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Authors: Charles W. Hoge M.D.

BOOK: B0038M1ADS EBOK
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The most important thing is to let yourself experience how your body
takes over sometimes. Let it do what it does, accept it, and learn from it.

SKILL 3: IMPROVE PHYSICAL CONDITIONING AND RELAX
MUSCLE TENSION

There is no better and more natural antidepressant, antianxiety, or anger
management medicine available than good physical conditioning. In study
after study, regular exercise has been shown to positively affect mood,
memory, anger, thinking, anxiety, work performance, sleep, blood pressure, cardiovascular functioning, and cholesterol. Physical exercise can
help resolve depression and improve the symptoms associated with PTSD.
Exercise improves circulation, strengthens the heart and lungs, and helps
control weight. Exercise can help with pain. There are even studies that
show regular exercise can help with memory impairment in elderly people
with Alzheimer's disease.

Physical conditioning is an integral part of being a warrior and is built
into the regular training that all warriors receive. There are five key components to good physical conditioning, all of which can improve mental
well-being: A) stretching/flexibility, B) muscle relaxation, C) aerobic exercise, D) strength building, and E) a healthy diet.

A) Stretching/flexibility: The goal of stretching is to improve flexibility by
lengthening muscles and tendons. Include the calves, thighs, hips, back,
shoulders, and neck. There are four important rules to stretching that
should be followed.

• Stretch when you're warmed up or after exercise. Muscles are more
receptive to stretching when warm and can be injured if stretched
cold.

• Don't bounce to achieve a greater stretch. Put yourself in the stretch
and let yourself settle into it for about thirty seconds, remaining still
without bouncing. After the first ten seconds or so, the muscles will
release slightly and allow you to achieve a greater stretch. When this
happens, settle into it. Don't force it, and never bounce, as this can
damage muscles or tendons.

• Stretching should feel good, not painful. If you feel pain, back off to
the point where you feel the stretch but it doesn't hurt.

• Breathe while stretching. Don't hold your breath.

B) Muscle relaxation: The ability to be aware of muscle tension and to
relax muscles is often included in stretching and flexibility, but deserves
its own category. We are often unaware of the degree of muscle tension
that we carry, particularly in the upper back, shoulders, and neck, or the
stress that we put on our body from certain postures. Warriors sometimes
hold a combat-ready posture, even when strolling through the park or
mall, characterized by general muscle tension, slightly hunched posture
and elevated shoulders (as if there's a weight on the back); arms held
stiffly out toward the sides like there's combat gear against the body that
prevents the arms from swinging naturally close to the body; hands curled
slightly in a fist position; and a purposeful stride. It's as if the warrior is
always fully loaded. All of this results in enormous muscle tension that can
contribute to poor sleep; chronic headaches; chronic pain or stiffness in
the neck, shoulders, upper back, lower back, or hips; high blood pressure;
irritability; and other problems. Warriors are often totally unaware of the
amount of postural tension they're holding and the variety of problems this creates for them. Pain medicines are sometimes prescribed that can
cause side effects or lead to overuse, worsening the situation.

Compounding this is today's increase in computer use and textmessaging, which often results in a slumped or hunched posture in both
men and women, with the upper back and chest collapsed and shoulders
pulled upwards; this puts strain on the upper back and shoulders and
leads to associated postural problems. For these reasons, becoming aware
of muscle tension and learning to relax muscles is an important skill.

To start, stand up straight, feet flat on the floor, and loosen each joint to
release tension, starting from your head down to your feet. Begin by gently
flexing and extending your neck by dropping your chin toward your chest to
look at the floor and then raising it up toward the ceiling. Repeat this several
times. Then turn your head all the way to the right and left several times. Then
tilt your head to each side (ear toward shoulders) several times. Rotate your
head around clockwise and counterclockwise several times. Do all of this in a
very relaxed manner with the goal of loosening up your joints.

Once your neck is loose, next release the shoulders by lifting both of
them up toward the ears as far as they'll go and then dropping them down
quickly in a relaxed way. Do this several times. Do circles with your shoulders in both directions. Then let your shoulders drop down and relax so
that they're simply hanging. Next, shake your arms and fingers out in a
relaxed way. Extend your fingers and then swing your arms in wide circles
at the shoulders to help release the shoulders and relax the arms. Then let
them hang naturally near your body. Counter any tendency to push them
out away from your body.

Next, become aware of your upper back and chest. Straighten the
upper back by thinking of making yourself taller up through the top of
the head toward the ceiling while keeping your feet flat against the floor.
If your chest is collapsed slightly from being slumped, open it up. Roll
the shoulders toward the back and pull the shoulder blades together for
a few seconds and then release. Repeat this until your shoulder blades are
relaxed, your chest is open, and your upper back is straight. Being open
in the chest does not mean sticking your chest out (like some people do
when standing at attention).

Next, become aware of your stomach, lower back, and hips, and let
them relax. Let your stomach relax by sighing and letting it drop toward
the floor. Do some circles with your hips and waist to help release the hips
and lower back. Continue down the legs. Release any tension in the buttocks, thighs, knees, and feet; feel your weight against the floor through
the center of your feet. Be aware of your toes against the floor.

