Saturday, August 17, 2019

Sorrow for the Long Tail - the memory machine I will never see

There are several software products I want nobody will build.

For example, I want a “screen saver” that will randomly select from a collection of video and still images and display them across multiple screens.

Pretty much like Apple’s annoying [1] screen saver, but for video it would randomly select a xx second file segment and play that without sound.

I don’t think anyone will ever build this. It’s too hard to do [2] and there’s no money in it. Only a small number of people would pay, say, $20 for this. Maybe 1 in a 1000. After expenses and marketing it would be hard to earn even a few thousand dollars.

Which reminds us of the false promise of The Long Tail. Those were the days that Netflix had a huge catalogue of barely viewed movies [3] that were often very fine. We thought there would be business for the interests of the 0.1%. That didn’t happen.

This is why I’ve given up on trying to predict the future ...

--

[1] Whenever macOS cannot connect to the folder hosted on my NAS it reverts to the default collection. I need to restore my share and I’ve never been able to find an automated way to do that. On iOS things are much worse. Speaking of products I want, I’d pay $20 for a macOS utility that that simply reset my screen saver to my preferred share.

[2] We never thought software development would keep getting harder. We used to think there would be a set of composable tools we could all use (OpenDoc, AppleScript, etc). We expected a much more advanced version of what we had on DOS or Unix in the 80s or the early 90s web. Instead we got AngularJS.

[3] In the mailer days our kids movies were unplayable due to disc damage about half the time. Finally gave up on that.

Monday, August 12, 2019

Rough personal notes on review of management of degenerative lumbar spondylolisthesis with lumbar spinal stenosis and pseudoclaudiation

Every so often I review a medical topic and stick my notes into Simplenote for later reference. The reviews are quite messy since it’s just for my use. For what it’s worth, some hasty notes on this topic.

IMAGING

Initial Plain film: spondylolysis/listhesis. Standing flexion/extension lateral plain film, oblique (for pars interarticularis), AP for severity. (or just lateral, oblique and AP). See https://emedicine.medscape.com/article/2179163-workup

Considering surgery: MRI (neurosurgeon will have preferences)

---------------

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2270383/
Degenerative spondylolisthesis - European perspective - 2008

“Symptoms of neurogenic claudication that cause the patient to stop and sit after less than two blocks of walking usually correspond to the time, when the patient consents to surgery …

…. The plain radiographic features include the essential finding on a lateral view of forward displacement of L4 on L5 or, more rarely, L5 on S1 or L3 on L4 in the presence of an intact neural arch. Defect of pars interarticularis (which has the appearance of a Scottie dog with a collar) that can be seen on lateral or bilateral oblique views helps to distinguish between DS and isthmic spondylolisthesis …

… Only 10–15% of patients seeking treatment eventually will have surgery…

… The intervertebral spaces of the slipped segments were decreased significantly in size during follow-up examination in patients in whom no progression was found. LBP improved following a decrease in the total intervertebral space size. The development of osteoarthritic spurs, hypertrophy and ossification of the intervertebral ligaments, and facet arthrosis may lead to secondary stabilization that prevents slip progression…

Indications for surgery:
1. Persistent or recurrent back and/or leg pain or neurogenic claudication, with significant reduction of quality of life, despite a reasonable trial of non-operative treatment (a minimum of 3 months).
2. Progressive neurological deficit.
3. Bladder or bowel symptoms.

--------------

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357993/ (2019 review, neurosurgery)
A systematic review of the literature has shown that delaying surgery for a period of conservative management is not associated with a worse surgical outcome and that surgery is more effective than continued conservative treatment when conservative options have failed for a period of three to six months…
… minimally invasive surgical approaches that preserve stabilizing paraspinal musculature …

————————
Some other odds and ends:

- We suggest that the angular instability of the intervertebral disc may play a more important role than neurological compression in the pathogenesis of disability in degenerative lumbar spondylolisthesis (this was weird — from MRI study of axial loading)

- Vanderbilt neurosurgery study from 2014 claimed medical management didn’t work but it looked like a horrible study

- BMJ review of 2016 was down on non-surgical treatment but not super keen on surgical. Consistent with trying conservative management for some time before trying surgery.

