Posted on Monday, January 5, 2015

My Top 5 Most Popular Posts of 2014!

For many of us, the healthcare system is too expensive or unapproachable as we try to improve our health and live life to its fullest. My desire is to provide you with useful information to achieve both objectives. Thank you for supporting The Physical Therapy Advisor website since its launch in April. I appreciate your questions and feedback, and I look forward to serving you in 2015!

My Top 5 Most Popular Posts of 2014:

My Top 7 Tips to Prevent Low Back Pain While Traveling – Low back pain is one of the most prevalent and pervasive problems in the western world. Whether you’re traveling or working in an office, review these 7 tips to prevent low back pain.
7 Reasons Why the Squat is Fundamental to Life – When was the last time you moved into a full squat? Why does it even matter? Find out 7 reasons why we should continue squatting as a lifelong pursuit.
How to Self-Treat Plantar Fasciitis – Plantar fasciitis is a very painful and potentially very debilitating condition. Don’t let foot pain stop you from reaching your goals in 2015! Learn how to self-treat plantar fasciitis and prevent it from slowing you down.
Q & A: How to Prevent My Mom From Falling Out of Bed – Falling is the number one cause for fracture in the elderly. Many times, a fracture will lead to a cascading decline in mobility and function. Finding methods to limit falling, without restraining or inhibiting important functional mobility, is critical. Discover tips to keep your loved ones safe.
5 Ways to Improve Range-Of-Motion (ROM) – As we age, we naturally lose elastin, an important component to our skin, muscles, and tendons. Elastin is responsible for the elasticity in the body’s tissues. Maintaining Range of Motion (ROM) is critical to maintaining our mobility and for injury prevention and sport performance. Poor ROM can also lead to pain and dysfunction as the body’s ability to move freely is impaired. Discover different methods to maintain your ROM and prevent injury.

2014 was a wonderful start for the blog. I look forward to empowering you to reach your optimal health in 2015! Don’t forget subscribe to my e-mail newsletter! I will send you weekly posts on how to maximize your health, self-treat those annoying orthopaedic injuries, and gracefully age. To thank you for subscribing, you will automatically gain access to my FREE resource, My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.

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!

Posted on Sunday, December 28, 2014

15 Strategies to Make 2015 Your Healthiest Year

With the upcoming New Year, we begin to make many resolutions. However, many of us don’t truly intend to follow through with them! In regard to our health and fitness, we may not feel capable of improving. Maybe you think you are too young or old, overweight, or just have too many medical problems to make a difference. Many of us feel exactly the same way! Let’s first acknowledge the positive. You are aware of your need to address this issue. You’re likely to live well into your 90’s, and you’re already taking action. It is never too late to start! The key to aging well is to maximize your health and wellbeing now!

Where we are now in our physical lives is the sum total of choices we have made, and a few random events all sprinkled with the genetics we inherited. We need to accept ourselves for where we are presently and acknowledge that our fitness and our health is not a destination, but a journey. Each person’s journey is different. We need to be realistic with our goals and give ourselves time to undo what we have done to ourselves for years. Leading a healthy lifestyle must include balancing the five pillars of one’s life including: physical, mental, emotional, social, and spiritual. Each one will affect the other both positive or negatively.

15 Strategies to Improve Your Health:

Do not diet! Be more concerned with counting chemicals on labels than calories.
Do not eat anything that comes in a package. Most of our food should be from low sugar fruits and vegetables as well as protein and healthy fats (primarily from plant sources such as avocados and coconut or olive oil). Any animal fat should be from organic and grass fed animals. 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.
Stay hydrated. The human body is primarily made of water, which is critical for all body functions. Adequate water intake is critical to avoid dehydration which can negatively affect your training and becomes increasingly more common in older adults. Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Water intake supports proper brain, muscle, and hormone function as well as lubrication of the joints and skin appearance. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names that you can’t spell or pronounce.
Manage your weight. Excessive body weight causes abnormal wear and tear on your body (particularly in the knees and feet). It also places additional strain on your cardiovascular system and increases your risk of diabetes—thus increasing your risk of stroke, heart disease, and dementia. As we age, our metabolism begins to slow. Tips to help you to manage your weight include: eat a healthy diet; stay hydrated; and move more frequently throughout the day. For every two hours of sitting, get up and walk around. A strength training and high intensity training (HIT) program can help you to maintain a suitable weight by insuring your metabolism stays elevated and your hormone levels remain balanced. When attempting to lose weight, aim for 1-2 pounds per week.
Stop sitting so much. The latest research indicates that sitting for more than two hours at a time can significantly lessen your life span. The real headline should be: Even if you are a regular exerciser, sitting for more than two hours a day will still lower your life span. The take home message is that frequent movement throughout the entire day is critical for health. Standing still for long periods of time is as equally hard on the body (particularly in the lower lumbar, knees, ankles, and feet) as sitting. It can cause negative effects in the joints as well as cause circulation issues.
Walk daily after dinner. To optimize your walking program, consider taking walks after dinner. It has a greater benefit on your metabolism and may reduce the risk of diabetes by stabilizing blood sugar levels. If you can only walk in the morning, try walking before your morning meal. This will train your body to perform more efficiently on its fatty tissue stores and not to be carbohydrate dependent.
Sleep more. Your body must rest in order to grow and develop. Most people are not getting adequate sleep and rest. Sleep is critical to maintaining your growth hormone and testosterone production as well as stabilizing your metabolism. Rest more! 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 yoga class, take a leisurely bike ride, or take a walk in the park. If you are participating in a yearly training cycle, be sure to incorporate an off season which involves a change of pace from your regular training to active rest instead.
Improve your growth hormone production. Strength training (focusing particularly on large muscle groups with appropriately heavy loads) has been proven to improve growth hormone levels. High intensity training (HIT) performed once or twice per week may also help to increase growth hormone levels. A proper diet is also the key to improving hormone levels by including adequate protein and fat levels while avoiding excess sugar. An adequate amount of sleep also plays a major role in growth hormone production.
Regulate your insulin production. Strength and endurance training have a positive effect on your body’s ability to regulate insulin levels. Strength and cardiovascular training are a critical part of a maintenance program for diabetes. To maintain an even energy level throughout the day, a stable insulin level is critical. Limit your carbohydrates and increase your protein and healthy fat intake. Diabetes prevention is important in order to avoid cardiovascular disease and dementia.
Perform high intensity interval training. Perform cardiovascular fitness in short bursts (ranging from 30-60 seconds at a time) followed by a 1-2 minute recovery. The 30-60 seconds should be at a high intensity, meaning 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 up hill at a quick pace, then stop and rest. This is performed in intervals. High intensity training (HIT) or high intensity interval training (HIIT) will produce the best result for weight loss and fitness. HIIT is a superior approach to increase cardiovascular fitness, improve hormonal regulation, increase insulin sensitivity, and burn more calories and fat in a short amount of time.
Maintain your strength. Although all muscle fibers show some decline as you age, the fast twitch (Type II) fibers show the most decline. Strength training is a critical component to maintaining and growing additional Type II muscle fibers. The stronger you are, the more resistant to injury you are. Also, strengthening of the core area (the abdominals and back extensors) helps to manage low back pain. Low back pain can be a rehabilitating condition. If you’re experiencing pain, please refer to How to Safely Self-Treat Low Back Pain.
Use a foam roller. As a person ages, the body tends to become stiffer as it loses elastin. This negatively affects a person’s range of motion (ROM). It also makes the muscle and tendon fibers more likely to tear if overstretched. I recommend that everyone participate in a flexibility program. (The older you are, the more important this becomes.) Mobility and flexibility become more difficult if you aren’t purposefully working on it. Yoga is an excellent choice as well as utilizing the foam roller. Using a foam roller can help keep tissues pliable. Regular use may also beneficial as it helps improve arterial stiffness and can improve arterial and vascular function. To learn how to use a foam roller, please refer to Does Foam Rolling Help or Hurt Your Performance?
Find an accountability partner. It is critical to have someone who will hold you accountable for the goals that you set and your choice of lifestyle. We all get off track from time to time. An accountability partner can nudge you back onto that path. Exercising with someone is an excellent way to insure consistency. Be sure to push one another–friendly competition is healthy!
Seek help early. If you are experiencing chronic aches or pain or are struggling with an aspect of your training, seek help immediately. 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, weight lifting coach, certified personal trainer, physical therapist, or physician can be beneficial.
Choose your influences. Jim Rohn once said, “You are the average of the five people you spend the most time with.” Choose wisely! Our thoughts and actions are greatly influenced not only by people we spend time with, but the audio and visual input we consume. Choose healthy influences and regulate what you read and watch on TV.

