Abdominal Excercises A Requirement
( Originally Published Early 1925 )
Weak abdominal muscles are practically always associated with intestinal stasis. The reason is plain, as has been elsewhere several times pointed out. Many people do not realize that they have them, and as to developing a good hard set of them, not one person in a thousand ever gives the matter any attention. In combatting the condition under consideration, a number of important remedies have been carefully presented but there is none of more importance than a form of abdominal exercise, regularly maintained for a few minutes each morning, that will enable the patient to largely eliminate the over-valued abdominal massage, that is, as a rule, ineffective yet costly in time, effort and money if performed by a professional and unsatisfactory if done by the patient.
A moment's reflection will disclose why this is so. If the reader desires to greatly strengthen the muscles of the arm, for instance, what will be the most effective way to go about it, by massaging those muscles or by exercising them? The muscles of the abdomen can be punished by pressure and kneading from the surface yet the deep-seated ones, unlike those of the arm, can hardly be reached to any desired extent by such a method. But when the forms of exercise set out in detail below are put into action the patient need do nothing more than spread the palms of the hands over the walls of the abdomen to note the tremendous stirring that is taking place deep under the surface.
Hurst says the majority of cases of constipation at the lower end of the colon in which the voluntary muscles of defecation are at fault, are caused by weakness of the abdominal muscles. Such weakness is also common among people who take too little exercise, owing to sedentary occupation, laziness or obesity.
Kellogg is of the opinion that the exercises that are of the greatest value in these cases are those which bring the muscles of the abdomen and diaphragm into strong action. The abdominal muscles are generally weak and relaxed and the intra-abdominal pressure consequently low. These muscles may be strengthened, the pressure raised and the colon thus enabled to contract with sufficient impetus?
This is a sound physiological truth and this chapter is written for the purpose of bringing the fact into strong relief. But nothing more is claimed for it than that it is but one of the accessories which, in the aggregate, work out relief when properly utilized in practically all cases where there is no organic defect. On the subject of the rapid physical degeneration that follows the giving up by primitive man of his natural habits McCollum makes an interesting observation, that the teeth of the primitive Eskimo are excellent. According to Stefanson, there is no word in their language for toothache. Today those of the younger generation dwelling along the Arctic coast of Alaska have teeth as defective as those of the children in the United States. They have been brought up largely on foods available in grocery stores—flour, sugar, molasses, muscle meat and fish.
Another instance was the quickly developed tuberculosis among the Apache Indians, taken from their wild life to Fort Sill, Oklahoma.
Of course the physical development of the entire body is such a widely recognized support of good health that it would be difficult to say anything new on the subject. But this is not the case with abdominal exercises. Ignorance on this subject is widespread and most disastrous in consequences.
Darwin in discussing the degenerative changes that come to organs from disuse says: "The term disuse does not relate merely to the lessened actions of muscles but includes a diminished flow of blood to a part or organ from being subjected to fewer alterations of pressure, or from becoming in any way less habitually active."
If a large percentage of overfed house-abiding people do no more than withhold excess of food from weakened stomachs, kidneys and liver and two or three times a day regularly and persistently throw up windows and pick up with much stooping and stretching a big handful of marbles or buttons flung over the floor and under furniture, they will take the first long step to restoring strength and circulation to neglected abdominal muscles. Such people desire health above every other blessing. But like a traveller who has taken the wrong road they need to be told that their skin marked with liver blotches, their pudgy abdomens, rheumatic joints and disorganized liver secretions and many other ills, enumerated elsewhere, have their source in a great majority of cases in ignorance of abdominal hygiene.
The following morning exercises have been found excellent in the development of the abdominal muscles.
1. As a preliminary step massage the colon as directed elsewhere in this chapter, the bladder being first emptied and the three glasses of water not yet taken.
2. Lie on the back, fill the chest with a deep breath and raise the legs to a perpendicular position and lower them. Repeat the movement four or five times with the palms spread over the muscles of the abdomen at first for the reassuring effect on the patient. At first, such is the weakness of the muscles involved, this can be done without fatigue but four or five times. Gradually in-crease to 10 to 15 times.
3. Lie on the left side and swing the right leg up against a full chest until the knee is well under and almost touching the chin with the foot over the inside of the left thigh, for the benefit of the cecum and ascending colon. This brings a vigorous pressure to bear upon this first section of the colon and liver between the full chest and compressing thigh. Reverse the process by lying on the right side using the left leg for the descending and pelvic colon. For the first week 10 times a day, gradually to be increased to 20 times or more for each side, divided into two periods of 10 each.