Tuesday, August 06, 2019

Warmer climate on the earth may be due to more carbon dioxide in the air. 1956.

Originally published in the NYT Oct 28, 1956 by Waldemar Kaempffert. Reprinted as Climate Science in 1956 and 2015 | HuffPost:

The general warming of the climate that has occurred in the last 60 years has been variously explained. Among the explanations are fluctuations in the amount of energy received from the sun, changes in the amount of volcanic dust in the atmosphere and variations in the average elevation of the continents.

According to a theory which was held half a century ago, variations in the atmosphere’s carbon dioxide can account for climatic change. The theory was generally dismissed as inadequate. Dr. Gilbert Plass re-examines it in a paper which he publishes in the American Scientist and in which he summarizes conclusions that he reached after a study made with the support of the Office of Naval Research. To him the carbon dioxide theory stands up, though it may take another century of observation and measurement of temperature to confirm it….

…. The atmosphere acts like the glass of a greenhouse. Solar radiation passes through to the earth readily enough, but the heat radiated by the earth is at least partly held back. That is why the earth’s surface is relatively warm. Carbon dioxide, water vapor and ozone all check radiation of heat.

Of the three gases that check radiation, carbon dioxide is especially important even though the atmosphere contains only 0.03 percent of it by volume. As the amount of carbon dioxide increases, the earth’s heat is more effectively trapped, so that the temperature rises.

... According to Dr. Plass, the latest calculations indicate that if the carbon dioxide content of the earth were doubled the surface temperature would rise 3.6° C and that if the amount were reduced by half the surface temperature would fall 3.8° C...

...Despite nature’s way of maintaining the balance of gases the amount of carbon dioxide in the atmosphere is being artificially increased as we burn coal, oil and wood for industrial purposes. This was first pointed out by Dr. G. S. Callendar about seven years ago. Dr. Plass develops the implications….

… Today more carbon dioxide is being generated by man’s technological processes than by volcanoes, geysers and hot springs. Every century man is increasing the carbon dioxide content of the atmosphere by 30 percent — that is, at the rate of 1.1° C in a century. It may be chance coincidence that the average temperature of the world since 1900 has risen by about this rate. But the possibility that man had a hand in the rise cannot be ignored.

Whenever the cause of the warming of the earth may be there is no doubt in Dr. Plass’ mind that we must reckon with more and more industrially generated carbon dioxide. “In a few centuries,” he warns, “the amount of carbon dioxide released into the atmosphere will be so large that it will have a profound effect on our climate.”

Even if our coal and oil reserves will be used up in 1,000 years, seventeen times the present amount of carbon dioxide in the atmosphere must be reckoned with. The introduction of nuclear energy will not make much difference. Coal and oil are still plentiful and cheap in many parts of the world, and there’s every reason to believe that both will be consumed by industry as long as it pays to do so.

I believe current predictions are on the order of 2C with doubling CO2 with longer term higher secondary increases. So bit less than 1956 model, but on the other hand the effects on climate have been obvious sooner than expected.

Overall, holds up quite well.

Monday, August 05, 2019

The rules change

On the 9th of August 2009 I wrote a post on at the start of my 51st year. It included an estimate that I was at "70% lifetime strength”. That was an improvement over June of 2008.

I figured it was downhill from there.

I was wrong though. Four years later, in April of 2013, I started doing CrossFit. It’s enlightening to look back at what I wrote then:

… I now do CrossFit twice a week; that's about as much as I have been able to safely handle. I currently need 3 days to heal between each session. Between sessions I do my usual 2 hours of bike commuting one day a week...

...After five months, despite my back strain injury, St Paul CrossFit has worked well for me. I haven't developed much visible muscle, but I'm significantly stronger and I can handle more exertion. My weight didn't decrease until about month 4, since then I dropped 8 lbs and am close to my optimal weight.

The net effect is that physically I perform and feel more like I did at 44 than at 54. That's a big difference; if I feel at 62 the way I was at 52 I'll be content.

I'm not as keen on CrossFit as some but I enjoy the people, the exercise, and the game of staying within my limits … I'll probably go to three times a week when ice and snow stop my bicycle commute...

