Monday, April 30, 2012

Weekend 5K and Keeping it Fun

This past weekend we spent Jess' birthday running in a local race called the Dig In 5K.  It was a race based on the premise of Earth Day.  Besides involving cup free racing with "hydropouch" it also featured medals made from recycled materials.  These are the types of races that make your day go from a good to a memorable one.
Jess wanted to start our her birthday with a run, despite spending the previous two nights celebrating.  We love running and spend much of our time together talking about running or plotting our running escapades.  The thing for us has always been that running provides a great reason for balance. We run because we can eat ice cream guilt free.  We run so we can stay out late that night with friends.  We run to have sexy legs.  We run to explore.  We run for our health.  We run for our happiness.  We run for our sanity.  We run because we love to run.  We've always found that using races to meet others that share one of your loves is the best way to keep yourself running.  The rest of the day when we explored historic Yorktown, ate 2,000 calories worth of seafood, and drank Legend Brown Ale like it was the last batch gave use more reasons to love what we do.  To us, that is keeping it fun, and everyone deserves to treat themselves.  Remember that as long as your doing what you love, you're never off the wagon.

Get out and do what you love!

Nick & Jess

Wednesday, April 25, 2012

Acute Hamstring Strain Rehabilitation Article Review

A physical therapy review and thoughts on "A Comparison of 2 Rehabilitation Programs in the Treatment of Acute Hamstring Strains" by Marc Sherry, PT and Thomas Best, MD, PhD.  Originally published in the Journal of Orthopaedic & Sports Physical Therapy.  This study was performed by researchers from the University of Wisconsin.  Volunteers with acute hamstring injuries were recruited from multiple sport backgrounds and randomized into groups.

The discussion here is based on the time to return to sport after acute injury (<10 days old) to the hamstring muscle complex.  Additionally, the rate of re-injury both at initial return and within a year after return were reported.  All of the volunteers had Grade 1, small or non-existant tearing, or Grade 2, partial tear, injuries.  Two separate programs for the athletes with recent hamstring strains were evaluated.  They were not separated by degree of injury and each group used athletes with both Grade 1 and 2 injuries.  The first group underwent static stretching, isolated progressive hamstring resistance exercise, and icing (from here will be referred to as SS group).  The second group performed progressive agility and trunk stabilization exercise combined with icing (PA group).

This study showed what we have seen as a increasing trend in rehabilitation in all levels of rehab.  More research and belief in "Full ROM and full range exercise" for stretching and return of pain free motion continues to compile.  The SS group is what many people would commonly do.  They rest it, stretch it lightly to tolerance, ice it, take pain meds, then slowly return to exercise and ramp it up as they feel better.  Can this work?  Of course it can!  Is it the best?  Research often will point to no for most individuals.  In this study, 54.5% of the individuals in the SS group re-injured their hamstring in 2 weeks, and 70% were re-injured within a year.  Comparatively, the PA group performing dynamic active range of motion (AROM) and full range exercise/plyometrics/agility training without further provocation of the injury showed a 0% re-injury rate within 2 weeks and a 7.7% re-injury rate within 1 year.  Additionally, the researchers reported the average return to sport for the SS group was 37.4 days compared to 22.2 days for the PA group.

Here is the program of the PA group divided into Phase 1 and Phase 2.  Patients were progressed when they were able to walk normally as well as march their symptomatic leg without pain.

The following information is from the article referenced at the top of this review and can be found in Table 5 of the original article.

PHASE ONE
  • low-to-moderate intensity sidestepping 3 x 1 minute
  • low-to-moderate intensity grapevine stepping in both directions 3 x 1 min
  • low-to-modeate intensity steps forward and backward over tapeline moving sideways 2 x 1 min
  • single leg stance 4 x 20 seconds progressing from eyes open to eyes closed
  • planking 4 x 20 seconds
  • supine extension bridging 4 x 20 seconds
  • side bridging 4 x 20 seconds on each side
  • Icing performed in long sitting x 20 minutes
PHASE TWO
  • moderate-to-high intensity sidestepping 3 x 1 minute
  • moderate-to-high intensity grapevine stepping in both directions 3 x 1 min
  • modeate-to-high intensity steps forward and backward while moving sideways 2 x 1 min
  • single leg stance windmill touches alternating sides 4 x 20 seconds
  • push up position into trunk rotation and upward reach with one hand, rotate sides 2 x 15
  • fast feet in place (running in place with quick steps) 4 x 20 seconds
  • PNF trunk pulldowns with thera-band, 2 x 15 each side
  • Practice of high speed activity including sprinting/cutting only performed if symptom-free
  • Continue ice if symptoms present
In summary, progressive pain free active range of motion, stabilization, dynamic stretching, and dynamic strengthening were shown to help return an athlete to sport sooner as well as reduce their future risk of re-injury.  If you would like some videos or pictures of these exercises please comment below.  In a future physical therapy review we will be posting that information as well.

