By Mark Yanai

My Morning Routine: Listening to My Heart

What’s HRV and why should I care?

pqrst wave

I’ve written about my morning routine in previous blogs and why it’s important to my wellbeing and me. Meditation and breathing exercises are key components of that routine and so is a movement practice that sets the tone of my day. But how do I know that this routine is effective? I did quite a bit of research to find some way to quantify my day-to-day improvement since I knew that using just my “gut feeling” wasn’t enough. Having a scientific background led me to look at measuring my heart rate, blood pressure and sleep cycles and I concluded that the best measurement of effectiveness was to look at Heart Rate Variability (HRV).

I first heard of HRV while listening to Ben Greenfield’s fitness podcast. He spoke about it often and wrote about it in his book, Beyond Training. He even has his own app to use for an iPhone. Unfortunately, I’m more of a Android guy and needed to look elsewhere. After an extensive search and multiple trials, I found one that I’ve used for the past year: Elite HRV.

So what is HRV? According to Elite HRV’s website, “Basic Heart Rate Variability (HRV) is the measured changes of the time intervals between successive heart beats. Unlike Heart Rate (HR) that averages the number of heart beats per minute, HRV looks much closer at the small fluctuations of the heart that occur in response to internal and external events. “

For those of you with the propeller hats, there’s a more scientific explanation. This one is from

Heart rate varies with every heartbeat. Heart rate variability (HRV) is the variation of beat to beat intervals, also known as R-R intervals. Electrocardiogram (ECG) is the electric signal originating from heart. The most distinct feature of the ECG is the QRS complex, which consists of the Q, R and S waves and originates from the electrical activation of the heart ventricles. Figure 1 illustrates the variation of time between R-R intervals.

HRV indicates the fluctuations of heart rate around an average heart rate. An average heart rate of 60 beats per minute (bpm) does not mean that the interval between successive heartbeats would be exactly 1.0 sec., instead they may fluctuate/vary from 0.5 sec up to 2.0 sec.

HRV is affected by aerobic fitness. HRV of a well-conditioned heart is generally large at rest. Other factors that affect HRV are age, genetics, body position, time of day, and health status. During exercise, HRV decreases as heart rate and exercise intensity increase. HRV also decreases during periods of mental stress. HRV is regulated by the autonomic nervous system. Parasympathetic activity decreases heart rate and increases HRV, whereas sympathetic activity increases heart rate and decreases HRV.

If you didn’t quite comprehend what was stated above, don’t worry. The takeaway is that HRV measures the balance of your nervous system. It lets you know if you’re more in the “fight or flight” or “rest and relaxation” mode. By measuring my HRV daily, I’m able to know if my morning routine, physical training, and sleep are being optimized.

Without fail, my readings have given me instant feedback about how my body is reacting. After hard training days, my HRV is usually lower and it gives me an idea about how I’m going to attack the day. It also gives me excellent feedback on when I’m over-reaching or over-training. It was interesting that after last month’s Spartan Race, my morning readings reflected the effects on my HRV:


My HRV the morning of the race:




My HRV the following morning:



Due to the information and knowledge that I’ve gained by measuring HRV, I decided to use it as a tool for treating patients. For our Work Hardening patients, we’ve collected six months of measurements to track the effectiveness of the program as well as looking for trends in patients. It’s been interesting to note that patients who’ve come in with low readings often struggle with the program and exhibit weak cardiovascular systems. I believe monitoring HRV during our patient exercise routines will become an integral part of their therapy treatment program and in the future, I hope to be involved with a medical model that is specific to patients in this capacity.


If you are interested in monitoring your HRV, you’ll need a heart rate monitor. I’ve tried several and so far we’ve had the best results with Polar’s H7. Also, there are several apps that are compatible with the Polar H7 (and other bluetooth HR monitors) and can be easily found on the internet. We use the Elite HRV app (compatible with Google Play and App Store devices) and you can download it here.  Start by taking a reading as soon as you wake up and then several more during your exercise routine. If you have any questions regarding this topic, feel free to email me or stop by our WORC site.



polar h7



By Mark Yanai

We Are Spartans!


F&L Conquers the Spartan Race

On Saturday, August 15th, F&L’s team entry into the Spartan Race Hawaii completed the Sprint category for the first time. Five brave souls joined over 3000 participants to complete in the two day long event held at Kuuloa Ranch on the northeastern side of Oahu.

The second annual race was spread across 4,000 acres on the working cattle ranch. It began early Saturday morning and consisted of three different courses: the Sprint, the Super, and the Beast. Each race increases in distance and number of obstacles. Obstacles included rope and wall climbs, sandbag carries, monkey nets, spear throws, and tire drags. Click here to see a list of the various obstacles.

The Sprint is the shortest of the races, usually a little more than 3 miles and includes about 20 obstacles. The Super is roughly 8 miles and 25+ obstacles and the Beast 13+ miles and 30+ obstacles. Should some crazy souls feel like they could complete all three of the races, they would become a member of the Spartan TRIFECTA Tribe.