… At 54 I'm into managed-decline rather than improvement, but at 34 I'd have been tempted. CrossFit workouts are intense -- and I'm not sure five or even four workouts a week makes sense for most 35+ bodies…

Six years later I would frequently do CrossFit five times a week, and I usually managed four times a week. At age 59, six years after starting, I amazed myself by surviving a 300 lb deadlift. That’s warmup weight for a strong middle-aged man, but it was a lot for me.

I got my dubs last year.

I've had several weight lifting and gymnastic personal records in the past two years. “Managed decline” didn’t happen at 54 after all -- despite being hit by the familial arthritis train at age 56. In retrospect, while my physiologic maximums had been declining for decades, there was more head room than I’d expected. I just started living closer to that maximum performance level.

But we know how the story ends. We know what 85 looks like. There’s a steep descent ahead.

I think I’ve started that run. Over the past few months I’ve been more fragile, prone to old injury patterns, healing more slowly. I didn’t make my 8/1/ Bar Muscle Up goal (still training though).

My peak performance has met my downward trending physiologic limit.

They probably met in May of 2019 - 3 months ago, but I only got the message last week when a minor back strain passed all my usual fitness tests — and got suddenly worse on a warmup lift. The rules changed.

I greeted this understanding with the mature wisdom of an Old person.

Hah, hah. Not really. I wanted to cry. I was crying on the inside. For a day or two anyway.

Now I have to figure out the new rules. I’m off CrossFit until after my early September Maah Daah Hey mountain bike trail ride — I need to be as rehabbed as possible until I’ve done that trip. So I’m doing my training rides, my rehab weight lifting (my strict pull-ups are 50% improved, also working on a new bench PR!), started swimming again, picking up more inline skating.

I’m studying my Supple Leopard book.

When I return to CrossFit (9/9/2019 is the plan) I can max on the cardio and the body weight reps and I can keep training for my maybe-never-bar-muscle-up, but it will be months before I let myself do serious weights. I have to figure out the new rules.

Maybe next year I’ll do my first triathlon.

Saturday, May 11, 2019

My exercise program towards the end of year 60

Current exercise guidelines are more demanding that the “12 minutes a day, 3 times a week” standard of my youth ...

For substantial health benefits, adults should do at least 150 minutes ... to 300 minutes ... a week of moderate-intensity, or 75 minutes ... to 150 minutes ... a week of vigorous-intensity aerobic physical activity...

… Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes of moderate-intensity physical activity a week.

… Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on 2 or more days a week

I’ll be 60 in 10 weeks. This is how, as a genetically ungifted athlete, I approach those recommendations between May and October

Sunday: 3-4 hour road bike ride, not counting lunch. If weather is bad then CrossFit St Paul. I’ve been enjoying CFSP for more than 6 years now. Often 9 holes of walking golf with #1 son.

Monday: CrossFit, usually with my teen daughter, followed by sets of sit-ups and dubs (120 and 80+)

Tuesday:  Mountain biking 1 hr at Battle Creek, River Bottoms, Leb or CarverSt Paul JCC with Emily and #2 son, weights and running — whatever I’m not doing at CrossFit. Usually Bench, SLR, and working on components of a Bar Muscle Up.

Wednesday: CrossFit, with the daughter, sit-ups and dubs.

Thursday: CrossFit (daughter) and the J with Emily and #2 son. Some light weights and sauna.

Friday: CrossFit, sit-ups and dubs.

Saturday: Rest day! Nothing scheduled but often kinetic anyway.

From October-April I do JMS Hockey on Friday nights, CrossFit on Sunday, and Nordic skiing when conditions allow. This year I’m planning to add winter mountain bike trail rides.

Because I once had a quite bad back I do a set of 9 stretches every morning and 20 weighted roman chair reps each night — but those go fast. I do dumbbell curls during phone meetings and before bed because of that muscle-up project.

I’d love to be able to also bike commute to work, but my current job is a remarkably bad fit for bike commuting.

On a good week I do at least 600 minutes of moderate to high intensity exercise. It keeps me more or less balanced and able to work. I didn’t start out doing 600 minutes a week, it just built gradually over the years. The older I get the more important exercise is, and the more time I need to spend on it. It helps that I’m quite good at amateur injury rehab.

