Category Archives: Fitness

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Q & A: My Top 10 Supplement Recommendations

Q.  Ben, you often recommend different supplements as part of treatment recommendations as well as for sports performance or recovery. Which supplements do you actually use?  -Seth

A.  Thanks, Seth, for this excellent question! Opinions on the best supplements to use vary widely and can be quite controversial. Your dietary belief system and what type of exercise or activity you mainly participate in will determine which supplements may work best for you.

I tend to use certain supplements, such as protein, coconut oil, magnesium and super greens, on a regular basis.  I take Creatine more intermittently as part of a cycling protocol.  I use other supplements intermittently for a specific purpose such as fueling for a long run or improved recovery.  I have tried many different types of supplements.  I have personally experienced the most benefits from consuming these specific supplements.

ProteinPowder

My Top 10 Supplement Recommendations:

1.  Protein.  I prefer to supplement with a plant-based protein source because I regularly consume animal-based protein.  Lifetime Life’s Basics Plant Protein is an organic vegan option that contains a blend of proteins which makes a complete amino acid profile. I prefer the vanilla, but it’s available in chocolate as well. It doesn’t have any other preservatives, chemicals or sweeteners. If you are used to mass produced supplements, your taste buds will have to adjust.

I also supplement with a goat-based protein source.  Goat protein is a smaller particle size and may be more easily digested and utilized by the body.  Mt. Capra Double Bonded Goat Milk Protein is an organic goat-based protein. Mt. Capra offers multiple flavor options. I prefer the chocolate, which is only flavored with organic cocoa powder. It doesn’t have any preservatives, chemicals or sweeteners. Again, if you are used to mass produced supplements, your taste buds will have to adjust.

If you’re interested in a whey supplement, Thorne Research Whey Protein Isolate doesn’t contain artificial flavors, colors, sweeteners, carrageenan or gluten. It is sourced from cows not treated with hormones.  For more information on protein supplementation, please refer to How Much Protein Do I Really Need?

2.  Amino Acids. Branch chain amino acids (BCAA) are the building blocks to protein. Runners and endurance athletes should pay particular attention to protein intake as maintaining muscle mass is critical for performance and injury prevention. Consuming amino acids before and during endurance events is an excellent method to keep your blood sugar stable and to maintain a high level of performance. It is also muscle sparing. You are more likely to metabolize energy from fats or carbohydrates stores (rather than muscle) when there are plenty of BCAA particles floating around in your digestive system and blood stream. I often combine supplementing BCAA with a carbohydrate fuel source such as Generation UCAN SuperStarch. If you prefer a ready-made product, I recommend Hammer Nutrition Perpetuem Ultra Endurance Fuel, which includes a carbohydrate source, protein, and fat source, and Hammer Nutrition Hammer Gel, which contains some amino acids.

3.  Creatine.  Creatine monohydrate is helpful for increasing skeletal muscle size, strength, and power production.  It may also have a preventative effect for dementia and neurodegenerative diseases.  I recommend 5 g per day.  I typically consume it in 6-8 week cycles.

4.  CapraFlex.  My most recommended supplement to help recover from injury is CapraFlex by Mt. Capra.  It combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation.  CapraFlex can be taken long term or intermittently.  I use it to help recover from acute injury.  I also use it as a preventative measure when in periods of high volume or high intensity training (HIT).  For instance, I consume it during the final month of preparation for a race or an event.

5.  Generation UCAN SuperStarch.  Generation UCAN produces my favorite synthetic carbohydrate source.  Generation UCAN SuperStarch is a gluten-free complex carbohydrate that is non-GMO.  It has been specially formulated to stabilize blood sugar and not cause an insulin reaction.  I typically utilize this product for any prolonged activity which exceeds 1.5 hours.  Although it can be consumed throughout a race or prolonged activity, I typically consume a serving along with BCAA at the beginning of my activity.  If additional fuel is needed during a longer run which exceeds 2 hours, then I typically utilize Hammer Nutrition Perpetuem Ultra Endurance Fuel and Hammer Nutrition Hammer Gel.

6.  Magnesium.  I use magnesium as a sleep and recovery aid.  I consume it at night to help me sleep.  This has been a major benefit for me as it significantly reduces muscle soreness, cramps and/or spasms.  You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates.  Most people are deficient in the amount of magnesium they consume on a regular basis.  I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed.  I would caution you that taking too much magnesium can lead to diarrhea.  Mag Glycinate in its oral form is the most highly absorbable.  Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

7.  Cinnamon.  Cinnamon is a spice that has cholesterol lowering benefits and antifungal properties. It can reduce the proliferation of leukemia and lymphoma cancer cells. It has an anti-clotting effect on the blood which can reduce your risk of stroke or heart attack. Cinnamon may help treat Type 2 Diabetes by lowering blood sugar levels and increasing the amount of insulin production in the body.

The primary reason why I consume cinnamon is to stabilize blood sugar. Although I love the taste of cinnamon, you cannot eat enough to gain the noted health benefits. It must be consumed in a supplement form. I take about 1 g of cinnamon prior to consuming a high carbohydrate meal (particularly if I have not recently exercised). My blood sugar remains more stable, and I feel better between meals.

8.  Caffeine.  Many supplements contain caffeine.  If you avoid caffeine, then you should continue to do so.  Caffeine has many health and fitness benefits when used appropriately.  Caffeine has been proven to increase cognitive performance.  It may also help to mobilize fat stores, which aids your body’s ability to use fat as a primary fuel source.  Better fat utilization can help to stabilize blood sugar and increase your energy levels.  This may allow you to participate in longer bouts of exercise or push yourself harder during your high intensity training (HIT) workouts.

