The 4-Hour Body Part 34

I had seven MRIs taken at a negotiated price of $400 each. For comparison purposes, similar MRIs in San Francisco would have cost approximately $750 each, so 7 $350 savings = $2,450 total cost savings.

I also saved roughly $640 on comprehensive blood and urine testing by having it done in Nicaragua rather than the United States. Thus, my total savings on medical expenses came to $3,090. $3,090.

I enjoyed a surf trip in luxury, got a ton of writing done, and then took care of testing and imaging that I wanted to do anyhow. The total cost savings of $3,090 put me ahead (in essence, gave me a profit on the trip) of $687.

"But," you might rightly point out, "what if I'm not a freak who wants seven MRIs?"

First, despite urban myths to the contrary, there is no radiation risk with MRIs, and I would therefore suggest one or two of them for nagging pains or injuries. Not to mention the preventative value: ask any cancer survivor if they wish they'd had MRIs earlier.

But MRIs aside, the beauty of this geographic arbitrage is the menu of options.

I never seriously considered medical tourism before 2009, as I didn't have pending surgeries I couldn't afford, nor did I want cosmetic procedures (b.u.t.t implants, anyone?), which medical tourism agencies have made popular.

Testing and prevention, though, opened up a world of combining world-cla.s.s travel with world-cla.s.s medicine.

Due for a dental cleaning and checkup? Perhaps you want to run comprehensive blood work, which I recommend no less than every six months? Consider making a kick-a.s.s trip out of it. That same exotic dream trip, something you might otherwise postpone forever because of expense, could end up as good as free.

Perhaps the lure of travel is exactly the incentive you need to take a closer look at your health?

To get a full appreciation of how easy it was, and how much my experience contrasted with most U.S. hospitals, let me recount the process.

As Easy as 1, 2, 3 I showed up at the private hospital emergency room at 10:30 P.M P.M. on a Sunday night with no advance notice. The Kiwi had swimmer's ear and needed to get it drained prior to his flight, and I wanted to cover the costs of the trip at the same time. The easiest option: take MRIs of all joints with residual pain from sports injuries.

I asked The Kiwi's doctor if I could have MRIs taken, and she informed me that I needed to speak with a supervisor, whom she called in. The list price was $600 per MRI. I asked for her best volume discount for five MRIs: she responded with $2,400. I told her I would pay in cash (credit card) instead of insurance if she could do $2,800 for seven MRIs, or $400 per MRI. She agreed. The entire transaction was cordial and pleasant.

The supervisor authorized the MRIs in five minutes and had a car service sent to pick up technician Edwin, who was at home, and bring him to the hospital. I would not be charged for the pickup. The doctors, realizing we had some time to wait, invited me to sit down with them and share their favorite indigenous fruit, called jocote jocote (Red Mombin), which I'd never tasted. (Red Mombin), which I'd never tasted.

I then asked them what else I could do to fill the remaining 60 minutes of time. Urinalysis? Blood tests? Two doctors pulled out a list of tests I could order and we went through them together, ticking off 25 boxes I wanted, as well as a few the doctors suggested as often-neglected but important. They priced out each item for me, I had blood drawn 10 minutes later, and they promised results from the lab within three hours. Three hours?! This amazed me, as I usually wait seven to ten days for blood test results in the United States.

Then I remembered: I was in the ER. It was a far cry from the UCSF Parna.s.sus equivalent, where I'd once been chastised by a doctor because I looked at my own chart after waiting for more than three hours in an empty room: "That's property of UCSF. Patients aren't allowed to look at charts. Give it to me."

This spotless and friendly environment in Nicaragua felt so much like a private club that I'd forgotten I was in an ER. I was the only person there.

Edwin came in, we completed the MRIs, and, at his insistence, we then took several X-rays for reference images, which I was not charged for. He handed me all of the images and showed me back to the front desk, where I had my blood test, urinalysis reports, and a gla.s.s of water waiting for me. The supervisor explained that there were few cabs at this late hour-around 3:00 A.M A.M.-so she ordered a car service, at the hospital's expense, to take me back to my hotel.

She gave me a hug and wished me safe travels.