The F&L team consisted of myself, Jamie Ford, Joy Yanai, Ross Suyemura, and Stacey Hertzog. We trained hard for the past two months to prepare for both the distance of running on hills and attacking the expected signature obstacles. We knew that interval training combined with practice on various obstacle components of carrying, climbing and pulling would help us conquer the course. We even practiced the spear throw!


The race turned out to be exactly what we expected. Running through the changes in elevation and attacking each obstacle were physically and mentally challenging. Rain throughout the week provided for an extremely humid Saturday and running through the open fields definitely required a strong cardiovascular effort. There were a few racers who cramped up.

The obstacles that proved to be most difficult were the ones that required the most practice: the rope climb, spear throw, and the monkey bars. Each of us was able to complete every obstacle but we also were subject to the dreaded burpees.


Burpees are a full body exercise where you transition from a horizontal position laying flat, face down in a push up position to a vertical position with hands over head and feet off the ground. Not sure who decided that failing a Spartan obstacle requires 30 burpees but they definitely created a strong motivator to avoid failure! Burpees challenge your entire body and stress your cardiovascular system. For Spartans there are no fails, just burpees.


The Spartan Race turned out to be an awesome experience despite the burpees. It was fun running through streams and rolling in the mud. There were parts of the race that mess with your head and conjure fear of failure but ultimately they bring feelings of accomplishment when completed. It was helpful to have teammates that would motivate you to keep up and support you when the humidity and hills challenged you. It was a great community to be around and the beauty of Kuuloa Ranch is often breath taking.





F&L did have one Trifecta entry: Talon Tengan. Talon competed in the Spartan Race held in March at Aloha Stadium and completed the Super and the Beast at Kuuloa Ranch. His experience in the previous race was one of the main reasons why I entered the race. I will lean heavily on his experience for next year, as we will enter a team to compete in the Super AND the Beast!

Congratulations to all the finishers of the Spartan Race and good luck to all the qualifiers who will compete in the World Championship in Lake Tahoe in October! Hope to see all of you at the next race in Hawaii!





By Mark Yanai

The Most Important Exercise

I’m often asked by patients “What’s THE most important exercise I should do?” My answer changes as my experience as a physical therapist evolves throughout the years. I would normally tell my patients to do some form of stretching or strengthening, until recently, when I started doing deep, abdominal breathing exercises as part of my morning routine. I now tell my patients that abdominal breathing is one of the most important exercises they can do.

There are a number of contributing factors that make abdominal breathing so important. A couple of years ago, I began focusing on abdominal or diaphragmatic breathing after studying Heart Rate Variability (HRV) which is a measurement of the balance between your sympathetic and parasympathetic nervous systems. By measuring your HRV, you are able to assess your body’s response to stress. The body reacts to stress by changing breathing patterns, which leads to physiological changes including hormonal responses and neurological patterning.

In normal breathing patterns, we SHOULD use abdominal breathing, which is focused on using the diaphragm, a muscle located below the lungs. This muscle is controlled by our parasympathetic nervous system via the Vagus nerve. Because of the daily stresses of life, we’ve adapted our body’s most vital need: to breathe. Abdominal breathing has such profound effects on our ability to handle stress, anxiety and physical activity. However, some of us have changed our breathing patterns and use more of a thoracic breathing pattern. This pattern is shallow, shorter and typically used when we are reacting to a “fight or flight” situation and triggers the production of cortisol leading to a weakened immune system.

“Habitual chest breathing not only reflects physical and mental problems. It creates them. It mildly but chronically over-stimulates the sympathetic nervous system, keeping the heart rate and blood pressure too high, precipitating difficulties with digestion and elimination, and causing cold and clammy hands and feet.”David Coulter, The Anatomy of Hatha Yoga

I often see this shallow breathing pattern in my patients. Pain is a factor in changing the way we breathe and we unconsciously respond to pain by holding or shortening our breath. When I see this response, I spend time educating the patient on focused abdominal breathing exercises which helps moderate pain.

One of my favorite references on how to breath correctly is Jill Miller’s The Role Model. Her book is excellent in explaining how the body breathes, the anatomy involved, and how to correct your breathing pattern. I incorporate her “Breathing Primer” into my breathing exercise routine each morning and it has positively affected everything that I do.

Roll Model Cover  the-roll-model-5-266x215c

After learning about the importance of breathing correctly, I discovered Breath Reset, a type of meditative breathing that helps me to focus my thoughts, settle my body, and allow me to get in touch with my body. This breathing practice has been performed by many for centuries and has been the foundation of Buddhism.



Chapter 4 of The Breath of Life

One who has gradually practiced,
Developed and brought to perfection
Mindfulness of the in-and-out breath
As taught by the Enlightened One,
Illuminates the entire world
Like the moon when freed from clouds.  

(Theragatha 548)

Each morning, I perform a routine of meditation, yoga, body weight exercises and reading while drinking my Bulletproof Coffee. This routine usually takes about an hour which is why my alarm goes off every morning at 5 A.M., even on the weekends. But the most important part of my routine, is my “belly breathing”.