One way in which caffeine improves performance is by sparing glycogen.  Glycogen is your body’s preferred fuel source (particularly during the first 15 minutes of exercise).  The sparing of glycogen can help you to transition from primarily carbohydrate utilization to fat utilization.  Caffeine peaks in absorption approximately 45 to 60 minutes after ingestion, but it likely has a much longer effect on fat utilization.

Caffeine has also been shown to lower submaximal heart rate.  When considering a long distance event, this can be very beneficial in how long you can sustain your pace (meaning that you can push yourself harder for longer).  Unfortunately, it has not yet been proven to lower maximal heart rate during maximal exercise such as HIT.  This means its best indication for use is likely during submaximal activity such as distance running.  The approximate amount needed for ergogenic benefits is 3 mg of caffeine per kilogram of body weight or 3 mg for every 2.2 pounds of body weight.

If you weigh 150 lbs., divide that by 2.2 lbs. which equals approximately 68 lbs.  Next, multiple 68 lbs. by 3 mg for your needed caffeine dose.  In this example, 204 mg of caffeine is needed for a person who weighs 150 lbs. 

I recommend ingesting caffeine at least 15 minutes prior to your run and approximately every 45 minutes (depending how long you will be running).  I would not over consume caffeine as potential side effects include: poor sleep quality; gastrointestinal distress; headaches; muscle cramping; and dehydration.  Caffeine is a mild diuretic and can cause anxiety.  If you are already taking a diuretic, please consult with your physician about using caffeine as an ergogenic or cognitive aid.

9.  Super Greens.  Most people do not consume enough greens.  Green super foods, such as spirolina and wheat grass, are packed high in antioxidants.  They can have a cleansing and an alkalizing effect.  Super greens boost your immune system and are generally good for you.  Super greens should be consumed daily, but it’s particularly important to supplement with during times of high stress (including high training stress).  Amazing Grass Green SuperFood is easily consumed in a powder form and typically tastes best when mixed in with food.  I usually mix it into hot oatmeal or a smoothie.  You can also utilize a pill form.  Energy Bits is spirolina in a pill form.  I have utilized Energy Bits as part of a fueling plan for longer runs and activities with great success.  I found them to have a blood sugar stabilizing effect while keeping my energy levels high.  I also combined Energy Bits with Generation UCAN SuperStarch which seems to work particularly well.

10.  Coconut Oil.  I typically purchase Kirkland Organic Coconut Oil at Costco.  Nature’s Way Coconut Oil is another option. I typically mix a protein supplement into my black coffee along with a teaspoon of organic coconut oil, which is full of medium chain triglycerides (MCTs).  Coconut oil does not negatively affect cholesterol levels. It has no added flavor. It helps to stabilize my blood sugar and keeps me satiated for hours.

Coconut oil offers many health benefits including:

  • Helps to stabilize blood sugar
  • Helps metabolize energy stores more efficiently
  • May have protective effects on brain related disorders
  • Reduces the risk of illness and infections
  • Helps to control hunger cravings
  • Reduces the risk of seizures and heart disease
  • Moisturizes skin
  • Helps children’s brains develop by providing the correct nutritional building blocks for the nervous system

When choosing supplements, I tend to gravitate to supplements that can enhance performance, improve recovery, stabilize blood sugar or reduce inflammation.  The ultimate goal with supplements is to aid your body in improving health and/or performance.  Try to choose the most natural products as possible and experiment to see what works best for you.  For a glimpse into my medicine cabinet (and other recommended products that I personally use), please visit my Resource Guide.  Thanks, Seth, for your question!

What is your favorite supplement and why?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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Exercise is an Effective Treatment for Knee Arthritis Pain

Knee osteoarthritis (OA) causes chronic pain, reduces physical function, and diminishes quality of life. Obesity, prior injury, and increasing age are among the risk factors for knee OA, which is more common in women. Typical treatments for knee OA include total joint replacement and exercise. Medication management may include oral anti-inflammatory use, cortisone injection, and supplementation with glucosamine and chondroitin.

A recent meta-analysis of 54 randomized control studies, published in Cochrane Database (January 2015), concluded that therapeutic exercise provides a 2-6 month benefit even after cessation of the exercise program. This benefit is comparable to the use of non-steroidal anti-inflammatory drugs without the side effect risk from drugs. The study concluded that exercise is just as effective in treating knee OA pain as anti-inflammatory medication.

This most recent study looked at 2-6 month benefit when performing exercise. It is reasonable to conclude that long term therapeutic exercise continues to have a positive effect in pain management and functional loss well beyond the 2-6 month time frame. Performing therapeutic exercises improves physical function and alleviates pain levels with little risk. When properly performed, exercise doesn’t significantly increase the risk of further damage or deterioration in OA (or in most other forms of arthritis).

The study also indicated that individually tailored exercise programs tend to result in a greater reduction in pain as well as improvement in physical function. If you suffer from knee OA, initiating a therapeutic exercise program could be the best long term solution in managing the condition while maintaining function and quality of life.  A thorough therapeutic exercise program should include cardiovascular exercise, flexibility training, balance activities, and strength training. Seek guidance from a physical therapist, who can design an individually tailored exercise program to meet your specific needs.