The New Year is an excellent time to make positive changes in your life! To optimize your health, seek balance in your physical, mental, emotional, social, and spiritual health. If you are deficient in one area, it will likely affect the others. Don’t get discouraged! Small incremental steps can positively affect your health. After setting your goals, get started and enjoy the journey. Cheers to a happy and healthy 2015!

Bonus Tip: Don’t forget subscribe to my e-mail newsletter! I will send you weekly posts on how to maximize your health, self-treat those annoying orthopaedic injuries, and gracefully age. To thank you for subscribing, you will automatically gain access to my FREE resource, My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.

If you have a question that you would like featured in an upcoming blog post, please e-mail contact@thephysicaltherapyadvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor where you will receive additional health and lifestyle information.

Posted on Sunday, December 21, 2014

Q & A: How Much Protein Do I Really Need?

Q. Depending on my level of activity, how much protein should I be consuming in my diet? -Amy

A. Thanks, Amy, for this excellent question! Opinions on this controversial topic vary widely. Your dietary belief system and what type of exercise or activity you participate most in may determine your protein consumption. Most power lifters, body builders, CrossFitters, and Paleo diet followers partake in a very high protein diet. Vegans and many endurance athletes do not. The research is still mixed on whether a high protein diet can be helpful or harmful.

The answer may be more subtle and complicated than you think. It depends on how your body responds to protein in general. The type of protein you eat (and its bioavailability) is also a factor when considering health optimization. An important point may not be about protein at all. Instead, how many carbohydrates do you eat and from which sources?

Plant-based protein sources, such as hemp, pea, and quinoa, and animal-based protein should be included in your diet for two reasons. First, animal protein is a complete protein, a protein with a full amino acid profile. Amino acids are the building blocks for protein. Some amino acids can be manufactured in the body. Others cannot and must be obtained from dietary sources. This is why you must ingest a full amino acid profile either through an animal source or multiple plant-based sources. Finding the right combination of plant-based foods to obtain a complete amino acid profile can be tricky.

Second, certain types of important fats come with animal protein. Fats, such as Docosahexaenoic Acid (DHA) found in fish, can be synthesized via alpha-linolenic acid (ALA), which is plant-based, but the conversion rate is very poor. Animal protein sources should include fish, chicken (free range), beef (free range), turkey (free range), and any wild game. Why wild game and free range animals? They are relatively free from likely contamination, hormones, or other chemicals used in commercial processing, and their fat profiles are healthier. They also tend to be leaner protein, especially wild game. A good percentage of calories from protein should be 20% (although it may be higher based on your dietary beliefs). I recommend taking in a variety of protein sources that are both animal and plant-based.

Although there are different methods to calculate protein needs, the following is the most common. The standard minimum amount of daily protein needed is .37 grams per pound of body weight (or .8 grams per kilogram of body weight). This is the bare minimum. Research has shown between 1.2 and 1.8 grams of protein per kilogram of body weight (approximately .5-.8 grams per pound) is important to maximize health and for athletes. (Use 2.2 lbs. divided by your body weight to calculate kilograms). Other methods recommend even more protein, but I’m not convinced it is necessary.

Please see the following examples for the average male and female. Then enter your own weight to determine the recommended amount of protein per day.

Male, 180 lbs. 180 lbs. / 2.2 = approximately 82 kilograms. 82 kg. x 1.2 = 98 grams. 82 kg. x 1.8 = 148 grams. The range is from 98 to 148 grams of protein per day.
Female, 130 lbs. 130 lbs. / 2.2 = approximately 59 kilograms. 59 kg. x 1.2 = 71 grams. 59 kg. x 1.8 = 106 grams. The range is from 71 grams to 106 grams of protein per day.

Another method to calculate protein needs is based on lean body mass rather than total weight. You will need to know exactly how much body fat you have. This calculation is not practical for most people, and it’s typically an inaccurate body fat percentage number. The method asserts that fat tissue needs less protein to support it.

If you’re interested in reading more about this method, please refer to Enter The Zone: A Dietary Road map by Barry Sears and Protein Power: The High-Protein/Low Carbohydrate Way to Lose Weight, Feel Fit, and Boost Your Health-in Just Weeks! by Michael R. and Mary Dan Eades.