4. To reach the transverse section of the colon and all the abdominal organs cause the intestines to be lifted bodily while the patient lies flat on the back. To do this, first fill the lungs and then exhale to the limit. With the lungs empty raise the chest as though drawing a deep breath but let no breath enter the lungs. This exhaustion of air pressure in the lungs while the movement of deep breathing is vigorously continued will lift the abdominal organs. On the first trial 3 times, repeated 4 times, to be gradually increased to treble the number. This valuable exercise promptly quickens the breath?
5. With a full chest raise the body from the hips up to a perpendicular position and each time press down hard 2 times with the diaphragm against the liver and then twice without such downward pressure, in the latter case touching the toes with the fingers. For the first week 4 of each movement, to be gradually increased to three times this number, 20 of them without the down-ward pressure. This exercise is designed to develop the efficiency of the liver, transverse colon and the neighboring muscles.
6. Turn over, face down; raise and lower the upper part of the body down to the knees by the hands and arms, inflating the chest to the limit at each second downward movement. This will also cause the breath to come quick, expand the lungs and develop important trunk muscles that usually receive scant attention and use. Five movements at first are enough, to be increased up to 15 or 20 times, stopping always short of fatigue.
7. Lie flat on chest and forearms. Raise the chest and head with the minimum assistance from the arms, to a point where the chin is as high above the bed as possible. At first the limit will generally not exceed 8 inches to be increased to 15 inches. This very valuable movement develops muscles of the neck, chest, shoulders, arms, back and abdomen that are much neglected.
8. Practice deep abdominal breathing and exercise by slowly raising the abdominal wall against 10 or 14 pounds of pressure, preferably supplied by a broad, fiat sack of sand, or a file of large magazines. Stop short of fatigue and do not persist against pain which may indicate a condition of disease.
9. Lie on the left side and raise the upper part of the trunk sidewise, with as slight help as possible from the arms, until the trunk from the hip up is in a position of moderate curve, but without inflation of the lungs, slowly 4 to 10 times. Then the same movement for the other side. When the right side is lifted the liver is compressed and massaged; on the left side the region of the splenic flexure and descending colon.
10. An excellent finish can be made by taking an upright position on the floor and shooting the hands as high in the air as possible and then bending down until the feet are touched while the lungs are inflated each second movement immediately before the descent. With hands on hips swing the hips in a circular movement, first one way and then to the other. First exercise five times at first with gradual increase to 20; second the same. (Use care in deep breathing. See p. 194.)
By the time No. 7 is finished the pulse should be quickened by some 30 beats to the minute. If there is any organic weakness, especially of the heart, care must be exercised.
If leg exercises are desired, such as raising the body to an upright from a squatting position, and rising on tip toes, etc., they can be added.
People who are feeble or with big stomach girths will have to exercise with care and discretion in all these exercises. The first movement in No. 9 particularly re-quires moderation.
Of the above exercises 3, 4, 4, 8, 9 (in particular) and 10 are of special value to the liver, while also greatly stimulating other abdominal organs. The largest of these, the liver, is constantly taking up from the blood, modifying and giving off material of many sorts. These and other functions are easily modified by disturbing influences. Those that are slight are met with compensating actions. But if' a disturbance is continued long enough a significant fact emerges—the development of structural change Such a disturbance is supplied by the tippler or a steady drinker. Fothergill says of alcoholic irritation that the liver first enlarges from excess of blood (congestion) and the surface becomes rough (hob-nailed liver). The development of granular degeneration (resembling grains or granules) follows in due course. This also is called the drinker's or nutmeg liver because when cut through it looks like a nutmeg. As time goes on the whole organ becomes more or less involved and a shrinking and hardening develops. This condition is called cirrhosis of the liver (a type of sclerosis) and is the ordinary illness from which so many tipplers die years before their time. The rate of progress depends on the amount of alcohol taken and its state of dilution. When taken on an empty stomach the worst result follows.
The liver becomes so debilitated by errors of diet and unhygienic practices that intestinal poisons instead of being destroyed set up inflammation and abscess that may be the starting point of cancer, particularly if cancer cells are present in the intestine; also the flow of bile may become so disorganized that crystals of bile-fat ("stone") form until in an examination after death the gall bladder is sometimes full of gall stones that had not as yet caused enough inconvenience to give rise to a suspicion of their presence. (See the interesting statement by Hurst on this same subject in Chapter )XXII, pages 261-262.)