I start by walking out to my backyard deck, a place that is quiet and peaceful. A regular spot in your home will help your routine become permanent. I usually sit with my back supported and with my legs crossed. With my eyes closed, I begin by taking a long inhale through my nostrils and exhale through pursed lips. I focus on my abdomen drawing in and out, trying to feel as if my diaphragm is elevating and depressing. My thoughts usually wander which is normal. I think it’s impossible to expect my brain to stop having random thoughts or emotions, so I don’t put pressure on myself to suppress them. Instead, I try to focus on feeling my body breathing.

During my breathing exercises, I am able to quiet my mind, induce a relaxed feeling, and trigger the hormones in my body that create an improved level of function. I start every morning this way so that I can control my thoughts and emotions throughout the day. The value of this ten minute practice is more valuable to me than an extra hour of sleep. It has helped me become more focused, productive, and clear about what my life’s journey is about. It has also improved my posture, breathing capacity and has taught me how to reduce my stress level at any time. No other exercise has had as much profound affect on my life as meditation and breathing. It is a simple practice that anyone can learn to improve your life immediately.



Wikipedia contributors. “Heart rate variability.” Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 4 Jul. 2015. Web. 5 Jul. 2015.



By Mark Yanai

Chatting with Erl Pettman

On May 17th, I was fortunate enough to spend some time with one of my mentors, Erl Pettman , PT, MCSP, MCPA, FCAMP, co-founder of NAIOMT (North American Institute of Orthopedic Manual Therapy). Erl has been coming to Hawaii for the past 8 years to teach NAIOMT courses. In addition to being a Senior Faculty member with NAIOMT, he has been a certified manual therapy instructor for the Olaf Evenjth system since 1990.

I first met Erl in 2007, when I started taking NAIOMT courses. Since then, I’ve taking all four NAIOMT Level courses and have been lucky to have Erl as my instructor. He has made a tremendous impact on my career and continues to be influential toward my performance as a physical therapist and clinical instructor. I’ve always wanted to sit down and chat with him about his life, career and thoughts regarding our profession and am honored to have Erl as part of my first F&L blog interview.

Here’s a transcript of our conversation:

Mark: I’m just going to ask you a few casual questions to get started.

Erl: Yeah, that’s what the police always say (laughs).

Mark: Haha. You has been a mentor to me since I attended the Level I class NAIOMT course. Thank you so much for joining us today, Erl. I know that you’re here this week to teach a Level I NAIOMT course. How is it going?

Erl: Very well. Good group. It’s one of the larger groups we’ve had for a long time. Good interaction with the old group and some newbies.


Mark: Let’s start off by talking a little about your professional career. You graduated from Nottingham School of Physiotherapy in England in 1972. How was your experience as far as physical therapy school is concerned?

Erl: I think the most valuable part was the emphasis on anatomy. And that’s followed me throughout my career. From a disappointment point of view, it was the lack of emphasis on anything orthopedic. There was no mention of manual therapy at all. So I had to catch up with it once I qualified.





Mark: And what was it that drew you to become a physical therapist? What motivated you to choose Physical Therapy as a profession?

Erl: Nothing motivated me, it was pure accident (we both laughed). My father hired a physio for one of the jobs he was a manager for. And I had quit school and was just working. He was concerned that I wasn’t going to get back into academics, so he suggested I look into physiotherapy (aka physical therapy). And that’s how I got into it.

Mark: So you’re first job was as a staff therapist in a hospital in England. What were your memories of that first job?

Erl: Mostly the post-surgical side. Because in England, we were involved in a lot of chest care. And that was very big. It was mostly neuro and post-surgical. So, not my favorite.

Mark: Do you have any funny memories of your first year as a physio?

Erl: No that was a long time ago, I’ll have to think about that one.

Mark: In 1982, you, Cliff Fowler and Jim Meadows founded NAIOMT. Tell me about that.

Erl: I got this idea in my head that we could start this North American institute so I approached Cliff, Jim and later, Ann Porter Hoke and the late David Lamb to see if they would help me get it going and help me teach. And Diane Lee was originally with us too. So there was quite a number of people that helped us establish the orthopedic division in Canada. And they ended up teaching for NAIOMT.

Mark: What were your thoughts in forming the organization? What drove you guys to have this educational model?

Erl: We had a number of friends in the United States who wanted a much more structured system that they could find in the U.S. and they looked at the Canadian system which was very structured and not biased to anybody. Nobody’s name was connected to it but we had levels, we had exams, and a system set-up. So they asked us to come down and start a similar system. So initially, it became known as the Canadian System, then eventually we changed it to the North American (Institute of Manual Therapy).

Mark: The last time you were here in February, I watched you do an examination for the Level Three Examination. It’s considered one of the toughest exams as part of the certification of NAIOMT. What makes it so difficult?

Erl: The level 3 exam is clinical reasoning and contains a lot of biomechanics. The emphasis is on why you would do something and what’s your reasoning for the assessment and treatment given, so it’s not just a practical exam which is why a lot of the people find it extremely challenging. But our reasoning is because it’s a competency exam, a reasoning exam and reckoned to be one of the tougher exams of any system in North America. It’s still largely based on the Canadian system, but even a little tougher than that one.