Possible options for cardiovascular exercise include bicycling, rowing, and the elliptical machine. Less impact options include swimming and pool-based exercise programs. Exercise studies indicate the effectiveness of aquatic-based programs in reducing knee pain while improving general functional mobility. Performing a long term aquatic exercise program can be highly effective for managing knee OA symptoms. To insure maximal strength gains and carry over in functional mobility tasks (such as going up and down stairs, up and down curbs, and navigating uneven terrain), also incorporate a land-based program.Image courtesy of Pond5Flexibility is an important component in managing knee OA pain. The goal should be to maintain full knee range of motion (ROM) with both extension (straightening) and flexion (bending). A joint should be moved through its full available ROM daily to remain healthy. Activities such as aquatic exercise, cycling, yoga, and flexibility classes are ideal for maintaining ROM.

Balance is an important component to maintaining functional mobility and limiting pain in the knee. Performing therapeutic exercises and weight training will help you to maintain your balance. Additional balancing activities should be performed to insure safe mobility and to reduce the risk of falling. Activities, such as yoga and Tai Chi, have excellent research demonstrating their effectiveness. Practice standing on one foot (near a counter top for support, if needed). It is an easy and effective method to maintain single leg balance which is critical for going up or down stairs and sidewalk curbs.

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Strength training programs should include closed chain exercises. Closed chain exercises are closely related to functional movements and tend to cause less strain on your body tissues and joint surfaces. Squats, lunges, and bridging are examples of closed chain exercises. The bridge exercise involves lying flat on your back and raising your pelvis up into the air.

There are many variations of the squat. Perform sit to stands from a chair. If this is difficult, start with using your hands, but eventually you shouldn’t need to use them. Use a standard height chair and see how many sit to stands you can perform in 30 seconds.

For another squat variation, perform wall squats.  Stand with your pelvis, back, and head touching a wall.  Your feet will be approximately hip width apart and far enough out from the wall.  When you slide down, your knees will make a 90 degree angle.  From your starting position, slowly lower your body down and hold for time.  As you improve, lengthen the amount of time you hold the wall squat.  (Another variation is to place an exercise band around your thighs above your knees.  It will help to increase the activation of the hip muscles.)

Wall Squat

To maintain physical function and quality of life, a therapeutic exercise program (including cardiovascular, flexibility, balance, and strength training) may be the best long term solution for managing knee OA pain. Be certain to perform a thorough warm up and cool down before and after each exercise session. Focus on maintaining your ROM. If it hurts, modify or discontinue the activity, and refer to your physical therapist.

How do you incorporate cardiovascular exercise, flexibility training, balance activities, and strength training into your therapeutic exercise program? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

(This article first appeared in the Seniors Blue Book, April-September 2015, pages 106 and 107).

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Q & A: Is Weight Training Safe for Children?

Q.  My son is 11 years old and wants to start lifting weights with me. Is it safe for him to do this at such a young age?  -Matt

A.  Great question, Matt! I believe weight training and activity in general should be encouraged in whatever form the child prefers.  Research regarding the effects of heavy weight training or high intensity training in younger children continues to evolve.  The long standing belief that weight lifting will stunt a child’s growth has never been proven.  In fact, current research indicates that weight lifting may actual help to increase a child’s growth rate.  This may be due to hormonal improvements or actual physical stress (in response to the training) on the child’s body.  Most likely, the positive effect on growth rate is due to a combination of both factors.

When addressing weight training, keep in mind that children’s physical, mental, and emotional development will vary widely and is not necessarily correlated to their chronological age.  Most children will have varying degrees of muscle strength and asymmetry in that strength as they grow and develop.  Encouraging activity and exercise is a critical component to how the child will ultimately develop.  When choosing which type of activity and exercise is appropriate for a child, his/her physical, mental, and emotional development need to be considered.

Physiological considerations include:

  • Growth Plates. The epiphyseal plate (growth plate), which is a cartilaginous plate at each end of a long bone, in children typically closes between 18-25 years old. It is most active when the child is younger. There is no evidence that weight lifting will negatively affect the growth plates. The question that research has failed to answer is: How much stress and strain is too much? A child’s boney structure is not the same as that of an adult. Lifting excessively heavy loads with poor technique could cause damage to these growth plates. In order to insure your child’s safety and limit the risk of injury, his/her weight lifting schedule or program should not be the same as that of an adult.
  • Muscle Strength. Adolescent muscle development will vary widely. It’s highly dependent on proper hormonal balance. Most children don’t have the proper hormonal balance to develop muscle like an adult. Therefore, a child should not be trained as an adult.

Weight training can be appropriate at a young age.  Focus on learning the techniques while developing proper motor patterns and motor control (particularly, if he/she is performing advanced activities such as Olympic weight lifting).  Children’s growth and development tends to occur in spurts.  They often have evolving issues with muscle tightness and asymmetric muscle development.  A weight lifting program that stresses proper movement patterns and full range of motion (ROM) is an excellent method to help insure proper muscle development.  Weight lifting is just one of many training activities for a child.  I highly encourage children to participate in many different activities in order to develop a wide physiological and neurological baseline.

Alexis_Squat

Consider the following when designing a training program for your child:

  • Keep it fun! This is your child’s time to learn and have fun. There is no need to push heavy weights on his/her young body. However, it’s perfectly acceptable to progress strength gains when he/she is able.
  • Develop proper motor programs. Focus on optimizing patterns and mobility. A weight lifting program that stresses proper movement patterns and full range of motion (ROM) is an excellent method to help insure proper muscle development.
  • Encourage variety. For other strength development and motor program development options, encourage body weight exercises such as the TRX system. A CrossFit class, designed specifically for kids, may also be fun option.
  • Proper programming. A child should not be trained as an adult. The exercise programming should be tailored to your child. I recommend an emphasis on technique and a slower progression of resistance and load compared to that of an adult. For young children, double the time it takes for an adult to progress the load. Physical ability will widely vary in the teenage years. Focus on form and technique while developing proper movement patterns. Encourage participation in many different activities in order to develop a wide physiological and neurological baseline. Training volume should be less than an adult.

