From Pain to Performance by Dr. Julia Evergreen Keefer

(Copyright 2005)<> Dr. Keefer is a professor, a kinesiologist, massage therapist, fitness instructor, and creator of four trademarked exercise classes and eight academic classes.

What is the nature of YOUR pain? A bad back, weak knees, torn shoulders, arthritis, page or stage fright, depression, anger, low self-esteem, fat, frailty, fear, or just existential psychic pain?

What is YOUR performance goal? To be in top shape physically and mentally, to run a triathlon, to dance or fight onstage or in a film, to win a game, to produce something creative, to have a baby, to play with your grandchildren, or just to enjoy life?

The missing link between Pain and Performance is Play! When something hurts, relax, soften around it, find ways to laugh, get back your sense of humor, and PLAY.

What You’ll Find in This Book

Part 1, “Preparation, Pain, Posture, Performance and Parameters” describes the four levels of fitness, relating to pain, posture, time, space, gravity, flow, and the emotional and performance aspects of exercise and cognitive training.

Part 2 and Part 3, “Dr. Keefer’s Corrective Clinic,” focuses on alignment, ergonomics and the missing links in strengthening programs that will help you prevent injury or rehabilitate problem areas, serving as the bridge between physical therapy and real-life aerobics and performance training.

Part 4, "Periodization for Performance," recommends schedules and combinations of routines for different populations--people with arthritis, endurance athletes, ball players and body builders, and dancers and martial artists to help you pop your plateau as you make the most of your performance.

Part 5, "Cognitive Performance," introduces the Keefer Brain Gymnasium to make the correlation between physical fitness and cognitive training, helping you develop the mental strength, flexibility, endurance, balance, agility, and focus to produce and perform what you create, or to make the most of your gifts and opportunities.

Physician’s Clearance: Before beginning any exercise program, you should discuss it with your physician--buy her a copy of this book and let her guide you. Levels I and II should see a cardiologist--actually, a professional stress test is recommended for all levels. Although we will be discussing injury prevention as well as the basics of osteoarthritis, which so many of us have to some degree, this book is not a substitute for physical therapy. If you have specific dietary needs, you should consult a certified nutritionist as well.

Throughout the book, pay attention to the following considerations:

Pain: What might hurt, when to stop, and how to make modifications
Posture: Posture hints for different body types and exercises
Performance: Movement Quality. Fast to Slow, Sudden to Sustained, Light to Strong or Heavy, Bound to Free Flow (Movement Control)
Purr, Prance, Pounce or Puke: Emotional Quality-the Exercise Catharsis Relax, Express Pleasure or Exorcise Anger and Negative Emotion.

PART ONE: Preparation, Parameters, Pain, Posture, Performance, Purr, Prance, Pounce, or Puke!

Ch01: Preparation and Parameters

If you have just been told you have a terrible disease, or you have just injured a joint and ligament, you may be depressed into immobility. Follow the advice of your doctor for now, but read on, and eventually you can get back to better function, spiritually, if not physically.

To the Mind who hates his/her Body:

Eventually we will get to ways to organize your library, your computer files, and your mind for better cognitive performance, as well as ways to empty it for relaxing hypnomeditation, but for now, let's start with your body. No matter how brilliant and intellectual you are, you have a body, and a brain that relies on the circulation of your blood to function. Even if you are a rich businessperson, a renowned professor, or a successful scientist, you may have to start exercising like a beginner. Be grateful: it will keep you thinking longer and livelier.

Pitfalls and Perks of Home Exercise

It isn’t always easy to workout at home. There is something human about connecting home with inertia, slowing down and lying around for it is the place where we escape from the stress of the world. If exercise is a chore to you, an obligation, something you hate, it is hard to do it at home, so you have to turn exercise into fun or a fight. Home is also the place where we recover from injuries or struggle with disease so I'll help you make the transition between physical therapy and performance training with Dr. Keefer's Corrective Clinic.

You may be reluctant to turn home sweet home into home sweat home. Unless you have an actual gym at home, it is hard to make the space for exercise, to fill a room with weights, bands, a step, a slide, a punching bag and a stationary bike and hope that you will do this stuff instead of the people things. Fortunately, the two can be combined. It is possible to watch TV and slide or jog on the trampoline, to punch the bag instead of your spouse in an argument, and to organize a Knockout Step/Slide/Strike party® for your friends. Start simply: set up your workout materials and your household cleaning items. Put on a workout outfit. Open the windows. Find out what you want to listen to-news or music. Set up your workout materials and your household cleaning items. Think of how much better your home is than the austere bleak weight rooms and cold metal lockers. Combine exercise with brain gymnasium, by watching or listening to something educational, or combine it with housework for a double whammy.

The gym is good for circuit training, particularly isokinetic machines, for professional spotters on Olympic and power lifting, and for the group atmosphere, competition and performance in expert exercise classes. It can also make you feel self-conscious if you are out of shape, confused if others know more than you do, or bored if you exceed the average person in your workout. However, you can get into shape at home so that you really shine when you go to your favorite class at the gym. If you are a pro, we’ll give you pointers to improve your teaching.

This book can also be used as a guide for your personal training sessions. People get help at home-either because they are still injured even though they finished their managed care physical therapy prescription, or because they are ambitious and want an edge for an event.

So whether you want to just work out at home or use this book as a supplement to other workouts, let’s knock out everything that stands in the way of your workout!

Know your Goal, then Let’s Roll: How will the Knock Out Program help you achieve your fitness goals?

Weight Loss





Better Posture



Physical Agility

Mental agility


Stress Reduction

Reduce Blood Pressure

Sleep Better

As many of you know, how much you weigh on the scale is deceptive. For example, I weigh 160 pounds! Muscle weighs more than fat and as you get older, you might also lose bone density, so losing weight is not necessarily a good thing. Maybe it is good to have some fat-if you hike or ski in cold climates, if you are pregnant or nursing. Different cultures have different aesthetics regarding beauty and belly fat. Put your health first.

Strength is measured by your maximum load for one repetition, but rarely do we measure this effectively because we usually need residual strength for another activity. Are you strong enough to lift that bag or that baby? How much weight does it take for your muscles to burn out? How strong is your argument in court?

Power and speed go together. Power is the most you can lift in the shortest amount of time. How quickly can you lift a car off someone’s leg? How quickly can you come to your own defense?

Flexibility refers to the range of motion of your joints and the soft tissues-ligaments, tendons and muscles-that restrict the range of motion. The most flexible people we see are ballerinas, yogis and gymnasts. There are some scientists who feel that you can be too flexible. I believe that as long as your flexibility is pain-free and supported by balanced strength and good alignment, it is fine. I have the flexibility of a ballerina supported by the strength of a body builder. Stretch yourself mentally by opening up to new ideas and cultures, taking opposites points of view, and trying to learn things that are difficult for you.

When you carry yourself well with good posture you not only look and feel better, but recover from injuries faster. Dancers spend hours correcting their alignment every day at the barre so they can do complicated tricks. Your voice as a writer is your posture, your stance, what makes you unique.

Speaking of tricks, balance and coordination are for everyone. You want to have the reflexes to stop or recover from falls, to participate in fun activities like hiking and skiing as you get older, and to be able to look good on the dance floor. In an age of multi-tasking, how can you keep your balance amidst multiple activities?

Physical agility, the ability to sprint, stop, start, and sustain complex movement patterns with grace and coordination helps me with the mental agility I need as a professor. As we get older, we tend to get stuck in ruts. Agility is the ability to get out of them.

Focus is also a mindbody affair, the ability to sharpen your concentration on one thing to the temporary exclusion of others. It took me years to master the pirouettes of ballet where you gaze at one spot as your body whips around in a circle. Complex movement patterns require changing but clear foci and even the simplest activity like gardening can help you improve your focus. Hyperactive children often use the focus required in martial arts and sports to help them channel their energy.

Exercise is a great way to reduce stress. By converting emotional and intellectual stress into physical expression through movement, we can finally slow down into stretches, meditation, relaxation and a good night’s sleep. This does take a change of focus to bring the energy down, which I will help you do with my massage and ideokinesis chapters. Many of the blood pressure benefits of exercise occur during the relaxation afterwards when the circulating blood eventually lowers the diastolic pressure after the heart rate has come down. Don’t neglect this important part of your workout. It is easy for me to relax physically but I am still struggling to relax mentally. At the end of the day let the desert winds blow the sandcastles out of your brain. You can build them again the next morning.

What is your goal?

When asked people often say, “To lose weight.” So they just jog and jog and all of a sudden they have shin splints, chondromalacia, plantar fasciitis, or hip bursitis. Then they stop, depressed because they did not achieve their goal.

Fitness is a component of all the factors listed above. Yes, you can choose your favorite routines and ways to achieve these goals but if you try to spot reduce or strengthen your abs but not your back, you will eventually run into problems.

This doesn’t mean that specific goals aren’t important. They are essential for motivation, satisfaction and as a way to get you off your plateau and direct energy and attention to challenging tasks. It helps if goals are specific and realistic, referring to active verbs, i.e. that you want to be able to run faster, lift heavier weight, learn to swim, kickbox or play tennis, and less successful when it comes to subjective aspects of appearance.