Mark: Yes, you’ve said that when I was going through the courses, NAIOMT was one of the toughest certifications in manual therapy that one can go through. Besides that exam, what else makes it so tough?

Erl: It’s the only system that has an examination at every level and there are a number of courses that you have to take to get through those test procedures. For example, there are ten courses, each with tests on level one, level two, etc… In many cases, in the United States, you can get certified after a few days. But in NAIOMT, it’s going to take you a few years. And that’s a BIG difference. And of course that makes it not popular with everybody.

Mark: After years of doing quite a few examinations, you must’ve seen some interesting things happen. What are some examples of the interesting or humorous things you’ve seen during the exams?

Erl: Well, people faint (laughs) so you always have to be ready for that! One of the most common responses in the exam is when people can’t speak. So we’ve learned over the years that making people feel comfortable is a huge part of becoming an examiner so that they don’t freeze up. Some people can’t remember anything for their exam when they’re going through it. Just a blank. So you can really see how much stress people can be under when they’re going through the exam. We’re very careful in choosing our examiners so that they’re capable of first making people comfortable and then able to ask them questions that will get the most of out of them.

Mark: Great. Everyone has asked me to ask you this question. They say that they feel like you’ve got or you’ve stated that you have a photographic memory. First of all, do you feel like you have a true photographic memory? And second, when did you know that you had that gift in you?

Erl: Well, I know people with a true photographic memory and I don’t have what they describe as a true photographic memory where you can just look at a page and remember it. But what I do have is a real retentive memory which is a better way (to describe it). I only have to read something once or be told something once and it’s pretty much in there forever.

Mark: Have you always had that?

Erl: Yeah. I think that’s been a feature since school. I didn’t always use it in school as much as I could’ve (laughs).

Mark: I as well as many others, view you as an icon in our profession and you’ve had a huge influence on my professional development. Who has been a major influence in your professional development?

Erl: Apart from my teachers Kaltenborn and Evenjth, the main people were the ones that started the orthopedic division of the Canadian system. The first one I ran into was John Olden. And as I mentioned, we knew nothing about orthopedics at school so he was amazed at my ignorance at manual therapy and was so affected by it, that he actually gave me his brand new copy of Textbook of Orthopedics by James Cyriax and that opened my mind like crazy. Then my association with Cliff Fowler, who’s become more like a brother than a friend. From a clinical perspective his innovative soul and mind has really turned me on. And Dave Lamb was probably the biggest influence in teaching and I could listen to him over and over again for hours. It’s his passion to get people to learn and enjoy work. Those three people have probably influenced me the most over my career.

Mark: One of the things that I’ve realized about our profession, is that more and more our worth as professionals is dictated by others not in our profession. Where do you see our profession going because of this trend?

Erl: If I look at the profession internationally, I see a trend where we are going to be unquestionably the next line of medical specialty. I think we’ve got the history, the background, and gradually we’re getting more and more researchers in the field. And our profession as a whole is getting far more scientific. So I actually think we’re getting prepared through our historic development to be the next specialist. And I think our title will be physical medicine specialist.

Mark: Where do some our professionals need to be coming from? Do we need more people invested in the clinical research or perhaps the administrative government side?

Erl: I think we need everything (laughs). Traditionally, physios have lacked PhDs and clinical researchers. I would like to see the PhDs be more clinically directed because sometimes they aren’t. But again, we’ve been very poor in political involvement. I think efforts in Washington show that when PT populace gets involved you can actually change the law and change the way we are viewed as a profession. So I think of those aspects. I think we’re doing extremely well from a clinical, investigative perspective and inventiveness is a strength but I think those are two of our major weaknesses.

Mark: Do you think it’s a product of what our professional educational system? Whenever I take students, I’m often surprised by the limited progression of the education. Do you see that as well?

Erl: Yeah, obviously as a teacher you are aware of the weaknesses of the post and pre-professional systems but I’m also aware of the fact that they have limited time and resources, so they have to try to develop a framework for a physio to be developed. So really when they come out, it’s really unrealistic to expect them to be expert clinicians. I think what we need is to train people that have that…that future to be expert clinicians. So, if there’s anything I’d like to see, it’s an emphasis on biomechanics, because that’s my bias (chuckles).

Mark: Are you familiar with some of the more recent systems like SFMA?

Erl: Yes, I’m familiar with them and for some instances I’ve run into some of these PTs and always been enriched by them because they have a different opinion. But from a change of perspective from a professional, it’s a little too late for me. You know that saying about an old dog learning new tricks (laughs).

Mark: So at this point of your career, what do you feel you have a lot left to do? What is it that motivates you to teach?

Erl: I think when you mentioned about the way my brain works, one of the other features I have is a very three- dimensional mind. And I can see biomechanics, human biomechanics in a three-dimensional perspective. That’s not something that’s shared by a lot of people. One of the things I’ve dreamed about and hopefully when I get less busy in the clinic, is to be able to set up a computerized system of teaching biomechanics in a three-dimensional manner. So if there’s anything left to do, that would be it.

