Posted on Wednesday, March 18, 2015

12 Tips to Prevent Overtraining Syndrome

If you exercise or participate in any sport, then you have likely had some experience with Overtraining Syndrome (OTS). It usually starts with extra muscle soreness and a feeling of fatigue. These symptoms can quickly morph into a serious case of overtraining syndrome. Overtraining can occur when the intensity and/or volume of exercise becomes too much for the body to properly recover from.

Although not well understood yet, research indicates two forms of OTS. One affects the sympathetic nervous system (SNS). The other primarily affects the parasympathetic nervous (PNS). Sympathetic OTS tends to affect sprint or power athletes. The resting heart rate tends to be elevated in the sympathetic form. Parasympathetic OTS tends to affect endurance athletes. In the parasympathetic form, the heart rate is even more decreased than typically found in endurance athletes.

There is no specific test for OTS. The diagnosis is usually determined when a number of factors or symptoms begin to manifest. Warning signs, ranging from mild to severe, include:

Fatigue (mild to severe)
Muscle and body achiness and soreness
A sudden drop in performance
A drop in strength
A drop in cardiovascular endurance
Insomnia or excessive sleepiness
Headache
Illness due to a drop in your immune function
Irritability and moodiness
Decreased appetite or weight loss
An increase in your resting heart rate
A decrease in your heart rate variability
A substantial drop in training capacity and/or intensity
Depression and a loss of enthusiasm for activities (such as training)

Avoid Overtraining Syndrome if you want to effectively train at a high level. It not only impedes your immediate performance, but it also substantially increases your risk of injury. Remember, recovery from a workout is a critical part in avoiding OTS. Your recovery routine should be an intentional and a multifaceted approach.

12 Tips to Prevent Overtraining Syndrome:

Keep a training diary. An exercise or training diary allows you to keep track of how you feel before, during, and after workouts. How did your body respond to training that day? How did you sleep? How was your food intake and nutrition? Also, record your heart rate response during your exercise session. Document as many variables as you can in order to look for patterns. Discover which combinations work well for you and those that have a negative effect on training. Focus on the positive and eliminate variables which cause negative effects. The diary helps you to keep track of it all. There are software programs available to assist in this as well. One such program popular with cyclists and triathletes is Training Peaks.
Monitor heart rate variability. Another potential warning factor for overtraining syndrome is heart rate variability (HRV). It is simply the variation in the time interval between heartbeats. HRV is affected by stress, hormone changes, and changes in the sympathetic or parasympathetic system. A decrease in parasympathetic activity or increased sympathetic activity will result in reduced HRV. A reduced HRV is a sign of OTS. The higher the HRV, the more capable your nervous system is able to adapt to stress. Many different apps can quickly measure HRV. Some apps are more accurate than others. The more accurate and precise the measurement, the more expensive the app. One free app that I use and recommend is Azumio’s Instant Heart Rate.
Monitor for OTS warning signs. Watch for the warning signs (listed above) and decrease your training volume if you are experiencing symptoms. Listen to your body.
Cool down. After performing your exercises, take the extra time to cool down and stretch. Choose exercises and activities that provide range of motion (ROM) to the particular area that you just trained or used. The perfect time to perform static stretching is after exercising. Work on tight and restricted areas. Keep moving throughout the day and avoid sitting for extended periods of time.
Foam rolling. The foam roller is a wonderful tool which allows you to manipulate the body’s soft tissues. This has a potential positive effect on the fascial system, the musculotendinous system, and the circulatory system. It can aid in recovery by improving blood flow and reducing myofascial restrictions. To learn how to use a foam roller for self-treatment, please refer to Foam Rolling for Rehabilitation.
Active recovery. Every day shouldn’t be an intense training day. As part of your training cycles, be sure to include time to participate in other activities to help the body to recover and rejuvenate. Participate in a yoga class, take a leisurely bike ride, or take a walk in the park.
Proper periodization. You cannot and should not train at a super high intensity all year long. Your work volume needs to be properly periodized. Well-balanced gradual increases in training are recommended. Be sure your training plan varies the training load in cycles with built in mandatory rest phases throughout the year. The plan will likely be based on when you need to peak for certain events or races. During the high workload phase, try to alternate between high intensity interval work and low intensity endurance work.
Taper up the training volume appropriately. The 10 Percent Rule is a guideline that many fitness experts use to help athletes (of all levels) avoid injury while improving performance. Many cases of OTS can be attributed to increasing the intensity, time or type of activity too quickly. The 10 Percent Rule sets a weekly limit on training increases. The guideline indicates not to increase your activity more than 10 percent per week. That includes distance, intensity, amount of weight lifted, and/or time of exercise. For example, if you are running 30 miles per week and want to increase the distance, add 3 miles during the next week for a total of 33 miles a week. If you are squatting 200 pounds and want to increase, don’t add more than 20 pounds during the next week. The 10 Percent Rule is only a guideline. In some cases, 10 percent may be too much. Instead, a 5 percent increase per week may be much more realistic.
Rest more. 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. Sleep more. Proper programming includes mini cycles with an off season as well as active rest cycles in between heavy load and heavy volume training cycles. Don’t fear rest, embrace it!
Eat healthy. 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. For more information on protein intake, please refer to How Much Protein Do I Really Need?
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.
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. Both of these supplements can be used in heavy volume or intense training phases to help you to recover faster and avoid OTS. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