It also depends at what state you are now. If you are overweight, you can certainly lose weight; if you are weak and out-of-shape, you can improve dramatically, but if you are already in great shape, it is hard to keep improving after a while. The goals of my patients are usually to simply get rid of pain and start functioning normally again. Practical goals should be attainable, manageable, realistic, although not always measurable, but it is fun to dream and fantasize because that opens up the imagination. In order to create big projects, I have engaged in utopian fantasies. Of course these bubbles will be burst, but it gets the creative juices flowing. On the other hand, I personally have given up on the mirror and lookist goals. My fitness goals are simply to continue kickboxing, ballet, body building, triathlon training, hiking, and skiing for as long as I can, and to help others enjoy their bodies doing what they love to do in a pain-free state. They should also be flexible if you encounter roadblocks and compatible. Many ballerinas want to be able to jump higher and do more turns, but also be less muscular, two goals that can be incompatible. It helps to have a target date and then constant re-evaluation. Once a goal is attained, it is time to set up a new one.

Even if you are a predominantly physical person, establish mental and emotional goals as well.

My mental goals are to keep my brain as sharp and elastic as my body, to teach and inspire students, and to write as many worthwhile books, journals, and screenplays as possible. How can YOU improve your mind? What new pathways or synapses can you open up? When you get injured, it's a chance to pursue mental goals to channel your restless energy.

Who are you?

The Baby Boomer, “I want to be forever fit!”

The Office Worker, “After sitting for 8-10 hours, I am too crumpled up to move or think.”

Parents with Young Children, “How can I combine a good workout for me that is also amusing for my kids?”

The Busy Student, “Most of my time is spent studying so when I work out I want to really kick butt!”

The Oppressed, “I am so mad I can’t take it anymore!”

Overweight and Overworked, “I want to workout and be creative but I am too depressed and exhausted when I get home.”

Movie Star, “I want to get in shape so it looks like I am actually doing my stunts.”

The Couch Potato, “I would like to look like the fit people on TV but my workout is shoveling potato chips into my mouth as I watch TV.”

Dancer/Martial Artist, “I want to learn ways to improve my technique at home.”

Middle-aged Woman, “I just gained a lot of weight with menopause and my doctor says I should worry about osteoporosis and maybe even getting Alzheimer's or cancer.”

The Weekend Warrior, “I am too busy to workout during the week but I kill myself on the weekends.”

Athlete, “I am looking for an edge, a way to beat the pack at my game.”

Just Married, “I wish I could workout with my partner.”

Just Retired, “I have the time and energy, but I don’t know what to do with myself.”

Just Injured, “Everything hurts so I don’t want to move!"

Locations: You can’t get to the gym? Exercise is waiting for you everywhere!




Living Room/Den

Plane, Bus and Train


Garden, Park, Playground and the Great Outdoors


Visual Aids: The above locations set up for exercise


An exercise mat, or bench, or hard bed

Dumbbells from 3 to 45 pounds, depending on your shape, size and health. Level I can use soup cans or nothing at all.

Barbells or body bars.

Leg weights-only recommended for Levels II and III if you have the core strength to support that resistance.

Bands: EvergreenEnergy Band for full body stretching, a stretchy band used to stretch and tone, particularly good for partner resistance and intrinsic (deeper) muscles that can’t be targeted with weights. Take bands when you travel or add them to weights for more resistance.

Balls: a BOSU and/or a Swiss Ball (make sure you know how to blow it up and keep it firm.) The best office chairs are the mesh ones with an adjustable lumbar roll. However, if you sit all day, you may want to purchase a Ball Chair, which is simply your Swiss Ball with a rolling base. It will strengthen your back muscles and be there for those ball breaks when you can do abdominal and back exercises. The flip side of the BOSU is good for balance activities.

A Step with eight potential risers. For example, you can get a Super Stepper Bench System with an Ablaster attachment for crunches or leg lifts, four hinged risers for flat bench or decline bench, and a durable, rubber non-slip surface. This is the best way to combine step aerobics with body sculpting at home. However, you could get an Economy Step for thirty dollars if you don’t want the other options. Created by Power Systems Fitness.

A stationary bicycle, recumbent or upright

A Slide, which you can purchase from PowerSystems for anywhere from a few hundred to five hundred dollars, or an old Reebok Slide for sale at a yard sale. ProPower Slide Board under 200 dollars, Premium Slide Board, $249.95 to $379.95, Ultra Slide Board $579.95.

or Gliders for your rug or floor.

Optional thigh squeezer

Optional-punching bag and gloves or just use a pillow

Optional mini-trampoline. This is great for Levels II and III.

Optional aquatic equipment
Water cuffs are worn on ankles or wrists, and can add buoyancy and resistance to workout. Neoprene water gloves increase resistance up to 50%. They are particularly good for people with arthritis because the hands can spread apart like a duck's web. The flotation belt provides buoyancy and resistance, allowing the spine to remain vertical, which is good for people with bad backs. The Bar Float is a longer version of the heavy water dumbbells.

N.B. A lot of this equipment can be obtained at a yard sale or health club sale for almost nothing. Unlike treadmills and ellipticals, not much can go wrong with dumbbells, a step or a thigh squeezer. This is a low maintenance program.

Visual Aids: Pictures of the above objects

Exercise Interrupted

Why can’t you stick to an exercise program? No time, patience, stamina or health? Follow the Busy Body Burn and Firm. Try to do some cardio at least 30 minutes five times a week, strength training two or three times a week, stretch every day somewhere somehow, and add balance, coordination, speed, and power workouts according to your level, abilities, and interests.


Give yourself incentives like new clothes, a social outing, a triathlon, marathon or kick-a-thon, a trip with your kids or grandchildren, an outdoor adventure, or just feeling good about yourself.

Like anything else in life, we must pay attention to the Definitions, Distinctions, Differences, Distractions and Dangers of exercise. This book is a reference book: not all exercise routines are good for all levels all of the time.

Mental Equipment

Even though you may be reading this e-book online or printing it out, buy books to put in your bag, read in the bathtub or bus, and keep in your library. Mark them up with your special notes.

My library includes every medical specialty, global literature, history of drama, art, and dance, particle physics, screenwriting and story structure, geology, Eastern and Western massage, shiatsu, yoga, and martial arts, every kind of fitness training, psychology, philosophy, hynomeditation, dialect and voice production books and tapes, Arabic, French, Spanish, German, Japanese, and Italian language tapes, all stained with my coffee, my messy notes, and my mind.

Let your Web site be an extension of your interests and curiosity, with links to the World Wide Web of knowledge. Stay connected in a constructive way, not just to chat or visit the x-rated sites.

Your best equipment is your brain. It can travel all over the world, into outer space, the past, the future and plummet the secrets of the present. Let it do its work.

Know Your Level, you Devil

At one point in our lives we may pass through all these Levels, but the secret of survival is to know our limits and work at a pace, intensity and duration that is both safe and effective. While we may exult in our power as a performance athlete, we know that one day we may also be sitting in the wheelchair or the nursing home, so it is best to approach exercise with compassion and humility, as well as enthusiasm. Unfortunately, many athletes and dancers get injured so they are always going back to Level I. Every morning, professional ballet dancers do basic exercises like plies and tendus, with the attention and simplicity of a beginner, so going back to the beginning should be considered an opportunity, not a punishment. Exercise is recursive.

Writing is also recursive. Whenever a professional writers starts a new project, he/she struggles with words, ideas, and structure just like a beginner. Refresh yourself with the basics and a fresh eye and ear every day.

Level I: Elderly, Infirm, Overweight, Sedentary, Injured Performance Athlete

Elderly person in nursing home

Level I is the beginning and the end, the place where we perfect the basics, or slow down with disease and age. Every day professional ballet dancers practice plies and tendus-bending their legs and pointing their feet-with the same attention, focus and skill as if they were jumping or doing multiple turns.

In terms of focus and alignment, all levels should begin with the basics.

Many elderly people are confined to a chair, sometimes able to walk with supervision or assistance, often residing in a nursing home. For years I did chair aerobics and wall exercises with my Dad in the nursing home.

Let us not forget that some Level I people, confined to wheelchairs, can be elite athletes. I just watched the 2005 New York City Marathon where the runners who inspired me most were those wheelchair athletes leaning forward and working their lats, traps and rhomboids at a ferocious speed.

All of us can benefit from the chair exercises when confined to a chair in a plane, train or bus. Consult chair exercises in Knockout Sculpt if you want them now.

Level I people may have neurological problems such as Alzheimer’s, multi-infarct dementia, Parkinson’s, and/or arthritis and cardiovascular disease, therefore it is imperative to discuss your program with appropriate physicians and physical therapists.

Level I can also be middle-aged, overweight, and/or sedentary. I am middle-aged and I do performance level routines so there is always hope to change levels, but it is best to know your limits. If you are male and over forty, female and over fifty, or just plain overweight, consult a cardiologist who can not only take a stress test, but listen for all the other problems and abnormalities that might crop up.

Middle-aged, Sedentary, Overweight

Refer to Dr. Keefer’s Corrective Clinic to address any specific injuries, chronic pains, or disabilities. Level I should do the back exercises instead of Knockout Your Core, and only do the chair and bed routines in Knockout Sequences. Save your kicking and punching for the pool and do it lightly.

Start by walking slowly and consistently for several weeks, stretching gently, and going through the strengthening exercises without weights. Increase your intake of water and bananas before you start working in your target range. Do modified versions of Levels II and III and when in doubt, go back to basics. Take it easy with the chores and don’t do any exercise that hurts or that involves impact.


Many otherwise active, athletic people are locked into a Level I status because of osteoarthritis.