Thanks for stopping by!

-Nick



Tuesday, April 24, 2012

Initial Review of Nike+ Fuelband

Out of the box I jumped to put my Fuelband on and determine what it could do for me and motivating daily fitness.  Would I want to take it for an immediate spin just like a new pair of shoes?
My first impressions are numerous: "Besides looking at steps and calories coinciding with the band, how do I really calculate what "Fuel" means?"  "Am I always going to need to press the button 4 times just to see the time?"  "Looks like I'll end up wearing it as a band and not a watch replacement. "  "Will I fall in love with competing with myself and the little colored dots?"

There's no doubt that someone who is a competitor will love the idea of the Fuelband.  Additionally, since it took multiple months to be able to get one at the normal price (which remains steep) I imagine it will keep you using it in order to validate such a purchase.  It is not a watch for an athlete by any means which may be the thing that limits my use of it the most.  I have a need for timing people during the day in my treatments and to make sure I'm in the right place, this wouldn't make it easy if that's something you need.  Nonetheless, the idea that the band (sadly unable to be used when swimming) can monitor activity at a price that is comparable to a high level accelerometer will be my primary focus in the future.

I hope as I go forward it becomes obvious that the little expensive band is a nice reminder what I have committed myself to and as Apolo Ohno would state, "[have] Zero Regrets".  Let me know what you think about the Nike Fuelband by commenting below including any interesting uses!  I'll see if I can answer some of my questions about it as well.

Thanks for stopping by.  Good luck with you exercise today!

-Nick

Sunday, April 22, 2012

Workout and Night Dates

Over the years Jess and I have found that being busy makes us happy.  I never love her more than when she gets me out the door and moving.  Today, she accompanied me after my morning run to the gym where we spent some quality spin time blasting "Europe Radio".  I'm not sure much is sexier than a little cycling chick rocking out to some classics like "The Final Countdown" and "Rock you like a Hurricane".  After our bike riding we spent the rest of our morning swimming laps and lounging in the hot tub at our fitness center.  I believe the importance of finding enjoyment in your activities whether it be with someone you love, friends, or acquaintances will always be what keeps you going.  Prior to Jess, that wasn't always easy for me.  I always had enough self-consciousness and worries to keep me far enough away from a good group of workout buddies.  What I found was that even a small question to ask someone about their exercising, or giving someone a spot at a bench can create and build a workout buddy.  Things may start small but when you know and like people at the gym it makes it that much easier to get to the gym or road.  Getting out is the best way to make and keep them.
 
That all may sound good; however, you never know how things are going to turn out unless you pursue them.  Luckily, for us it has turned out that we can keep each other exercising and each have someone to head to the Circus with when it's in town.  Taking my chances on the little cycling chick has made my heart rock.  I hope you find your groove and love it.
Have a great week of training and life!
-Nick

Saturday, April 21, 2012

Making Fitness Your Priority


Making Fitness Your Priority

There are a variety of reasons we may be motivated to maintain fitness.  We stay fit for our families, our health, athletic goals, and our looks, among other things.  Despite this obesity has crept up to epidemic status in America.  We need to make fitness a priority!

This week I attended a lecture by this title at work.  The health system I work for is taking on a new initiative to encourage fitness among their employees and many other companies are following suit.  Our modern sedentary lifestyles, both at home and in the workplace, are costly for us and for our employers.  Research has shown that healthier employees are more cost effective not just by being more productive but also by requiring less company expenses in terms of health care.  In fact many employers have taken note and are beginning to implement health insurance discounts for employees who demonstrate better fitness in terms of health markers such as tobacco use, blood pressure, blood glucose, cholesterol, and body mass index. 