If your child is experiencing pain or you suspect a developing problem, consult your pediatric physician or a qualified physical therapist about your concerns.  I would also caution you that many pediatric physicians may not be too keen on the idea of weight training in pre-teen children.  Seek a physician who is open to the idea and can work with you and your child to insure optimal health.

As parents, we want to encourage activity and exercise while instilling a life time love of exercise in all of its many forms.  When weight training at a young age, focus on proper ROM and symmetrical strength development.  Thanks, Matt, for the question!

Does your child lift weights and/or participate in sports such as CrossFit?  Why or why not?  Please share your thoughts below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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Q & A: Should Children Run Long Distances?

Q.  My son is 14 years old.  He wants to run a marathon this summer.  He has participated in many races ranging from 5k to 5 miles in the past.  Is long distance running safe for children?  -Mark

A.  Thanks, Mark, for this great question! The topic of children running extreme distances from marathons to ultra-marathons is still debatable (as is strength training in younger children).  In general, the science and research supporting adolescent runners is inconclusive and continues to evolve.  Children’s physical, mental, and emotional development varies widely and isn’t necessarily correlated to chronological age.  When choosing which type of activity and exercise is appropriate for a child, his/her physical, mental, and emotional development need to be considered.

I believe that children are capable of running longer distances even at an early age although most will not want to.  The real question is: Should they?  Running and activity should be encouraged in whatever form the child prefers.  There has been very little research on the effects of long distance mileage on younger children.  Physiological considerations include:

  • Growth Plates. The epiphyseal plate (growth plate), which is a cartilaginous plate at each end of a long bone, in children typically closes between 18-25 years old. It is most active when the child is younger. Excessive stress (either in the form of overload such as weight lifting very heavy loads with poor technique or repetitive loading such as running long distances) could cause damage to these growth plates, which affects the child’s ability to properly grow.
  • Muscle Strength. A child’s muscle development is not the same as that of an adult. This means that the repetitive strain of long distance running (particularly on hard surfaces) could again increase the risk of repetitive motion injuries. A child’s musculature may not be mature enough to handle the repetitive load.
  • Energy Metabolism. Children typically have a very high metabolism. They require more carbohydrates than adults as well as additional fat consumption to insure adequate cholesterol to promote normal brain development. A child’s ability to store carbohydrates is less than that of an adult due to a smaller body mass size. Issues with fueling during longer runs could have more consequences for younger runners.

A child’s ability to tolerate longer distances will widely vary based on his/her physical, mental, and emotional development.  If a younger child desires to run a long distance race, then he/she will require supervision.  A healthy eating plan that is high in fat and protein is critical.  A proper fueling plan for carbohydrate intake will insure that the child acquires additional nutrients for the activity and for normal growth and development.

Typically, younger kids and teens will not be as proficient of runners compared to most adults because children’s lungs and VO2 max don’t peak until the 20s.  However, they can run surprisingly fast!  A younger child’s body is more adept at handling shorter distance intervals or bursts of running than longer distances.

Running

Consider the following when determining if long distance running is appropriate for your child:

  • Assess your child’s physical, mental, and emotional development.  Could he/she handle long distance running in these three crucial areas?
  • What kind of surface will the majority of the running take place on? I highly advise grass, trail or dirt path versus concrete and sidewalks. Definitely avoid long runs on hard surfaces. Keep to softer surfaces, such as dirt or grass, when possible. This decreases the strain on a child’s growth plates and body in general.
  • What is the anticipated training volume? How many actual miles of running? I would advise a lower mileage program.
  • A proper fueling and rehydrating plan must be addressed. This needs to be closely monitored by a parent (and not only by the child involved).
  • Consider tackling a shorter distance such as the half marathon. Increase the mileage as the child ages and matures.

A new runner (of any age) should spend more time initially working on an adequate running base and proper running form.  Encourage your child to develop good habits and proper technique now, so that running can be a lifelong pursuit.

I’m a supporter of children who participate in cross country programs at school.  It provides an opportunity to run 3-5 mile distances regularly on softer surfaces while developing a wonderful base (and comradery as well).  I also highly encourage children to participate in a school track program.  Run different distances, such as the 800 or 1200 meter distance, in order to develop proper running form and technique.  It also helps to develop the child’s ability to run faster, not just longer.

Encourage your child to be active and participate in various activities.  If he/she desires to engage in long distance running, progress slowly and closely monitor for any symptoms of pain or injury.  If you suspect a developing problem, consult your pediatric physician about your concerns.  I would also caution you that many pediatric physicians may not be too keen on the idea of long distance running in pre-teen children.  Seek a physician who is open to the idea and can work with you and your child to insure optimal health.

Pre-teens and teens are best suited for shorter distance running, but with proper training they could safely run longer distances (ranging from the 10k to the half marathon).  Most children’s physical, mental, and emotional development is not suitable for running distances such as the marathon and especially, ultra-marathons.  I typically don’t recommend those distances until at least mid to late teens.  If attempted, special care should be taken to avoid over taxing their young bodies.