Back in the U.S., when I began to reverse more injuries with the help of MDs (the last chapter), the MRIs from Nicaragua were invaluable. Each saved me expensive imaging orders, as well as guesswork that would have led to weeks of inappropriate therapies. Sadly, the 11-minute visit average per patient in the United States produces a lot of mistakes, but most MDs will not order just-in-case images to prevent them. Why? Because, as a clinic or doctor, ordering a lot of images increases the likelihood of being audited by insurance companies. In my case, if a hasty diagnosis was made in 11 minutes, I was now able to pull MRIs out of my bag and say, "Let's make sure, shall we?"

This, I believe, is a very prudent thing to do.

Putting off those white sand beaches you've fantasized about? Consider treating yourself to some relaxation and defraying the costs with a visit to a clinic or two.

You might even get some tasty jocote jocote.

TOOLS AND TRICKS.

Patients Beyond Borders by Josef Woodman by Josef Woodman ( (www.fourhourbody.com/woodman) The most comprehensive print guide to medical tourism. This 400+-page book contains 40 of the top medical travel destinations, lists hundreds of hospitals around the world, and has an index that matches your medical condition to the best clinics. The most comprehensive print guide to medical tourism. This 400+-page book contains 40 of the top medical travel destinations, lists hundreds of hospitals around the world, and has an index that matches your medical condition to the best clinics.

International Medical Travel Journal Medical Tourism Guide Medical Tourism Guide (www.imtjonline.com/resources/patient-guide) The The IMTJ IMTJ's 10-step guide to medical tourism is a useful starting framework for those considering a fun but productive trip abroad. The plethora of options can be daunting, and this checklist will minimize the paradox of choice.

b.u.mrungrad Hospital (www.b.u.mrungrad.com) This world-cla.s.s hospital in Thailand has been featured in the "Top 10 World's Medical Travel Destinations" ( This world-cla.s.s hospital in Thailand has been featured in the "Top 10 World's Medical Travel Destinations" (Newsweek) and is one of the "Top 4 Medical Tourism Pioneers" (Wall Street Journal). The pictures on their website will probably make your own US hospital look like a third-world hovel.

Med Retreat (www.medretreat.com) Med Retreat can walk you through the decision-making process and help you find the best international clinic for your needs. Popular destinations include Argentina, Costa Rica, and Turkey. Med Retreat can walk you through the decision-making process and help you find the best international clinic for your needs. Popular destinations include Argentina, Costa Rica, and Turkey.

MedTrava (www.medtrava.com) Similar to Med Retreat and based in Austin, Texas, MedTrava can introduce you to hand-picked facilities around the world and save you up to 70% on common procedures. Similar to Med Retreat and based in Austin, Texas, MedTrava can introduce you to hand-picked facilities around the world and save you up to 70% on common procedures.

PRE-HAB.

Injury-Proofing the Body I never struggled with injury problems, because of my preparation. In particular, my stretching.-Edwin Moses, two-time Olympic gold medalist in the 400-meter hurdles; winner of 122 consecutive races

Preface: This is the longest and most difficult chapter in the book, and for a high percentage of readers, it will be the most important. This is the longest and most difficult chapter in the book, and for a high percentage of readers, it will be the most important.

Pursuing rapid increases in performance without doing "pre-hab" for injury prevention is like getting in an F-1 racecar without checking the tires. The small upfront investment of time (even two to four weeks) will allow much faster progress while avoiding serious setbacks.

Skim it now or return to it later, but don't forget to read this chapter if you're incorporating strength or speed training.

1:30 P.M., CAPE TOWN, SOUTH AFRICA P.M., CAPE TOWN, SOUTH AFRICA.

The security guard at Virgin Active Health Club was not impressed. In a country with 25% official unemployment, violence was less common than you'd expect, but it still paid to be vigilant.

I explained my idea again, which involved taking a thick three-foot metal pipe into the gym. The plan was to saw off the base of an umbrella stand and drill a half-inch hole in one end.

"No, really. It's for my workout. Not for hitting receptionists."

The last part didn't seem to help my argument.