Mark: That’s interesting because when I graduated from PT school, my graduate thesis was a 3D presentation on cervical biomechanics. And this was when 3D animation had just come out and I taught myself how to create short videos on how the cervical spine moved with cervical flexion, extension, sidebending and rotation. I thought that’s where the profession would go as far as the teaching part of it but it really didn’t expand that way. I mean, there have been some programs that have come out with 3D animation but there hasn’t been as much change as I expected.

Erl: No it hasn’t and I think it’s because a lot of people don’t view anatomy and biomechanics in three- dimensional perspective and if you do, you’re very lucky. I think because the vast majority of people still see anatomy in a two dimensional thing from Gray’s Anatomy. That’s one of our biggest challenges. And once we have something that people can utilize, even on the undergraduate level, I think that’s where the interest will be. But I think that people can’t get that view. But you’ve never shown me that.

Mark: Haha, I’ll have to dig that up somewhere. So you’ve been coming here since 2007 when I started taking the level I and you’ve been coming back every year since. What is it about Hawaii that you are so fond of?

Erl: Well, obviously I’ve built up a huge circle of friends in Hawaii over 20 something years. It’s a beautiful place to come but it’s also a nice atmosphere. It’s just been great to be a part of a developing professional culture that is being created in Hawaii, almost the embodiment of what NAIOMT wants. If we could create in the rest of the U.S. what we’ve created in Hawaii, we would be very, very happy. And I’m not just talking financially; I’m talking about from a professional point of view and our impact on the future of the profession.

Mark: Alright, I just have one question left. I love to read and I’m always reading two or three books at a time. What books would be the biggest influences on you? They don’t have to be physical therapy related, just any book.

Erl: Any book?

Mark: Any book.

Erl: Including Dean Koontz?

Mark: Sure!

Erl: (Laughs) Obviously I don’t have any obvious ones ‘cause I can’t think of anything in physical therapy (laughs). But unquestionably, Gray’s anatomy has to be a favorite and I still read that and I still get caught reading that at lunch time. Some of the others, the new books on pain…Dave Butler’s Sensitive Nervous System. And probably I think Diane’s book on her approach to therapy especially about her approach to treating the pelvis. I always like the detective books, books on crime…

Mark: Like Sherlock Holmes?

Erl: Yes, like Sherlock Holmes (laughs).

Mark: Well I want to thank you for allowing me to pick your brain. Hopefully we can do this again.

Erl: Yes, thank you.


Eidetic memory. (2015, May 20). In Wikipedia, The Free Encyclopedia. Retrieved 07:36, June 9, 2015, from

By Mark Yanai

Celebrating Memorial Day

Memorial Day in America is a day when people remember and honor those who have fallen in service to their country. In Hawai‘i, with its diverse population, traditions become easily adopted and assimilated into its rich cultural fabric. It is a custom for people in Hawai‘i, on Memorial Day, to not only place flowers and offerings on gravesites of those who served their country, but to honor all loved ones who have passed on.


One famous Memorial Day tradition in Hawaii is the The Lantern Floating Ceremony, held at Ala Moana Beach Park. In 1999, the inaugural Lantern Floating Ceremony was held at Ke’ehi Lagoon on the south shore of O’ahu. In 2002, the ceremony was moved a few miles down the coast to Ala Moana Beach where it has been observed every year since.


The Lantern Floating Ceremony brings together over 40,000 people on the beach, joined by thousands around the world via live streaming and telecast for an evening of honoring loved ones and generating collective hope toward the future. The ceremony is an opportunity where all can come together for a personal and collective moment of remembrance, reflection, and offering gratitude to those who have gone before us. It is a chance to be surrounded by the love, understanding, and support of others – even strangers. We are strengthened as a community as we reach out to support others and build understanding of our common values and experiences.

In remembering those who have recently passed, I think of Parker Moore. Parker, a student athlete at Linfield College in McMinnville, Oregon, was stabbed to death at a 7-Eleven convenience store across the street from his school last November. In a random act of violence, he was attacked by a 33 year-old male that had no known connection with him. The assailant returned to the store shortly after the attack and was shot to death by police officers at the scene.




Parker was a classmate and football teammate with my son, Kaleo. He was a sophomore who studied business management, played linebacker on the football team and was popular among the student body, acting as a resident advisor. The tragic incident occurred a day after the team’s biggest win of the year: a conference clinching win over Pacific University. His death stunned the small community of McMinnville, a town where there wasn’t a fatal shooting in almost ten years and almost 25 years involving a police officer.

Surprisingly, the Linfield football team banded together from the tragedy and went on an inspiring run through the Division III football playoffs. The team won against Chapman University then traveled to Belton, Texas were they upset the 2nd ranked University of Mary Hardin-Baylor. The following week they upset another top ten team, Widener University in Pennsylvania. Their run ended in the semifinals against the number one team in the nation, University of Wisconsin Whitewater, in a thrilling 20-14 game.

On May 9th, the first “Parker’s Run” was held at Evergreen Aviation & Space Museum.  The 5K run was a fundraiser put together by Linfield students and Linfield’s Economics Department, with all of its proceeds going to the Parker Moore Memorial Scholarship Fund. There was also a tree ceremony on campus where head football coach, Joe Smith, read a remembrance letter he wrote about Parker on the eve of the dedication. Thank you to ADvantage Catdome for posting this emotional, moving letter.