Precautions regarding protein:

Excessive protein intake may be hard on the liver and kidneys. If you have kidney or liver related issues or a predisposition, I recommend that speak with your physician prior to over consuming protein.
Many protein powder supplements contain artificial sweeteners, preservatives, and other chemicals. Choose the healthier options, and read the labels on the products.
Many protein powder supplements contain whey protein. Whey, a complete protein, has an excellent price point. However, many people may be intolerant to whey. While supplementing, keep track of how you feel to insure that you aren’t experiencing a negative reaction to the protein source.

My Top Protein Supplement Recommendations:

I prefer to supplement with a plant-based protein source because I regularly consume animal-based protein. 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. If you are used to mass produced supplements, your taste buds will have to adjust.
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. 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.

I am often asked how I prefer to consume protein supplements. I typically mix the protein supplement with black coffee and a teaspoon of organic coconut oil, which is full of medium chain triglycerides (MCTs). The coconut oil has no added flavor. It helps to stabilize my blood sugar and keeps me satiated for hours. I typically purchase Kirkland Organic Coconut Oil at Costco. Nature’s Way Coconut Oil is another option.

Obtaining the proper amount of protein from a quality source (via both food and supplements) as well as diversifying protein sources are important components to healthy eating and maximizing performance. To maximize your benefit and performance, you will likely spend time self-experimenting to determine how much protein you need to consume and from which sources.

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 way to keep your blood sugar stable and to maintain a high level of performance. 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.

As we age, it’s important to continue to eat adequate amounts of protein. Sarcopenia is a condition in which muscle mass decreases with age. Strength training and consuming an adequate amount of protein is critical in avoiding sarcopenia and aging successfully. Red meat is a complete protein source. Consuming an adequate amount of red meat is an easy method to increase your iron consumption. Iron can help to reduce anemia, a common condition in women and the elderly population. Proper protein consumption is also critical to effectively manage diabetes.

For a conservative opinion on the subject of protein supplementation, watch the following video, How Much Protein Do You Really Need? by Yuri Elkaim. Elkaim is a nutritionist with an interesting history and has a wide range of experience working with athletes (particularly soccer players).

For a more aggressive opinion and information on the general physiology of protein use in the body, please refer to 7 Rules to Optimize Protein Intake by Barbell Medicine.

How much protein do you typically consume? What is your favorite protein supplement? 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 new Resource Guide. Check it out today!

Thanks, Amy, for your question! 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!

Posted on Monday, December 15, 2014

How to Self-Treat Patellar Femoral Pain Syndrome (Runner’s Knee)

Patellar Femoral Pain Syndrome (PFPS), also known as runner’s knee, is a common running related issue. The sooner you can manage this condition, the easier it will be to recover and eliminate future problems. Many of my recommended exercises can be adopted as part of a cross training program to prevent PFPS. I will address the many potential causative factors for PFPS and offer advice on how to self-treat this condition.

PFPS can be quite painful and significantly affect a person’s ability to run or move properly. The cause of the pain is often associated with a patellar or knee cap that is tracking in the femoral groove improperly. This can occur for many reasons, but the most common causes are:

Poor quadriceps strength (particularly the inner or medial quadriceps).
Poor hip abductor and/or hip external rotator strength.
Improper foot biomechanics during the single leg stance phase of the gait cycle or the mid foot strike during running. The most common issue within the foot is usually overpronation (when the feet excessively roll inward and cause the knee to roll inward as well during each step). Overpronation is more common among females although males experience it as well. Women may experience overpronation due to the angle of their hips in relation to the knee. A woman’s pelvis is typically a different shape to allow for child bearing. The larger “Q-angle” associated with the hip and knee can cause increased strain on the knee.

PFPS symptoms include:

The pain will typically increase when going downstairs. In more severe cases, going upstairs is also very painful.
Pain with squats, lunges, knee extensions, or other plyometric activity.
Pain typically worsens with prolonged sitting. The longer you sit in one position, the worse the pain becomes.
Grinding, popping, and cracking are often associated symptoms.
Pain can be anywhere along the patella (knee cap), but it’s typically associated with anterior knee pain or medial patellar pain.

In many cases, a very thorough warm up may allow you to participate in activity. However, the pain may worsen again later that day or the next day. Seek help or guidance quickly when your pain worsens with activity. For the best result, the treatment plan should be multifactorial.

How to Self-Treat PFPS:

Improve your quad and your hip strength. Please refer to Patellar Femoral Pain Syndrome Rehabilitation Exercises for my recommended exercise program which is designed to improve quad and hip strength. To improve your quad strength, the emphasis should be on the inner quad known as the vastus medialis oblique (VMO). Weak hip abduction and hip external (lateral) rotation muscles significantly contribute to PFPS. The purpose of the lateral and external rotators of the hip is to prevent internal rotation (rolling inward) of the hip and knee. My recommended exercise program will help to improve your strength.
Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients. Use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated. Then work on moving into a deep squat position multiple times as part of the warm up. You may need to hang onto a beam or a pole to take some pressure off of your knee as you move in and out of the squat.
Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine. Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as increasing range of motion (ROM).
Self-Mobilize the Tissue. Myofascial release of the quadriceps muscle is an important component in order to relieve the pain and reduce the pressure and tension through the patellar femoral tendon and joint. I tend to use the foam roller for the larger part of the quadriceps. I also use a tennis or lacrosse ball to aggressively work the tissue above the patella. You can use your hand to press the ball in and work it around the tissue. To use the weight of your leg for a more aggressive mobilization, place the ball on the ground and mobilize the tissue with your leg on top of the ball.

Kinesiological Taping. The purpose of the tape is to assist the patella in its tracking. I have had luck using Kinesio Tape and Mummy Tape brands. There are many other useful taping techniques which utilize different forms of tape. When treating PFPS, I recommend that you apply the tape in a medial direction across the patella approximately 30 minutes prior to exercise or activity. To utilize Mummy Tape, first measure how much of the tape you intend to use. Start from the outside of the knee cap to half way around the leg minus about an inch. Cut the strip, then round the corners on the edge of the tape. This helps the tape to not catch onto clothing. Apply the tape without extra stretch to the first half of the knee cap, then apply between a 50-75% stretch for half of the tape medially toward the inside of the leg. With the last of the tape, apply without a stretch to the inner side of the leg. (You could also utilize Spider tape or KT TAPE.) To visually learn how to apply the tape, please refer to Kinesiological Taping for Patellar Femoral Pain Syndrome. For application and removal tips, please refer to Skin Care with Taping.
If it hurts, don’t do it! Modify the activity or discontinue it completely. If your knee is hurting when performing a squat, then initially don’t move as deep into the exercise. This would also be true for a lunge position or step up. Modify any exercise as you need to, and don’t compromise technique to complete an exercise. Poor technique will only increase your risk of injury elsewhere.
Have your gait analyzed while running. Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic. If you’re not a runner, but you’re experiencing pain during other forms of exercise (group aerobics or CrossFit), ask your teacher or coach to analyze your movements during an exercise session. How is your foot striking the ground? Is it rolling in (landing flat footed)? Does your knee rotate inward or stay tracking in line with the foot? Ideally, the knee tracks in line with your second toe. This is important for running as well as squats, step ups, and lunges. If your foot isn’t maintaining a good position during its mid foot strike, a new pair of shoes may be indicated specifically to control pronation. Over-the-counter orthotics can help as well. Superfeet Blue Premium Insoles are available in varying models to help support the arch and heel. They are color coded by model. I wear the blue insoles which are for moderately flat feet. These insoles are very durable. In the past, these insoles have lasted for 1,000 miles through the life cycles of two different pairs of shoes.
Start a supplement. Many herbs help to reduce inflammation and pain. CapraFlex is one of my favorite supplements. Essentially, 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 to help heal from an injury. I recommend that you try it for 30 days to see if it improves your pain. Another option is Phenocane Natural Pain Management. It combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