Don't be intimidated or impressed with these big names: "itis" simply means inflammation and those other things are the soft tissue covering the bones. But it is important to learn a little anatomy, physiology and kinesiology in order to really help yourself. One of my 80-year-old students said,"Julia uses more big names than any other teacher, but I am now strong enough to hold my own;" she no longer feels like putty in the hands of doctors and fate. For some people the basic anatomy will be a review to help pinpoint and demystify those obnoxious sites of pain and to improve exercise technique. It is easier to isolate and vary the intensity of muscular contraction if you know where the muscles are. If you know how a joint is supposed to move, you can visualize its optimal pattern and then gently move it yourself with confidence that in spite of what you might feel, you are conforming to kinesiology. The muscle charts in this book can guide you as you learn to "own" and control your body.

You can’t cure arthritis, but you can develop a responsible, scientific, comprehensive plan to live with it in as strong, flexible and pain-free a state as possible. All these theories about pain control apply to injuries and osteoarthritis. Rheumatoid arthritis is completely different because it is so easy to permanently destroy a joint with the push/pull/compression of daily living or exercise. People with RA should develop a lower pain threshold and work more gently, never to burn out, with frequent periods of rest.

Osteoarthritis is a misnomer. The word "arthritis" comes from the Greek arthron or joint and itis or inflammation and osteo refers to the culprit: bone on bone. Yet osteoarthritis rarely involves inflammation unless bone chips cause synovitis or whatever. Physicians diagnose osteoarthritis as pain, stiffness and limitation of range on movement. In their pocket book on Back Pain, 1995, the AMA says: "Osteoarthritis is non-inflammatory because it involves the degeneration of the cartilage tissue in joints." Later they say the symptoms are "pain, swelling, tenderness, stiffness or redness." If osteoarthritis is defined as degeneration, wear and tear, then why are some people, (myself included) whose x-rays show osteoarthritic degeneration, strong, flexible, pain-free and able to engage in strenuous physical activity? Just because a cartilage has evenly or unevenly degenerated or even "popped out" (as in knees and back), it does not necessarily follow that the joint must be stiff, painful and disabled. Over the years many myths have grown up about what it means to be "arthritic," and now the mythology is often more rigid and unyielding than the disease itself.

The Arthritis Foundation lumps all 100 rheumatic diseases together in programs like their aquatic exercise, and yet osteoarthritis is as different from rheumatoid arthritis as coronary artery disease is from AIDS. One must be very gentle with RA patients lest the inflamed joint be completely destroyed, but people with the beginning of OA benefit from some stress on the joints provided their posture is good, for mechanical stress (accompanied by recovery and good nutrition) is what builds bone and muscle. For years, I have seen people with arthritic x-rays move like athletes! Many people with OA just aren't working out hard enough nor paying enough attention to their posture; they also get involved in a vicious circle of fear, pain and disability made fuzzy by psychogenic and mechanical soft tissue pathologies such as fibromyalgia, tendonitis and simple sore muscles or just the memory of pain that no longer exists. In other words, while your x-rays might reveal degenerative changes compatible with osteoarthritis, you can be stronger, more flexible and more pain-free than you are at present.

People under 50 often need massage to help treat muscle, ligamentous and tendinous injuries, but as we get older the flesh doesn’t hold on so dearly to the bone and it is in fact the bones that hurt.

There is no one, single, simple way to turn the hell of arthritis into the heavenly state of bodily comfort and strength. That's one reason why so few approaches succeed on the mass level. Osteoarthritis must be treated with a comprehensive approach that includes everything that affects body and mind. You can’t focus on one thing to the exclusion of others.

I have a few students who take glucosamine and chondroitin sulfate religiously as they stuff themselves with wine, beer, anchovies, caffeine, chocolate, butter, fast foods and aged cheese. Their cartilage has already degenerated so it's not going to reappear magically, and even if it does, the compressive forces of their extra weight will wear it down again as their diet is already making them 100 pounds overweight. I know very frail, thin students who come religiously to the arthritic swim class at the Y, but will not do land exercise, and are so osteoporotic that they are always getting fractures. I know weekend hikers who rock scramble for hours with arthritic knees and refuse therapeutic exercise because "it's too boring."

Some people want to strength train to the exclusion of aerobics or vice versa. Other people feel excessive pain everywhere and anywhere and spend so much time limping, favoring and protecting their bodies that they can't even function. Some people hold on to their arthritis unconsciously as a way to gain attention or make mental pain more concrete. Whether we like it or not, osteoarthritis must be attacked with everything we have. So be prepared to change your posture, your furniture, your exercise regime, your diet and especially your mental attitude. However the side effects may be strength, vigor, and improved function.

Listen to your body and don’t do anything that stimulates sudden, sharp pain or makes you feel dizzy or nauseous.

Is your brain getting a bit arthritic--stiff, painful, with a limited range of motion? Soften, stretch, open up, laugh, learn, lengthen, and then strengthen your new creativity, or your new muscles.

Baby Boomers come in all shapes and sizes with different levels of fitness. Some are amazingly still working at the performance athlete level, while others are overweight, sedentary, or arthritic. As a fit Baby Boomer, I offer the following advice.

Baby Boomer Rejuvenating Program

Maintain a healthy weight.

Avoid alcohol, excessive caffeine, too many prescription drugs, high-cholesterol foods, smoking, and highly polluted places.

Exercise five days a week. Begin at Level I and see how far you can go! If you are strong and skilled enough to get to Level III, pace yourself, leave your ego at home, keep a steady program of strength and cardio conditioning, and just sample the athletic tricks.

Get lots of fresh oxygenated air to clean the lungs, and sound sleep to rest your mind and body.

Keep your mind youthful and flexible by writing, thinking, creating, and learning new things and languages.

Use your mind productively but let it go to rest and sleep.

Share your skills, education and experience with the next generation. If you don't have children and grandchildren, teach or make friends with younger people.

Every once in a while, act stupid and playful like a little kid.

Don't look in the mirror too much--it is the spirit that counts.

Sex is the fountain of youth, even if you have to go it alone.

Fresh air and water are essential so contribute to a clean planet by using your legs to travel around.

Whether it is your religion, your spirituality or your values, develop a larger vision that transcends your self.

Keep your sense of humor--nothing lasts forever, even you!

Level II: Healthy but Busy with Work and Family

Level II refers to all the active people out there, whatever your sport or routine. You are busy and want to stay fit, increasing your flexibility, strength, endurance, speed, balance, and coordination. However, you stay within the parameters of what is recommended by the fitness associations for the general population. Because you are so busy, you value routines that combine exercise with all those chores you have to do.

Busy Body Burn or Firm

Do a few exercises from the back program in bed morning and night.

Take the stairs instead of the elevator.

No matter where you are, you can work on breathing and posture.

Use natural weights like groceries, your baby, boxes, and furniture.

Run to catch a bus or make the light.

Do exercises from the chair program at work.

Exercise interrupted is better than none at all.

Try to combine social life with workouts like hiking or ball sports.

Exercise is good for the whole family so set an example.

Jump rope while doing laundry or outside chores.

You may not have time to burn your muscles but all these activities will firm them.

Calm down and focus to help kids with homework.

Set an example by improving your mind and body.

Level II can do every exercise in this book, avoiding the advanced modifications recommended for Level III performance athletes.

Level III: Performance Athletes or Highly Trained Individuals with Ambitious Fitness Goals

Level III is for the performance athlete, dancer, or average person with ambitious fitness goals. You want a lot of bang for your buck and your butt, and are always looking for challenging new routines that will give you an edge. You are experienced with exercise, know your limits, and how to push them, but may need help with some preventive exercise, complex/compound routines or ways to get you off your plateau and help you achieve excellence in your specialties. Before you push past your limits, have a stress test and/or visit a reputed cardiologist to make sure you don’t have any hidden problems waiting to erupt. You must also know when to slow down, or decrease your effort to prevent injuries. Many of you may be Type A personalities who push yourselves too hard.

Ironically Level III professional performers may try to avoid real life aerobics to conserve their energy. I see ballerinas taking the elevator, and martial artists taking cabs instead of walking. However, some walking and climbing would be good cross-training for these activities to stabilize neutral posture and get rid of lactic acid.

Performance Training versus Recreational Fitness

Fitness classes designed for the average, healthy person incorporate more repetition and lower skill levels than performance training, which is often anaerobic. The speed, agility, and balance of neuromuscular coordination is more important than losing weight, or steady state aerobic training. The performance must get better every week, while a recreational athlete is interested in safe, effective, efficient, fun workouts that achieve standard fitness goals. Performance training isn't always fun, and while it strives to be safe, there is often the risk of injury.

Cognitive Performers

You may be so drawn in to your work as a writer, performer, scientist, professor, businessperson etc. that you do nothing else but this. Remember you are a human being first. Reconnect with the earth in Evergreen's Fitness for the Four Seasons.

When, How and Why to Change Levels

In one second a performance athlete can get injured and go back to Level I. Even someone who is elderly or disabled in some way can train hard enough to enter a performance competition. Level II could find the commitment, time and energy to become Level III. However, if you do exercises unsuited for your level, you may get seriously injured or just bored. Not all the programs in this book are suited for everyone all the time.

Homogenized Exercise

Ever since homogenized milk, Americans have loved to simplify, standardize and franchise, and the same goes for exercise and education. The good part about this is that different groups can get together, and people know what to expect. The bad part is that since people are different with different needs, not every exercise is good for everyone all the time. Most health clubs cater to Level II, making workouts difficult or intimidating for Level I, or too easy, simplistic and boring for Level III. Most textbooks cater to Level I.

Androgynous Exercise

Why is that men gravitate towards Olympic and power lifting, ball sports and a stop-start approach to endurance sports and martial arts and women to steady state aerobics, Yoga, Pilates, dance classes and light body sculpting? Why do men purchase the punching bag and women the thigh squeezer? An androgynous approach to exercise usually yields the best results. Men should learn to stretch more and do endurance aerobics, and women to lift heavier weights and engage in martial arts. Just as a great writer successfully creates male and female characters even if she is heterosexual, so should an athlete cultivate the Yin and Yang of exercise to develop his full movement potential.