If you begin to experience any of the warning signs of OTS, be proactive about modifying your training. It is important to objectively measure your training routine and make adjustments before you become sick, overtrained or injured. Incorporate these recommended prevention strategies to help keep your training at a high level. In the follow up post, 10 Tips to Self-Treat Overtraining Syndrome, I specifically address self-treatment strategies.

If you are experiencing chronic aches or pain or are struggling with an aspect of your training, seek help immediately. Seeking advice specifically from an experienced coach, physical therapist, or physician can be beneficial.

Nothing can derail your best laid training plans and goals like an injury or suffering from OTS! If you develop OTS, you will need to take specific steps to speed up your recovery in order to prevent injury and return to a normal training schedule.

AVAILABLE NOW ON AMAZON!

In my book, Preventing and Treating Overtraining Syndrome, I show you how to recognize the risk factors and symptoms of OTS. You’ll learn how to utilize prevention strategies to help you develop a personal training strategy that will allow you to push past your limits and prior plateau points in order to reach a state of what is known as overreaching (your body’s ability to “supercompensate”). This will speed up your results, so that you can train harder and more effectively than ever before! In addition, learn how to use the foam roller (complete with photos and detailed exercise descriptions) as part of a health optimization program, recovery program, rest day or treatment modality.

Discover how you can continue to train hard and avoid the associated poor performance, illness, and injury that can result in lost training days and opportunity!

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I am excited about presenting a Low Back Pain Seminar at CrossFit Station.

Date:	Saturday, April 11, 2015
Time:	10 a.m. – 12 p.m.
Location:	1396 E Iron Eagle Dr. Eagle, ID
Registration:	$25 Registration Fee (due by Friday, April 3)
More Info:	Contact Trina or Tony at 208.631.3410 to reserve your spot! Click CrossFit Low Back Pain Seminar for more information.

Event:	Low Back Pain Seminar

Posted on Wednesday, March 11, 2015

6 Reasons to Self-Treat and Manage Your Health

The United States spends more money by a wide margin than any other country on health care. Our health care system is set up to keep us from dying, not thriving. Our average life span barely makes it in the top 30 when compared to other nations. As it stands now, the American health care system is poorly equipped to help us maximize our health span. Health span is defined as a period of time in which a person is generally healthy and free from serious disease.

Health care costs in America continue to increase without actual positive change in our health status as consumers. It is imperative that we take a leadership role in our own health care by continuing to be proactive. Part of being proactive is learning how to care for and manage common non-life threatening injuries and illnesses. The medical system is not designed to help you to maximize your health and well-being. It is designed to prevent you from dying and to maximize profits for the corporatocracy that controls our health care system. It is imperative that we manage our health by learning how to self-treat non-life threatening and non-emergent injuries and illnesses.

6 Reasons Why You Should Self-Treat and Manage Your Health:

Money – Health care is expensive. Many of the most common treatments and fancy diagnostic methods are not necessary. Costs are only going to rise more in the future. As this occurs, it will be even more important to be able to take care of the simple common place injuries and illnesses. It will save you a lot of time and money!
Empowerment – There is nothing more important than your health. You have control of most of the aspects in your life that affect your health status. Taking care of yourself and your health needs leads to a sense of empowerment.
Improved Care – If you understand how to be healthy and take care of yourself, you will be able to assist your medical practitioner in making the best decision on how to manage your care. Remember, it is your body and your health. Being your own advocate will insure that you receive quality care.
Quicker Recovery Time – Often by taking out the middle man, you can help to increase the speed of recovery. You can address the condition and help your body to initiate the healing response to insure a faster recovery.
Emergency Situations – You never know when an emergency, such as a motor vehicle accident or inclement weather, may occur. You may experience an injury or illness during a camping trip when resources are a far distance away. In the event of an emergency situation, you will be knowledgeable and equipped to take care of yourself and your loved ones. (If necessary, please seek appropriate medical assistance as soon as possible.)
Healthy Living – Take the time to focus on your health. Often, small changes in your diet, activity level, and relationships can make a big difference. You can take control of your health and your life! For more healthy living tips, please refer to My Top 10 Anti- Aging Tips and How to Age Successfully.