Patellar Femoral Pain Syndrome can be very painful, but it can be easily self-treated if you handle your pain and symptoms quickly. If you’re not experiencing relief after aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing PFPS. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a specific treatment for PFPS helped you? Which treatments haven’t worked for you? Additional discussion can help others to manage this condition more effectively. Please leave your comments below.

Don’t forget to subscribe to my e-mail list to gain immediate access to My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain for step by step exercise instructions and photos!

Posted on Wednesday, December 10, 2014

How to Self-Treat IT Band Syndrome

Pain in the lateral (outside) leg or knee is commonly associated with a condition known as Iliotibial Band Syndrome (ITBS). (Iliotibial Band Syndrome is also known as IT Band Syndrome, ITB Syndrome, or IT Band Friction Syndrome.) Pain can range from the lateral side of the leg up toward the hip area to just below the lateral side of the knee joint (where the head of the fibula bone begins). The pain can be very debilitating to the point that running or hiking activities have to be stopped. Even walking becomes difficult. I will address the many potential causative factors for IT Band Syndrome and offer advice on how to self-treat this condition.

The IT Band is a very thick fibrous band of tissue that spans from the hip’s origin point at a muscle known as the Tensor fasciae latae (TFL). The TFL transitions into the IT band and progresses down the lateral thigh and ends at the head of the fibula. The IT Band’s primary function is to provide additional lateral support for the knee joint (particularly when standing or landing on one leg). IT Band Syndrome is often associated with an over use injury. It can be very painful, but it can be easily self-treated if you handle your pain and symptoms quickly.

How to Self-Treat IT Band Syndrome:

Improve your mobility. Mobility issues and myofascial restrictions are highly correlated with ITBS. Tightness in the IT Band or in the deep hip internal or external rotators is a contributing factor to ITBS. The tighter the IT Band, the more likely it will rub on the femoral condyle and develop into pain. Bowlegged describes a medical condition known as a varus deformity, an inward rotation of the tibia resulting in a leg that looks like it is bowed out. It can develop due to chronic friction of the IT Band along the femoral condyle. ITBS may also occur after a total knee replacement (TKA). I recommend using a foam roller to address tightness in the quadriceps or IT Band. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation. I also recommend a Thera-Band Standard Roller Massager, which is very firm and allows for a deep amount of pressure. You may also utilize a tennis or lacrosse ball to mobilize the Tensor fasciae latae (TFL) appropriately. The foam roller and roller massager don’t work as well because the greater trochanter of the hip (the boney part of the hip that sticks out) tends to be in the way. Stretching the IT band or the TFL is very difficult, so I tend to utilize other mobilization techniques. However, I recommend a few pelvic and hip stretches. Please refer to IT Band Syndrome Rehabilitation Exercises for my top stretches, foam rolling, and self-mobilization techniques to address IT Band related issues.
Strengthen your hip muscles. Weakness in the hip external rotators and the hip abductors, like the Gluteus medius and the Tensor fasciae latae (TFL), can lead to IT Band Syndrome. Strengthening of these muscle groups can help avoid future ITB issues as well as reduce your risk of developing Patellar Femoral Pain Syndrome (PFPS). Please refer to Hamstring, Hip Flexor, and Piriformis Stretches for LBP for additional hip and lower leg stretching exercises.
Over use injury due to downhill running? IT Band Syndrome is often associated with an over use injury. For runners, a common cause of ITBS is running downhill. Few runners actually train appropriately for a race with downhill running. Afterward, they end up with a case of ITBS. I have been guilty of improper training in the past. If you have ever run in the Robie Creek Half Marathon, then you understand the importance of downhill training. To avoid ITBS, adequately train for the downhill portion of the race. Also, vary your running routine and surfaces while training. Although ITBS is often associated with over use, always address other contributing factors as well.
Check your shoes. Your shoes may be worn out and may be the cause of the pain. If you wear a shoe that helps to limit overpronation, remember that the inner cushion and structure of the shoe can wear out before its outer appearance. If this occurs, the shoe can no longer adequately control inappropriate foot and heel movements such as overpronation. This could result in IT Band Syndrome or other hip, knee, or ankle related issues. Shoes typically only last 350-500 miles. If you are nearing those miles, then it may be time to change. If you’re unsure if your shoes are performing correctly, visit your local running shoe store. The trained staff can inspect your shoes for wear and tear. They may ask you to walk or run in order to watch your gait to fit you in the appropriate shoe. Another option to help control overpronation is an over-the-counter orthotic such as Superfeet Blue Premium Insoles. The blue tends to fit most feet, but a variety of options are available for customization. In my experience, these insoles can last 1,000 to 1,500 miles easily. If the over-the-counter options aren’t helping you, please see a physical therapist or podiatrist for custom orthotics.
Did you progress too quickly into a minimalistic shoe? If you are used to a standard built up shoe, progressing into a minimalistic shoe may be more difficult and take more time. Unless you are a child or teenager, expect a safe transition to take at least three months. Don’t transition during a period of intense sports. I highly recommend waiting until the off season as progressing slowly is always a better choice.
Have your gait analyzed while running. Gait or running abnormalities can increase your risk of developing IT Band Syndrome. Over striding tends to occur while running downhill. Scissoring occurs when your leg crosses over the midline with each step. Both over striding and scissoring are easily recognized by a professional. Check with your local running store or a physical therapy clinic for a monthly gait analysis clinic. If you’re unable to obtain a gait analysis, ask your spouse or a friend to video record you (from behind) while you’re running. Then watch the recording to see if you notice either over striding or scissoring.
Don’t forget to ice. IT Band Syndrome is typically is due to a specific event. Afterward, there is usually an active inflammatory process occurring. I typically apply ice to the lateral part of the knee, but place it on your most painful location. The rule for icing is to apply ice no more than twenty minutes per hour. Don’t place the ice directly against the skin, especially if you are using a gel pack style. Individuals with poor circulation or impaired sensation should take particular care when icing. A bag of frozen peas can be a cheap alternative or you could use one of my favorite gel pack style cold packs.
Start a supplement. ITB Syndrome is typically associated with a specific event and an active inflammatory process typically occurs. I am a supporter of natural supplements and remedies. Many supplements include herbs which are designed to help reduce inflammation. Phenocane Natural Pain Management combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. If you are taking blood thinner medication, please consult with your physician prior to taking Phenocane Natural Pain Management.