Thanks, Mark, for the question.  I wish you and your son all the best in his future running endeavors!

Do you have a child or know of one who has participated in long distance racing?  Please share your thoughts below. 

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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14 Tips and Strategies to Self-Treat Muscle Pain

Muscle pain is common and often occurs after exercise or activity.  Although the pain is uncomfortable, most types of muscle pain are benign and quickly pass.  Muscle aches and pains can affect your ability to compete or train at a high level.  It also can affect your sleep and mood.  Discover the possible causes of muscle pain as well as prevention and treatment strategies.

Possible Causes of Muscle Pain include:

  • Delayed Onset Muscle Soreness (DOMS). This soreness typically occurs 24-48 hours after an exercise session due to micro trauma within the muscle tissue. It tends to be worse after eccentric biased exercise where the muscle is lengthened.
  • Muscle Strain. If you strain your muscle either by over lengthening or over exerting the muscle capacity, muscle tearing may occur. Depending on the size and location of the tear, it may range from minor to severe (potentially needing surgical intervention).
  • Myofascial Issues. Layers of the myofascia (the dense, tough tissue which surrounds and covers all of your muscles and bones) may become bunched or knotted up and result in pain. This is typically due to poor posture, repetitive motion injuries or over exertion.
  • Neurological Issues. Many neurological disorders, including pinched nerves, can cause pain. Other medical conditions, such as muscular dystrophy, cause muscle dystonia.
  • Illness. Muscle pain can occur as a symptom in colds, flu, Rocky Mountain Spotted Fever, and other viral or bacterial infections.
  • Disease. Many diseases, such as Polio, Lupus, and Lyme’s Disease, cause muscle pain.
  • Medications. Certain medications, such as statin drugs for cholesterol, have been strongly associated with muscle pain.
  • Fibromyalgia. This condition causes muscle pain, joint pain, and extreme fatigue.
  • Rhabdomyolysis. A serious condition, due to either direct or indirect muscle trauma, which causes pain. It can be life threating due to the potential for kidney failure. Common causes include extreme exercise, statin medication, severe injury or illicit drug use.
  • Compartment Syndrome. A serious condition in which excessive swelling and pressure build up in a confined space. It leads to extreme muscle pain and eventually, numbness and tissue death.

This list highlights some of the many potential causes of muscle pain.  Many are benign while others are true medical emergencies.  The most common reasons include: delayed onset muscle soreness (DOMS); muscle strains; myofascial related issues due to posture and/or repetitive motion injuries; and fibromyalgia.

In order to properly treat muscle pain, first identify the cause of your muscle pain.  Can you correlate the symptoms with a certain activity or exercise?  Are you suffering from a cold or flu like symptoms?  If you are unable to correlate a reason for the pain, then you may consider consulting with your medical physician to rule out other possible causes for muscle pain.

Young man experiencing neck pain against a white background

The following tips and strategies to treat muscle soreness specifically address mechanical causes related to DOMS, minor muscle strains, and myofascial issues.  Many of these strategies are also appropriate in helping to manage fibromyalgia symptoms.