Current medical wisdom is that exercise won’t control weight, but I think that depends on how much exercise one does. In the winter I am more careful, but in the summer I sometimes need to add extra food to maintain my weight.

Saturday, May 04, 2019

Gordon's platform 2020

It is my privilege to announce that I will running for the Presidency of the United States of America.

I understand that, as a foreign born dual citizen of the United States and Canada I am technically not eligible for the Presidency. On the other hand, America elected Donald Trump. Compared to him I’m eminently qualified.

My Presidential Platform is achievable and focuses on our core challenges as a nation and wannabe world leader ...

  1. Free community college. This was, I think, part of HRC’s platform. Didn’t get much media coverage but just makes sense. Unlike free college, which is dumb. Quebec basically does this and it has worked very well for them. A lot of health care workers can be trained in 3 years of community college.
  2. Restore ACA, including the individual tax penalties for non-participation, with a public option that leverages experience from Canada and Veterans Health Administration. Incorporate broad support for physical activity (aka exercise) in health care system. Attack agricultural subsidies for unhealthy foods and subsidize healthy foods. Move the dial on obesity and lifestyle diseases.
  3. Restore Obama’s carbon control framework, not including a carbon tax. I love the idea of a carbon tax, but I’ve seen my fellow citizens. Some costs are better buried.
  4. Increase employment income of the non-college. Reduce taxation incentives that favor automation (it will happen anyway, but slower is better). Create plug-and-play packages for small businesses that employ non-college. Provide subsidies for training in skills accessible to non-college. Extend the framework used for disabled employment to subsidize and support non-college work including public sector employment. Subsidize minimum wage. Tax breaks to employers that promote employment. This will be a core pillar of my administration.
  5. Strong antitrust; promote competition among corporations and consumer choice. May include breaking up several MegaCorp.
  6. Transit, bikes, walkability, parks, attractive infrastructure. Make car ownership optional. Require new motor vehicles to incorporate technology that makes pedestrians and cyclists safer. Require autonomous vehicles to meet strict standards for safety of the non-armored.
  7. Taxes. Of course. VAT. Restore the "death tax”. Various forms of wealth tax. Tax soda and the like. Fund my platform, start to beat back dysfunctional wealth concentration.
  8. Attack political corruption, particularly post-political employment, at every level. Public funding for elections including mandated free media time.

There’s more, but you get the idea.

Vote for me. 

Whatever my name is.

Sunday, April 21, 2019

Healthcare reform 2020: Public option based on the VA healthcare model

Medicare for All won’t work in 2020. We have an insurmountable path dependency problem.

We can, however, implement the ACA public option. It should be based on the VA model for healthcare delivery, which is basically the American version of the UK’s NHS. It’s not luxurious, but it’s more than good enough healthcare.

Tuesday, February 26, 2019

Primary care 2019 vs. 1989

There’s been at least a 200-300% increase in care complexity between when I started medical practice and today. Many new classes of medications for fairly common disorders, many more specialty interventions that may be considered.

At the same time computer based clinical decision support systems have been a surprising failure. (Emily uses Epic, I use VistA/CPRS). In the 90s we expected far more than we actually got.

We are asking a lot of the modern primary care physician.

Monday, February 18, 2019

Greenlight card for "kids" - early impressions

I ordered the Greenlight cards for our children. Only one is a minor (and she uses a regular debit card) but two are special needs adults who are more vulnerable to financial scams or misjudgments. I also got one for a sibling with some similar issues though that is certainly not the Greenlight market.

So far it’s been a mixed experience. The Greenlight site has suprisingly poor documentation — basically some simplistic FAQs. They don’t document where the cards don’t work but from customer support I got:

Since our cards are meant for children, there are certain places that our cards will not work. Liquor stores, gambling websites or establishments, money orders, MoneySend and wire transfers are some examples of things that our cards will not work for. Since we are a prepaid debit card, we have also had families experience some trouble when attempting to use our cards to pay bills. We recommend not transferring funds to the Greenlight card that need to be used for utilities or other bills.

That seems reasonably, but it’s not the complete list. They don’t work for Patreon for example — my son wanted to donate there. Greenlight won’t provide a full list.