Finally, move in any other way that helps to release any tension you
feel. The best way to release tension is through movement. If necessary,
hang off a pull-up bar or other object to help release the shoulders. You
can also lie on your back on a bed with your head and upper back hanging in a relaxed manner off the edge of the bed to give yourself a stretch
in the opposite direction from slumping or hunching forward. The way to
release tension is to get more movement into each of your joints in a comfortable and relaxed way, so you end up standing tall in a natural manner
with good posture.

Although movement is usually the simplest way to release tension,
another technique to relax muscles that is frequently taught by mental
health professionals is called progressive muscle relaxation. This involves lying
down on your back (or sitting) and consciously thinking about relaxing
each muscle group sequentially, beginning with your face and moving
down slowly through your neck, upper back, chest, arms, hands, lower
back, stomach, pelvis, legs, and feet (or vice versa). If you have trouble
relaxing, then you can consciously tense each muscle one by one by flexing or extending it, holding it for a five-count, and then releasing it.

Get comfortable "taking off" your warrior posture whenever you're
"off duty." When walking, stand tall and let go of any tension in the upper
back and shoulders. Let your arms swing naturally close to your body.
Don't text-message while you walk.

In addition, any activity that helps to relieve muscle tension or improve
flexibility, such as massage or yoga, is beneficial. Massage therapists are
readily available, and many shopping malls have chairs where you can get
a brief massage of the back, shoulders, and neck. Having a massage is one
of the best ways to learn to appreciate the difference between tense and
relaxed muscles.

C) Aerobic exercise: Regular aerobic exercise that increases heart rate
provides the greatest benefit to overall health. There are numerous ways
to do this, including running, swimming, biking, rowing, dancing, and
martial arts. Aerobic exercise should increase your heart rate, cause you
to breathe faster, and develop at least a light sweat. You should be winded
enough that it's difficult to carry on a conversation while exercising. Your
muscles should feel like they're exerting themselves. A commonly recommended minimal amount of aerobic exercise is thirty minutes a day for
five days a week, or three times a week if the activity is very vigorous, such
as running or martial arts. However, this is a rough guide, and each person
needs to find the routine that's most comfortable, practical, and beneficial
for them. Obviously, more exercise has more benefits (as long as you don't
overdo it), but even ten minutes a day of vigorous exercise is much better
than nothing.

D) Strength building: Improvement in strength doesn't require hours in the
gym. It can be achieved in three twenty- to thirty-minute weight training
sessions each week. Also, you don't have to do multiple repetitions. Research
has shown that a single set of repetitions at the correct weight level achieves
optimal results. Select the weight that allows you to do twelve to fifteen repetitions, with your muscles tiring enough that you're barely able to complete
the final repetition of the set.

E) Healthy diet: It's important to eat regular meals and get the right balance of protein, complex carbohydrates, and fats. Eat a wide variety of
foods that include plenty of fresh fruit, fresh vegetables, whole grains,
fiber, and legumes. It's better to "graze" throughout the day by eating
smaller meals more often than one big meal, and to snack on fresh fruits
and vegetables and unsalted/unsweetened nuts, rather than sweets. This
results in a more-balanced release of insulin, the hormone responsible for
maintaining your blood sugar level and distributing the calories you take
in, so that they don't go immediately toward building fat cells.

It's very important to limit your sugar intake, particularly candy, pastries, sodas, and other beverages that include high quantities of sugar (sucrose), corn syrup, high fructose corn syrup, glucose, dextrose, and
related sweeteners. A single twenty-ounce bottle of regular (non-diet)
soda usually contains 200 to 300 calories, which can rapidly tip the scales
toward weight gain, obesity, and abnormal insulin regulation. There are
also enormous calories in many processed, packaged, and fast food meals.
Many breakfast cereals, as well as nut and dried fruit mixes, are marketed
as being healthy but are actually heavily sweetened. It's much healthier to
get your carbohydrate calories from complex grains, vegetables, or fruit
than from simple sugars. The bottom line is that unless you read labels
regularly, you're unknowingly eating many foods with high sugar content.
Educate yourself about the different ways to maintain a healthy and balanced diet.

SKILL 4: IMPROVE SLEEP

It's common to experience sleep disturbance after returning from combat, both because the body's physiology may have been changed from the
intensity of combat, and because your body has likely become used to functioning on less sleep. With many operations going on at night, reversed
sleep cycles disrupt the normal internal human clock linked to sunshine
and the hormone melatonin (circadian cycle); this can make it very difficult to reset back to normal nighttime sleep after returning home.

While warriors may experience difficulty falling asleep, the more common problem is waking in the middle of the night, either from a nightmare or for some other reason, and then not being able to fall back asleep.
This is similar to the sleep patterns they experienced during deployment.
The overall quality of sleep isn't as good, and warriors often don't feel sufficiently rested when they wake up.

Sleep is an essential part of good health and ensuring a successful
transition home from combat. Warriors often find it difficult to readjust
after months in a combat zone where they were constantly revved up and
may have only been able to get a few hours' sleep each night. Nightmares
are often the product of being revved up, and if you go to bed tense or
angry, there's a greater chance of having one. The quality of sleep can be negatively affected by high stress or an inability to let go of stressful experiences after coming home.

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