If you’re not experiencing relief after a week or two of aggressively managing the symptoms, contact your local physical therapist for an assessment and help in managing IT Band Syndrome. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a specific treatment for IT Band Syndrome helped you? Which treatments haven’t worked for you? Additional discussion can help others to manage this condition more effectively. 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 new Resource Guide. Check it out today!

Posted on Monday, December 1, 2014

How to Self-Treat Plantar Fasciitis

Plantar fasciitis is a very painful and potentially very debilitating condition. It’s one of the most common causes for heel and bottom of the foot pain. The plantar fascia is essentially a band of connective tissue (a ligament) which runs the length of your foot from your heel to your toes. It helps to support the arch of your foot by using “windlass mechanism” to make the foot more rigid and aid in the foot’s ability to transfer force and push off when walking or running. In the case of plantar fasciitis, the fascia on the bottom of the foot becomes swollen and irritated and may cause pain when you stand and/or walk. It’s typically at its worst in the morning with your first several steps after sleeping. Plantar fasciitis is also more common the older a person becomes.

Image courtesy of www.runnersgoal.com

Risk factors for developing plantar fasciitis include:

Excessive foot pronation. Your feet tend to roll inward as you stand, walk, and/or run.
Either excessively high arches or overly flat feet.
Spending long periods of time standing or walking.
Spending long periods of time on hard surfaces, such as concrete.
Obesity
Your shoes don’t fit well or the shoe is worn out.
You have transitioned too quickly from a more built up running shoe into a minimalistic style.
Poor ankle mobility, particularly excessive tightness in the Achilles tendon or calf muscles.
Poor foot muscle strength, particularly the foot intrinsic muscles which help to support the arch of the foot.

Plantar fasciitis typically begins as a mild discomfort which grows steadily and quickly to the point that a person may struggle to walk, stand, or run. Plantar fasciitis may occur after a specific event. The plantar fascia could be over stretched due to a slip. It could occur after an overzealous training day in unfamiliar circumstances, such as running barefoot in the sand.

Fortunately, plantar fasciitis doesn’t always require formal medical treatment. The key is to intervene quickly to identify the actual cause or causes that led to the inflammation and irritation. The recommended treatment is the same whether or not the plantar fasciitis developed over time or due to a specific event.

How to Self-Treat Plantar Fasciitis:

Begin your rehabilitation. Start with these Plantar Fasciitis Rehabilitation Exercises. Complete with instructions and photos, this guide outlines how to safely self-treat your plantar fasciitis. Stretch your calves as tight Achilles tendons and calf muscles can cause excessive strain on the plantar fascia, which increases your risk of pain. Stretch your plantar fascia by performing stretches prior to standing or walking upon morning waking and after any prolonged sitting.
Mobilize the tissue. Depending on how aggressive you want to be, a tennis ball, lacrosse ball, or golf ball can be used to mobilize the tissue. I recommend mobilizing once or twice per day for 2-3 minutes. Then perform additional stretching of the plantar fascia and calves.
Use ice. My favorite technique for icing this area is to use a frozen water bottle. Roll your foot over the bottle for 3-4 minutes until your foot starts to feel numb and the pain subsides. It’s possible to frost bite your foot, so be mindful of the length of time you’re icing.
Strengthen your foot and ankle complex. Weakness in the foot and ankle muscles (as well as the smaller foot intrinsic muscles) can lead to excessive strain on the plantar fasciitis. I recommend initiating a complete ankle/foot strengthening protocol. Please refer to Ankle Resistance Exercises.
Improve your balance. Poor balance is often associated with muscle weakness in the foot and ankle as well as the knee and hip musculature. Weakness and balance deficits can lead to poor foot mechanics, which can lead to excessive strain on the plantar fascia. Improving your balance can help reduce the risk of plantar fasciitis and is an important part of the rehabilitation. Please refer to Improving Balance by Using a Water Noodle.
Start a supplement. I am a supporter of natural supplements and remedies. Many supplements include herbs which are designed to help reduce inflammation. Phenocane Natural Pain Management combines the following: Curcumin, an herb that reduces pain and inflammation; boswellia, a natural COX2 inhibitor that also reduces pain and inflammation; DLPA, an amino acid that helps to increase and uphold serotonin levels in the brain; and nattokinase, an enzyme that assists with blood clotting and reduces pain and inflammation. If you are taking blood thinner medication, please consult with your physician prior to taking Phenocane Natural Pain Management.
Use a plantar fasciitis night splint. Although a little cumbersome and annoying, night splints can be helpful. While lying, the natural tendency is to flex the foot to point your toes (plantarflex). This position causes the plantar fascia to shorten and tighten, which explains the pain you might experience during the first few steps after sleeping or resting. The night splint helps you to heal by maintaining a neutral position which doesn’t allow the fibers to shorten.

While you’re self-treating your plantar fasciitis, you’ll likely need to modify your exercise or running program. It’s an excellent time to focus on cross training activities. I recommend following this protocol for two to three weeks.

If you’re not experiencing significant relief upon progressing into your exercise program, please consult a medical professional. I recommend a physical therapist who specializes in feet or who works with athletes for the treatment of plantar fasciitis. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a specific treatment for plantar fasciitis helped you? Which treatments haven’t worked for you? Additional discussion can help others to manage this condition more effectively. 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 new Resource Guide. Check it out today!

Posted on Monday, November 24, 2014

Top 10 Strategies to Avoid Injury

An ounce of prevention is worth a pound of cure. –Benjamin Franklin

As a physical therapist, I help people who have suffered from an injury through the process of rehabilitation. Accidents will happen, but certain activities can help you to avoid and limit the chance of an injury. Nothing will derail a perfectly designed training program like an injury. Optimize your health and lessen your risk of injury by being proactive upfront.