Parker Moore Header   Parker Moore Tree

Memorial Day is a time when we can all share in the loss of loved ones and reach out in the spirit of creating harmony to support one another. Flowers, floating lanterns and a 5K run are all remarkable and memorable ways to honor and remember our loved ones. It’s traditions like these that we, as a family and a nation can look forward to celebrating each year.

By Mark Yanai

Olympic Lifting – “DOING IT RIGHT!”



2015-04-25 15.01.10


As part of the 2015 UH Strength Coaches Clinic, Leo Totten, of  Totten Training Systems, spoke about Power Development with Olympic style weightlifting. Totten is an expert in weightlifting, with over 20 years of coaching at the Olympic, Pan American, and World Championship level.


Totten Training is located in Littleston, PA. The major focus of Totten Training Systems is to provide the best in Olympic style lift training in conjunction with other modes of strength and power training for weightlifters and all athletes. Totten created this system after many years in the field as an athlete, coach, teacher and athletic administrator. He has worked with athletes and coaches from the high school level, to the collegiate level and even national and international level, working with individuals as well as teams. As a well-known speaker and author with has a strong reputation in the strength and conditioning field, Totten is one of most influential strength coaches of all time. His resume is full of achievements in lifting:

  • Recognized as one of the 65 most influential Strength Coaches –
  • Senior International Coach for USA Weightlifting (Level 5)
  • Head Coach, East Coast Gold Weightlifting Team
    • 8 time National Men’s Team
    • 6 time National Women’s Team Champions
  • President, WerkSan Barbells, 2005-2012
  • Over 20 years as Olympic weightlifting coach
  • Over 20 years as clinician for USA Weightlifting
  • Over 20 years training High School / College elite athletes
  • Over 30 years in Physical Education and Athletic Administration
  • Two Olympic Teams
  • Three Pan Am Teams
  • Five World Championship Teams
  • USA Weightlifting Coaching Excellence Award, 2005


At the UH clinic, Totten gave a hands-on demonstration on the Clean, one of the three recognized Olympic lifts. He spoke about the benefits of lifting and how the skills transfer to sports that require strength and power, with the emphasis on power.

Following the clinic, Totten offered a class in Beginning Olympic Lifting Course (BOLC), which included instructions on the three lifts: Clean, Snatch and the Jerk. Check out this video on the clean:









About 35 people of various backgrounds, high school and college coaches, athletic trainers, and physical therapists attended this eight-hour class at Crossfit Oahu. Totten took us through each of the lifts from set-up to finish. The class was very detailed as he dissected each lift step by step from the floor to the receiving position. He gave great tips on training and improving at each of the key positions.


I had signed up for the clinic with great apprehension. I knew very little about Olympic style lifting other than it being different at the receiving position. My feelings were heightened when I saw that most of the other attendees were coaches and looked more the part. I felt a little better when a fellow colleague (physical therapist) showed up and we were able to learn together, sharing common thoughts about how we would apply these new lifting techniques to physical therapy. As a therapist that works mainly with injured workers, I noticed key body mechanics in the lifts that would assist in generating the necessary power to lift and manipulate heavy objects. I also felt that training with a barbell would be another great instrument to use for patients and personal training clients.

I was given a BOLC certification for completing the course, which allows me to begin teaching the lifts I learned. It by no means makes me a knowledgeable coach like Totten, but it’s a good starting point. He is a fantastic coach and his teaching style is methodical and systematic. He has great anecdotal stories that kept all of us interested at all times.

Despite my original fear, I was able to learn a great deal, meet new people, and pick up new skills. By the end of the day, I probably lifted a barbell a hundred times and I sure felt it the next day. But the soreness in my muscles were a great reminder of the hard work I put in and new skills that I gained.

Many thanks to Leo Totten, Tommy Heffernan, and Hank McDonald for putting the class together. And thanks to Crossfit Oahu for hosting it.

For more information on Totten Training Systems, email Leo Totten at

BOLC Crossfit Oahu (1)

By Mark Yanai

2015 UH Coaches Strength Clinic


Last month I attended the University of Hawaii‘s 2015 UH Coaches Strength Clinic on April 24-25th. After gaining valuable knowledge from last year’s clinic, I was excited to hear and learn new things from this year’s speakers, especially Tommy Heffernan, who heads the Strength and Conditioning Program at the University of Hawaii

Tommy Heffernan

Heffernan played for the UH football and baseball teams from 1988 to ’91 and has been affiliated with the Rainbow Warrior football program ever since. Upon receiving his bachelor’s degree in Hawaiian history from UH in 1991, Heffernan taught at Kahuku where he also coached football and baseball.  In 1995, he served as an assistant strength and conditioning coordinator at UH and then became the head coordinator four years later.

