Posted on Wednesday, September 9, 2015

Q & A: How to Self-Treat Osteopenia

Q. I had my annual visit with my physician, and she says that I have osteopenia. She recommended that I start taking calcium and maybe even another prescription to help. Isn’t there a better way to treat this without the use of drugs? -Mary

A. Thank you, Mary, for this fantastic question! Osteopenia can be a very serious condition and is the precursor to osteoporosis. Osteopenia is defined as lower than normal bone density, but not to the severity of osteoporosis.

Osteopenia and osteoporosis significantly increase your risk of a bone fracture if you fall. When the condition is severe, the fracture can occur spontaneously from normal activities. Nearly 20% of all hip fractures in the elderly will result in death within the first year, and 50% of people will never regain their prior level of function after suffering from a hip fracture. Treating osteopenia and osteoporosis is a critical first step in reducing fractures and maintaining independence as a person ages.

Osteopenia can occur for many different reasons. Risk factors include:

Side effects of medications, such as chemotherapy or chronic corticosteroid use
Eating disorders
Radiation exposure
Gender – Females are more likely to experience bone loss.
Certain ethnic groups – White Anglo-Saxons are more likely to have thin bones.
Smoking
Prior family history
Alcoholism
Chronic soda consumption
Having a very thin build
Lack of physical activity

Osteopenia and osteoporosis are typically diagnosed via a bone density scan, which is recommended for woman over the age of 65. Depending on the risk factors for both men and women, your physician may order the scan at different times. For more information on a bone density scan, please refer to Q & A: Which Type of Imaging to Use?

Mary, you are correct. There are many options to help manage this condition other than prescription medications. I highly suggest that you speak with your physician about all available treatment options. The following recommendations are helpful in managing and treating osteopenia, but there may be more complicated internal issues affecting your body’s ability to improve bone density. Hormonal imbalances (such as low testosterone), menopause related hormone changes, and thyroid related issues (among others) may affect bone density. All possible hormone regulation issues should be screened for and addressed as you implement the following strategies.

How to Self-Treat Osteopenia:

1. Weight Training

Weight training (particularly barbell training) loads the skeleton progressively over time, which can decrease bone loss and increase bone mineral density. It also positively affects hormones, such as human growth hormone (HGH) and testosterone, needed to improve bone density and muscle strength. Barbell training is the most effective method due to the progressive load on the skeletal system, and the muscle pull being exerted on the bone, which also stimulates bone formation.

Weight training or resistance training (other than through barbell training) can also be beneficial. An example of weight or resistance training would be any type of pushing or pulling exercise that exerts a force on the muscle, which causes it to work harder than it would normally. Although any form of resistive exercise would be beneficial, the most effective exercises either activate large muscle groups and/or load the skeletal system. Examples include squats, lunges, and dead lifts.

2. Weight Bearing Activities

This refers to any activity, such as walking, jogging, and hiking, performed against gravity. Biking and swimming are examples of exercises that are not weight bearing and therefore, they aren’t as beneficial for bone development.

3. Vitamin D

Vitamin D is critical to the absorption of calcium, which is important for bone health. Although calcium is a critical component of bone health, I cannot recommend extra supplementation because of the potential cardiac risks to over supplementation. A healthy varied diet will typically supply adequate calcium levels (assuming that adequate vitamin D levels are present for absorption and that you are avoiding drinking soda).

4. Avoid Soda

Excessive soda intake (particularly diet soda) has been linked to poor bone density. The exact cause isn’t entirely clear. It’s debatable as to whether it’s a sign of an unhealthy lifestyle or that the additives, acids, and artificial sweeteners affect the bone density (but it’s likely both factors). What is clear is that too much soda is bad for your health and bad for your bones.

5. Creatine

Creatine monohydrate is helpful for increasing skeletal muscle size, strength, and power production. Increased muscle strength means increased muscle pull on the bones, which causes them to grow stronger. It may also have the added benefit of a preventative effect for dementia and neurodegenerative diseases. I recommend taking 5 g per day, and I typically consume it in 6-8 week cycles.

6. Magnesium

Magnesium is a critical component of bone health and health in general. I also use magnesium as a sleep and recovery aid. I consume it at night to help me sleep. Magnesium can also reduce 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. Stop Smoking

If you smoke, please stop. It not only affects your bone density, but it has negative effects on every other body system. It also increases your risk of cancer and heart disease.