Top 10 Strategies to Avoid Injury:

1. Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients and remove any cellular waste products. I like to use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated.

2. Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine. Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as provide range of motion (ROM). The perfect time to perform static stretching is after exercising. Work on those tight and restricted areas. Keep moving throughout the day and avoid sitting for extended periods of time.

3. Eat healthy. A healthy diet is critical to avoid injury. 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.

4. Stay hydrated. The human body is primarily made of water, which is critical for all body functions. Adequate water intake is critical to avoid dehydration which can negatively affect your training. Dehydrated tissues are prone to injury 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.

5. Supplement. I take certain supplements during times of heavy training volume or when I am in a phase of overreaching. I also take them intermittently to help prevent injury or heal from one.

My most recommended supplement is CapraFlex by Mt. Capra. Essentially, 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 to help heal from an injury.

I also recommend a colostrum supplement called CapraColostrum by Mt. Capra. 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.

Like CapraFlex, Tissue Rejuvenator by Hammer Nutrition contains glucosamine and chondroitin as well as a host of herbs, spices, and enzymes to help support tissues and limit inflammation. I recommend taking either CapraFlex OR Tissue Rejuvenator. You can take CapraColostrum independently or in conjunction with either CapraFlex or Tissue Rejuvenator.

I recommend taking these supplements for injury prevention or as a recovery strategy. I recommend trying a 14-30 day protocol. (Please consult with your pharmacist and/or physician prior to starting any new supplementation protocol.)

6. Take cross training seriously. Performing the same activity day after day without variation can lead to overuse injuries or muscle imbalances. You may spend a majority of your time specifically training for a particular sport or activity, but it is important to vary the training load and/or stimulus. Not only can cross training limit your risk of injury, it makes training fun by keeping the body stimulated and ready to improve.

7. Actively manage your aches and pains. Spot train your weak areas and work on whole body mobility and fitness. Don’t neglect the small stuff as it will catch up with you sooner or later. Consider seeing a masseuse for regular body work. To learn how to use a foam roller for self-treatment, please refer to Foam Rolling for Rehabilitation.

8. If it hurts, don’t do it! Modify the activity or discontinue it completely. Modify any exercise as you need to, and don’t compromise technique to complete an exercise. Poor technique will only increase your risk of injury elsewhere. Work with your coach or athletic trainer to determine if poor form and technique is causing the pain. With instruction, you may avoid pain and injury while taking your training to the next level.

9. Adequate rest is important. 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 yoga class, take a leisurely bike ride, or take a walk in the park. If you are participating in a yearly training cycle, be sure to incorporate an off season which involves a change of pace from your regular training and some active rest. Proper programming includes mini cycles with an off season as well as active rest cycles in between heavy load and heavy volume training cycles.

10. Seek help early. If you are experiencing chronic aches or pain or are struggling with an aspect of your training, seek help immediately. 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.

Unfortunately, injuries will occur. However, incorporating these strategies will reduce your risk of injury while likely taking your training and exercise program to the next level. If and when an injury occurs, take it seriously and manage it quickly.

How do you avoid injury? Which particular strategy has aided in your recovery? Please leave your comments below.

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.

Posted on Wednesday, November 19, 2014

Q & A: Should I Exercise if I’m Sick?

Q. I had a sinus infection this past week. I have felt really guilty about not exercising. Should I exercise if I’m sick? –Josh

A. Thanks for the question, Josh, and I hope you’re feeling better! Feeling ill is never a fun experience, but it happens to all of us. Cold and flu season starts as the weather begins to turn. I’ll first address the reasons why we tend to experience more illnesses during this time of year, and then I’ll offer guidelines to determine if exercising while sick is the best choice for you.

Why do I tend to get sick during the winter?

Decreased sun exposure as there are fewer daylight hours. With less sun exposure, the body isn’t able to produce the same amount of vitamin D as it did during the summer months. Vitamin D is a powerful antioxidant that helps prevent illness. Consider supplementing with vitamin D during the winter months.
Decreased ultraviolet radiation from the sun allows viruses and bacteria to live longer on surfaces. Consider frequently cleaning your cell phone, keyboards, door knobs, and remote controls to avoid exposure. Wash your hands frequently and teach your children proper hygiene.
Dry conditions lead to dried out mucous membranes. The colder temperatures tend to be the driest times during the year. Drier conditions can lead to dried out mucous membranes which exposes and damages them. Then the mucous membranes can’t optimally function as a physical barrier to virus or bacteria exposure. Consider using a humidifier in your home during the winter months.
As children head back to school and more people spend time indoors, the close quartered contact allows for easy transmission of illness. In the U.S.A., the winter months include major holidays, which mean more shopping and gathering together. You may be exposed to many people who are ill. Once again, wash your hands frequently and teach your children proper hygiene.

Should I exercise if I’m sick?

A small amount of activity or exercise can actually boost the immune system, but a heavy amount can actually lower your immune system in the short run. Follow these guidelines to determine if exercising while sick is the best choice for you:

How sick are you? Determine the severity of your illness. If you have a fever or may be contagious, it’s your responsibility to not spread the illness. Stay away from others. If you have an upper respiratory illness, I recommend that you don’t perform any heavy cardiovascular exercise as you run the risk of driving the illness further down into the lungs.
Listen to your body. How are you feeling? If you’re just a little under the weather, light activity might actually help you. If you’re too tired to get out of bed, listen to your body and rest. You need to support your immune system in every way you can. Don’t feel guilty about not exercising! A missed work out will not completely derail your training program. Remember, quality over quantity.
Take the time to cross train. An illness is an excellent time to perform light cross training. Take a break from your regular exercise routine with active rest. Take a few walks or perform yoga at home. Focus on your problem areas. When I’m not feeling well, I concentrate on performing back strengthening exercises. Is your knee, low back, or shoulder bothering you? Now may be a good time to start a rehabilitation program. Please refer to the following posts to get started: 7 Tips to Get Rid of Knee Pain, How to Safely Self-Treat Low Back Pain, and How Should I Treat Shoulder Pain and Impingement?
Don’t expose others just so you can get your work out in! If you are coughing, sneezing, or have a fever, you’re likely contagious. Please don’t spread it around! If you insist upon exercising, then exercise in your home or outside. Be mindful of others and always clean the exercise equipment at the gym after working out.
Stay hydrated. Regardless of illness, it’s important to stay hydrated. Colder air can be very dry and can lead to dehydration. Prevent illness during the winter months by drinking extra fluids.