One of the most important of the liver secretions (stimulated by the abdominal exercises), says Kellogg, the bile, is a stimulant to the colon but not to the small intestine. An excellent proof of this is found in the remarkable colon-stimulating qualities of "bilen," an extract from bile, which when introduced into the rectum often produces active colon movement (peristalsis) within a few minutes. A recent discovery shows that the spleen also produces an active intestinal stimulant, acting upon both the small and large intestine. Another remarkable substance secreted by nature from the pituitary glands of the brain and secured externally from cattle, is a most powerful stimulant of the entire intestinal tract. Recent observations have shown that putrefactive bacteria are carried from the colon in great numbers through the walls of the intestine into the blood stream that goes directly to the liver (portal circulation) where many of them are destroyed, but not a few may pass out in the bile and infect the bile passages. In some cases it is possible that infection may occur directly from the intestine. The bacteria may also ascend the gall duct to the gall bladder and liver. Modern research shows that gall stones are practically always due to bacteria, found in the interior of these concretions, and which are almost invariably associated with constipation. Marked enlargement of the liver and spleen are frequently the result of chronic constipation. The infecting germs may pass direct to the right kidney, through the closely adjacent wall of the colon.
Resuming the question of exercise, Fothergill says the matter is of far more moment than before Voit made the discovery that we can store up oxygen for use when we are placed where the supply of oxygen is deficient. A man devotes time to his meals; he ought also to devote it to storing up oxygen; and so he will when he knows that such storage is feasible. As it is he is utterly ignorant of the fact and only takes exercise because he believes it is "good for him." If he really understands the subject he will sedulously cultivate the air in every way, especially in the practice of deep breathing, and at every opportunity. Many a case of tuberculosis associated with indoor occupation would by this simple method be avoided.'
The following fine statement of the value of general exercise is by an able physician at the age of 94.
When reasoning about the remarkable improvement in the heart's action and in the mental and physical conditions effected by climbing tours, Sir Hermann Weber came to the conclusion that it was caused in a great degree by the deep breathing which is induced by the act of climbing, especially steady and prolonged climbing. This led him to pay particular attention to breathing exercises which later were useful to himself and many of his patients, especially persons of sedentary occupations. By deep breathing the entire lungs, including the apices and bases, become expanded, while in ordinary breathing the apices (plural of apex—in this case the air chambers farthest from the base) are only partially inflated. The flow of blood and lymph through them is imperfect. In consequence of being ill-nourished they become the seat of disease such as chronic catarrh and tuberculosis. As in walking and other bodily exercises moderation must be exercised in deep breathing, as it is often injurious in cases of great weakness of the heart or lungs or in the after effects of pneumonia or other acute diseases, especially rheumatic fever and influenza. Even in healthy persons a commencement should be made with moderately deep breathing in a well-ventilated apartment and continued during two to five minutes with gradual increases to ten minutes or a quarter of an hour or longer once or twice a day. The duration of the breath should likewise be gradually increased. At the beginning ten seconds or less for each inspiration (intake of breath) and each expiration ought to be sufficient. If this is well borne each act may be gradually prolonged to a quarter of a minute or more.
