“Are you ready?” Klaus asked finally.

“No.” Sunny answered.

“Me neither,” Violet said, “but if we wait until we’re ready we’ll be waiting the rest of our lives.” — Lemony Snicket, The Ersatz Elevator

I was standing on the porch of the tiny green house my daughter’s and I had only just moved into. My head was spinning. My heart was racing. The voice inside me was saying just do it. But then, “I’m not ready. I can’t possibly pack up and move again. We’re just getting settled. What the fuck am I thinking….”

In the preceding months, I had left a marriage that needed leaving. The girls and I regrouped and recouped for a couple of months at the home of my childhood best friend. Meanwhile the other amazing women in my life helped me make a cozy little home out of this weird green box. As the realtor had driven us up to it, the only real option in our town on my current budget, I remember thinking, “Oh God, don’t let it be that one.”

But now I kind of liked it and was standing on it’s postage stamp porch about to make another very big decision I clearly wasn’t ready for. The head spinning and stomach churning was the result of three things that had happened that day (never underestimate the power of three’s, especially when they hit you all at once).

One — the owner of the small private practice I had been contracting with had rather unceremoniously told me it was time for us to part ways. My side of that story has to do with his big ego and know-it-all style. I’m sure his side is quite different, but isn’t that always the case?

Two — our house, the one before ‘the leaving of the marriage’, went under contract. That meant I could get my equity, pay off the debt I had rung up after taking the leap, and maybe — just maybe — breathe again.

Three — a phone call from a friend, offering to partner with me on a new business six hours away in Western Massachusetts. I had just hung up the phone with him and was running through the incredibly timed conversation in my head. “I just spent an entire flight across the country thinking about how I could get you to move out here and do this,” he said, “so I had to call…”

Was I ready? Hell no. Did we do it anyway? Damn right.

That was July of 2015. We scrambled and moved to Williamstown the last week in August, and the girls started in their new school after Labor Day. Today I am 4 years into a successful and growing business. I have a wonderful partner who makes me laugh and think and loves me and my girls.

Had I not taken that opportunity, I’m not sure where we’d be right now. What I’m quite sure of is, had I not ‘started before I was ready’, I’d have regretted it.

I would never describe these last four years as easy. It’s not supposed to be easy. When I look at the strength and humor and wisdom my teen daughters now have — I know unequivocally that I made the right decision.

All progress begins with a brave decision. –Marie Forleo

These days, I see opportunities in everything. I’m not afraid to jump in to a project and make mistakes, because I know it’s the only way toward the next best thing. When I feel myself overthinking something, I take action. Action spawns courage, not the other way around.

So whatever it is that kept you reading today — whatever the next thing is for you (starting to exercise, taking that course you’ve been thinking about, fixing a relationship worth fixing or letting go of one that’s no longer healthy…) take a step. Sign up for the class. Send the email. Pick up the phone. Lace up your sneakers.

Bodies in motion tend to stay in motion.

I had the opportunity to give a talk on my experience with radical change in 2015 at Gray Institute in Adrian, MI.

The inspiration for sharing this story comes from the book I’m currently obsessed with. Everything is Figureoutable, by Marie Forleo.

Common sense and good health go hand in hand.

It stands to reason that if you feel stiff every morning, you ought to stretch yourself out. Don’t waste time feeling old or pining for the days you could jump out of bed without giving you body a second thought. Just stretch it out.

The vast majority of muscle aches and joint pain can be worked out with a combination of mindset and movement. If you are sore you aren’t broken. Your body is craving something different and nothing good will happen until something changes.

Choose to do something different and be consistent with it. If you aren’t sure where to begin, try this or some variation of it.

Knee pain can stop you in your tracks. It also continues to be surprisingly mishandled by many healthcare practitioners. People with knee pain would do anything to be rid of it, so following a doctor’s advice for a cortisone (steroid) injection or two is often a no-brainer.

Unfortunately, there’s a problem with that.

Despite mounting evidence that they do no good, steroid injections are among the most common ‘treatments’ for knee pain. The research has been clear for years — steroid injections do not lead to good outcomes for joint pain. A 2017 Journal of American Medicine (JAMA) article raises the stakes and brings the Hippocratic Oath to mind — ‘do no harm’.

Numerous researchers have proven that steroid injections have a placebo effect at best. The 2017 JAMA article goes one crucial step further — the steroid injected into your joint causes your cartilage to degrade. That’s exactly the opposite of what we want.

Doctors at Tufts Medical Center in Boston did a two year blind study with two groups of patients with arthritic knee pain. They also had what’s called synovitis — a type of inflammation in the joint, verified by ultrasound. If anyone is going to respond to steroids, these people should.