Did you know that as you get older, you tend to experience fewer colds? Your immune system is more geared to fight the cold after many years of practice. You can more easily recognize those who are sick and stay clear. You make wiser choices such as frequent hand washing and less sharing of personal items and food. (Teach your children how to prevent spreading germs as well.) Unfortunately, we can’t avoid getting sick every time. When you are sick, use the guidelines noted above to determine if exercising is the best choice for you. Thanks for your question, Josh!

Do you exercise if you’re sick? Can you offer any tips on how to quickly recover from an illness? Please leave your comments below.

Posted on Wednesday, November 12, 2014

My Top 10 Anti-Aging Tips

The science of aging and how to age gracefully and successfully continues to evolve, and the results are amazing. The accepted norm for an aging adult is crumbling before our eyes! This is such a wonderful time to grow older! Many age-related declines can be counteracted with exercise, diet, and lifestyle modifications. What are my top 10 anti-aging tips? Let’s get started!

Improve your growth hormone production – Strength training (focusing particularly on large muscle groups with appropriately heavy loads) has been proven to improve growth hormone levels. High intensity training (HIT) performed once or twice per week may also help to increase growth hormone levels. A proper diet is also the key to improving hormone levels by including adequate protein and fat levels while avoiding excess sugar. An adequate amount of sleep also plays a major role in growth hormone production.
Regulate your insulin production – Strength and endurance training have a positive effect on your body’s ability to regulate insulin levels. Strength and cardiovascular training are a critical part of a maintenance program for diabetes. To maintain an even energy level throughout the day, a stable insulin level is critical. Diabetes prevention is important in order to avoid cardiovascular disease and dementia.
Maintain your strength – Although all muscle fibers show some decline as you age, the fast twitch (Type II) fibers show the most decline. Again, strength training is a critical component to maintaining and growing additional Type II muscle fibers. The stronger you are, the more resistant to injury you are. Also, strengthening of the core area (the abdominals and back extensors) helps to manage low back pain.
Keep your heart healthy – Decreased stroke volume, cardiac output, and a decreasing maximal heart rate are all age associated declines. These declines affect your ability to perform maximum efforts. Strength training (particularly incorporating large muscle groups such as performing squats and HIT) can insure the heart remains strong by maximizing its ability to pump blood. HIT appears to be one of the best methods available to slow the progression of a decreased maximal heart rate. Strength and endurance training cause the heart muscle to hypertrophy. The heart is capable of growing stronger just like any other muscle.
Perform high intensity training (HIT) – As you age, your VO2 max can decline. VO2 max is the maximal amount of oxygen you can uptake during exercise or activity. HIT has been proven to increase a person’s VO2 max, so incorporating all types of HIT is important. Activities could include CrossFit, running intervals, or hill repeats. Perform your cardio in short bursts (ranging from 30-60 seconds at a time) followed by a one to two minute recovery. The 30-60 seconds should be at a high intensity, meaning your rate of perceived exertion (RPE) is high. You should be breathing heavy. If you are overweight or have arthritis, HIT may be performed while using a stationary bicycle or in the pool. You can also walk uphill at a quick pace, then stop and rest.
Use a foam roller – As a person ages, the body tends to become stiffer as it loses elastin. This negatively affects a person’s range of motion (ROM). It also makes the muscle and tendon fibers more likely to tear if overstretched. I recommend that everyone participate in a flexibility program. (The older you are, the more important this becomes.) Mobility and flexibility become more difficult if you aren’t purposefully working on it. Yoga is an excellent choice as well as utilizing the foam roller. Using a foam roller can help keep tissues pliable. Regular use may also beneficial as it helps improve arterial stiffness and can improve arterial and vascular function. To learn how to use a foam roller, please refer to Does Foam Rolling Help or Hurt Your Performance?
Manage your weight – Excessive body weight causes abnormal wear and tear on your body (particularly in the knees and feet). It also places additional strain on your cardiovascular system and increases your risk of diabetes—thus increasing your risk of stroke, heart disease, and dementia. As we age, our metabolism begins to slow. Maintain a diet rich in protein (particularly plant based protein as well as healthy fats such as olive oil or avocados) while avoiding processed foods and excessive carbohydrate intake. A strength training and high intensity training (HIT) program can help you to maintain a suitable weight by insuring your metabolism stays elevated and your hormone levels remain balanced.
Stimulate mitochondrial growth – Mitochondria are known as the power plant for your cells and are responsible for much of the energy production in cells. Endurance exercise stimulates mitochondrial growth. Keep moving! Also, foam rolling can help to promote more blood flow to the muscle tissues by bringing in much needed nutrients while removing wastes to help promote cell health.
Stay active and cross train – As a person ages, the nervous system can slow and the muscular system can also decline. Balance and mobility can suffer. The best way to combat this decline is to continue to move. Move in various ways and cross train. Participate in activities like yoga and tai chi to gain the balance and motor control as well as strength and cardiovascular training. Eating adequate amounts of healthy fats also helps to support nerve function and avoid excessive carbohydrate (sugar) intake.
Drink more water – The human body is primarily made of water, which is critical for all body functions. Adequate water intake is critical to avoid dehydration, which can be a common problem for older adults. Water intake supports proper brain, muscle, and hormone function as well as lubrication of the joints and skin appearance. Skip the fancy drinks with ingredients that you can’t pronounce and drink more water! Your body will thank you.

Many medical conditions can make aging gracefully more challenging, but don’t let it deter you from trying! Engaging in an exercise program may even help you to manage your medical condition. A lifestyle that includes a well-rounded exercise program and healthy diet can push you to the next level as you optimize your health. It is never too late to start living a healthy lifestyle!

If you are over age 50 or have never exercised before, I recommend that you take a Physical Activity Readiness Questionnaire (PAR-Q). The PAR-Q has been designed to identify the small number of adults for whom physical activity may be inappropriate or those who should have medical advice prior to initiating in physical activity.

With a proper exercise and nutrition program, we can strive to age gracefully and successfully and continue to enjoy our favorite activities well into our senior years. For inspiration regarding the aging process, I recommend reading Ken Dychtwald’s Age Power: How the 21st Century Will Be Ruled by the New Old.

What does it mean to YOU to age gracefully and successfully? Whether or not you’re still running or CrossFitting into your senior years, I’d love to hear your thoughts on aging. Please submit your comments below.

Don’t forget subscribe to my e-mail newsletter! You will receive each week’s blog post sent directly to your e-mail making it even easier and more convenient! To thank you for subscribing, you will automatically gain access to my FREE resource, My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.