There’s also a problem with Greenlight.app behavior on one child’s phone. Again, this is undocumented, but I think there are two paths it should follow on launch. One path should enable access to card balance, the other is for requesting a card. On his phone it goes down the wrong path. Hard to sort out since, again, there’s no documentation.

The vibe I get from Greenlight is that is a venture funded effort that didn’t scale quickly enough …

Saturday, February 16, 2019

CrossFit for Olds - years to build ligaments and tendons

My son bought me a slim book on rock climbing techniques. Rock climbing was my brother Brian’s gig, but I could see doing it when my knees knock me out of CrossFit. It’s something I did in college back when we belayed using ropes wrapped around our body (no belay hardware).

The book talks about single finger pinch holds. Specifically, it says not to try them until at least two years of building up tendons and ligaments.

Two years is a fair amount of time. I’ve not seen that mentioned in any clinical references I read. I suspect it’s right though; it’s obvious muscles can develop much faster than tendons.

I think we should be more aware of this in CrossFit training. Young muscles develop fast, but ligaments and tendons take time. To lift heavy things safely we need connective tissue to be at least as strong as muscles (ideally stronger).

In my 60th year I lift significantly heavier things than I did when I was younger-Old. Probably heavier than I could have done in my mid 30s. My muscles are somewhat stronger, but I think a lot of that is connective tissue development, and that took years. More than two years for Olds I think.

Saturday, February 09, 2019

The curious psychiatric state of Robert F Kennedy Jr

Robert F Kennedy Jr showed up in a scrum of pro-measles whackos recently. It  me wonder how he got so nuts.

There’s an extensive wikipedia page for him, starting with a time I remember:

He was 9 years old when his uncle, President John F. Kennedy, was assassinated during a political trip to Dallas, and 14 years old when his father was assassinated…

Despite childhood tragedy he was a successful academic and he’s done some decent work legally and for the environment. He seems to have started off the rails in the 80s:

In 1983, at age 29, Kennedy was arrested in a Rapid City, South Dakota airport for heroin possession after a search of his carry-on bag uncovered the drug, following a near overdose in flight.

By 1989 he’d started on vaccines — but not with autism … 

His son Conor suffers from anaphylaxis peanut allergies. Kennedy wrote the foreword to The Peanut Allergy Epidemic, in which he and the authors link increasing food allergies in children to certain vaccines that were approved beginning in 1989

By 2000s he’d jumped from immunizations causing his son’s anaphylactic disorder to immunization causing autism. He became "chairman of “World Mercury Project” (WMP), an advocacy group that focuses on the perceived issue of mercury, in industry and medicine, especially the ethylmercury compound thimerosal in vaccines”. It was a downward spiral from there.

Despite his vaccine delusions and troubled marriages he seems to have maintained a fairly active wealthy person life. He’s said to be a good whitewater kayaker.

Psychiatrically it’s curious. He combines fixed irrational beliefs (the definition of delusions) with relatively high functioning in other domains. He reminds me of L Ron Hubbard, founder of Scientology

We need to keep him far from the political world.

Saturday, February 02, 2019

Against superhuman AI

I am a strong-AI pessimist. I think by 2100 we’ll be in range of sentient AIs that vastly exceed human cognitive abilities (“skynet”). Superhuman-AI has long been my favorite answer to the Fermi Paradox (see also); an inevitable product of all technological civilizations that ends interest in touring the galaxy.

I periodically read essays claiming superhuman-AI is silly, but the justifications are typically nonsensical or theological (soul-equivalents needed).

So I tried to come up with some valid reasons to be reassured. Here’s my list:

  1. We’ve hit the physical limits of our processing architecture. The “Moore-era” is over — no more doubling every 12-18 months. Now we slowly add cores and tweak hardware. The new MacBook Air isn’t much faster than my 2015 Air. So the raw power driver isn’t there.
  2. Our processing architecture is energy inefficient. Human brains vastly exceed our computing capabilities and they run on a meager supply of glucose and oxygen. Our energy-output curve is wrong.
  3. Autonomous vehicles are stuck. They aren’t even as good as the average human driver, and the average human driver is obviously incompetent. They can’t handle bicycles, pedestrians, weather, or map variations. They could be 20 years away, they could be 100 years away. They aren’t 5 years away. Our algorithms are limited.
  4. Quantum computers aren’t that exciting. They are wonderful physics platforms, but quantum supremacy may be quite narrow.
  5. Remember when organic neural networks were going to be fused into silicon platforms? Obviously that went nowhere since we no longer hear about it. (I checked, it appears Thomas DeMarse is still with us. Apparently.)