The lecture on 'Making Fitness Your Priority' wasn’t just a plug for joining the company
wellness center, it sought to raise awareness of how sedentary many of us are and encouraged making time for physical activity throughout the day instead of just 30 minutes throughout the day before or after work.  According to Genevieve Healy, Ph.D., a research fellow at the Cancer Prevention Research Centre of the University of Queensland in Australia, “We've become so sedentary that 30 minutes a day at the gym may not do enough to counteract the detrimental effects of 8, 9, or 10 hours of sitting”.  Could this be the reason so many people still struggle with weight, blood sugar, and cholesterol woes despite keeping consistent workout routines?

In a recent study, Healy and her colleagues found that regardless of how much moderate to vigorous exercise participants did, those who took more breaks from sitting throughout the day had slimmer waists, lower body mass indexes, and healthier blood fat and blood sugar levels than those who sat the most.

We’re all aware that increasingly sedentary lifestyles have become a problem and working as a DPT I’ve seen first hand how a sedentary lifestyle can negatively impact one’s health, but now we’re finally compiling research to show just how detrimental prolonged sitting can be.

Doctors at the Mayo Clinic are calling this phenomenon "sitting disease" and liken current research into the ill effects of inactivity to the discovery of negative side effects from smoking. "Our bodies have evolved over millions of years to do one thing: move," says James Levine,M.D., Ph.D., of the Mayo Clinic in Rochester, Minnesota, and author of Move a Little, Lose a Lot. "As human beings, we evolved to stand upright. For thousands of generations, our environment demanded nearly constant physical activity." But thanks to technological advances, the internet, and an increasingly longer work week, that environment has disappeared.

A Vanderbilt University study of 6,300 people published in the American Journal of Epidemiology estimated that the average American spends 55% of waking time in sedentary behaviors such as sitting.  That is 7.7 hours per day spent in seated commute, seated work, and seated homelife!!  So chances are, you're reading this article sitting down. And if you're like most computer users, you've been in your chair for a while. PLEASE STAND UP!
Simply by standing, you burn three times as many calories as you do sitting! Muscle contractions, including the ones required for standing, trigger important processes related to the breakdown of fats and sugars.

When you sit for an extended period of time, your body starts to shut down at the metabolic level. When muscles (especially the big ones meant for movement, i.e. quads and gluts) are immobile, your circulation slows, you burn fewer calories, and the key fat-burning enzymes responsible for breaking down triglycerides simply start switching off.  Sit for a full day and those fat burners plummet by 50%!

And that’s not all. The less you move, the less blood sugar your body uses.  Research shows that for every two hours spent sitting, your chance of contracting diabetes goes up by 7%!. Your risk for heart disease goes up, too, because enzymes that keep blood fats in check are inactive. You're also more prone to depression due to less blood flow and consequently fewer feel-good hormones like endorphins circulating to your brain.

Sitting too much is also terrible for your posture and spine health.  When you sit for a prolonged period your hip flexors and hamstrings tighten and your core musculature becomes stiff and weak.  It’s no wonder that the incidence of chronic low back pain has increased threefold since the 1990s!

So if exercise alone isn't the solution, what is?  According to research from Dr. Levine and the Mayo Clinic the answer may be incorporating more non-exercise daily activity in addition to regular exercise aka ramping up your NEAT (non-exercise activity thermogenesis).  NEAT is the energy that you burn doing everything but exercise (folding laundry, tapping your toes, and simply standing up).  In the Mayo Clinic’s study on NEAT, motion sensors were used to track every single step and fidget of 20 people who weren't regular exercisers (half of them were obese; half were not) and after 10 days, they found that the lean participants moved an average of 150 minutes more per day than the overweight people did (enough to burn 350 calories or one cheeseburger). Additionally, Dr. Levine states that "NEAT activity can improve blood flow and increase the amount of serotonin available to the brain, so that your thinking becomes sharper and you'll be less likely to feel depressed."  