14 Tips and Strategies to Self-Treat Muscle Pain: 

  1. Fix Your Posture. Poor posture is one of the most common causes of muscle spasming and pain. This is particularly true if you spend a good portion of your day sitting. Sign up to receive my weekly blog posts via e-mail, and I will share with you My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain. These simple exercises, with complete instructions and photos, will help you to improve poor posture and can be performed at home.
  2. Massage. Contact a masseuse, physical therapist, athletic trainer or friend who is skillful in body work and massage to relieve the area in spasm. The specific massage technique to use will vary according to your preference. Massage techniques range from a light relaxing massage to a deep tissue massage or utilization of acupressure points.
  3. Foam Roller. The foam roller allows you to perform self-massage and tissue mobilization. The foam roller is a wonderful tool to prevent muscle cramping and spasms. Please refer to the following posts for more information: Foam Rolling For Rehabilitation and 5 Ways to Improve Range-Of-Motion. I highly recommend a High Density Foam Roller to help aid in your recovery.
  4. Other Self-Mobilization Tools. Many times, a friend or masseuse isn’t available to assist when you need the help the most. A foam roller cannot effective reach places in the upper back or arms, so other self-mobilization tools may be necessary. You can get creative and use a tennis ball or golf ball, but I like a specific tool called a Thera Cane Massager. This tool allows you to apply direct pressure to a spasming muscle. When held for a long enough period of time, the Thera Cane Massager will usually cause the muscle spasms to release and provide much needed pain relief! I am also a big fan of the Thera-Band Standard Roller Massager. I particularly like that its firmness allows for a deep amount of pressure. If you prefer something similar, but more flexible for the boney regions of the thigh or lower leg, I recommend The Stick Self Roller Massager.
  5. Topical Agents. Many topical agents can help to decrease and eliminate muscle spasms. The method of action varies greatly according to the product used. You may find that one product works better than another. Some of my favorite products in my medicine cabinet include: Biofreeze Pain Relieving Gel; Arnica Rub (Arnica Montana, an herbal rub); and topical magnesium.
  6. Magnesium Bath. The combination of warm water with magnesium is very soothing and relaxing. Magnesium is known to help decrease muscle pain and soreness. Options include: Epsoak Epson Salt or Ancient Minerals Magnesium Bath Flakes. I find that the magnesium flakes work better, but they are significantly more expensive than Epson salt.
  7. Oral Magnesium. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates. Taking additional magnesium (particularly at night) can help to reduce muscle cramps and spasming. It is also very helpful in reducing overall muscle soreness and aiding in a better night’s rest. Most people are deficient in the amount of magnesium they consume on a regular basis. I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose as needed. I would caution you that taking too much magnesium can lead to diarrhea. Mag Glycinate in its oral form is the most highly absorbable. Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.
  8. Stay Hydrated. The human body is primarily made of water, which is critical for all body functions. Your muscles are approximately 80% water. Dehydrated tissues are prone to injury and pain as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce.
  9. Eat Healthy. A healthy diet is critical to avoid injury, illness, and pain. Your body tissue needs nutrients to be able to perform at a high level. Avoid processed food as much as possible. Limit sugary food and add more protein and healthy fat in your diet. Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system. Adequate protein intake is necessary to support muscle health and development. Give your body the needed nutrients to combat illness and function at a high level.
  10. Move More! Not only has research proven that sitting for more than two hours at a time decreases your expected life span, but extended sitting also leads to increased muscle tension, cramping, and pain. If you sit most of the day, get up and walk. If you stand most of the day, frequently change your standing posture. To optimize health and joint function, you should take each joint in your body through a least one full range of motion (ROM) every day. If you are experiencing pain, I recommend performing more frequent ROM (every 1-2 hours).
  11. Stretch. Stretching is a wonderful way to help eliminate a muscle spasm. We instinctively stretch when we feel a spasm begin. Try gently stretching (lengthening) the muscle affected by the spasm. I recommend beginning with a short 30-60 seconds stretch, then repeating as needed. If the spasm or cramp is severe, you will likely need to continue stretching several times in a row, multiple times throughout the day. Stretching should always be part of a general fitness and lifestyle program. As we age, muscle and tendons tend to lose elasticity so stretching becomes even more important. I highly recommend a daily stretching routine or participation in a group class, such as yoga, which incorporates full body stretching.
  12. Acupuncture. I am personally a big fan of acupuncture. It is very useful in treating all kinds of medical conditions. It can be particularly effective in treating muscle cramps, spasms, and pain as it addresses the issues on multiple layers. Acupuncture directly stimulates the muscle by affecting the nervous system response to the muscle while producing a general sense of well-being and relaxation.
  13. Sleep and Rest More. Most people are not sleeping long enough or often enough to optimize health. Take a nap or go to bed earlier. Your body requires time to repair and heal as you sleep. Your body must rest in order to grow and develop. Training every day is not the best way to improve. It can lead to injury and burn out. Take a rest day and have fun. Participate in a Tai Chi or yoga class, take a leisurely bike ride or take a walk in the park.
  14. Speak with your Physical Therapist (PT) or Physician (MD). If your muscle pain cannot be correlated to a specific mechanical cause, please speak to your medical provider to determine if other causes are contributing to the problem. The American Physical Therapy Association (APTA) offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to hear your physician’s opinion as well).

Most muscle pain and soreness can be self-managed and self-treated if you are proactive.  These tips and strategies are highly effective in managing muscle pain.  A healthy lifestyle is a lifelong pursuit.  If you are injured or not enjoying an activity, you will not stay engaged or motivated in the long term.  Seeking advice specifically from a running coach, physical therapist or physician can be beneficial.

How do you manage your aches and pains?  Which tip or strategy will you incorporate into your treatment?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer:  The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice.  No health care provider/patient relationship is formed.  The use of information on this blog or materials linked from this blog is at your own risk.  The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment.  Do not disregard, or delay in obtaining, medical advice for any medical condition you may have.  Please seek the assistance of your health care professionals for any such conditions.

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How to Quickly become Heat Acclimated for Your Race

Spring racing season can be particularly difficult as you prepare for the weather.  Unless you live near the equator or the southern hemisphere (where seasons are opposite), then you likely spend most of the winter preparing for a spring race in relatively cold weather.  How can you quickly and safely become heat acclimated to prepare for a race, soccer or other outdoor sports when most of your training was performed in cold weather?

As you approach mid to late spring, the weather becomes more unpredictable in many parts of the world.  The conditions could be cold, windy, and rainy or in near summer heat while you’re running or playing your sport of choice.  The change from heat to cooler weather is usually an easier transition for most runners and athletes.  However, the transition from colder weather to heat can affect performance.  The exact ideal temperature (approximately 45-55 degrees Fahrenheit) is debatable and also based on humidity.  Most running experts suggest performance impairments of between 1.6% and 3% in marathon times for every 10 degrees above 55 degrees Fahrenheit.

Running and exercising in warmer weather tends to be more taxing on your body and requires more energy to remain cool.  When you’re not acclimatized to running in heat, it takes more effort to keep your running pace.  This increases your risk of muscle cramping, bonking (hitting the wall), and/or being unable to maintain your goal pace (which leads to a longer finishing time).

Group of people running.