For the past six years, Heffernan has organized the Coaches Strength Clinic. He invites local speakers from Hawaii as well as from the mainland, each bringing great insight into various areas of strength and conditioning for athletes. Attendees were given hands on instruction on improving mobility, speed and quickness, and of course, strength training. It was interesting that the speakers had such different and unique perspectives on strength and conditioning, depending on their specialty and area of expertise which ranged from the armed forces and college athletics to specific sports like rugby and weightlifting.

One of the best moments of the two-day clinic, in my opinion, occurred when Heffernan presented the first Coach’s Recognition Award to one of his childhood coaches, Philip Chun. Heffernan talked about Chun’s influence on him as a young athlete and realized, as he grew older that all of the athletic knowledge he gained from Chun wasn’t as significant as the relationship he built over the years with Chun. He spoke highly of the nurturing relationship that coaches have with young athletes and how it sometimes isn’t realized until much later in life. The emotion in which the speech was given was moving and memorable. It was a sentiment that I’m sure all of the coaches (in attendance) experience with their athletes and it drives them to attend these types of clinics.

As a representative of F&L, I will continue to attend and support the Hawaii Strength Clinic as it brings great value to us in knowledge, community involvement, and connection with other health providers. I look forward to sharing what i learned from the clinic with my staff and patients at our therapy clinics. I expect to attend next year’s clinic which is expected to be held on January 29-30th.

Look for a future blog about my experience with one of the speakers, Leo Totten. I attended his certification for Olympic Lifting that he offered to attendees of the clinic.

Speakers included:


2015-04-26 13.50.32



Leo Totten, a Level 5 Senior International Weightlifting Coach and owner of Totten Training Systems



Elizabeth Ignacio   



Elizabeth Ignacio, MD and Rachel Coel, MD,
IMUA and Queen’s Center for Sports Medicine



Brian Norwood  charlie-weingroff



Brian Norwood, Defensive Coordinator University of Tulsa

Charlie Weingroff, D.P.T., Certified Athletic Trainer, Certified Strength and Conditioning Specialist



Steve Englehart Scott Swanson



Steve EnglehartStrength and Conditioning Coach and Assistant Director of Sports Performance for Colorado University

Scott Swanson, Director of Strength and Conditioning for the Army at West Point



Charlie Melton  McDonald_Hank14_2327.jpg



Charlie Melton, Director of Basketball Men’s Athletic Development, Baylor University

Hank McDonald, Assistant Strength & Conditioning Coordinator for the University of Hawaii



David Tuinauvai



David Tuinauvai, owner of Conquest Fitness and Rugby Union League Strength & Conditioning Coach


Bronson and Dane Sardinha, Pacesetters Baseball Academy
Tommy Heffernan is a member of the International Sports Science Association, the National Strength and Conditioning Association, and has been designated Master Strength and Conditioning Coach by the Collegiate Strength and Conditioning Coaches Association. He resides in Kane‘ohe, O‘ahu.

By Mark Yanai

F&L introduces Graston Technique



Last weekend, Nate Lowry, PT, one of our therapists, and I attended a M1 Graston Technique introductory course in Seattle, Washington. F&L decided to use Graston Technique in our clinics after the company’s owner, Randall Fukuji, P.T., took the course and has since been successful in using the technique at the Kailua clinic for the past several months. In order to be able to offer this treatment at all of our clinic locations, Nate and I went up to Seattle to become providers.

Graston Technique ®  is an advanced form of instrument-assisted soft tissue mobilization which enables clinicians to effectively break down scar tissue and fascial restrictions. Graston is performed with patented stainless steel instruments designed to effectively detect and treat areas exhibiting soft-tissue fibrosis. It was developed by athletes and is used by more than 21,750 clinicians worldwide — including physical/occupational therapists, hand therapists, chiropractors, and athletic trainers.

The course was taught by Shawn Burger, PT, and Ted Forcum, DC, at the Hilton Seattle Airport Hotel.


Shawn Burger




Shawn Burger is currently the Vice President of Burger Physical Therapy, Inc and is responsible for the day-to-day operations of 14 outpatient clinic sites that provide physical, occupational and speech therapy to the greater Sacramento area. He specializes in post-operative and acute injury management and has been a GT instructor since 2006.



Ted Forcum is currently in private practice at Back In Motion Sports Injuries Clinic LLC in Beaverton, Ore., and has been a GT instructor since 2003. He is the team chiropractic for the Portland Timbers Soccer Club (MLS) and the Portland Winterhawks Hockey Team (WHL).



The benefits of Graston Technique:

  • Decreases overall time of treatment
  • Fosters faster rehabilitation/recovery
  • Reduces need for anti-inflammatory medication
  • Resolves chronic conditions thought to be permanent







I thoroughly enjoyed both instructors and gained great insight into the use and benefits of Graston. Shawn taught most of the general principles of Graston and gave great examples of how he uses Graston “instruments”. He was one of the rare instructors that always kept your attention with useful examples, funny moments and simplified principles. He shared some of his success with and without Graston, which is always encouraging for other therapists to hear. Ted brought great flavor to the course with his experience in sports, from the Pan American Games to the Beijing Olympics. His interaction with top athletes always grabbed the attention of the attendees. Ted has a great teaching style and I can’t wait to take the advanced course, which is his specialty.