Here are 10 ways to move more during your day:

1.  Walk faster.  If there’s just one change you can make to get more fitness out of your days, try to pick up the pace each and every time you walk, whether it’s heading down a hallway, getting to your car, or enjoying nature. Walking at a faster pace burns more calories (nearly 100 more calories per hour), strengthens leg muscles, is great for your heart and lungs, and improves your attitude.

2. Take the stairs. You’ve heard that one a million times, but consider this:  taking the stairs can burn 5x as many calories as riding the elevator.  In fact, climbing stairs for two minutes, five days a week provides the same calorie burn as a 36-minute walk. Consider setting yourself a quota of say, 60 stairs per day; a typical staircase has 10 steps, so that’s six flights. Try going up or down a flight to use the rest rooms on another floor.

3.  Park on the perimeter. You’ve been hearing this one for years, too, but you might be surprised to learn how much exercise you get from leaving your car at the far edge of the parking lot. For example, if you park in the empty spot closest to a store entrance, you’ll walk 25-50 feet to the front door but parking at the far edge of the lot could mean walking 200-300 feet or more. And if you carry your shopping bags instead of using the cart you’ll build some more muscle along the way too.

4.  Go public. Take public transportation more often.  Riding the bus or train to work or other activities requires you to walk more, and the extra movement can have an impressive impact. Commuters in Charlotte, NC, who gave up driving and started taking a new light-rail system, lost more than six pounds in 18 months.

5.  Rearrange the office. The suggestion of installing treadmills at every workstation may not be a reality at your work, but there are a lot of other things you can do.  Move trash cans out of cubicles to make people walk to throw out garbage. Relocate water coolers by windows, where people will want to congregate. Get face-to-face; instead of e-mailing or calling colleagues, walk to their part of the building for some face time when you need to ask a question or solve a work issue.  When you do talk on the telephone, stand up and if possible, walk or pace. Consider trading your desk chair for a large stability ball.  Have walking meetings; skip the conference room, slip on some comfortable walking shoes, grab a small notepad and pen or a voice recorder, and invite colleagues for a stroll.

6. Add 15 minutes of walking to your lunch menu. Whether at work or at home, the typical lunch break lasts 30 to 60 minutes, but eating usually takes just 10 minutes. Spend your extra time walking, not sitting.

7.  Get your groove on.  Dance around while straightening up your house, washing dishes, or brushing your teeth. Dancing is both joyful and healthy; you don’t need a dance floor, special occasion, or even a partner to do it :o)

8.  Limit TV time to 2 hours per day.  In a study among women, the risk for metabolic syndrome (a combination of health woes including high blood pressure, high cholesterol, and high blood sugar) shoots up 26% for every hour per day they spend watching the tube. 

9.  Turn TV time into a workout.  Instead of sprawling out on the couch, try doing a few simple stretches or exercises during tube time. Take it a step further and use commercial breaks during as a chance to rise off the sofa and spend commercial time doing crunches or jumping jacks.

10.  Spend an hour per week outdoors, preferably much more. There’s a direct correlation between fitness levels and the amount of time you spend outdoors versus indoors. People who spend more time outside are more energized, upbeat, and fit. What to do outside? Pull weeds, walk the dog, practice your golf or tennis swing, mulch your flower beds, bird watch, visit a neighbor.

Think of your body as a computer… As long as you're moving the mouse and tapping the keys, all systems are go; but let it idle for a few minutes, and the machine goes into power-conservation mode. Your body is meant to be active, so when you sit and do nothing for too long, it shuts down and burns less energy. Getting consistent activity throughout the day keeps your metabolism in high gear. Fidgeting, standing, and puttering may even keep you off medications and out of the doctor's office!  Try to aim for 10 minutes of NEAT each hour.

Friday, April 20, 2012

Week In Review and Things to Come

What a rollercoaster of a week!  Last Friday and Saturday Jess and I were traveling from Hampton, VA where we currently reside working as traveling Physical Therapists to the great town of Alburtis, PA where my parents reside and all the way up to Boston, MA.  It was a great weekend to get a long visit in with my sister and brother-in-law and their beautiful home mixed with the bitter swallow that was my "3rd" Boston Marathon and coming up short on the course. 
Looking at this week as a whole, after returning to Virginia and resuming my daily life it shows the importance of being well-rounded in your life in order to be well-rounded in running.  Happiness surrounds me despite a personal feeling of failure.  Nothing is as inspiring to a runner who needs a pick me up when your family, friends, and co-workers will rally around you to keep you going. 
Don't get me wrong, a bad experience in one race is never a reason to quit.  The only way to truly learn in my opinion is to repeat the cycle of experience and thoughtful reflection on that experience.  I hope everyone has the chance in their endeavors to figure out what works for them whether it be through failures or successes.  Anyways, life is too much fun to dwell on one race and it's time to get some base work in for Chicago!