6 Tips to Quickly become Heat Acclimated for Your Race:

  1. Perform High Intensity Interval Training (HIIT).  You will need to adequately train your body to handle the extra intensity needed in order to maintain your pace.  The best method when training for a more intense pace is through High Intensity Training (HIT) or High Intensity Interval Training (HIIT).  Perform short bursts (ranging from 30-60 seconds at a time) of activity followed by a 1-2 minute recovery.  The 30-60 seconds should be at a high intensity, meaning that your rate of perceived exertion (RPE) is high.  You should be breathing heavy.  If you are overweight or have arthritis, this may be performed while using a stationary bicycle or in a pool.  You can also walk uphill at a quick pace, then stop and rest.  This is performed in intervals ranging from 30 to 60 seconds as well.
  2. The Sauna.  My preference is to utilize the sauna post running.  This allows me to put forth max effort in performing my scheduled run followed by a 10-20 minute sauna session.  (Initially, work up to a 30-40 minute session if tolerated.)  You can use either a dry heat sauna or a steam room, but choose this based on the anticipated humidity during your race or sport activity.  Utilizing the sauna provides best results if initiated three to four weeks prior to the event.  However, positive effects can occur in as little as one to two weeks before the race.  I recommend tapering down and discontinuing sauna use two or three days prior to the event.  If you’re hard core, try performing light exercise when in the sauna or steam room.  A few rounds of push-ups or squats can be beneficial.  If you own a sauna, you may even consider gently riding a stationary bike.  (If you have a heart condition, please first clear any use of a sauna with your physician.)
  3. Hot Yoga.  Currently, this form of yoga is a “hot” fitness trend.  Preforming hot yoga is an excellent cross training method which allows you to acclimatize to the heat.  I recommend one to two sessions per week as part of your cross training routine.
  4. Increase your Fuel Intake.  You will likely be putting forth a harder effort in the heat to maintain your pace.  I recommend increasing your fuel intake by 100-200 Calories per hour during the race.  This will provide your body with enough energy to push harder than expected.  Experiment with the increased fuel during your training runs or prior to the event.  This will eliminate any potential gastrointestinal (GI) issues from the change in your fueling strategy.
  5. Salt.  It is rarely necessary to supplement with salt tablets during the race.  Muscle cramping can be an issue, but it’s usually due from over exertion and not from a lack of salt.  Heat increases your exertional levels.  If you start to cramp, you can quickly place something salty (such as some pickle juice or a mixture of sea salt and honey) in your mouth.  (You don’t even need to ingest the food or beverage.)  It will trigger a neurological response which can alleviate the cramp.
  6. Colostrum.  Colostrum is the first milk produced by female mammals after giving birth. It contains a host of immunoglobulins, anti-microbial peptides, and other growth factors. It is especially good at strengthening the intestinal lining which prevents and heals conditions associated with a leaky gut. Colostrum can also help a person more effectively exercise in hotter conditions. Over all, it can boost the immune system, assist with intestinal issues, and help the body to recover faster. I recommend CapraColostrum by Mt. Capra, which is a goat based supplement. If you have a goat allergy, I also alternatively recommend a cow (bovine) based supplement known as IgG 2000 CWP. This supplement is an immunoglobulin concentrate made from bovine colostrum.

In general, exercising in warmer weather tends to be more taxing on your body.  It requires more energy to remain cool.  Incorporate these 6 tips on how to quickly and safely become heat acclimatized as you prepare for a race or other outdoor sport.  You will likely experience a successful outcome by maintaining your goal pace while avoiding dehydration and muscle cramping.

What is your preferred weather condition for running or outdoor sports?  Do you have any tips to share that have helped you to acclimatize to warmer than expected conditions?  Please leave your comments below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com.  Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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How to Avoid an ACL Injury

Spring soccer season has begun!  ACL injury can be devastating.  Unfortunately, it’s a common injury that occurs in soccer as well as other sports.  The ACL (Anterior Cruciate Ligament) is an important ligament of the knee that is responsible for knee stability.  ACL injury often occurs in combination with other injury to the knee, including injury to the medial collateral ligament (MCL) and the meniscus.  Depending on the severity, surgery is typically indicated to correct an injury to the ACL and meniscus.  Discover the risk factors for ACL injury, and learn how to implement strategies in order to avoid injury while staying active in sports.

Risk Factors for ACL Injury:

  • More common in females.
  • Hamstring weakness.
  • Poor lower leg strength.
  • Poor core strength and stability.
  • Knee laxity.
  • Genetic anatomical variations including: certain bone shapes in the tibia, femur, and the knee joint, as well as a wider q-angle in women (due to the shape of the pelvis, the angle of the femur to the tibia is larger).
  • Prior ACL injury.
  • Extrinsic factors such as weather conditions and different surfaces (typically those surfaces that have a high level of friction and little give such as turf or playing indoors).
  • Higher body mass.

When surgery is needed to repair the ligament, an ACL injury is a season ending process with a long recovery.  It can take 9-18 months to adequately heal and recover from injury prior to returning to pre-injury levels.  Therefore, it’s critical to take steps to limit your risk of injury.

6 Tips for Avoiding ACL Injury:

1.  Increase your core strength and stability.  Please refer to Core Exercises for ACL Injury Prevention for detailed descriptions and photos of my recommended core stability exercises.

BallBridgewithLegRaiseExercise

2.  Increase your lower leg strength and focus on your hamstrings.  Hamstring strength is critical in avoiding ACL injury.  In general, lower leg strength is a critical component in avoiding injury.  Perform exercises such as the squat (for general lower leg strength) as well as lunges and the straight leg dead lift to increase hamstring strength.  For more ideas on how to improve your leg and hip strength, please refer to Q & A: How to Increase Hip Strength and Improve Mobility.

3.  Add plyometric exercise to your routine.  Plyometrics is an excellent technique to improve strength and explosive power to your lower legs.  When performing the movements, be sure to focus on the alignment of your legs and knees.  Let the knees absorb the force, then rebound out of the movement.  Don’t allow your legs to buckle inward.  Keep the patella (knee cap) in line with your second toe to insure proper form.