8. Eat Healthy

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. A healthy diet equates to healthy bones.

9. Avoid Excessive Alcohol Consumption

A moderate amount of alcohol has been shown to have cardiovascular health benefits. Excessive amounts can lead to kidney and liver related issues as well as negatively affect bone density. The general recommendation is to consume no more than 1-2 servings of alcohol per day.

Mary, you should be able to affectively treat osteopenia without prescription medications by implementing these strategies, avoiding known risk factors when possible, and addressing any potential hormonal related issues. Thanks again for the question!

How has osteopenia or osteoporosis affected your life? Which strategies can you implement to improve your condition? 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.

Posted on Wednesday, August 19, 2015

How to Self-Treat Runner’s Knee

http://marathontrainingacademy.com/how-to-self-treat-runners-knee

Marathon Training Academy

August 16, 2015

In this guest post for Marathon Training Academy, you will discover the common symptoms and causes for Patellar Femoral Pain Syndrome (PFPS), also known as runner’s knee, and learn how to effectively self-treat and manage this condition.

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. As part of a quick and thorough method of treatment, first address the biomechanical causes for the pain. Then utilize the following strategies to quickly recover from the pain in order to keep training and running at a high level. Continue Reading

Posted on Wednesday, August 12, 2015

Q & A: Do I Need an MRI for Low Back Pain?

Q. I have been dealing with low back pain on and off for the past several months. The pain is severe. I cannot participate in my normal exercise activities. In fact, I struggle just getting in or out of my car. My doctor says my X-ray results are fine, but do I need an MRI? -Brad

A. Thanks, Brad, for the question! I am often asked if an MRI is necessary when someone is experiencing low back pain (LBP). You state that your X-ray results are fine, so that immediately rules out the possibility of certain types of injuries such as a fracture or more chronic conditions like spinal stenosis. Fortunately, most LBP is mechanical–meaning it is from a physical or structural cause and isn’t related to conditions such as fractures, cancer or infections.

The answer to your question is no. An MRI is not needed in a majority of cases of LBP. It is best to diagnosis the cause and the best treatment strategy through a thorough physical assessment because most LBP is mechanical. There is definitely a time and place for an MRI. There are very clear indications when additional follow up such an MRI is necessary. Your physician will take a thorough history and determine if it’s necessary based on your history and examination. (To learn more about the different types of imaging, including an X-ray, CT Scan, and MRI, please refer to Q & A: Which Type of Imaging to Use?)

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.
Numbness, pins and needles or severe pain in the toes or lower leg.
Any history of cancer or tumor. The pain did not have a specific and correlated mechanism for injury.
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.)
A high fever or any other symptoms in relation to your low back pain or you generally start to not feel well.

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. I will discuss an extension biased program because it is by far the most common directional preference. Flexion biased programs are often found in older adults particularly in cases of spinal stenosis.

In the case of mechanical LBP, 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 moving in the opposite direction. If you were moving into flexion, try extension. If you had trialed extension biased movements, try flexion.

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.

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. 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).

Thanks again for the question, Brad, and good luck with resolving your pain! For more self-treatment strategies for low back pain, including specific exercises and recommendations, please refer to the following posts: How to Safely Treat Low Back Pain, 12 Sure Fire Ways to Injure Your Back, and My Top 7 Tips to Prevent Low Back Pain While Traveling.

Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities! Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional unnecessary and costly medical bills!

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In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP. In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

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Posted on Wednesday, July 29, 2015

15 Tips to Self-Treat Achilles Tendinitis

http://marathontrainingacademy.com/achilles-tendinitis

Marathon Training Academy

July 26, 2015

In this guest post for Marathon Training Academy, you will discover the common symptoms and causes for Achilles tendinitis and learn how to effectively self-treat and manage this condition.