Jess and I are hoping to roll out a few more female-male blogs in the near future as well as expand upon our physical therapy and product review output.  Feel free to send any preferred body regions or other ideas our way; this is an area for all those anatomy/injury questions as well!  
Thanks for stopping by!  -Nick & Jess

Thursday, April 19, 2012

Therapy Review of Achilles Pain Part 1 (in the Heel)

Physical Therapy Review:  Achilles Injuries Part 1 of 3 (Pain in the Heel)

Being a runner, I have experienced many aches and pains.  Today, I thought I'd start with some thoughts on an injury that is very common to endurance athletes and can present with many different feels.
Usually divided in research, Achilles injuries can present in 3 general areas:  back of the heel, mid-tendon, and upper tendon/calf muscle region.  It is believed that most Achilles injuries felt by endurance athletes are primarily degenerative changes rather than inflammatory changes.  The caveat to this would be acute rupture, partial tear, or strain which would commonly be caused by an abnormal force rather than a on/off pain presenting during different periods of endurance exercise and waxing-waning in level.  I will focus on Achilles tendinopathies or degenerative changes due to my interest of addressing a common endurance athlete injury in this post.  If suffering an injury acutely, it is important to address the issue as soon as possible to prevent further damage.  Injuries that crop up from explosive activities or stepping into a surface that causes the leg to buckle should be professionally assessed and therefore will not be appropriate material for a blog such as this.  Injuries that do not accept weight are often fractures and should be professionally evaluated.

*It is important to remember to only do stretches and exercises that can be performed without causing additional injury.  This blog is meant for education and idea collection only.  It is important to understand your own body and to evaluate your need prior to deciding on trying any program of exercise as we are all different.  Please consult your primary physician or therapist as these exercises are done at your own risk.  Feel free to ask questions about how they are properly utilized and performed in someone who requires them.*  

1. PAIN IN THE HEEL
If pain is occurring in the heel there are usually a few different areas to treat to address the area under stress.  These areas include the bottom of the foot: primarily the plantar fascia, and the calf itself: composed of the gastrocnemius, soleus, and their transition into the Achilles tendon.

To focus treatment on those individuals suffering from pain in the heel I will demonstrate and discuss 5 different exercises commonly used by physical therapists for this presentation. Usually, both the calf muscle/achilles tendon and the plantar fascia have an involvement.

First, here is a simple video on performing myofascial release to the bottom of the foot:


Besides needing to improve my video creation skills, this video shows the tennis ball providing a stretch and massage to the muscles and fascia of the plantar aspect of the foot.  This procedure may feel uncomfortable and this would not necessarily be a reason to stop.  Stretching, fluid movement, and adhesion removal are all benefits of this exercise.

Second,  here is a simple stretch of the plantar fascia:
 
This video shows the heel being stabilized, followed by the ball of the foot being pressed towards the shin as well as the big toe being extended in order to stretch the bottom of the foot and plantar fascia.  This stretch can be tricky, but it helps to remember that you are trying to maximize the distance from your heel (calcaneus) to your big toe (first phalange) in order to provide the most beneficial stretch.  

Third,  a video of towel scrunching with your toes.  This exercise is meant to strengthen the intrinsic muscles of the foot:
 
Perform the exercise demonstrated in this video for 1 minute, and build to 2 or 3 minutes over the next couple weeks.

Fourth, a video of a gastrocnemius stretch.  This main calf muscle crosses the back of the knee and thus requires the knee being extended in order to provide a stretch.
 
Hold the gastrocnemius stretch for 30 seconds.  Repeat 3 times after running or lightly when the muscles is cold (not after warm-up or exercise).

Fifth, a video of a soleus stretch.  This important postural muscle located underneath the gastrocnemius does not cross the knee and is best stretched with the knee bent in order to assure the gastrocnemius is not limiting your soleus stretch.