My list doesn’t make superhuman-AI impossible of course, it just means we might be a bit further away, closer to 300 years than 80 years. Long enough that my children might escape.

Sunday, December 30, 2018

Why the crisis of 2016 will continue for decades to come

I haven’t written recently about why Crisis 2016, sometimes called Crisis-T, happened. For that matter, why Brexit. My last takes were in 2016 …

  • In defense of Donald Trump - July 2016. In which I identified the cause of the crisis, but assumed we’d dodge the bullet and HRC would tend to the crisis of the white working class.
  • Trumpism: a transition function to the world of mass disability - Aug 2016. “How does a culture transition from memes of independence and southern Christian-capitalist marketarianism to a world where government deeply biases the economy towards low-education employment?"
  • After Trump: reflections on mass disability in a sleepless night - Nov 11, 2016. "Extreme cultural transformation. Demographics. China. The AI era and mass disability. I haven’t even mentioned that pre-AI technologies wiped out traditional media and enabled the growth of Facebook-fueled mass deception alt-media … We should not be surprised that the wheels have come off the train.”
  • Crisis-T: What’s special about rural? - Nov 16, 2016: "The globalization and automation that disabled 40% of working age Americans isn’t unique to rural areas, but those areas have been ailing for a long time. They’ve been impacted by automation ever since the railroad killed the Erie canal, and the harvester eliminated most farm workers. Once we thought the Internet would provide a lifeline to rural communities, but instead it made Dakka as close as Escanaba.”

How has my thinking changed two years later? Now I’d add a couple of tweaks, especially the way quirks of America’s constitution amplified the crisis. Today’s breakdown:

  • 65% the collapse of the white non-college “working class” — as best measured by fentanyl deaths and non-college household income over the past 40 years. Driven by globalization and IT both separately and synergistically including remonopolization (megacorp). This is going to get worse.
  • 15% the way peculiarities of the American constitution empower rural states and rural regions that are most impacted by the collapse of the white working class due to demographics and out-migration of the educated. This is why the crisis is worse here than in Canada. This will continue.
  • 15% the long fall of patriarchy. This will continue for a time, but eventually it hits the ground. Another 20 years for the US?
  • 5% Rupert Murdoch. Seriously. In the US Fox and the WSJ, but also his media in Australia and the UK. When historians make their list of villains of the 21st century he’ll be on there. He’s broken and dying now, but he’s still scary enough that his name is rarely mentioned by anyone of consequence.
  • 1% Facebook, social media, Putin and the like. This will get better.

That 1% for Facebook et all is pretty small — but the election of 2016 was on the knife’s edge. That 1% was historically important.

Rupert Murdoch will finally die, though his malignant empire will grind on for a time. Patriarchy can’t fall forever, eventually that process is done. We now understand the risks of Facebook and its like and those will be managed. So there’s hope.

But the crisis of the white non-college will continue and our constitution will continue to amplify that bloc’s political power in rural areas. Even if civilization wins in 2020 the crisis of 2016 will continue. It will test human societies for decades to come.

Thursday, December 27, 2018

Life goal #2 - The CrossFit Kipping Bar Muscle-Up

In 2018 I met one of my two CrossFit Life Goals (tm) - 10 consecutive dubs (hit 42 in a wild fluke the other day). Only took me five times as long as anyone else I know.

The other goal is the Kipping Bar Muscle-Up. So that’s on the list for 2019. I’m also planning an IMBA “Epic” mountain bike trek — the Maah Daah Hey, but that’s mostly about showing up and moving my feet. The Bar Muscle-Up may be impossible, so it’s more interesting. (Watching Paoli video I should be able to do it now [1], but that’s now what I’m feeling!)

I’m putting my training notes and references on this page.