Achilles tendinitis tends to affect runners more than any other group or athletic population. There is typically a high correlation to the amount of activity and volume performed in relation to biomechanical abnormalities and training errors which lead to Achilles tendinitis or tendinopathy. The Achilles serves as the conjoined tendon for both calf muscles, the gastrocnemius and soleus muscles. Achilles tendinitis (also called tendonitis) is a serious condition for any athlete as it typically means a significant reduction in training volumes and modification to training routines. A complete stopping of sporting activities may be necessary in severe cases. Learn the potential causative factors for Achilles tendinitis and how to self-treat this condition so you don’t lose too much time with your training. Continue Reading

Posted on Wednesday, July 22, 2015

How to Recover Quickly from a Hamstring Strain/Pull

A hamstring strain, also known as a hamstring pull, is a relatively common injury that can occur in almost any sport: running, CrossFit, ice skating, and weightlifting. The injury typically happens when one of the hamstring muscles (which are located in the posterior or back of the thigh) become overloaded. This causes a strain or small tear of the muscle and a complete tear in severe cases. The pain is typically located in the back of the thigh near the site of injury. This area can range from the back of the knee to the buttock area (specifically near the bones of the pelvis you sit on called the ischium). Discover the factors that increase your risk of straining your hamstring and learn how to self-treat this condition.

The strain most commonly occurs during running or jumping (in particular during sudden movements or when quickly starting and stopping). However, you could just as easily pull your hamstring while weightlifting or working in the yard. The following factors increase your risk of straining your hamstring:

Not warming up prior to exercise
Tightness in the hip flexors or quadriceps muscles
Weakness in the glutes/buttock muscles

Although hamstring strains are relatively common, they can be very debilitating. Depending on the severity of the sprain, you may have to discontinue your sport. A minor strain is classified as Grade I. Grade I injuries tend to be mild. With proper care and rehabilitation, the healing time can be shortened.

Grade II tears are partial ruptures. Grade II tears can often be rehabilitated, but the time frame for healing is longer.

A complete rupture is classified as a Grade III tear. Grade III tears may require surgical intervention. Severe Grade II and Grade III tears cause impaired muscle function and usually have associated bruising that occurs near the site of injury.

The course of treatment is dependent on the severity of the pain and the location of the injury. I recommend that you seek competent advice from a medical doctor, physical therapist or athletic trainer if you’re experiencing severe pain. A professional can assess the severity of the strain and address how to handle the injury.

Initial Treatment

For the purpose of this discussion, I will address a Grade I or minor Grade II injury. The initial course of treatment following the sprain includes RICE, which stands for Rest, Ice, Compression, and Elevation.

Rest. In this case, rest would indicate tapering down from your regular exercise activity or any activity that involves using your hamstrings (bending over, walking uphill, squatting or activities involving hip extension or bending your knee).
Ice. Apply ice to the painful area–typically the sooner, the better. 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. A bag of frozen peas can be ideal. Individuals with poor circulation or impaired sensation should take particular care when icing.
Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response, so limit it as much as possible. You can utilize a common ACE wrap. If you have a friend who is medically trained, many different taping techniques can also assist in decreasing swelling. Many physical therapists or athletic trainers can apply KT Tape, Rock Tape or Mummy Tape for you or you can find application techniques online.
Elevation. Compression and elevation may not be fully possible if the injury is located higher into the buttock region. If there is swelling in the lower leg, then elevating the leg may be helpful.

Gentle Movement

During the acute phase, gently move the leg as you can tolerate. Don’t be aggressive with the movement. Walking is usually the best way to keep the area moving. Be sure to keep your steps shorter if you are experiencing pain. You may also try gently floating or walking in a pool as long as the pain does not worsen.

How to Self-Treat a Hamstring Strain/Pull:

Mobilize the fascia and muscle tissue. As you progress through the initial acute phase (typically 10 to 14 days), work on restoring normal pain free movement of the leg. Mobility issues and myofascial restrictions are very likely to occur following a hamstring injury. Along with tightness in the hamstring, you are likely to have tightness throughout the lower leg including the buttocks, quadriceps, IT Band or in the deep hip internal or external rotators. You may also have more spine tightness or pain due to altered movement patterns in the lower extremity. I recommend using a foam roller to address tightness in the lower leg. Care should be taken, and don’t roll too aggressively on the site of the injury. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation. I also recommend using 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 deeper hip and buttock muscles or to more deeply and aggressively mobilize the restricted areas appropriately.
Stretch. As you progress through your rehabilitation, care should be taken when stretching the hamstring. I tend to utilize both mobilization and gentle stretching to help maintain hamstring and lower leg motion. Don’t let the hamstring become tight and restricted. Hamstring Rehabilitation Exercises demonstrate my recommended stretches, foam rolling, and self-mobilization techniques.
Strengthen your glutes, hamstrings, and hip muscles. Weakness in the glutes, hamstrings, and hip muscles is common after injury and was likely a contributing factor to the injury itself. Strengthening of these muscle groups can help avoid future hamstring and even low back pain issues as well as reduce your risk of re-injury. Please refer to Hamstring Rehabilitation Exercises for additional exercises.
Hydrate. The human body is primarily made of water, which is critical for all body functions. I highly encourage you to hydrate more frequently during recovery. Adequate water intake is critical as your body attempts to heal and flush out metabolic wastes. 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. Keep steady supplies of nutrients going to/from the site of the injury. Try to avoid beverages that contain artificial sweeteners or chemicals with names you can’t spell or pronounce. Water is best.
Start a supplement. A hamstring strain 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 and support the healing response. My most recommended supplement to help recover from injury is CapraFlex by Mt. Capra. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation and support healing. CapraFlex can be taken long term or intermittently. 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 these supplements.

Return to Activity

As your pain decreases and after your hip and hamstring range of motion has returned to normal, slowly start tapering back into your training routine. During this time, you remain at a higher risk of injury. As you continue working through your rehabilitation and your return to activity, implement the following strategies:

Warm up prior to exercise. I recommend that you increase your normal warm up time. You should warm up at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also prepares the tissues for exercise. You can use a self-massage tool or a foam roller to roll up and down the hamstring as part of your warm up. If you perform hamstring stretches, be mindful that prolonged static stretching before exercise may worsen performance. Warm up exercises may include light jogging, bicycling, rowing or any activity to get the heart rate up and the blood flowing in the lower legs. Be careful when performing any movement that puts the hamstring in a stretched positon with speed or force.
Cool down. After performing your exercise or activity, take the extra time to cool down and stretch. Focus on hamstring stretching as well as general lower extremity mobility stretches. Use the same self-massage tools as you did during your warm up.
Initially avoid potential high risk activities. As your recovery progresses and you return to activity, initially avoid high risk activities that put the hamstring muscle under heavy load or a very quick load. Progress slowly. If an activity begins to cause pain in the hamstring, don’t push through it. Instead, stop and give your hamstring more time to heal prior to trying it again. You should be pain free before you progress the intensity of the activity or sport. Hamstring pulls have a high likelihood of re-injury if you rush the process.
Regain full strength and motion before returning to sport. Before a full return to sport or activity is initiated, you should have full lower leg and hamstring mobility and strength without pain. If you continue to experience soreness or restriction, continue to work on your rehabilitation until the leg and hamstring have returned to normal. Then initiate a full return to activity.

If you’re not experiencing relief after two to three weeks of aggressively managing the symptoms, contact your medical doctor, physical therapist or athletic trainer for an assessment and help in managing the injury. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area.

Has a hamstring strain/pull ever sidelined you? Which treatment was the most effective 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 Resource Guide. Check it out today!

Disclaimer: The Physical Therapy Advisor Blog and its information 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, July 8, 2015

Out of Balance?

Poor balance and the fear of falling are primary reasons for declining mobility as a person ages. Mobility is an important factor in the quality of life. As balance worsens (increasing the risk of falling), it is more difficult to be mobile. Unfortunately, falling is the number one cause of hip fracture. Nearly 20% of all hip fractures in the elderly will result in death within the first year, and 50% of people will never regain their prior level of function.

Physical therapy is a very viable and helpful resource in improving balance and mobility in order to maintain your independence. The key to helping someone improve balance is to understand why his/her balance is worsening in the first place. Determining the best intervention to address balance-related issues can be difficult and is typically multifactorial. Once the reason for the decline is determined, an effective treatment program can be designed by the physical therapist to address the issue. The following different body systems affect balance:

Musculoskeletal System – A person needs to have adequate strength and bone structure for mobility and balance.
Somatosensory – This system consists of all of the touch and nerve receptors in the muscles, tendons, and joints. A common problem affecting the somatosensory system is neuropathy. One very common form of neuropathy is from diabetes. Having numb feet makes it very difficult to balance!
Eyesight – We rely heavily on our eyesight for mobility and to know where we are located in our environment. Eyesight can be affected by eye conditions such as glaucoma, cataracts or even if you wear poorly fitting eyewear. Your eyesight is not just about the acuity at which you see, but is also how the eyes move. Gaze stabilization is how well you can stabilize on a target in your field of vision.
Vestibular System – Our vestibular system is located in our inner ears. It provides us with information on head movement. It works to process information on the head’s position in your environment. The vestibular system is one of the more adaptable systems, and with practice, it can be improved.
Central Nervous System – The brain is responsible for coordinating all of the information gathered by the body’s other systems. Damage from trauma or conditions, such as Parkinson’s disease, or a stroke can also affect balance. Other factors such as medications and dehydration can also affect balance.

One of the best ways to maintain your balance as you age is to remain active and move more! Balance is an integration of many body systems, so movement is an excellent way to work on all of the body systems!

If you desire specific advice, I highly recommend that you seek assistance from a qualified medical doctor or physical therapist that is well versed in balance related disorders. 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).

For additional information on the five different body systems which affect balance and how they work together to insure proper balance and mobility in our environment, please refer to How Do I Improve Balance? (Part I), How Do I Improve Balance? (Part II), and How to Improve Balance Using a Water Noodle.

How do you incorporate balance activities into your therapeutic exercise program? Please leave your comments below.

Don’t forget to subscribe to my e-mail list to receive each week’s blog post sent directly to your e-mail. You will automatically gain access to my FREE resource, My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain. Download the .pdf file, which is full of photos and exercise instructions, to get started! Subscribe now by clicking on the subscribe button located on the upper right-hand sidebar. (Or scroll down further if you’re on a mobile device.) Thank you!

(This article first appeared in the Seniors Blue Book, October 2014-March 2015, page 84.)

http://blog.directcapital.com/business-insights/top-physical-therapy-blogs/

Top Physical Therapy Blogs
July 1, 2015

I’m excited to report that The Physical Therapy Advisor web site has been featured in this fantastic resource! I recognize many on the list, and I have discovered a few blogs that I will start following. Thank you for your help spreading the word and your continued support!

Posted on Wednesday, July 1, 2015

How to Train for an Obstacle Course Race

Obstacle course racing (OCR) is growing quickly and becoming a very popular sport. It is a fun way to challenge your strength, fitness, and mental fortitude. With the proper training and recovery, this style of racing can be performed safely. Whether you are a newbie or a seasoned Spartan, I offer tips on how to optimize your racing experience.

(Courtesy of Reebok Spartan Race)

I competed in my first OCR, the Boise Spartan Sprint, thanks to a friend. She transferred her registration to me after suffering a knee injury and was unable to participate. Thank you, Jenifer, for prompting me to try something new! It was a blast!

How to prepare for an OCR? Without any prior experience, I started by listening to Ben Greenfield’s Obstacle Dominator Podcast and reading about Spartan Race Training. I have competed in many running and trail races at varying distances, so I felt that I could adequately train despite being on a long vacation the two weeks prior to the race.

The Boise Spartan Sprint

Obstacles, courses, and distances vary for each event. This particular course offered options to skip certain obstacles, but you had to pay a 30 burpee penalty. Although there were options available to insure all who wanted to participate could, the terrain was not suitable for everyone. There were five quite steep hills to climb up and down during the 4 mile course. They were much steeper than I expected, and I’m used to hiking similar terrain while hunting.

The other surprise was how the water obstacles made for a new challenge (particularly when combined with other obstacles such as the rope climb). I am typically a pretty good rope climber, but getting a good foot hold was difficult when submerged in 3 feet of water. Fortunately, I was able to overcome the challenge.

After experiencing the general tempo of this particular course and its layout, I better understand how to train for an OCR. My final ranking was number 180 out of 3,394. Not too bad for a first attempt, but nothing like the elites! I will be sure to incorporate more of these tips and lessons learned when training for my next OCR.

