Building and Maintaining: Good News!

http://well.blogs.nytimes.com/2010/12/29/phys-ed-if-you-are-fit-you-can-take-it-easy/

Whenever someone comes into my clinic with back pain, I always have the same conversation.  I tell them that I will work hard to help them decrease their pain and help restore their function.  But I also tell them that I can't guarantee that I will cure their back pain for ever.  Rather, I say that I will teach them ways to manage their backs for a lifetime.  I feel it is an important distinction to make so that people develop realistic expectations  about their condition.  I also don't believe that there is a singular cure for back pain.  There are just too many variables.  I certainly know that many conditions that cause back pain are very treatable in a variety of ways.  But whether a person is seeking help from an orthopedic doctor, a massage therapist, an acupuncturist, a chiropractor, or a physical therapist, I believe they should have realistic course of action laid out for them.  If somebody tells you, "I guarantee to eliminate your back pain forever," I would be skeptical and probably seek another opinion.

As a physical therapist, I rely on using active modalities (exercise) to address many physical ailments, including back pain.  This always involves developing a home exercise program for my patients.  Inevitably I am asked, "Do I have to do these exercises every day for the rest of my life in order to prevent the pain from recurring?" The answer is no.  First of all, if I tell somebody who is generally sedentary that they now have to do daily exercises forever, they will probably head for the door.  Instead, I let them know that once they begin to demonstrate strength gains from their routine, they can begin to dial back the frequency.  I tell them that I will give them a "box of tools" (i.e., stretching, strengthening, balancing, ergonomics, etc.) that they will be able to go to when they feel that their back (or other body part) may be starting to act up again.

I posted this article from the Times which cites some studies that should be encouraging for everybody, pain or no pain.  Just like my patients, I think that people want to know that they can derive health benefits without having to put too much time and effort into exercise.  The answer is yes, you can.  The initial stages of getting into shape are generally the most arduous and painful, which is why most people throw in the towel on their fitness resolutions.  But if you can just get to the top of that mountain, then the rewards can be great.  And they can be maintained with much less time and energy!  That is the key.  I've known this through practice and personal experience, but I think these studies clarify this point.

The bottom line is this.  To build any machine takes time and effort, but to maintain it requires much less of each.  Our bodies are the world's most complex machines and this same principal applies.  If you can just get past the initial difficult stages, the rest should be smooth sailing.  Your body (and mind) will be very appreciative!

Escalators: Rides or Opportunities?

http://nyti.ms/wlTYfi

The above article on interval training caught my eye last week.  It discusses the benefits of performing high-intensity exercise interspersed with light or moderate intensity periods.  One of the primary benefits of interval training is that it takes much less time than your typical gym workout.  With interval training, people have a harder time relying on the excuse, "I just don't have the time."

A few years ago the American Medical Association (AMA) changed it's guidelines for the amount of exercise recommended for good health.  Rather than 3-5 times a week of 30 minutes of moderate activity, they said people required 7 days a week of 1 hour of moderate to intense exercise.  I hated reading that and thought it was the wrong message to send.  I thought that by setting the bar so high, more people would be inclined to throw in the towel on regular exercise all together.  I felt that people would say, "It's so far out of reach that I'm not going to bother doing anything at all."

Another study demonstrated why interval training works.  In a test with two individuals, one ran on a treadmill for 60 minutes at a steady moderate pace.  The other ran for 20 minutes doing bouts of intense running (one minute at a time), interspersed with periods of light jogging for 3 minutes.  At the end of the exercise period, the person running for a longer period had burned more calories than the interval trainer.  However, as the post-exercise hours wore on, the interval trainer burned significantly more calories than the steady-eddie runner.  In essence, the interval trained individual kept their internal furnace stoked much longer than the steady pacer.  Hence the benefits of interval training; more calories burned with less time spend exercising.  What's not to like?

My feeling as that ANY exercise, no matter how small, will have cumulative health benefits.  Every day I have to take a long escalator on 53rd and Lexington.  Most people choose to stand to the right, missing a great opportunity to get 30 seconds of FREE exercise!  Why not walk up escalators, or walk on people movers at the airport rather than just stand there?  You will not only get to your destination faster, but you will get there healthier.  There are free stair masters every where you go (and in most homes).  Stairs are one of the best ways to get in a quick "interval" training session.  Another opportunity for "free" exercise can be found in parking lots.  Rather than waste time looking for the closest spot, why not just park a little further and fast-walk to your destination.  These are not ground-breaking ideas, but they're simple examples of how to make yourselves healthier throughout the course of your ordinary work day.  No gym fees required.

"Excuse Me, But......."

Last week I was in my local gym and saw a guy (maybe in his late 20s) performing barbell squats with 135 lbs.  Everything about his form made me cringe because he looked like an accident waiting to happen.  His knees buckled inward, his lower back rounded out, and his movement was choppy and fast rather than smooth and controlled.  Probably the only reason this guy was getting away with his terrible form was that he is still pretty young.  So what did I do or say?  Nothing.

While I am not a trainer, I certainly know biomechanics and understand mechanisms of injury, so I feel qualified to instruct someone on such things as squatting form.  But in my 10 years of being a practicing physical therapist, I've NEVER offered unsolicited advice.  This goes for settings outside of the gym as well.  Another example of seeing something without saying something is when I see a person using a cane that does not fit them properly.  I see it all the time, a person walking down the street, his or her shoulder hunched up because the cane is too long.  The cane may be offering stability, but in the long run that person will likely end up with shoulder and neck pain.  But again, I've never stopped anyone and offered advice.