4.  Focus on sport specific mobility drills.  Sports, such as soccer, football, and basketball, have higher rates of ACL injury.  Be sure to work on sport specific mobility drills.  Focus particularly on proper landing after jumping, decelerating movements, and quick cutting movements.  When performing these drills, don’t allow your legs to buckle inward.  Keep the patella (knee cap) in line with your second toe to insure proper form.

5.  Improve your balance.  Balance is an important part of mobility.  It is usually overlooked and taken for granted until mobility is significantly affected.  In How to Improve Balance Using a Water Noodle, I demonstrate a clock drill which I highly recommend you perform in order to maintain and improve your balance.  Also, please refer to Q & A: How Do I Improve Balance (Part II) for specific suggestions on how to improve balance in each of the five body systems.

6.  Participate in an ACL conditioning program.  The Santa Monica ACL Prevention Project developed an ACL Injury Prevention Program specifically for female soccer players.  This 15-minute training program incorporates balance, agility, and performance drills into the warm up phase of training and practice.  This particular ACL prevention training plan has 6 phases including: warm up; stretching; strengthening; plyometrics and/or agility drills; and cool down.  The conditioning program is usually performed two to three times per week.

Incorporate these 6 tips and strategies as part of your normal training and cross training routine to avoid ACL injury.  They can be incorporated into your off season as well as part of an in season training program.  If you suspect an ACL injury, please consult with your physician, physical therapist (PT), or athletic trainer (ATC).

Do you participate in an ACL prevention program?  Which specific tip can you incorporate into your routine?  Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

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Q & A: How to Increase Hip Strength and Improve Mobility

Q.  Hi. I have been noticing that even with my current strength training I’m pretty weak in my hip area.  I’d like to work on strengthening this area, so I don’t have problems when I’m older.  Can you recommend a few exercises that I can add to my routine?  Thanks, I love your posts and utilize the information as often as I can.  -Amy

A.  Thanks, Amy, for this fantastic question! It’s wonderful that you are aware of this particular weakness and you’re being proactive now versus experiencing potential issues later. Maintaining adequate hip and pelvic strength is important for many reasons. The hip muscles control or influence most of the lower leg mechanics, including the hip, knee, and foot.  They also play a role in lumbar stability and mobility.  Both hip strength and mobility is vital to insure proper lower extremity movement.

Weakness and/or poor mobility in the hips can lead to potential problems including:

  • Hip pain
  • Knee pain
  • Lumbar pain
  • Abnormal gait patterns
  • Increased fall risk
  • Early development of osteoarthritis in the hips and knees
  • Iliotibial band syndrome
  • Hip bursitis
  • Shin splints
  • Plantar fasciitis

Many other conditions and pain can also be attributed to poor hip strength and mobility.  This is by no means an all-inclusive list.  I have written specific blog posts regarding many of these conditions.  In each case, one of my recommended tips is to improve both hip strength and mobility.  Many of the hip muscles are located deep in the pelvis and buttock area.  They are not necessary large, but they are critical.  These hip muscles can also be responsible for pain, particularly when spasming.  Piriformis Syndrome occurs when the piriformis muscle (a deep hip rotator muscle) spasms.  The spasm can cause buttock pain.  Due to its proximity to the sciatic nerve, it can also cause radiating pain down into the leg known as sciatica.

How to Increase Hip Strength and Improve Mobility:

  • Squat. The squat activates nearly all of the muscles in the lower leg. It is particularly effective at activating the muscles in the legs referred to as the posterior chain, which includes the hamstrings, the glutes (or buttock muscles), and the hip adductors (or the groin muscles). It also activates muscles in the hips, the calves, the stabilizing muscles in the ankles, the quadriceps, as well as the core (the abdominals and lumbar extensor muscles). These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something. For more information on squatting, please refer to 7 Reasons Why the Squat is Fundamental to Life.
  • Target the hip muscles. Many of the muscles of the hip require specific exercises to insure that the correct muscle is activated. Please refer to Hip Strengthening Exercises for detailed descriptions and photos of my recommended exercises.

MonsterWalkWithExerciseBand

  • Improve your mobility. Tightness and restrictions in the hip and pelvic musculature are often associated with pain in the legs and low back. Please refer to Hip Stretches and Mobilizations for detailed descriptions and photos of specific stretches for the hip and pelvis and how to self-mobilize by using a foam roller and lacrosse ball. Tightness and restrictions increase your risk of injury due to improper mobility. For example, tightness in the hip internal rotator muscles causes the hip and lower leg to roll in, which is associated with Patellar Femoral Pain Syndrome (also known as runner’s knee). For more information on this condition, please refer to How to Self-Treat Patellar Femoral Pain Syndrome.
  • Self-mobilize. Using a foam roller is an excellent method to decrease pain and improve mobility throughout the hip and pelvis. For more information on how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
  • Walk more frequently. Walking is a critical component to healthy aging. Walking on various surfaces and terrain is an excellent way to improve your health, fitness, and hip strength. To discover other benefits walking, please refer to Why You Should Walk, Not Run.

Maintaining adequate hip and pelvis mobility and strength is an important strategy in avoiding many lower extremity orthopaedic conditions.  Being aware of a particular area of weakness and being proactive now could save you from experiencing pain in the future. Thanks, Amy, for your question!

Which strategy will you use to increase your hip strength and improve mobility?  It could be as simple as using the foam roller or walking.  Most importantly, just get started!  Please leave your comments below.

Looking for that exercise or book I mentioned in a post?  Forgot the name of a product or supplement that you’re interested in?  It’s all listed in the Resource Guide.  Check it out today!

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!