7 Tips on How to Train for an Obstacle Course Race:

High intensity interval training (HIIT). The amount of HIIT in preparation for your race will vary and is dependent on the distance. If the race course will be a shorter distance (under 5 miles), then a majority of your running could be HIIT and shorter distance recovery runs. If you will be competing in longer distances (10 miles or more), then I would still incorporate a weekly longer run just so your body will be prepared for the mileage and time on your feet. I highly recommend that you run outside–preferably on a trail or uneven terrain to prepare your legs adequately. You will need to feel comfortable running downhill on uneven terrain. Please refer to my Training Plan that I used for Race to Robie Creek, a very steep half marathon 8.5 miles uphill and 4.6 miles downhill.
Train for the pack. In larger races or in races where there is a variation in skill levels, I recommend training for this variable. Constantly changing your running pace faster or slower is more tiring than just running at your preferred pace. One easy and effective running style to train for this variable is called the Fartlek, Swedish for speed play. It involves taking your normal forty to sixty minute run (after a warm up) and intermittently changing your pace from jogging (at different speeds) to sprinting. This can be performed in a structured form or randomly in true Fartlek style. One method is to pick objects in front of you and vary your running speed as you approach them. This is a critical training method if you want to improve your race time.
CrossFit as a form of high intensity training (HIT) is an excellent method to train your legs to handle the hilly terrain (including a very fast and steep decent). The obstacles may include: picking up heavy objects and carrying them either in front or sometimes overhead; scaling walls; swinging and climbing along monkey bars; rope climbing; and crawling in mud. CrossFit taught me how to prepare for these different obstacles by refining the skill sets necessary to tackle them. It also prepared me to perform the obstacles when fatigued.
Climbing Wall. One of the obstacles included traversing a climbing wall sideways for 20+ feet. Participants were not allowed to climb up or let their feet touch the ground. I suggest practicing this at a local climbing wall. Although I was able to perform the obstacle, I was much slower as I rarely spend time on a climbing wall.
Monkey Bars. Spend time practicing swinging, climbing, and moving in different directions on monkey bars to better prepare for the different obstacles. It’s also an excellent method to increase your grip strength.
Clothing can be an interesting variable. For my particular OCR, the temperature was quite warm (above 80 degrees). The water obstacles helped to keep my body cool. In hindsight, additional clothing should have been considered in order to avoid cuts and scrapes. I wore a long pair of compression socks to help with cramping and protection from ground cover. I wish that I would have worn knee protection. The crawling cut up my knees and made them feel sore. Also, when scaling the walls, I got scrapes under my arms because I wore a tank top. I recommend wearing clothing that will protect your body for the likely scrapes and cuts that will occur.
Ankle Sprain Prevention. I had been warned that this particular course was hilly. In preparation, I decided to utilize Mummy Tape for ankle stability. (You can also use Rock Tape, KT Tape or any other Kinesiological style tape.) This video, KT Tape Ankle Stability, demonstrates the technique I utilized to help improve my ankle stability in order to prevent an ankle sprain. For application and removal tips, please refer to Skin Care with Taping.

Once you complete the OCR, enjoy your accomplishment, but don’t forget to implement proper recovery strategies! Be sure to properly cool down after the race. Don’t sit! Stretch and continue to move. You will need to make sure that any scratches or wounds are properly cleaned and covered. Hydrate appropriately and begin working through your recovery process. For more information on how to quickly recover, please refer to the following posts: 14 Tips and Strategies to Self-Treat Muscle Pain and Muscle Cramping & Spasms – Treatment Options.

Have you competed in an OCR before? Please share your experience by leaving a comment below.

Posted on Wednesday, June 17, 2015

12 Strategies to Prevent and Self-Treat Muscle Cramping

http://marathontrainingacademy.com/muscle-cramping

Marathon Training Academy

June 16, 2015

In this guest post for Marathon Training Academy, you will discover the common causes for muscle cramping and learn prevention strategies and self-treatment tips.

Muscle cramping and spasming can significantly derail your best intentioned race plans. A muscle cramp or spasm is a sudden, involuntary, and typically severe muscle contraction. Thankfully, it’s very rare for a muscle spasm or cramp to permanently damage the muscle. However, the cramp or spasm can produce mild to excruciating pain. The pain can be very short lived or linger for days after a severe episode. Unfortunately, muscle cramping can affect your performance. Common causes of muscle cramping include overexertion, prolonged immobility, dehydration, and electrolyte imbalances. Continue Reading

Posted on Wednesday, May 27, 2015

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.Flexibility 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.

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.)

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.

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