Why You May Love It or Hate It: Cognitive Domains and Exercise

If you are a visual person, schedule workouts in beautiful surroundings like nature or museums. If you are a linguistic person, listen to books on tape while you workout. I have created my best books while hiking. If you are a musical person, work out to your favorite music. If you are a people person work out with friends and family. If you are a logical/mathematical person, keep measuring your results to give you incentives.

Howard Gardner, a cognitive scientist and educational theorist, developed a way of assessing human performance and potential through what he called the six cognitive domains-linguistic, visual/spatial, rhythmic/musical, people skills, logical/mathematical and kinesthetic. While we may have some aptitude in all areas just to survive, most of us are stronger in one or two domains, a phenomenon, which effects how we approach exercise. A kinesthetic person has a highly developed internal and external sense of movement, a necessary skill in dancers and athletes. They can enjoy the movement for its own sake and respond to corrections better than others, although they may prefer to listen to their own bodies rather than conform to lines in space.

I have had patients whose primary domain was visual so in order to motivate them I suggested that they walk around the museum-the Metropolitan Museum Marathon-or visit gardens or beautiful natural vistas rather than try to do all their aerobics on a treadmill. When correcting them, I use visual cues as they look at themselves in the mirror. Sometimes I take photos of them doing certain exercises and have them paste them on the fridge. A person whose cognitive domain is logical/mathematical may respond well to measurement goals such as scales, tape measures, body fat calipers, as well as performance goals such as weight lifted, miles run, speed attained and other quantitative criteria. Paste these charts to the fridge and fill them in after every workout.

Some people love music much more than movement so the trick is to focus on a medley of sounds for every sensation. If you pick the music you love, you may find you enjoy it even more when you are working out to it. Although it is not my primary domain, I have a good sense of rhythm and prefer to choreograph movement to music than not. If your domain is people, you may feel lonely exercising alone, or unmotivated if your friends are fat and lazy. Here is where you can help them: organize an exercise social where you get together for Knockout Step/Slide/Strike™ followed by fresh fruit juices and protein shakes instead of tea and cookies. Find a partner for your weight workouts, do Knockout Ballet 'n Box™ with your kids, or expand your dog walks. Even cats can work out: my cat Fuzzy still does step aerobics with me twice a day (up and down the stairs in my building), even though he is frail and fifteen years old.

Many linguistic people do not have a well-developed kinesthetic sense and would prefer to read or write rather than exercise. Now that most research is conducted online, the good old days of library browsing aerobics are over. I recommend books on tape and classes by the Teaching Company so that you can hear words, learn things, as you hike, walk or run. My primary domains are kinesthetic and linguistic so I like to move and write (think) at the same time, learning new things as I tramp through the wilderness-call me the nomadic scholar.

Professor Keefer’s Stride and Study Program

I combine hiking with my academic work by reading books and correcting papers on the train or bus, and then listening to books on tape or audio courses on everything from ancient Egypt to particle physics, thereby stimulating my brain as I tramp through the wilderness. Sometimes I like to turn it off and just listen to the sounds of nature, but if you are out all day, there is a way to include the brain gymnasium in your workout. In fact, some of my best ideas for books have come while walking, as the blood flows vigorously through my brain.

Find some books or courses on tape to accompany you on your morning jog or weekend hike. Of course it is important to have some silent communion with the wilderness but you can do both.

Ch02: Pain and Posture:
How pain interferes with good posture, creating even more pain.


Level I may feel pain some of the time if they are injured, elderly, arthritic, or sedentary. Level II is too busy to exercise, so they often block out bodily sensations, and that includes pain. Level III may feel great one day as they fly to new heights and then sore the next when they crash. Our gladiator approach to professional ballet and sports often necessitates the ability to live with and transcend pain as limits are exceeded. But pain isn’t fun and it doesn’t make you feel good, so let’s see how you can deal with it.

The roots of pain may be muscular, neurological, visceral or somatic, vascular, or psychological. Pain can be a result of inflammation, irritation, or injury, aggravated by psychological factors such as depression, anger, anxiety, fatigue, frustration, or distraction.

When you feel pain, write down the type, location, frequency, and duration of the discomfort and chart its course. Hopefully, it will go away, but if not, you have an excellent pain journal to help your doctor with the diagnosis.

The theory that pain is a sensation is relatively recent. The famous Greek philosopher, Aristotle, said pain was an emotion, the opposite of pleasure, rather than a sensation. All sensory experiences as well as thoughts could have painful dimensions to them. In 1965, Melzack and Wall developed the Gate Control theory of pain. According to this theory, attention, anxiety, anticipation and experience affect your perception of pain scientifically. You can also control these emotions consciously or unconsciously so that the "gates" (dorsal horn cells in the spinal cord) are not flooded with pain. This explains why need for attention and masochism can exaggerate or even create physical pain. Therefore, pain depends on your unique physiology, your memory, the way your parents handled pain, cultural and biochemical factors.

The goal in all injuries and diseases is to restore optimal function. If you are functioning optimally, then it's best to find ways to ignore the pain or at least to identify and separate the sensation from other factors such as fear, hysteria, embarrassment, anger, and expectation of an acceleration of the present pain.

Yes, pain is connected irrevocably to posture, one of the main theses of this book. Posture is your cognitive stance as well, so when you suffer mental pain, it affects your self-esteem.

Acute versus Chronic Pain

If you feel a sudden pain while doing one of these exercises, stop, check your posture, slow down, decrease the weight and in some cases, rest. However, sometimes we avoid workouts because of a vague feeling that “everything hurts,” when in fact, we would feel better with some gentle aerobics, stretching and eventually strengthening.

If pain isn't serving a useful purpose, ignore it. What does this statement mean? If you put your hand on a hot stove, pain takes it away like lightning to protect you. Individuals with a congenital insensitivity to pain often die because bones, muscles, nerves and organs have no way to protect themselves against the onslaughts of life. On the other hand, pain can work to make you eternally miserable. Some people feel pain in the absence of any identifiable medical cause. This pain causes them to compensate, collapse and crumple up so that eventually they lose the function and health of most of their body.

Studies have shown that those who feel persistent intractable pain heal slower, if at all, than those who don't. For example, Indians stick hooks in their chest and swing ecstatically from poles until their flesh falls off. They say they do not feel pain and their wounds heal very quickly. Naturally, we would not want to get involved in masochistic undertakings like sticking hooks or nails into our chest, walking on hot coals like the yogis or burning at the stake like heretics. But these facts might help us control the pain we do have, converting a persistent ache to a sensation of pressure so that we can stand taller and walk straighter.

Pain and the Evaluator

Pain changes depending on who is evaluating it. A neurologist will attribute it to neurological abnormality; a psychiatrist to emotional conflict; an orthopedist to joint dysfunction or instability; and a chiropractor to mal-alignments. Whatever the reason, you know that it hurts.

For short-term pain due to sudden injury, the treatment is clear. It hurts for a while, you treat it, and it feels better. Orology is the science of chronic pain. There are long-term medical conditions such as arthritis, herniated sic, and cancer. Then direct involvement of the peripheral nerves, cord or brain in disease or injury. Finally there are those people who receive a reward for being sick-the malingerers.

Some doctors believe most soft tissue pain is just ischemia, due to tension and lack of oxygen. In that case, stress reduction, massage and aerobic exercise should be able to fix anything, but they can’t, although they help a lot.

Pain isn’t just a problem for Level I. Professional athletes and ballet dancers probably experience the most excruciating pain. They learn to block it out. I knew a ballet dancer whose feet were bloody and bruised all the time and she claimed she felt nothing. However, she knew she was paying a long-term price for the extreme demands of her art. Take care of yourself but if you do have a pain that can’t be controlled, remove yourself from that part of your body. It is what your body does naturally when you go into shock after a car accident.

I just finished writing an 800 page fictional fantasy memoir that cost me a tremendous amount of psychic pain to create, a pain that punctured through the defenses, delusions and deceptions that keep me and others going on a daily basis. Childbirth is painful but it produces a new being.

Level III accepts and pushes through pain to exceed normal limits to win a competition, to conform to a team's movements, or to make beautiful patterns in space to precise time as in dance. To do this, healthy signals of pain must be ignored or transcended. But when you go back to normal, you must feel them again so that you can protect yourself. Ballerinas must walk in parallel, boxers must open their chests and bring their heads back, ball players must use both sides of their back equally. Don't let the idiosyncrasies of your performance infect your optimum alignment for daily life.

Objective versus Subjective Pain

Because pain can save your life, always get objective evidence in the form of MRIs, CT scans or other radiographs, so you can then weigh the subjective pain against objective findings.

Basic anatomy will help pinpoint and demystify those obnoxious sites of pain and to improve exercise technique. It is easier to isolate and vary the intensity of muscular contraction if you know where the muscles are. If you know how a joint is supposed to move, you can visualize its optimal pattern and then gently move it yourself with confidence that in spite of what you might feel, you are conforming to kinesiology.

 The Gate control theory of pain allows you to open and close gates due to a variety of hormonal and psychological factors, enabling you to control your pain.

I had the misfortune to get into a car accident a week after very serious abdominal surgery. The car was wrecked in a snowstorm on the expressway and I was stuck for 5 hours without painkillers. I stayed very still and meditated. When I finally got home, I realized some of the staples had split but there was no blood. I continued daily relaxation and meditation with a vigorous rehab program of abdominal/back exercises from isometric to slight range of motion and walking slowly at least 5 miles a day. Two weeks after this surgery, I was back in ballet class. Much of the rehab was painful but I'm glad I did it so fast because I had no adhesions and came out stronger than before.