The right position is to stand erect with raised arms and closed mouth during the intake of breath; then to bend the body down, retaining the breath if it can be done without distress, so that the fingers touch the ground or the toes. The intake must be through the nose, by which means the air is moistened, warmed and strained. The expiration can be through the mouth. An important point during the expiration is to thoroughly contract the abdominal muscles to strengthen them, and compress the intestines.* By 'degrees the abdominal movements can be developed into stretching, side bending and circular bending during each inspiration with several up and down movements. These exercises also bring into exercise muscles of the back which are apt to be imperfectly developed by most people. Thus we keep the spine flexible and correct the tendency to stoop, so common in old people, and the bad' posture of many that are young. There are other combinations such as swinging the legs over a chair, or rising on a step as if starting upstairs, first with one foot and leg and then with the other, with alternate inspirations and expirations. In addition to these, other muscle and joint movements in connection with deep breathing of good air will occur to the exerciser. But the main attention must not be diverted from the breathing exercises since to them the beneficial effect on the heart, blood vessels and lungs is mainly due. In addition they promote nutrition, elasticity and efficiency of the .lungs which are apt to undergo a kind of atrophy (shrinking) in old age. The permanent distention of air cells of the lungs in old people and likewise the destruction of many of the small blood vessels of the lungs, diminishing the aerating surface of the blood, is thus prevented; also such results as heart dilatation, heart failure, and all its attendant troubles of which the chief symptoms are shortness of breath and attacks of bronchitis, with certain breathing irregularities, seen also in asthma. By improving the nutrition of the lungs we also counteract the tendency to chronic bronchial catarrh and pneumonia, which are the most frequent causes of death in old age. Deep breathing also assists in removing slight, passive, watery effusions in the lung cavity by acting as a respiratory pump. The elasticity of the chest walls is also maintained. They are apt to become rigid with advancing age. Intimately connected with this elasticity is the healthy condition of the rib bones and their marrow, which greatly favors the formation of the blood globules; also by the contraction of the diaphragm, the liver, the spleen and other abdominal organs are thoroughly massaged, the blood squeezed out towards the heart and the latter forced to contract more vigorously. Thus addominal venosity (vein congestion) is avoided. The most convenient time for practicing these exercises is in the morning before and after the bath, either naked or clothed lightly, and in the evening when dressing for dinner. Persons deprived of the power of walking should frequently and regularly practice deep abdominal breathing exercises by downward pressure of the diaphragm while driving, or sitting out of doors or near an open window. Very great benefit should result if this regimen is faithfully adhered to. The habit of deep breathing must be created and then maintained. To it should be added very valuable static or tension exercises while sitting or lying quietly in bed, by the contraction of all the muscles of the body for one or two minutes, several times a day.
In action from exercise the smallest arteries of the muscles become widened, more blood flows into the capillaries (the smallest blood vessels) and the flow of lymph is increased, thus more nourishment and more oxygen are carried to the tissues and at the same time the products of waste are removed. It is, however, not only the muscular fiber which gains, but the nutritive vessels and absorbents gain as much by being kept in action. The increased afflux of blood forces the small vessels to work in conducting more blood to the tissues, and thus their coats are maintained in a sound condition. At the same time the lymphatics are kept in action by the removal of increased amounts of fluid from the lymph spaces, containing the used-up material and the substances not wanted by the muscular fibers. Similar is the case with the brain and nerve centers. The increased afflux of blood to the brain by the act of thinking has by the ingenious experiment of Mosso of Rome, been demonstrated. The subject was placed horizontally on a finely balanced table and in the act of thinking the head end of the table went down. Through a hole in the skull of a person he also observed that the volume of the brain increased in size. Muscular exercise also acts as a powerful means of preventing arterio-sclerosis, which Sir Lau-der Brunton calls "the great enemy to longevity."
The atrophy (shrinking) of the muscles is in most per-sons, one of the first signs of the weakness of old age and is one of the main causes of the loss of weight and of the deterioration of the power of heat production in old people. The beneficial influence of walking extends to all the organs of the body, internal as well as external. Many persons think that walking exercise is quite unnecessary; but the great majority of those who hold that view and act on it suffer in later years from the neglect. Many persons also walk very little in the winter, especially those engaged in offices. This is one of the principal causes why, during the winter and early spring, the resisting power of many people is diminished, and why in consequence they fall a prey to frequent colds, bronchitis, pneumonia, rheumatic fever and other illnesses of spring. Those who spend several hours by night or day in the open, with their lungs well expanded and filled with fresh air, are infinitely less liable to such diseases than those who remain indoors. Some persons walk with a firm step, well-contracted muscles and the body held erect. Others walk with a slack step, half-bent knees and a partial stoop. There is a great tendency to this latter in old age which ought to be fought against with strength of will. When a person accustomed to a distance of one or two miles an hour is induced by vigorous companions to walk four or more, great harm is occasionally done. Stout persons, many of whom have weak hearts, ought not to run or walk fast. Whatever can be accomplished by the aged in both the matter of pace and amount of exercise ought to be maintained, but exhaustion ought to be avoided. The condition of the vital organs, especially the blood vessels, is of greater importance than the number of years. Persons advancing in years, after having been prevented by illness or other causes from taking their regular walks, feel fatigued when again resuming them and infer that they are too old or too weak to take such exercise. When such persons begin with short walks to be gradually increased, they quickly regain the habit of regular exercise and thus postpone the penalities of old age. The same holds good with the giving up of the exercise of the mind and of professional or other work. To many persons the retiring from business or from work on obtaining a fortune or a pension is the cause of pre-mature decay. A remarkable instance of this result was observed in the case of a legless beggar who in following his livelihood wheeled himself about the public promenades. At 40 he retired with a modest competence and thereafter remained in his room or on his doorstep, sleeping much and eating heartily. In four years he was dead of apoplexy. Many more people wear out from overrest, generally associated with overeating, than from over-exercise.