By  becoming Graston providers, F&L can use this technique  as a new method to accurately diagnose and treat soft tissue lesions. We are  now one of three Graston technique providers on Oahu and offer this service at each of our locations. Watch for future blogs on this website as we share our experience with GT and combine it with other techniques in our practice model.

IMAG4447_1 (1)


By Mark Yanai

My Morning Cup


I’ve been fortunate to work for F&L for ten years and during this time, I’ve had many patients return for physical therapy. Some have commented that I’ve lost a lot of weight since they last saw me. They all ask me the same question, “What did you do?”

Most of my life I’ve been in decent shape. I’ve always been active and practiced mostly what I’ve preached by having a movement practice that involved many of the things that I’ve learned while being a therapist for 15 years. I’ve gone through different phases of exercises and nutrition as the research has evolved. I’ve weighed as much as 170 lbs and as low as 135 lbs during that time period.

Last year, like most people, I made a New Year’s resolution to be in the best shape of my life since I would be turning 50 years old. I came up with a plan to work out, eat right, and have the right attitude. Like most resolutions, it went out the door after a week. But not for the usual reasons of unreasonable goals or loss of momentum and motivation. Turns out that it all changed with a cup of coffee.

The day after New Year’s 2014, my nephew Ramsey, introduced me to a cup of Bulletproof Coffee. It contained a fresh brewed cup of coffee blended with coconut oil and  grass-fed butter. It was smooth, delicious and the best cup of coffee I’ve ever had. It really sparked my interest that something so contradictory, (butter in my coffee?!?) could be so satisfying. It led me to do some Google-ing so that I could make myself a cup the next day.

Bulletproof Coffee was created and branded by Dave Asprey, a self described “biohacker“.  Asprey came up with coffee idea after having a cup of tea that contained yak butter while hiking in the mountains of Tibet. He has gone on to create a brand that not only includes coffee, but other supplementations and technological tools to “biohack” oneself. He also created the Bulletproof Exec, which features a blog and podcast that is both informative and inspirational. His interviews are with other biohackers that have a specialty in exercise, nutrition, lifestyle, or performance.

Dave AspreyBP Diet Book

I’ve listened to every podcast that he has put out and it has led to significant changes in my life style. By being introduced to other people interested in improving human performance, such as Ben Greenfield, Jimmy Moore, Kelly Starrett, Hal Elrod and Ari Meisel, I’ve been able to attain my goal of being in the best shape that I’ve been in for years. My perception of “best shape” has changed as well. While  improving my physical presence was important, it was clear that focusing specifically on my diet, personal development and gratitude would make the most positive changes to my health. And with those positives changing first, my body changed as well. Most of my weight loss was body fat and i had increased energy, mental focus and a greater awareness to change.

There are many detractors of Bulletproof Coffee and of the biohacking community. There is the perception that many of the ideals behind it are not based on medical research and old views of what traditional medicine, nutrition and exercise should be. Yet our society continues to see increases in heart disease, diabetes, and cancer. Challenging that traditional thinking has affected everything that I’ve done since drinking that cup of coffee and it’s led to a new life of fulfillment and gratitude. Starting my day with a cup of Bulletproof Coffee is part of my morning routine that I doubt will change for a while.

Over the next few blogs, I plan to talk about the changes i’ve made and how I think it can help others. If you have any questions for me, please feel free to email me at


Biohacking. (2015, February 7). In Wikipedia, The Free Encyclopedia. Retrieved 17:50, March 9, 2015, from

By Mark Yanai

Indian Clubs


Indian Clubs have made it to F&L

Indian clubs are a type of exercise equipment used for developing mobility, strength and cardiovascular endurance. According to Wikipedia, Indian clubs or meels “comprise of bowling-pin shaped wooden clubs, which are swung in certain patterns as part of an exercise program.” Clubs can vary in shapes and weights depending on the type of exercise they are intended for. Wrestlers in ancient Persia and Egypt originally used these clubs as training tools. British colonists erroneously referred to them as “Indian clubs” despite their Middle Eastern origin.







Indian clubs have been used for over a century and have made their way to F&L’s WORC site. The clubs have recently become a popular exercise tool due to a recent trend of using unorthodox exercise equipment like kettlebells, swinging maces, and sandbags.  At WORC, we use them to improve shoulder and scapular mobility. Patients go through a series of movement patterns that emphasize scapular protraction, retraction, elevation, depression, and rotation. This prepares them for other movements that require full range of motion of the upper extremities. I’ve found them to be very effective as a warm up exercise that involves all of the scapular muscles including the rotator cuff. Learning the unique movement patterns of the clubs takes patience but once mastered, they can provide a great tool for rehabilitation and exercise.


During a recent vacation to Tucson, Arizona, my father-in-law taught me how to use a lathe (machine tool below) and I attempted my first run at creating my own clubs. It was a fun experience and am so happy to see our patients using my creation as well as my father-in-laws clubs that he made for the clinic.




Indian club. (2014, December 2). In Wikipedia, The Free Encyclopedia. Retrieved 22:21, March 1, 2015, from