I never push my students as hard as I push myself. Few people have the innate sense of kinesiology to do a rehab like the above without injuring themselves. On the other hand, most people fall apart for months after surgery, and often never get back to where they were before.

Specificity is so important. When I tore my calf dancing, I tested the muscles after the swelling went down and found that the concentric fibers of the proximal medial gastrocnemius were torn. This enabled me to use the soleus, toe flexor and rest of the calf to walk and do other exercises. Eventually I "filled in" the entire calf and was able to jump higher than before. Again this Herculean rehab is not recommended for the novice but it's important to know exactly what joint is injured, how, why, where and what soft tissue is involved. Don't be an "arthritic person;" be a healthy person who has some osteoarthritic changes in the right knee or wherever.

And remember that the harder you rehab and workout, the more rest and relaxation you need. When I was recovering from the surgery/car crash, I slept 10 hours a night and took a 2-hour nap and I was only in my thirties. Don't let sleep make you feel guilty.

Static or Kinetic?

Does it hurt all the time or only when you move it? Write a pain diary to chart how it feels, when, and where. Does the pain interrupt your sleep or make it uncomfortable for you to sit? Or does it just hurt when you are engaged in strenuous activity?

Does it come on suddenly, or insidiously, gnawing at you slowly and subtly? Give it a color, a shape, a smell, a name, and a pattern in space. The more concrete your pain is the easier it is to annihilate it because you have a clear target.

Pain and Arthritis

Sometimes chronic pain creates its own vicious cycle of immobilization, which leads to disability, loss of independence and self-esteem, depression, isolation/withdrawal, stress, muscle tension, and even more pain.

Relax and listen to your body and mind to intercept the pain signals in order to apply the techniques of good posture pertinent to your individual structure so that you can begin a graduated program of exercise which leads to vigorous physical and mental activity, which eventually makes your mindbody strong, flexible and pain-free, in spite of your radiographs.

The sources of pain in arthritis are very specific: inflammation in the lining of the joint--synovitis, small fractures in bone under cartilage, subchondral bone pressure from blood in the area, stretching of nerve endings over a bone spur. Pain may also come from nerve endings in muscles, tendons, ligaments and other soft tissue. Even if you feel general nausea, fatigue and aching, the pain itself usually doesn't come from everywhere. If you float in a warm pool, you may be able to alleviate all this pain. Then you can start to strengthen muscles and realign joints with water exercise. After a few weeks or months, begin the bike, land weights and eventually the treadmill and review the exercise section of this book. In the meantime, keep going back to that buoyant pain-free state, a state you should also try to recreate in bed or after a massage.

Relaxation and pain control must lead to an improvement in posture and neuromuscular efficiency. If we compare contemporary posture to the way people held themselves in Europe's eighteenth century, we will see that our bodies have crumpled up and caved in as our minds have soared into cyberspace. Approximating good biomechanics relieves pain, decreases the chances of worsening your arthritis, and gives you more power and flexibility.

Acute pain from a sudden injury is there to protect you but chronic pain can get in the way of your program.

Dr. Keefer’s Steps for Chronic Pain Control

Listen to your body.

Identify the exact source of pain with the assistance of a health professional or radiographs and blood tests if necessary, or a psychiatrist who can plummet your behavior, past, and unconscious.

Identify the pain wave--how does it rise and fall and what provokes the intensity. Identify the behavior in yourself or others that causes the pain.

Isolate the painful area from the rest of the body and mind. Acknowledge the weakness that leads to this pain.

Try hyper-stimulation analgesia such as ice packs, heat, massage, even acupuncture to divert attention from the pain pathways. Mental diversion consists of hypnomeditation, entertainment, laughter and play.

Do relaxation, breathing and meditation exercises to release tension in and around the painful site, letting the whole body soften and melt.

Strengthen, stretch and condition everything around it. Reflect about what is good and functional about your mind and body.

Assess your overall posture and biomechanics and compensate to achieve good alignment.

Begin isolated physical therapy exercises for the painful areas. Compensate for your weaknesses through collaboration or education.

Once you are pain-free, strengthen the entire body with complex-compound, fun movements, beginning in the pool, if necessary. Create first in a non-threatening, non-competitive environment.

Then rejoin the fight with renewed energy.

Pain and Performance

Most athletes and professional ballet dancers say they are always in pain. Certainly frequent injury, pushing to anaerobic threshold, and exhaustion can cause pain. It is also dangerous to take drugs or cortisone shots to mask the pain when you are pushing yourself. Learning how to relax, meditate, conserve energy, and recover quickly are essential skills of performance training.

Posture: Examples of Good and Bad Posture

Become plum gorgeous on your plumb line-front, side and back, as you walk lead with chest.

Posture is very subtle and individualistic, but it is possible to outline certain principles of alignment while describing variations on how each person approaches the alignment best for their body. Too often fitness experts simplify and standardize posture, as in the military and some exercise techniques, but people with arthritis are so different that numerous examples of good and bad posture must be given for different body types. For example, if you tend to "tuck under," curving your pelvis into a posterior pelvic tilt with shortened hamstrings, then the traditional admonition to "flatten your back against a wall or into the floor" is the worst thing you can do. You would even be better off doing abdominal exercises with a rolled-up towel at the back of the waist to encourage more lumbar lordosis-or arch in the lower back. On the other hand, if you have a "sway back" with weak abdominals, an anterior pelvic tilt etc., then you might want to press your abdomen into your back as you exhale. (I never tell patients to press their back into the floor for reasons I will elucidate.)

There is a current theory popular with physicians that alignment in exercise and the different techniques, styles and progressions are mumbo-jumbo. The idea is to make the person move any way they want. While I welcome improvisation in all my classes and often ask students to show me what feels good or challenging or relaxing, I feel kinesthetic awareness is a skill like any other. Some people have an ear for languages; others don't. Most of my patients are visual people who need instruction to develop their kinesthetic sense. A strong kinesthetic sense can isolate pain, work around it, get rid of it, develop superior function, coordination and hence, optimal health.

Posture and Vision

If you spend much of your time looking down while walking, or looking down at your computer screen, or if you are tall or near-sighted, you could have a forward head and rounded shoulders related to vision. Only your eyes should look down: your ears should remain over your shoulders. Imagine you have eyes in the back of your head. Feel the top of your head pulled to the roof or sky, lengthening your neck like a giraffe. Remember your eyes see the world-don’t let your whole body dive into the image.

Posture and Society

Individual versus social norms

Some societies want people, particularly women, to walk with their heads down. Posture is very subtle and individualistic, but it is possible to outline certain principles of alignment while describing variations on how each person approaches the alignment best for their body. Too often fitness experts simplify and standardize posture, as in the military and some exercise techniques, but people with arthritis are so different that numerous examples of good and bad posture must be shown for different body types. For example, if you tend to "tuck under," curving your pelvis into a posterior pelvic tilt with shortened hamstrings, then the traditional admonition to "flatten your back against a wall or into the floor" is the worst thing you can do. You would even be better off doing abdominal exercises with a rolled-up towel at the back of the waist to encourage more lumbar lordosis. On the other hand, if you have a "sway back" with weak abdominals, an anterior pelvic tilt etc., then you might want to press your abdomen into your back as you exhale. (I never tell patients to press their back into the floor unless they have an anterior pelvic tilt and sway back.)

Not all people sit in chairs. In Asia, Africa, the Middle East and Latin America many people work and rest in a deep squat or cross-legged squat, often without using chairs at all. Historically in Euro-American cultures, women were taught to cross their legs while sitting to be polite.

Posture and Furniture

Furniture styles come and go but your house may be filled with soft sofas where you sink into postural distortion, or elegant chairs that don’t allow you to sit straight. Furniture should be functional and ergonomically healthy, not just pretty. Look over your apartment or home and try to pick and use furniture that is as good for you as it is pleasant to look at. The same with food.

Our furniture, clothes, social life, body image and personality affect our posture. In the interests of comfort, we have created furniture that reinforces soft, protruding abdomens, a dangerous spinal C curve, forward heads, and hunched shoulders. To relax means to slump, collapse and compress those delicate vertebral structures responsible for our upright stance. Unfortunately most seats in planes, cars, buses etc. are not designed to maintain the arch in your lower back and keep you perched on your "sit bones" instead of your tailbone. I will show how you can change this with towels, lumbar rolls, imagery, body positioning etc. I will also illustrate sleeping patterns and work habits such as typing, reading and talking on the phone.

Posture and Personality

Sometimes we develop habits like shifting our ribcage to the right, tilting our heads, or crossing our legs that become mannerisms attached to our personality. When told to stand up straight or uncross our legs and lift our chest, we may feel unnatural. You have to get over this. Good posture is the most natural and effective response to gravity. Find more constructive ways of showing your personality.

Every effort should be made to decrease limping and create a strong, graceful gait. Some people feel embarrassed, stiff or self-conscious standing up straight. Posture is intimately connected with body image, self-esteem and social life.

"I can't walk like this because I feel like a snob." "I don't want to draw attention to myself." "I am most comfortable when I slump my shoulders and round my back." The history of politeness often pairs crossed legs with bulging discs.