Posted on Monday, October 20, 2014

How to Safely Self-Treat Low Back Pain

Did you know that an estimated $50 billion dollars is spent annually on back pain related issues? Low back pain (LBP) is one of the most prevalent medical conditions treated in the United States and throughout the western world. It affects nearly 80% of the U.S. population at one time or another. It’s one of the top reasons for physician visits and one of the most common reasons for missed work days. The previous post, 12 Sure Fire Ways to Injure Your Back, addressed potential risk factors for low back pain. This follow-up post includes how to safely self-treat your low back pain and helpful methods for a speedy recovery. (Not to mention, possibly saving you time and money by avoiding a physician visit for minor pain!)

To safely self-treat your low back pain, first take a moment to assess your symptoms and pain level. What led to your pain and/or injury? Did the pain come on suddenly or slowly? Evaluate the severity of the injury. If you’re experiencing any of the following, please seek immediate medical attention:

Loss of bowel/bladder function.
Uncontrollable pain. The pain is so severe you cannot function or move.
You are losing muscle function or control. The muscles in the legs will no longer work. (This is different than pain preventing the muscle from working.) This sensation of paralysis occurs when the muscles will not actually function.
Significant loss of sensation in the leg or groin area. This is not a tingling sensation, but an actual loss of sensation. For example, you cannot feel the toilet paper when you wipe after using the toilet.
Onset of pain without any known mechanism for the injury. (Thoroughly consider your activity. Many times, a slow onset of pain begins several hours after performing an activity.)

Fortunately, most LBP is mechanical–meaning it is from a physical or structural cause and isn’t related to conditions such as cancer or infections. Most LBP will have a directional preference for extension. A majority of injuries occur when performing a forward biased (flexed movement) like chronic slouching or a spinal flexion biased movement. For discussion purposes, I will be addressing an extension biased program.

You should be able to alter and change your LBP within a short period of time. First, establish a directional preference by identifying a pattern to the pain. Does the pain get worse when you bend over or does it improve? What happens when you repeat this movement? Determine how your pain responds. If it spreads away from the spine and down into the leg, beware that you are moving in the wrong direction. Stop that particular movement, and instead try flexion biased movements. In my experience, most episodes of LBP tend to respond better to extension biased movements. If flexion or extension doesn’t help or change the pain in any way, then you may need assistance from a medical provider.

The rule of thumb for movement: If the pain worsens by spreading peripherally down the buttock and into the leg and/or foot, then the condition is worsening. We must stop that activity. If the pain centralizes and returns back toward the spine (even if the pain worsens slightly), then keep moving as the condition is actually improving. For a thorough discussion and an excellent treatment resource, please refer to Treat Your Own Back by Robin A. McKenzie.

Although most LBP isn’t considered serious, the pain tends to re-occur. One major reason for this is that the deep stabilizing muscles known as the multifidus muscles reflexively shrink, weaken, and lose function. Without proper rehabilitation, the muscles will not fully recover. This increases the risk of future episodes because the spine no longer has the ability to stabilize itself normally.

How to Safely Self-Treat Low Back Pain:

Perform Press-ups – Once you have injured your back, immediately start press-ups. Perform this exercise with high repetitions and frequently throughout the day as long as the pain does not periperalize down the buttock and into the leg and/or foot. Lie on your stomach and perform 10-20 press-ups. Move slow and easy, but work your way up to full motion multiple times a day.

Perform Standing Back Extensions – After sitting, stand up and perform standing back extensions. Ideally, perform this exercise at least 10 repetitions each time you stand.

Activate the Multifidus – Start exercises to activate the multifidus muscles as soon as possible. Think spine extensor muscle activation. Again, perform this exercise frequently during the day after the initial injury. The Lumbar Extensor Exercises are designed to progressively activate the multifidus muscles (with the final exercise being the most challenging). Once the pain subsides and muscle function improves, more advanced lumbar extension strengthening and stabilizing exercises should be performed to decrease your risk of re-current low back pain.
Don’t Sit – Walking is critical to your recovery! It’s the number one way your spine receives nutrients and disposes of metabolic waste products. Walk frequently, and try to avoid any prolonged sitting.
If you Sit, Use Good Posture – Use a McKenzie Lumbar Roll to help insure a good lumbar curve. If you can’t sit comfortably, listen to your body and don’t sit! Be sure to stand up and walk every 20-30 minutes. Make sure you stand with good posture as well.
Stretch the Muscles of the Legs and Pelvis – Hamstring, Hip Flexor, and Piriformis Stretches for LBP help to reduce muscle spasms and tightness throughout pelvis area when performed daily. Stretch for at least 30 seconds at a time, 2-3 times each session.
Reduce Inflammation and Support the Healing Response – I recommend starting a thirty day course of CapraFlex by Mt. Capra. CapraFlex is an organic glucosamine and chondroitin supplement which also includes an herbal and spice formulation designed to naturally decrease inflammation and support healing. I recommend it to anyone recovering from an injury or attempting to prevent injury when performing at a very high level. I personally use it, and in my practice, it has helped clients recover faster and prevent injury. It can interfere with some blood thinning medication, so if you are on this type of medication, please check with your physician.
Ice as Needed for Pain – The rule for icing is to apply ice no more than twenty minutes per hour. Do not place the ice directly against the skin, especially if you are using a gel pack style. Individuals with poor circulation or impaired sensation should take particular care when icing.
Use Topical Analgesics for Pain – There are many topical agents which can be used for pain. My two favorites to help manage pain and stiffness are Arnica Montana (an herbal rub) and Biofreeze.
Be as Active as You Can – Don’t stop moving! It’s important that you remain as active as you can. You should taper certain activities that you know will increase your pain. This typically would be activities involving heavy loading of the spine such as squats with weight, deadlifts, and other activities that may cause forward flexion (particularly under a load). As you are able to, continue to work on cardiovascular conditioning and core muscle activation, particularly the lumbar extension exercises. Remember the concept of peripheralization and centralization. If your pain progresses from the area of the injury into your leg, then you need to stop that activity. If the pain remains constant or is progressing out of the leg, then continue with the activity as you are helping the body to heal.
Ask for Help – Yes, even physical therapists have to ask for help sometimes! Many useful manual techniques can help to manage LBP. You just can’t perform them on yourself. If your pain is not improving, I highly suggest seeking a qualified and competent physical therapist who works with clients suffering from LBP. The American Physical Therapy Association 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 seek your physician’s opinion as well).

Low back pain is a serious and debilitating condition. It will either most certainly affect you or someone close to you. Be pro-active in maintaining a healthy back by incorporating these helpful methods for a speedy recovery. Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities!

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