Each group got injections every 12 weeks for 2 years. One group had saline (placebo) injected, the other a steroid. An MRI was done at the beginning, after one year, and again at the end.

The dismal results are no surprise to Physical Therapists, who often see these patients at some point in time after injections. In my 25 years as a PT, I’ve heard a version of these 12 words more times than I could possibly count, “It seemed to help for a little while, but it didn’t last.”

The results of the JAMA study should NOT be surprising to doctors who continue to inject. This information is widely circulated in journals.

Here are the conclusions of that revealing study:

For pain it was a net zero effect. No difference in pain between the two groups. Thanks to the placebo effect, both groups did experience some decrease in pain.

No difference in function in either group. No improvement in stiffness. No improvement in walking.

Remember, one group got the steroid, the other got saline.

There was one significant difference discovered between the two groups, and it’s bad news for the cortisone recipients.

The steroid group had definitively less cartilage in their knees after two years. That’s BAD. The steroids sped up the rate of arthritic changes. The saline group had no change in thickness — that’s GOOD.

This is exactly the opposite of what patients (I like to call them people) and their doctors would want to happen.

Will this 2017 JAMA study change the recommendations from doctors and surgeons who’ve been giving them for years? We could assume it should, but assumptions are dangerous.

A Google search for information on cortisone shots brings up the current Mayo Clinic recommendations:

There’s concern that repeated cortisone shots might cause the cartilage within a joint to deteriorate. So doctors typically limit the number of cortisone shots into a joint. In general, you shouldn’t get cortisone injections more often than every six weeks and usually not more than three or four times a year

The JAMA study was within those current guidelines of a shot every twelve weeks or four times a year.

My advice would be to simply ask your doctor what they think about this and other studies or find a good Physical Therapist to consult with first. All 50 states allow direct access between you and your Physical Therapist — meaning you don’t need a referral.

One last thing, in 2018, a year after the JAMA study was published, there was an increase in supply and demand of cortisone shots. According to MarketWatch: Cortisone Shots Market 2018 Receives a Rapid Boost in Economy due to High Emerging Demands with CAGR of 5.2% by Forecast to 2023

America acquires the first position in the market for cortisone shots owing to the rising prevalence of various types of allergies, arthritis, tendinitis, and others, and rising demand for corticosteroid injection in the U.S. According to the Center for Disease Control and Prevention, an estimated 78 million i.e. 26% of the U.S. adults aged 18 years or older are projected to have doctor-diagnosed arthritis by 2040. Additionally, the prevalence of tendinitis among athletes is found to be increasing from last few years in the U.S.

Despite years of researchers — and patients — telling us that cortisone injections don’t really do the job, the market tells a different story. They are being purchased in even higher quantities. They are still being given liberally and usually before any Physical Therapy. They are causing more harm than good.

We need to handle joint pain differently. We’ve been discussing the knee here, but the same goes for hips, shoulders, spine and any other joint that gets injected. All treatment and advice should be geared toward getting a good outcome for the person experiencing pain and difficulty.

Any practitioner helping you with joint pain should be looking at you when you talk (not checking boxes on their computer), listening and asking questions, watching you perform the tasks/movements that cause pain, strategically finding moves that don’t, and giving you new cues and habits to build into your day. Habits based on mindset and movement.

If your doctor is still giving cortisone injections, ask them why. Perhaps they have a convincing argument, I just haven’t heard one yet.

I understand now that no one else in the world knows what I should do.

I doubt that I am alone in feeling this feeling today.

The news of closures and precautions and viral pandemic are blazing across my phone, my watch, the tv, our dinner table, and in the eyes of everyone I meet.

The experts don’t know, the doctors, the therapists, the journalists, the authors, my friends, my kids, they don’t know. Because this level of global shut down has not happened in our lifetime — certainly not in mine.

Yet through all the unknowing, I feel a weird calm — except when I read the article on the front page to the New York Times this morning about two guys in Tennessee (along with thousands of others) who went out and bought 17,700 bottles of hand sanitizer and began to resell it for $70 a piece. That’s just gross.

But now I’m calm again, because Amazon and EBay have cut them off. Karma is real.

Calm is not the same as indifferent. I know people are in pain, in fear, and suffering. I know there is a world of unknown about to hit our finances, businesses, and bodies.

So what I’m going to do is stop looking for someone else to tell me the right thing to do. It’s clear that this is spreading and I don’t want to make it worse by pretending I know something about it that I don’t know.

I’m going to stop. Breathe. Be still. Listen. Do the next right thing.