The Case for Massage
One of the best authorities says massage has no rival in promoting intestinal activity. It promotes the more rapid emptying of the stomach, excites the intestinal reflexes (nerve stimulation) whereby the alimentary mass is moved more rapidly through the small intestine and colon to its final discharge from the body and greatly increases the number of corpuscles of the blood, to as much as 7 per cent in the red cells and from 40 to 80 per cent in the white cells. This increase usually, in the cases under observation, becomes apparent within 30 minutes and lasts from an hour and a half to two hours. In persons in whom the blood count (of corpuscles) is deficient the in-crease continues for several hours, and if the application is repeated daily there will be a permanent increase in blood from day to day.
We are interested here particularly only in that form of massage that is supposed to promote vigor and activity of the intestinal tract. A great deal has been written in an advisory way on this subject with rather unsatisfactory results. Case (for footnote, see index) goes so far as to say that even with strong pressure it is not possible by massage to lift the contents of the ascending colon into the transverse colon nor to advance the contents of the transverse colon into the lower portion of the bowel. In only a few cases of his many observations with the x-rays was it possible to effect any movements of the bowel con-tents even for short distances. Groedel, says Case, was unable to accomplish this with a vibrator in full action. Case was able to move a small bolus of food along several inches of a gas-distended colon, but in general it holds true that the contents of the colon can be shifted very little by massage. The reason for this difficulty is that the colon attaches itself very closely to its contents by means of the haustral contractions so that these haustra (tucks making up the outside fluted form of the colon) are so many grips or brakes upon the bowel contents. So we must conclude that the well-recognized favorable influence of massage and mechanical vibration must be produced indirectly through increasing the tone of the bowel muscle rather than through any actual mechanical pressure on the bowel.
As a contributory means for the relief of intestinal stasis massage has received a great deal of attention with results that are in doubt, although Hurst says he has on several occasions seen considerable benefit result from massage applied to the part of the colon in which the x-rays had located stasis. When this is independent of spasm the massage should be deep and moderately vigorous, but where there is spasm it should be superficial and gentle.
The most effective means of colon massage is to begin with the last 12 inches of the small intestine, thence to the ileo-cecal valve, thence up the ascending colon to the hepatic flexure, across and along the transverse colon to the splenic flexure, thence down the descending colon to the pelvic colon and as far as possible within the pelvis, as recommended by Kellogg. To do this with a deep indentation by the finger tips in a semi-spiral motion it is plain that knowledge of the location of the transverse colon must be obtained, as it frequently drops in a loop to a position below the navel owing to its relaxed condition, and the weight of the delayed contents generally present. A person of finger sensibility and intelligence can often secure this information by the delicate sensitiveness of the finger tips. The impacted contents are easily distinguished from the surrounding soft tissue. Also it is often found that the course of the colon is marked by tenderness that deepens into pain upon pressure. After irrigation in the knee chest position and the colon is thoroughly emptied the pain in the region of the colon on pressure, if from functional causes, is quickly relieved. But the most effective method of accurately locating the colon is by means of the barium meal, or barium enema, fully described elsewhere.
With the above information in hand as completely as possible a deep rotary motion with the finger tips should begin on the last 12 inch section of the ileum (lower end of the small intestine), while lying on the back in bed, follow its general line to the cecum, first on its upper side and then on the lower, with deep, curving indentations, corresponding roughly with the curves of the colon (haustra). With each impression of the fingers, increase the pressure by raising the abdomen stiffly against the fingers, thus developing a squeeze of the ileum and colon between the fingers and internal pressure.
From the cecum to the hepatic flexure, while lying on the right side.
Across the transverse colon, and down to the sigmoid flexure with relaxed abdomen while lying on the left side.
The semi-rotary motion of the finger tips, with deep pressure, should describe elongated shallow loops. If there is an error in the location of the colon the loops will be large enough to probably cross its course.