Now that we have analyzed the mechanics of good posture, why is it that so few of us can maintain it for more than a few minutes, if at all? Wardrobe and furniture may be to blame but so are our moods and personalities. I had my NYU students assume various postural positions mechanically and then shut their eyes and tell me how they felt. When their shoulders were slumped with concave chests, forward heads and protruding bellies, they said they felt "comfortable." When they assumed a well-aligned, upright stance, they said they felt "stiff, uncomfortable and even arrogant or snobby." Many people complain of feeling too "open or vulnerable" in the correct posture. If this is the case, then imagery must be done to create a feeling of lightness in the stiff ones (head is a helium balloon), or an inner, vertical strength to shield the vulnerable ones. Why is it that most people in our society feel more sociable and likeable if they slump? What does that say about our culture?

How are you sitting now as you read this book

Clothes, Body Image and Self-Esteem

The mirror usually just sees the front of your body, usually your face. Marketers spend millions of dollars making women, in particular, feel insecure about their looks so they will buy more beauty products. Be the healthiest person you can be and have the courage to pull away from the mirror, which is only a glass that reflects the surface. An unhealthy attachment to the mirror will not only frustrate you but prevent you from achieving your full potential.

For years, women have struggled with the sylph syndrome, trying to lose so much weight that they suffered from intestinal problems, amenorrhea, or loss of periods, and even osteoporosis before menopause. Now men are suffering from a similar body obsession, dysmorphia, where they will do almost anything to get bigger muscles-5 protein shakes a day, (I never have more than one), 5 hours of weight lifting a day, which may actually tear down muscle fiber, constant weighing, and often, anabolic steroid use, which complicates this obsessive-compulsive disorder with ‘roid rage.

Advertising creates impossible images such as a Twiggy, or the muscular woman with enormous breasts, or faces that could never exist in real life in order to make women insecure enough to keep spending money to look good. This book is about health, not image.

It is essential to discuss posture before prescribing exercise because if your posture improves, you may be able to do a lot more than what you had thought possible. Being careful of your back or knees does not mean babying yourself. I align myself in ballet class so I can balance or turn multiple pirouettes. I watch my knee alignment so I can jump higher. All modalities should lead to greater function. Too often, arthritis is considered a chronic disease where all thought of improvement is abandoned and the best one can hope for is maintenance, which really means further degeneration, because that is the law of biology: anabolism or catabolism; you are either breaking down or building up.

Mental Pain

The worst pain sometimes is emotional. It is possible to take drugs for depression or hallucinations, but nothing can cure a broken heart, unbearable frustration, anger bordering on rage or the deep sadness of great loss. Don't let this emotional pain immobilize you and make you even more depressed. Use exercise to express the pain in order to exorcise it.

Ch03: Performance
Analysis of different movement qualities and techniques.

Movement is a graceful, intricate combination of relaxation, rest and effort. Everything you do from grooming, writing, chores, to love-making is movement, although we have somehow put exercise into a separate category of something you like or hate, do or can’t do, have time for, or not. The truth is that all of us move until we die.

Laban Movement Analysis

Rudolf Laban, a German kinesiologist and dance educator, analyzed the movements of workers and dancers in order to categorize them in terms of effort-shape, a system still used in choreography and ergonomics, or the study of how humans adapt to their surroundings. The eight basic efforts are wring, press, glide, float, flick, slash, punch, and dab, containing three of the six movement elements such as strong, heavy, sudden, sustained, direct and indirect or flexible.

Laban’s Chart

Movement has an effort-strong, light, quick, slow, sudden or sustained, in relationship to weight and time and a shape in space, depending on whether it is bound flow-a movement that can be stopped-or free flow. Movement efficiency is dependent on the balanced coordination of effort/shape. It is similar to the dynamics of music. Just as you would not want to go to a concert where the music had one monotonous quality, unless you were trying to hypnotize yourself, so should your movement express a full range of different dynamics. This means that if you are tired or in pain you can begin with a light, slow, sustained effort, controlling your direction in space. On the other hand, to develop power and speed for performance, you may want to combine fast, strong, sudden, free flow, as in kickboxing.

Dancers always think of drawing lines and making shapes in empty space, but rarely are exercisers conscious of the empty space when they are working out. By projecting your body into space, you can decrease compression on your joints, lengthen your muscles and improve your posture and even alleviate depression. Taking the space is also a way to exert your personality and gain an edge in performance.


Performance is irrevocably connected to your moods, unless you deliberately enter that Zen-like zone of non-attachment.

Movement quality is related to balance and coordination and the ability to perform complex/compound, integrated movement. As we get older, balance and coordination can be impaired by balance abnormalities, muscular weakness from reduced activity, cognitive impairment from diseases like Alzheimer’s, cardiovascular disease, gait abnormalities like the Parkinson’s shuffle, visual and inner ear disorders and the side effects of medication. Therefore, it is important to fight this by starting now with basic, safe ways to help you move with grace and power. Throughout the book, we will give you hints about how to control your movement quality.

Time: Sustained

As you get older, people usually tell you to do things slowly and carefully. This is normally good advice, particularly with new activities, but it won’t help with aerobics or your reflexes. Speed is good in the right situations. As I stated before, speed with resistance is power and that can damage the joints if they are mal-aligned or exhausted. On the other hand, it is the best way to train the body for optimal performance.

Slowing down isn’t exactly the same as sustained movement. Yes, you must slow down but you must have the effort control to keep the movement fluid. Very old or out-of-shape people may have trouble with sustained movement. Wipe the counter slowly and smoothly to practice sustained movement. At the end of the counter, pretend you are flicking off a crumb to sense the difference between sudden and sustained.

Time: Sudden

Support your wrist on the table and move your fingers as rapidly as possible, as if they were manic mosquitoes. Note that speed is increased when the joint is light and free with a stable base of support. Try the same movement with the wrists, elbows and shoulders. With the shoulders it would be like a shimmy. The longer the lever the harder it is to move quickly, which is why a small, light person can go faster than a tall, overweight person, given the same level of skill.

Notice the time difference between the following movements:

Press to Punch

Wring to Slash

Glide to Dab

Float to Flick

A skilled athlete can accelerate and decelerate in a second. One of the hardest things to control is your heart rate when you go from a cross-country ski race to a complete stop in order to shoot a target. I don’t recommend you do this as Levels I or II but it is the control of time that gives you superior movement skill.

However, do this for me: turn on your favorite music and just dance to it, noting which joints speed up or slow down and how conforming to the musical rhythm makes you feel.

Choreographers and film-makers are paid to make human designs in space but every joint you have is designing a movement even now as your eyes move from left to right across this page.

Space: Direct

The body has direct planes of movement based on the articulation of the joints: flexion, extension, abduction, adduction. But think of what design your body is drawing in space.

Space: Indirect

Your joints are designed to carve rotary, elliptical and all kinds of geometric shapes in space. Indirect movements include painting your name in space with your hands or feet, swinging your torso in figure-eights, letting your head make circles. Weight machines and body sculpting exercises stress direct planes of movement and yet our bodies are capable of so much more.

Indirect is often called flexible. If you feel that you aren’t flexible enough, it could be that you move your body only in direct planes in space. Draw a figure-eight on the ceiling with your arms to see how much it can open up the body. Do diagonal lines or squiggly lines coming from the floor to the ceiling.

Then do round, spiral, zigzag or elliptical movements with different joints.

If you have any joint pains don’t do indirect movements with heavy resistance.

Humans, plants, animals and even rocks are subject to the earth's gravitational pull. The law of physics dictates we should press down to pull up. As we get older, gravity can make us crumple up if we don't exert our own forces on it.

As with time, you can either fight or indulge in gravity: ironically, heavy movements indulge in gravity while light ones move away from it.

Gravity: Heavy

An effort that is heavy is one that that meets resistance as it travels through space and time, the resistance of a weight or band, or heavy water, isometric as it stays in place, or even imagined resistance, when told to "push against an imaginary object." The heavier the resistance, the greater the strength gains.

Heavy movements can raise the blood pressure so be sure to exhale your breath and your extra tension at the peak of exertion.

Gravity: Light

However, if you want to work aerobically or develop speed, use a light effort. Light efforts are good for warm-ups, cool-downs, to conserve energy in endurance sports, to mark complex movements in an athletic or dance rehearsal, to recover from injuries, or simply to create dynamics when alternated with heavy movements.

Practice a swinging movement of your arms and spine, combining a relaxed and stressed phase, similar to pushing your child on a swing and then letting go for the ride.

Every movement has a kind of flow. Sometimes we want a choppy movement and other times we want a seamless flow, the difference between being stuck in mud or diving through water.

Flow: Bound

If an action can be stopped and easily held at any movement, then it is bound.

Flow: Free

If the movement is difficult to stop once it has begun, it is free flow. Press a stamp onto an envelope for bound flow. A slashing action is free flow that usually fades out into floating. Most movements are a combination of degrees of bound and free flow.

If you do strong, free movements like slashing with bad posture, you could end up hurting yourself.

Marking it means to go through the movements with an efficient, very light, free but controlled effort quality concentrating on the timing of movements in their particular spatial patterns. “Marking” is what dancers do at a rehearsal to learn the patterns of complex choreography when they want to save energy for a real performance or when their bodies are exhausted. It can also be used for Level I exercisers to start exercising without too much effort or pain and could be used by any level when learning something new.

Sometimes aerobics teachers scream and yell in class to encourage students to expend a greater effort than necessary for the movement in order to get their heart rates up in a short time.

If you always use one type of effort such as sudden, strong and direct or light, flexible and sustained, it could reflect a limitation in your personality. Movement is an orchestra and you are the orchestra leader. Even in sickness and old age, we can vary the dynamics of our movement to some degree. Start by expressing all the effort qualities with your bare feet and see if this motivates you.