Examples

Movement notes

Some of the best tips came from a post in the CrossFit Physicians Facebook group.

  • Hands a bit wider than shoulder, but narrower than bench
  • From beneath the bar jump up and back to a big arch then fall forward into extension position — gets good start there
  • Drive hips to bar from top of “hollow” position, while “push down on bar with straight arms”. There should be a bend at hips so can “pop” the hips and pull, row bar into chest/navel (pop/pull is the trick - need timing). The pull should be very hard and fast
  • Grip. Begin with the end in mind. You want to think about the position the hands and wrists need to be in when you're on top of the bar and doing the dip portion of the BMU. A lot of people struggle because they grab the bar from directly underneath and don't really wrap their hands over the bar. Instead of doing that, wrap your hands as far over the bar as possible. It's basically a 'false grip' maneuver that you've probably seen on the rings, just on the bar. The idea is to have to turn your hands/wrists over as little as possible. The-two word actionable cue for this is "meaty grip".
  • In the kip swing, think about getting your body as loooooong as possible in as you move in front of the bar into the extreme of the arch position. Maximize the full range of motion of your shoulders, keep knees as straight as possible, and point your toes. Your body is a sling shot. Two word cue: "get long". 
  • For the pull up & over the bar. Pick a spot on the floor in front of you. Your goal is to stare at that spot all through the first part of the kip and the initiation of the transition into the hollow position & first part of the pull. At some point, as you pull your hips up to the bar, you're going to lose that spot from your vision (it's unavoidable - the head tilts backwards), but your goal is to see that spot again as soon as possible. The instant you don't see the spot anymore, your sole focus is to find it again. This will help you with the speed necessary to execute the transition. Actionable cue: "find the spot". 

Training programs

Some of these are for the (ring) muscle-up, the bar muscle-up is considered to be harder

Training exercises

  • Strict pull-up
  • Kipping chest-to-bar with elbows behind the back
  • Lat Pull-downs
  • Use gym machine with pulley’s ropes to emulate the curious straight arm downward push-pull (see still below).
  • Back extension and arching
  • Shoulder range of motion, esp. internal rotation
  • Band-assist Muscle-Up with gradually diminishing bands
  • Box jump muscle-up with gradually smaller box
  • The glide kip drill - stand on 1-2 bench, bar a bit above eyes, arms and back in line with hip flex to big hollow, hop up, glide out with feet just above bench and extend to small hollow, then reverse on return.
  • Paradiso progression
    • 3 sets of 5 high back kip swings
    • Hip to bar pull up (20 repeat 1 rep) - kip swing with hip snap
    • Transition (atop box, etc) - 20 to 30 reps of jumping box muc
  • Hip-to-bar progression with a slight arm-pull, hip drive from the hollow (I can’t get my hips to the bar yet), note in this still from Paoli video his elbows are bent, but he’s mostly pushing the bar down towards his hips and lower abdomen. Feet are below hips. Trapezius muscle here. I have to figure out how to build something like this.
    Screen Shot 2018 12 27 at 4 27 15 PM
    and note he’s actually hitting bar around navel at this point (not hips), feet are still in front as he transitions.
    Screen Shot 2018 12 27 at 4 32 13 PM

[1] Well, not now exactly. My left biceps is strained, so I have to rehab that first.

Saturday, December 15, 2018

Old doctor pet peeve - disease descriptions were better in Osler's day.

I didn’t know Sir William personally, but I think he’d be appalled by the descriptions of patient-disorders in our medical textbooks.

We typically present a collection of findings, sometimes organized by ‘history’ or ‘physical’ or ‘lab’, but the sequencing and relationships are all lost.

We should have textbooks that describe a disease or disorder with 3-8 case histories that span a reasonable spectrum of presentations. So not x% have red eyes and y% have chest ache, but a case called “common” that might be “8 yo both with cough, then red eyes for day and a swollen lymph node, then a day later some red palms …” and another case called “often”, and 2-3 called “unusual1”, “unusual2”, and so on.

Ok, it’s not just my Oldness. I’ve been grumpy about this for roughly 25 years, even when I was only old in spirit. It annoys me a great deal.

Now I’ve said it.