"But, but, Gray Cook told me to do it!" I wanted to pout. "Don't you know Gray Cook?!"

He wouldn't know him.

The real shame is, most people don't, even if he could make their bodies indestructible.

Gray's Anatomy: From the NFL to Special Ops Mich.e.l.le Wie was, for several months, arguably the most famous injured athlete on the planet.

During a brief time in 2008, her injuries prevented her from doing a single push-up or holding steady on one foot for 10 seconds. Not exactly what you would expect from the youngest woman ever to qualify for an LPGA golf tour event. Sponsored by Nike and heralded as "one of 100 people who shape our world" by Time Time magazine, it seemed that she had been forced past her prime. She wasn't even 20 years old. magazine, it seemed that she had been forced past her prime. She wasn't even 20 years old.

"Before [training], Mich.e.l.le could drive 320 yards with the wind at her back. Now, one year later, she can still drive the same 320 yards. The difference is that she can now do it 300 times a day."

Gray Cook, the mastermind behind Mich.e.l.le's rapid recovery, was schooling me from his quiet base in Danville, Virginia.

He saw what the general public missed. Even injured, Mich.e.l.le could crush the ball. Most a.s.sumed that, if power was there, all was well. But she was inconsistent. Power was just one piece of the puzzle.

Fixing professional athletes in his human durability factory, Gray has become perhaps the world's most sought-after injury-prevention specialist. In 2007, both the Chicago Bears and the Indiana Colts used him as their secret weapon to keep athletes on the field, and both teams ended up at Super Bowl XLI.

Gray wasn't limited to the ranks of the NFL, MLB, NHL, or NBA. The special forces also placed their bet on this soft-spoken southerner. Gray explains: "The Pentagon puts as many millions into someone on the Special Ops as an NFL team puts into a player, but an NFL career might last three years, whereas a Delta Force career should be more than ten."

Millions. That's a lot of money.

How on earth do you you injury-proof yourself if you don't have access to someone like Gray? injury-proof yourself if you don't have access to someone like Gray?

Revisit beating my favorite dead horse, of course: the 80/20 principle.

80/20 Functional Screening According to Gray the most likely cause of injury is neither weakness nor tightness, but imbalance. Think doing crunches or isolated ab work is enough to work your core muscles? Think again. "The core, as just one example, often works fine as long as one's hips aren't moving. It's when the hips are moving-a more realistic scenario-that the core starts to compensate for left-right differences." That's when you get injured.

Gray's fundamental tool for identifying imbalances is his brainchild: the Functional Movement Screen (FMS). The FMS is a series of seven movement tests administered by a certified professional. Each test is scored on a three-point scale.

For self-a.s.sessment, his professional FMS can be abbreviated to five movements with simple pa.s.s-fail evaluation:

1. Deep squat 2. Hurdle step 3. In-line lunge 4. Active straight leg raise 5. Seated rotation

This self-FMS is designed to identify two things: left-right imbalances (asymmetry) and motor control issues (wobbling and s.h.i.+fting).

Even if you can bench-press 600 pounds, it doesn't mean you won't dislocate a shoulder five minutes into a game. More weight with more reps does not equal stability.

"Most people can press more weight overhead for a set than they can walk with overhead for the same period of time. Strength [the former] should never never exceed stability [the latter]," Gray Cook explains. "It's a recipe for disaster. The biggest misconception is that you can strengthen stabilizers [like the rotator cuff for the shoulder] alone to prevent injury. Even 10% stronger is like p.i.s.sing in the ocean." exceed stability [the latter]," Gray Cook explains. "It's a recipe for disaster. The biggest misconception is that you can strengthen stabilizers [like the rotator cuff for the shoulder] alone to prevent injury. Even 10% stronger is like p.i.s.sing in the ocean."

Working muscles in isolation will change muscles, but it's not likely to make movement safer. In contrast, working on basic movement patterns will make muscles stronger and it will also make movement (whether running a 40-yard dash or carrying luggage) safer. To use an a.n.a.logy of Paul Chek's, the basic movement patterns are like the 09 keys on a calculator. All other numbers, complex movements in this case, are still combinations of the basics.

Does the FMS work?