You can also use different effort-shapes with different joints doing the same movement. For example you can ripple your arms fluidly like the swans in Swan Lake in a sustained, light, flexible motion while your legs jump from a squat to straight in the air in a sudden, strong direct motion.

This coordination is the hallmark of a great dancer or athlete.

Ironically, so many people with arthritis walk around as if their bodies were made of cement, yet complain of lifting weights. When I am doing superslow negatives, I relax my entire body and just exhale the weight through space; when I jump in ballet class I try to feel light and buoyant; when I hit the bag I try to sting it like a bee, lethal but light.

Think of the verbs that describe movement.

walk run hike

step climb

slide skate ski

float swim




fight box kickbox

squeeze wrestle sex

How would you change the effort qualities to make these movements easier or harder?

If your job requires lots of meetings, how can you change the dynamics of conversation and communication so people don't get so bored? How can you read faster or speak slower? When is it useful to attach a problem directly, or to take a more circuitous, lyrical approach?

Ch04: Purr, Prance, Pounce, or Puke!
How your emotions affect your movement qualities.

How you feel when you exercise affects your workout. You can use exercise to make you feel better as feel-good endorphins are released into your bloodstream, giving you a healthy “high.”


Think of how a cat purrs when it feels good. Endorphins can accomplish this for you, but some movements, like stretches, are performed better if you think of purring. Exercise also increases testosterone levels, which can enhance your sex drive. Of course too much exercise-to complete exhaustion-can diminish this drive, which is why performance athletes may not “perform” so well the night after a competition. I use exercise to sublimate my excessive sexuality. If you are feeling low on energy, some light sexual stimulation beforehand may enable you to attack your workout with more vigor. Purr is a soft mellow feel-good relaxation. Pet is a caress, a gentle stroke, a good beginning and end, or excellent movement quality for Levels I and II. When you finish your workouts with a purr, it helps lower your diastolic blood pressure.


Watch a cat the next time it wags its tail, and prances around as if life were perfect. Prancing is like dancing-a rhythmic movement that helps your momentum, improves your coordination and gets you through the most difficult sequences. It’s how you move when you feel happy in a joyous, ecstatic way.

This movement quality helps you get the playful, youthful energy for aerobic activities, or new intellectual ventures.


If you need to renew your attack, especially for ballistic movement or the aggression needed to lift a heavier weight, you may want to think of a cat pouncing. Pounce is aggressive, a power move combining speed and weight. It is the knockout.

Once you have warmed up, nailed your focus, and garnered your strength, you can then prepare to pounce. The best attorneys really know how to pounce.

Since pounce requires tremendous effort, make sure you bounce back to good posture to protect yourself.


Now I don’t want you to puke, or throw up, when you exercise, but that kind of quality may be useful when throwing punches and kicks, letting all the anger out of you, instead of keeping it bottled up inside. If you look forward to your workouts as a way to express or exorcize your feelings, then you may be able to avoid the “couch,” in more ways than one. Prance is a dance, playful, like a cat coquettishly wagging its tail. Puke is free flow without power. It throws away like punches and kicks, but it is almost involuntary once it has been aimed.

Human movement is an art as much as a science, subject to the id, superego, and ego of personality, ergonomics, and the social conformity of clothes, behavior and body image. We can measure biomechanics byusing the science of physics, (levers, gravity, laws of motion and acceleration etc.) but because we are humans instead of machines, there will always be exceptions to every rule.

In addition to my fitness/health career, I also teach writing and research at NYU, and am developing a Keefer brain gymnasium, analogous to physical fitness training. For example, strength is the ability to hold up a thought, lift it and examine it scrupulously. Flexibility is the ability to see all sides of an argument, to turn ideas backwards, forwards, sideways, upside down and inside out, to imagine the "what if," to stretch oneself into other disciplines, other cultures, other points of view. Endurance is the ability to sustain concentration and focus on a project. We are in the age of the short attention span. It's as if you decide to get on the bike and then get off after one minute. It takes persistence and training to develop physical and mental stamina. To see a scientific experiment, or a novel, or even a budget for a company to its end takes endurance. Balance is maintaining your position, your sense of reality amidst a barrage of stimuli and points of view. While we want to be open-minded, we also have to steer our ship in the ocean of the information age without drowning. That takes mental balance.

Our posture is our focus as we choose what to examine carefully, what to ignore, and what to throw out. The coordination of all our different mental capacities, creative and critical, verbal, visual, kinesthetic and musical, helps us dance through knowledge with skill and lightness. Mental and physical dexterity require varied rhythm, dynamics and effort-shape. Your mental nutrition is as important as the food you eat, the water you drink, and the air you breathe. The antidote to arthritis is flexibility, playfulness, an elastic strength. Often people's minds become arthritic with their bodies, encased in rigid, painful, self-destructive, predictable circles of behavior. Find the life-sustaining food for mind and body that keeps you young and healthy. Yes, we all die eventually, but let's not die for fifty years. If my 80-year-old students can own and change their bodies, you can!

I am guilty of not puking enough. When you deal with stores of knowledge, there is a tendency to get lost in data smog, or buried in academic treasure. Every once in a while you have to puke, to throw out, to let go, if only temporarily. The World Wide Web is always there, but human brains need to clear themselves regularly, and to discharge bottled emotion.

Emotions and Posture

The following are some of the ways emotions affect posture: anger can tighten the jaw, can cause indigestion and back ache, bring the shoulders up to the ears and make the teeth grind. Depression can cave the chest, tuck the pelvis under, or slow down the metabolism. Anxiety can create nervous tics, tighten the fingers and toes, turning them into iron claws, or contribute to fibromyalgia. So let it all go, knocking out fear and fury as you pounce into your training zone to conquer fat or frailty.

To stimulate exercise, it's best to convert depression to anger. Anger can be released directly through exercise. If you are frail, out of shape, or overweight, do aggressive movements in the pool.

Anxiety is related to hope. If you hope something will happen, but are afraid it might not turn out as you wish, you may feel anxious. You rehash the past, dread the future, and are too stressed to milk the moment. This feeling is common in competitive sports but when you workout, you should pull yourself into the present, and exult in the joy of what you are doing and how you are feeling now, except when you are doing that last push for power to increase strength or cardiovascular endurance. Even then your complete concentration is on your performance, with the hope that it will soon be over.

There is a relationship between your physiology and your emotions: heart palpitations, increased heart rate, hyperventilation, muscle tensions, cotton mouth, clammy hands and feet, butterflies in the stomach, visual distortion, nausea, vomiting, flushed skin, rashes, inability to concentrate, and a sense of confusion can occur when your emotions affect your movement. In sports psychology, trainers try everything to make sure their athletes function at their optimal level of performance, a delicate balance between stress and relaxation, fight, flight, surrender, and staying the course.

Ch05: Ideokinesis
How imagery, goal-setting, and attitude affect pain and performance.

You think before you move. You think as you move. You think when you are not moving. Movement is always a mindbody experience, but ideokinesis is the deliberate, conscious attempt to improve movement through imagery.

Postural Ideokinesis

Movement analysts like Bartenieff, Lulu Sweigard, Moshe Feldenkreis, Alexander have used imagery to improve posture and neuromuscular coordination. In Dr. Keefer's Corrective Clinic, postural ideokinesis will be used to correct specific injuries and problems.

Athletic Ideokinesis

A good coach has her players use this technique when watching videos or other players; a good choreographer will allow his dancers to "mark" a difficult performance in order to mentally rehearse it. Every time you watch a sporting event or dance performance on TV you may be doing this unconsciously. This technique can help break bad habits caused by your own limitations. When I am tired or injured, I go to ballet class and stand behind the best, professional dancers, gently marking my movements but pretending that my body is their body.


Self-hypnosis is one of the best ways to create auto-suggestion for pain control as well as athletic or intellectual performance.

Hypnosis is an altered consciousness, which tends to produce heightened suggestibility, narrowed awareness, focused attentiveness, selected wakefulness to deal with a problem or issue.

Hypnosis is just suggestive repetition done in such a fashion as to program your unconscious. Although not everyone can be hypnotized, everyone responds to these repetitive suggestions, or millions of dollars would not be spent making commercials. Instead of just being a pawn for mass consumerism, you can make your own tape and choose what messages you want to send to your unconscious. The following is just a guide, helping you identify and organize the various stages of auto-suggestion.

Catharsis of Negative Emotions

If you are furious and bitter after a hard day at work, you may not be able to relax until you have let off steam through aerobic exercise and/or vented angry emotions to a friend, a lover, a diary, a cat. When you want to kill your boss try not to slowly kill yourself with cigarettes, cheesecake, alcohol and/or drugs, but acknowledge the rage and frustration, express it and exorcise it. Use your conscious mind to determine the healthiest way for you to discharge the day's anger.


Then find a place in your room where you can relax completely. We usually think of ocean waves and gentle sounds as relaxing but some of my students have to distract before they relax completely. I know one student who has to listen to hip hop music after a day typing legal papers. A very depressed, lonely, obsessive-compulsive needs to watch sitcoms to relax. A frustrated personal trainer who lives with his mother watches boxing matches to let go. An emergency medical technician listens to classical music after her chaotic day of blood and guts. One student gets anxious listening to waves, bird calls and thunderstorms and needs complete silence. Get to know yourself well enough to know what you need to separate mindbody from your particular daily stresses.

Fractional Relaxation

After distraction with your favorite music or activity, lie on the bed, futon or carpeted floor, getting into the position that is most comfortable for your arthritis. Fractional relaxation is the progressive relaxation of each body part. Again everyone is different. Some people respond best to tighten and contracting in sequence with simple words such as clench your fists, inhale hold them tightly, exhale let them go and relax the hands completely. They prefer the incantation of relax, relax, relax. If your arthritis is severe, make sure you don't clench and drop joints so that they hurt.

