If you intentionally take someone’s foot and externally add a structure that forces that foot into excessive supination, there will be resulting compensations throughout the entire body.
The supinated foot will not remain the only changed body part, but rather will cause a subsequent external rotation of the tibia.  That will in turn cause an external rotation of the femur.  Then the pelvis gets a crack at compensation, and in this particular scenario, will often rotate forward on the side of altered position.  Now you’re up into the spine, which can present with any number of compensations.
That’s the cornerstone of the discussion of interconnectedness.  When one body part changes or is out of proper alignment, the rest of the body must adapt to that new reality.
        The leg bone’s connected to the hip bone
As in the case above, excessive supination of one foot can have a profound effect up the entire biomechanical chain.  For this person described, they might be complaining of lower back pain due to the compensatory rotation.
You can give them the best core stabilization program in the history of exercise, but until the actual problem is fixed, in this case the foot position, their back pain will remain unchanged.
Thinking back to those tricky clients or scenarios that were not changed with proper cueing and attempted form correction, it is reasonable to assume there is an area of the body that is misaligned and therefore causing the problem.
        How do you find the problem?
The answer to this question can get highly detailed and challenging for even the most senior trainers and physical therapists.  Pinpointing the singular biggest positional fault within the entire body can seem a daunting task.
Initially, start with standing posture.  It seems like a terrifically simple thing and potentially not what you’d consider a productive training session, but huge secrets are hidden in someone’s posture.
What you are looking for is symmetry and neutrality.  Think of the body segments as building blocks.  If the blocks are stacked perfectly atop each other, the vertical forces passing through those segments will be distributed evenly.
If you take a stack of blocks and offset one block in relation to the other, that same vertical force will cause the whole stack to fail and come crashing down.
The same applies to the body.  If a person stands with their thorax laterally translated in relation to the pelvis, any vertical forces will cause a site of failure.  Failure equals pain.
As is possible, design your early sessions or part of the prescribed routine to correct these postural abnormalities.  Sometimes simple corrections will keep a person moving a pain free with incredible efficiency.
After standing posture is observed, you should also look at the body alignment during the activity of interest.  If the problematic exercise is planks, assess the posture of the body in that particular position.
Again, what you are looking to find are areas that are not symmetrical and neutral.  Not surprisingly, these problem areas can be anywhere from the toes to the top of the cranium.  What you’re looking for however is the big thing that seems incorrect.
Is the pelvis rotated?  Does one side of the rib cage seem higher than the other?  Is one knee slightly bent when compared to the other?  Is one scapula in a different position than the other?
Once you find what seems to be the most significant positional problem, try to fix it.  This can be done giving the person verbal cues, or even taking a photo of the problem and showing it to them.  Making their brain aware of what their body is doing can make huge changes.
You can also use gentle tactile cues.  If their pelvis is rotated, gently attempt to rotate it back and ask them to hold that new position.
The possibilities abound and time should be spent working on the most notable areas of poor alignment.  If that magical cure doesn’t happen with one correction, get creative and try another.
The body wants to be properly aligned.  It’s how it works most efficiently and when you give that gift to a client’s body, it will be thankful.
Experiment with interconnectedness and how small changes make large contributions to overall biomechanical neutrality.  The answer to those tricky clients is often easier than you might have thought.  Just step back, take a look, and don’t be afraid to make changes.