As Glennon Doyle has beautifully written in Untamed:

HOW TO KNOW:
Moment of uncertainty arises
Breathe, turn inward, sink.
Feel around for the Knowing.
Do the next thing it nudges you toward.
Let is stand. (Don’t explain.)
Repeat forever.
(For the rest of your life: Continue to shorten the gap between the Knowing and the doing.)

Why do some of us struggle with time, while others make it look so easy? We all have the same 24 hours in every day.

I like to keep things simple, so a good visual goes a long way for me.

Imagine you have a large glass jar. Next to it, you have a few large rocks, a small pile of marble sized pebbles, and a pile of sand. If you put in the sand or pebbles first, what happens? You can’t fit the big rocks in. But if you add the big rocks first, followed by the medium sized pebbles, and only then the sand, it all fits. (I got this from Tim Ferris, serial experimenter, podcaster, author, etc)

It’s a crystal clear reminder that the important things — the big rocks — come first. So why is it so easy to do the opposite? To get so focused and exasperated from dealing with the minutia that we repeat unhelpful mantras like:

“I’ll make time for that {important thing} tomorrow, or next week when it’s not so crazy, or next month after the Holidays, once this project is done, when I retire…”

The big rocks are the things that matter. In my personal life, that’s my kids, Nicole, the couple of handfuls of friends and family that I love and connect with, and my health. A positive state of health and wellbeing is the cornerstone for success in anything and everything. We can measure that health by our physical, emotional and social states.

If you are looking for the big rocks, start with your own personal state of the union.

Not sure how to put this into action? First, check your ‘personal state’ — your physical, emotional and social health. How does your body feel and are you moving enough and with some variety? Is your mind racing with schedules, worry, doubt, resentment and if so, what are you doing to quiet that fire? How are your relationships and are you nurturing the good ones or forcing the bad ones?

When your personal state is in the positive, the stories you tell yourself and others create a powerfully positive narrative. The opposite is true for when your story has shifted to the dark side. This internal and external narrative is the best barometer of what your state is at any given point. Use it to check yourself and to right yourself. It can be as simple as noticing when you are thinking and spewing negativity and deciding to stop.

The big rock visual works in business too. For me, the one thing I don’t want sitting outside my jar is customer service. We are a customer service company that happens to help people with pain, fitness, and performance. You can’t help people — in the way we seek to — without building relationships with them.

We measure our success by the personal state of our clients and by clearing the path for them to move better and feel better, so they have the freedom to do whatever they like. When you sift away the sand the the pebbles, it really is that simple.

In my consulting practice with people and organizations, we find the big rocks by asking questions to identify two things: what they really want (not always obvious), and what has gotten in the way of that. Once you recognize barriers, you have an opportunity to remove them. Often the gold is not found by adding more, but by taking away.

Here’s a recent example. When consulting for a non-profit in Boston, the issue at hand was an 80% participant drop out rate. The point of the organization is to make it easy for a specific group of people to get much needed, highly specialized, life saving services around PTSD.

I organized the research around my personal and professional experiences, asked a lot of layered questions, worked closely with the team on the front lines, and went to Boston to present my two cents. They were putting the sand and medium sized pebbles in the jar first and there was no room for the big rocks.

I did a customer on-boarding analysis, taking screenshots of my online registration process as if I were someone in their target audience attempting to sign up for the program directly from their website. This is a non-profit closely associated with a BIG hospital system. Someone made the call that all communications with even potential participants (the people they seek to serve) had to be ’secure’.

I presented the leadership with screenshots, of the 13 frustrating steps I had to go through in order to receive my first ‘welcome’ email from them. After all my trouble, the ‘welcome email’ was decidedly underwhelming. They had absolutely no idea this was happening to potential participants. The unintended consequence from that one decision to require ’secure’ communications was devastating to their mission.

I felt like Ralphie in the The Christmas Story when he worked his butt off to get his Little Orphan Annie Secret Decoder Ring, excitedly wrote down his first secret code, found the only place in the house he could get some privacy, and broke the code… only to reveal a crummy commercial: Be sure to drink your Ovaltine.

Back in Boston, there were three big problems with insisting on this ’secure’ policy so early on in the engagement process:

1. The people they are seeking to serve, by the nature of their circumstances, are easily frustrated and skeptical.
2. There was nothing confidential being shared, so a 13 step process to ensure the security of the impersonal ‘welcome email’ was overkill.
3. People in real need were dropping out before they even began.

Time, after all, is our only real commodity. They were wasting their own time by creating these inefficient and elaborate systems. Even worse, they were wasting precious time and patience of those they set out to support.

When things aren’t working — in life, work, relationships — it’s worth taking the time to dump out your jar and choose the biggest rocks first.