Other people prefer to try to relax completely and use images to enhance the feeling such as imagining the flesh as overcooked chicken falling off the bone, the buttocks as uncooked loaves of dough, the hands and feet as loose rubber bands letting go etc. Go through every body part in succession so that you are sure you are as relaxed as possible.

Stay with a stubborn area, trying different images to let it go. Images can appeal to any of the five senses. Feel your ice cold shoulders melt into a stream of hot butter. Imagine your feet softening and smelling like rose petals.

People with arthritis, disabilities and injuries often feel ugly. Use images to make you feel good so that your body lightens and softens. Turn it into a cloud, a fish, a snake. Or if it starts off feeling heavy and cumbersome, let the heaviness sink into the floor, surrender to gravity, get rid of all your tension and then feel the body like a cloud floating above the earth.

Deep Relaxation

Deep relaxation relaxes the conscious mind so that you are ready to focus for induction. This should include watching the rise and fall of the breath, listening for the spaces between the heartbeats. Thoughts become bubbles blowing into the air. Everything gets slower and slower. You can count backwards.


As you relax deeply, you begin to narrow your focus, the way people do when they meditate. You can meditate on a fixed object, candle, hypnodisc, inner eye, anything but the objective is to still the mind.


At this point you can induct yourself, through the tape that you have already made so that you are open to suggestions.


Again this portion should be tailor made for each individual. In the same calm, soothing voice used for the relaxation, address your attention to the area of greatest pain. For example, if you have arthritis of the knee, feel a light shining on your knee, clarifying the structures; imagine new shock absorbers growing around it so it has the plasticity and elasticity of a child's toy; feel it glowing with warmth and health. Then see yourself walking briskly without pain, gliding up and down stairs effortlessly, getting up and down from chairs gracefully.

This is a great place to make specific suggestions regarding athletic or intellectual performance.

It is also the only way to try to get your mind to relax, let go, and eventually sleep. After giving and receiving massages for so many years, I can instantly let go of my muscles. I can also focus my thoughts, slow down my heart rate, and decrease my respiratory rate. But it isn’t easy to relax my mind enough to sleep. I must program that specifically during the auto-suggestion portion.


You may need to get rid of negative thoughts, rage, and frustration to sleep. Sometimes hypnosis can take over where the hardest knockout workout left off

A few notes about the unconscious: use simple, clear commands. Stay in the present tense and don't keep talking about the arthritic knee, the pain, the ruptured ligaments, damaged cartilage etc. It's not because you are forcing yourself to be positive; it's because the subconscious is imagistic rather than syntactical. Your conscious mind can decipher the syntax of "you'll never change the grade III chondromalacia and the torn menisci but you can relax the muscles;" but your unconscious can be given the image of a healthy knee so that your body can let go of some of the pain. The unconscious also does not have a linear approach to time, as evidenced by our dreams which are everywhere all over the place all at once.

Repeat incantations like "let go of the pain..." and any affirmations you like. You want to be as specific as possible, addressing your attention to what bothers you most. It may be your hands and fingers. You can imagine yourself typing painlessly for hours as if your hands were floating through corn silk. For those with neck arthritis, imagine a cashmere turtleneck making your muscles as soft as its delicate fibers. If you have sciatica, grow a furry tail out of your tail bone to relax your lower back; imagine your buttocks turning into uncooked loaves of dough; feel cool hands smoothing away all the aches and stings from your legs; lengthen your spine as you would stretch and slinky toy and put soft sponges between all the vertebra.

As you can see, a basic knowledge of your pathology and the anatomy where it occurs can help you construct these images.

After focusing on your problem area, reintegrate the body with images for total healthy functioning. Now you can give yourself positive affirmations without being falsely cheerful. Say you will walk painlessly down the street, workout more often, sit comfortably but correctly etc. Try to be as specific as possible. Use the present to put yourself in the situation. You can end the auto-suggestion with repetitive phrases like relax, let go, etc.

As with exercise, end your hynosis sessions with a purr.

Once you have finished your self-hypnosis, you may choose to program yourself into your bedtime sleep or to reawaken refreshed and rejuvenated. People who are highly suggestible should return to the conscious state. I am very hyper and usually program a night sleep at the end of the hypnosis so I can leave the tape running. I don't finish work until late at night and after I play hypnosis tapes, it's time to go to bed. Do what works for you, but don't end the session abruptly. Either drift off to sleep with quiet music or incantations or gently bring yourself back to your conscious mind.

You can make this CD or tape, adding whatever music you like. You may prefer to hear your own voice talking to yourself, however if you respond better to authority figures or your voice is strident and irritating, you can have a friend with a more resonant tone record it. However, your unconscious is a tricky thing. The hypnosis will be colored by the relationship you have with the person recording it. In that case, if you do not want to make the CD, it might be best to have a professional of some kind do it. I have made tapes for students and myself successfully.     

Ch06: Massage
How the different types of massage can heal, stimulate, refresh or relax you.

Rest, Relaxation and Recovery

You get stronger when you sleep, that is, if you have worked out hard before. Yes, it is when you rest and recover that your muscle fibers repair themselves. There is nothing more relaxing than a deep massage in the privacy of your home. For the performance athlete or exercise-aholic, rest is sometimes the most difficult thing to do. Some Level III people don’t even know they are over-exercising.


Swedish massage includes a number of techniques such as effleurage or stroking where you run the hand lightly over the skin's surface, usually spreading oil or lotion for deeper work. Effleurage is used to enhance circulation and drain lymph system, especially when the strokes move from the extremities to the body's core. Petrissage or compression and kneading is used to relax muscles by grasping and releasing fascia and muscles with constant motion but intermittent pressure, thereby improving the mobility of muscles tissue as well. Friction is deep pressure of soft tissue against underlying hard tissue show as bone or tendon with the thumb or finger pads in a criss-cross or circular motion to break down scar tissue or tension in problem areas. When you can't exercise, Swedish massage will keep your tissues moving. When you can, it will flush out lactic acid and help you recover faster. If you are troubled, Swedish massage can be sensuous and soothing.

Athletic Massage

Before or during a game, athletes need stimulating massage that doesn't fatigue the muscles so tapotement, effleurage, light petrissage, shaking, stretching, and mechanotherapy can help the body continue the performance. Afterwards the performer may need medical massage.


Medical massage is a more specialized approach including prolonged friction, mechanotherapy and mobilization, and drainage massage for inflammation. In both Swedish and Medical massage, direct pressure on naked skin usually yields the best results. A J-stroke can be used on longitudinal scars and limited areas because of its multidirectional stretch. If a muscle spasm is present, oscillation or a back-and-forth application of a moderate pressure can relax the area. PNF stretching of reciprocal muscles and mechanotherapy are useful in conjunction with medical massage. Wringing is similar to petrissage but demands the use of both hands in full rotation. Stripping is a deep-tissue release using knuckles, elbows or thumbs in a slow, consistent pressure. It can be uncomfortable but effective in breaking down adhesions. Arm, leg and neck pulls create traction in the joints. Medical massage can speed recovery, reduce inflammation, break down scar tissue, stretch tissue, and stimulate muscles for eventual strengthening. If you are injured, you need medical massage. Swedish and Shiatsu can only accomplish so much.

Shiatsu and Reflexology

Shiatsu uses direct pressure on the acupressure points to stimulate the nervous system and the chi. This type of massage is usually done with your clothes on, on the floor where the practioner kneels beside you. This is similar to the technique used for reflexology. I used these techniques for mentally troubled patients to recenter them.

Massage helps me diagnose muscular problems that can't be seen on radiographs or through movement. For example I can feel the scar tissue or adhesions in old injuries, how much tension is in the piriformis muscle, or how weak the shoulder rotators are. A house call is never complete without a massage. Postural retraining, ergonomics, and therapeutic exercise only go so far. Massage gets right into the skin, bone, and muscle to release the tension mechanically. It feels good afterwards but it doesn't last forever. You have to eventually program your own relaxation and improved biomechanics with meditation and self-hypnosis.

You have an emotional history embedded in your nerves and muscles that shapes your skeleton. Although rolfing throughout the body may be too extreme for many people with arthritis, a soothing massage combined with myofascial releases in specific areas might some of the tension.

Contraindications for massage include fever, very high blood pressure, infectious diseases, skin rashes, cancer, varicose veins, and severe osteoporosis.

Beds and Sleeping Posture

You spend from 5 to 10 hours a day in bed so your sleeping posture is important. If you sleep on your back, place a cervical roll under your neck and a lumbar roll under your lower back. On your side, put a pillow to even off the distance between your neck and shoulders, and a pillow between the knees. Try not to curl into a foetal position. If you have a sore shoulder, sleep on the uninvolved side. Only move on to your stomach to stretch in TV watching, half-Sphinx position, or if you have a headrest so that you don't twist your neck.

Sleep on a firm mattress or a platform bed.

Mental Massage

If we could actually open up our brains and massage them we might get rid of the neurofibrillary tangles that contribute to Alzheimer's, we could improve synaptic connections, and stimulate neurotransmission. Until this happy day arrives, we will have to settle for soothing our brain. Now many people use alcohol for this purpose, but since it destroys brain cells, we must find healthier ways to relax, such as hypnomeditation, listening to music, having good sex, and being positive about who we are and what we have done.

We will now proceed to Dr. Keefer's Corrective Clinic where specific instructions will be given on how to isolate, exercise and massage different body parts for various injuries.