After my observation of the poor form squatter, I asked a few patients and two fellow therapists what they would do in a situation like the one I described.  The responses among this small sample size were very mixed.  One of the patients said, "Yes", they would absolutely appreciate if someone intervened with the good intention of injury prevention.  Another responded that their pride might make them put their guard up if approached unsolicited.  One of the therapists said he would never say anything because what if, god forbid, the stranger took your advice and ended up getting hurt anyway?  I found it interesting that the responses varied so much, and it made me more curios.  Hence this blog.

I would love to hear from you what you think.  Would you appreciate unsolicited advice on injury prevention?  Or would you find it annoying to be approached?  I suspect that your responses will also be varied.  My suspicion is that most guys would respond, if approached in the gym, "Thanks, but I'm good."  Maybe the women might feel like they were simply being hit on.  I've definitely seen that happen and it's usually a cringe-worthy moment.

So I'm asking for your thoughts on this topic.  If approached in the gym (or elsewhere, for that matter) by a physical therapist or another healthcare professional familiar with biomechanics, would you be open or closed to advice?

What is My Rotator Cuff, and Why Should I Care?

Last week, as I was preparing to depart from a flight, I noticed the woman next to me struggling to lift her arm above shoulder height.  I overheard her mention to her friend that she's been struggling with her shoulder for months.  I asked her what was going on with her shoulder after explaining that I am a physical therapist.  She responded that she had adhesive capsulitis, which is a painful condition that restricts movement.  What struck me was that this relatively young woman (maybe 50's?) didn't stand a chance of reaching overhead to get her bag.  It was a clear example of impairment negatively impacting function.  Nobody should have to deal with such a thing, in my opinion.

I am choosing to write briefly about shoulder pain because I've seen a lot of friends dealing with it recently.  The shoulder is a great joint, with a ton of available range of motion that allows us to perform a myriad of tasks.  But the downside of having all this functional movement is that the joint is not necessarily the most stable (as compared to the hip).  In addition, when we lift our arms overhead, or reach in certain positions, a lot of important structures are prone to being impinged (pinched).  If this impingement happens for too long in a repetitive fashion, these tissue can become inflamed and ultimately wear down.  This is where your all-important rotator cuff comes into play.

You've all likely heard about rotator cuff injuries, especially if you are a fan of sports requiring a throwing motion.  But what exactly is it?  The rotator cuff is a series of four relatively small muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) that come together in a common tendon at the top of your shoulder (deep to the large deltoid muscles that give the shoulder definition).  It's main purpose is to center the head of your humerus (the long bone in your upper arm) in the shallow socket in which it resides, called the glenoid cavity.  The shoulder is a ball-in-socket joint.  When you move your arm overhead, or into extension, or to reach behind your back to scratch an itch, the ball has to roll and glide within this shallow socket.  The large deltoid muscles (which give the shoulder it's rounded appearance) is the primary mover of your arm away from your body (along with a bunch of other muscle actions that simultaneously occur).  If the deltoids are overdeveloped from doing a lot of shoulder presses at the gym, they run the risk of overpowering an unfit rotator cuff.  Without the rotator cuff working well to maintain the head of your humerus in it's proper position, the deltoid will end up overpowering it and you'll increase your chances of developing shoulder pain.

As I've stated in previous blogs, these rotator cuff syndromes are more likely to develop in people in their 30's and above.  Tissues are not quite as flexible and extensible as we get older, making them more susceptible to wear and tear.  If the mechanics of the shoulder are interrupted, then these tendons may wind up becoming damaged.  The entire shoulder complex can get thrown out of whack simply by poor habitual posture caused by mundane things such as prolonged sitting (i.e., at work).  Once these tissues become inflamed, simple acts such as washing one's hair or sleeping with your arm raised above your head can become a painful endeavor.  

As always, there is a solution to this potentially painful and limiting condition.  Now, I should say that there are certainly cases where the rotator cuff tendons are damaged to the point of requiring surgical intervention.  Traumatic events such as falling on an outstretched hand can be enough to tear the rotator cuff.  The extent and exact location of the damage plays a big role in determining the type of intervention that may be most effective.  But for non-traumatic shoulder pain, very often some basic strengthening of the rotator cuff muscles can do the trick.  They can be done with a simple tool call a resistance band (Theraband), a light dumbbell, or a cable column at the gym.  These are not exercises that require lifting a lot of weight.  Rather, you'd be better served doing higher repetitions with lower resistance in order to build your rotator cuff endurance.  In cases where the condition is chronic (lasting more than 6 months), it's very likely that restrictive scar tissue and adhesions have developed in the area.  Before undertaking strengthening exercises to improve rotator cuff function, it's important to release those muscles through certain soft tissue techniques.  This will help to restore the proper muscle length in order to train the muscle properly.  I have seen these soft tissue interventions work very effectively in the clinic with great results.

If you are experiencing any pain in you shoulder that is detracting from your life, please feel free to give me a call.  I would be happy to offer you some advice to help you out, or explain how to perform the above referenced exercises.