Hold the soleus stretch for 30 seconds.  Repeat 3 times on a warm muscle or lightly on a cold muscle.


Try these 5 exercises daily and in combination with anti-inflammation techniques it is possible to greatly reduce your symptoms of pain in the heel.  Please comment or e-mail with any questions.

-Nick


Wednesday, April 18, 2012

Fall Marathon Cross Training Ideas

Starting Again:  A look at future training and cross training ideas with Chicago Marathon 24 Weeks Away

With a memorable Boston Marathon in the rear-view mirror it is time to look towards fall marathons.  This year my girlfriend, sister, friend, and I will be participating in the Chicago Marathon.  Along the way we anticipate many ups and downs during marathon training.
Last year I found a new love of running rocky and somewhat technical trails for marathon training.  It turned into my slowest and most miserable road marathon to this date.  A lesson learned in needing to stay focused on specificity of training in addition to enjoying your training and keeping it fresh.  Despite rock scrambling and hopping rattlesnakes being a great physical activity, it didn't promote the rhythm and speed of running that is required to run quickly on asphalt over 26.2 miles.  It did get me thinking however, what are the best cross-training activities to truly complement running?  It seems pretty apparent that corework, cycling, swimming, and weight-training are the chosen activities for cross-training in order to assist in training for a running race.  Personally, I believe in and love the addition of any of these activities to a routine.  Here are a couple activities I have also found to have a complimentary role that provide a little freshness to a weekly routine.  They are less commonly thought of as runner's activities but may be just as useful as that spin class or weight training.

Tennis:  So what does hitting a ball over a net have in common with running?  Well, like any sport you have to run to do it well!  More specifically though, it is a sport that requires socialization and a partner which keeps any individual happy while also providing: core stabilization while striking the ball, lightness on your feet to be ready to change directions in anticipation of the ball being returned, quickness and fine motor control in the footwork and placement, and prolonged raises of your heartbeat.

Soccer:  You probably played it as a kid, but when was the last time you tested your balance, speed, coordination, and endurance at such a level.  Soccer requires different gears than normal distance training.  Those gear changes tax your multiple energy systems and provide a shock to your body in terms of effort variation that mimics speed work.

Basketball:  One thing I learned quickly when playing basketball on the playground as a full grown adult is that you can't be shy.  It takes bumping, jumping, and quick cuts which provide great core and proximal hip strength.  YMCA membership is cheap and so is the local playground which make an occasional basketball game within reach and a way to provide a little variety along with free plyometric training included.  Grab a few buddies and give it a shot!  (pun intended)


I hope these sports can make you a well rounded and healthy individual as well as runner.  Always remember that running is the best training for running and that getting injured doing any of these sports can ruin your long preparations for a race.  Always listen to your body and know when it is right to push on or back off.  It is also important, as with running, to slowly build your participation in any new sport to reduce your risk for injury.  Despite this, you never know when an injury can bite you.  One thing I do know from experience is that nothing can bring you down quite like running with pain which is why I look forward to soon providing some ideas for exercises/stretches for a variety of musculoskeletal injuries that can occur with any of these activities.  In the meantime, do you have any races coming up this summer or fall?  Are there any injuries you're interested in discussing?  E-mail me or post a comment below.  I look forward to building this blog around those who benefit from the education as well as a comprehensive look at what I have learned and come to view after physical therapy school and a 20 year history of racing my bike and my feet.  Thanks for visiting, have a great day, and run healthy!

Cheers,
Nick

P.S.  Below is another great way to get great core and upper body strength while resting those long run beat legs of yours!

Tuesday, April 17, 2012

Welcome!

Welcome to my first official blog post on a blog meant to encourage an open discussion about running healthy, happy, and the benefits of voicing thoughts to learn about oneself.  I always find it easier to hear myself in a different forum that exists outside of my brain in order to learn about myself.  Hopefully, with some article reviews discussing injuries and running health as well as some real life experiences from my daily job working as an outpatient physical therapist I can answer and create questions that allow this blog to grow to a useful tool for my practice and any interested readers education.  Once again, thanks for reading and I hope to add some questions/answers/educational info soon.