The Atlanta Falcons professional football team suffered seven season-ending injuries in 2007. In the 2008 season, there was just one minor surgery late in the season. The difference: their new director of athletic performance, Jeff Fish, made the FMS mandatory. Once players are "diagnosed" with the FMS, they receive personalized programs to correct imbalances and improve range of motion.

Then there's the Colts. The Indianapolis Colts have been the smallest NFL team in the nation for the last nine years. They've also had the fewest injuries of any NFL team and the highest total of games won in the last nine years. This is an unusual combination. Jon Torine, their head strength coach, has used the FMS for that entire period of time.

The Critical Four Initially, this chapter was going to be dedicated to the FMS. That was, until I realized that isolating the problems with the FMS was just the first step. Step two was prescribing the corrective actions for each major mistake in each of the five movements, and that would easily take 50 pages of dense material.

So I e-mailed Gray to reduce the seemingly irreducible:

a.s.suming people do the screen, what are the 24 corrective exercises that you'd suggest to best fix the most common imbalances/weaknesses? If you had a gun to your head and had to pick 24 exercises for correction across the board, what would you choose?

Gray's picks were, without hesitation, the following critical four: Chop and lift (C&L)Turkish get-up (TGU)Two-arm single-leg deadlift (2SDL)Cross-body one-arm single-leg deadlift (1SDL) I've put the exercises in the order that you should learn them, as greater coordination is required as you move down the list. There is no shame in sticking with just the C&L for two to four weeks if the other three prove awkward to incorporate at the beginning.

I'll first summarize the exact schedule I used to find and fix my imbalances in "The Critical Four Schedule" below. This provides the big picture before we dive into details, and it should serve as an easy-to-find reference later. Then I'll describe the exercises, using primarily Gray's words.

The exercises are not complicated, but using text instead of video can make it seem so. Use the videos listed in "Tools and Tricks" to become familiar with the Critical Four, and return to the below summary if overwhelmed.

The Critical Four Schedule: Finding and Fixing Here is a potential schedule for putting it all together.

WEEK 1: TUESDAY, 3045 MINUTES COORDINATION.

This is not a workout. This session is about practicing the movements, just like a dance or karate form. For this purpose, light weights are used, even for movements that use heavier loading in training (like the deadlift).

Developing a base level of coordination with these patterns will ensure that you do not base an entire training program on ma.s.sive imbalances that could have been fixed with a few minutes of practice and neural adaptation.

Practice both the TGU and variations of the SDL with no weight until you can perform the movement on both sides, then add light weight. In all exercises, use the minimal weight needed to help stabilize the body.

WEEK 1: THURSDAY AND SAt.u.r.dAY, 4560 MINUTES PER SESSION TESTING.

Now we will test to find your weakest quadrant and weakest sides in each movement. Perform the TGU and SDL only if you can execute them flawlessly without weight: C&L (like my example on this page this page) Chop down to left knee 612 reps Chop down to right knee 612 reps Lift up to left knee 612 reps Lift up to right knee 612 reps TGU.

5 TGU each side (16-kg kettlebell) 5 TGU each side (24-kg kettlebell) These TGU weights are what I used. Read the TGU description that follows for suggested male and female starting weights. Dumbbells can be used in place of kettlebells.

2SDL.

5 reps each leg 1SDL.

5 reps each leg FULL-RANGE SQUAT.

10 reps I've added the full-range squat because it's important to at least maintain (or have) the ability to perform this movement, even if our focus is on the deadlift.

Repeat this testing both Thursday and Sat.u.r.day to ensure that you haven't misdiagnosed imbalances. Use the same weights on Sat.u.r.day, but don't look at the number of reps completed on Thursday. Sat.u.r.day is, once again, to confirm that imbalances aren't just mistakes of some sort.

WEEKS 26: MONDAY AND FRIDAY, 3045 MINUTES PER SESSION FIXING.

Once you've identified your imbalances, the exercises for weeks 26 are designed to fix them.

If you can perform 10 a.s.s-to-heels squats with no weight, do the following in each workout (sets and reps are explained next):

1. Half-kneeling C&L 2. TGU.

3. 1SDL.