Taking a passive role in your health is not a wise choice in America’s current health care environment. Only you are responsible for your health. My goal is to have a positive impact on the lives of others and on the health care system in general. I desire to accomplish this by providing useful and practical types of “how to” information. With the cost of healthcare on the rise, I desire to help proactive adults of all ages to understand how to safely self-treat and manage common physical therapy related conditions in a timely manner so they can reach their optimal health.

To accomplish this goal, I need to hear from YOU! What are your pains? What injuries are you suffering from? Please submit your questions to contact@thePhysicalTherapyAdvisor.com. I look forward to answering your health related questions! You CAN achieve optimal health!

Get started now by checking out the Resource Guide! The specific exercise section is full of rehabilitation exercises ranging from low back pain to knee pain. These .pdf files include photos and detailed descriptions to help you get started. This list of resources also includes books, products, resources, supplements, topical agents, videos, and web sites that I personally use and recommend to my family, friends, clients, and patients (for use in the clinical setting).

Also, 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, March 4, 2015

Q & A: Why Am I Dizzy Upon Standing?

Q. Almost every time I stand up, I feel dizzy. It seems to be worse if I am lying down before standing up. Should I be concerned? –Jill

A. Great question, Jill! We have all likely experienced the sensation of dizziness upon standing at one time or another. You are likely experiencing a sensation known as orthostatic hypotension (also known as postural hypotension). Orthostatic hypotension (OH) is defined by a drop in blood pressure that is greater than 20 mm of mercury during contraction of the heart muscles (systole, the top blood pressure number) and more than 10 mm of mercury during the expansion of the heart muscles (diastole, the bottom blood pressure number).

Suddenly standing up can cause blood to pool in the blood vessels of the body and legs. For a short period of time, a decreased supply of blood is carried back to the heart to be pumped to the brain. This results in a sudden drop in blood pressure which causes a feeling of dizziness.

Unless you’re experiencing severe symptoms or losing consciousness (blacking out), OH is typically not a concern and can happen to anyone. In my clinical experience, I have treated highly active adults and athletes as well as the elderly for OH. The concern is greater for the elderly as it may be a sign of additional cardiac related illness such as congestive heart failure (CHF). OH can increase the risk of falling which is already an issue for many elder adults.

The following conditions may increase the likelihood of developing OH:

A low blood volume from dehydration can cause OH, fatigue, and weakness. Be sure to adequately re-hydrate after activity. Soda and other processed drinks do not optimally hydrate your body. Water is best. Other options include coconut water, caffeine-free tea, and consuming fruits and vegetables.
Postprandial hypotension is a sudden drop in blood pressure after eating. The body shunts blood to the stomach and digestive system to aid in the digestion and transport of nutrients out of the gut. This can lead to low blood volume in other parts of the body and could cause OH. Eating small, low-carbohydrate meals may help to reduce symptoms.
When I am in a high volume cardiovascular training cycle, I tend to experience low blood pressure. Average blood pressure (BP) should be around 110/70 mm mercury. My blood pressure will be close to 100/60 mm mercury when I struggle with OH. To eliminate this problem, I increase my salt intake. Sherpa Pink Gourmet Himalayan Salt is my preferred type of salt to use. The extra sodium retains more fluid in my system which keeps my blood pressure up while providing important trace vitamins and minerals.
Bradycardia (slow heart rate) can increase your risk of OH. A slow heart rate is generally considered a healthy side effect of being cardiovascularly fit. A heart rate less than 60 beats per minute (bpm) is considered low. This is a common finding in well trained athletes as they range between 40-60 bpm. Other more serious heart conditions, such as heart valve related issues and CHF, can be associated with bradycardia. OH is also common post cardiac surgery or heart attack. If your heart rate is low or you’re experiencing cardiac issues, please consult with your physician.
Diabetes, thyroid dysfunction, and adrenal insufficiency as well as other hormone (endocrine) related issues can cause OH.
Many illnesses affecting the nervous system (spinal paralysis, Parkinson’s disease, and some forms of dementia) can cause OH related symptoms.
Many medications have side effects that can result in OH symptoms. If you develop symptoms of OH, address your medications with your medical physician or pharmacist.

Treatment options for OH include:

Compression. Lower extremity compression serves to help prevent blood from pooling in the lower extremities and can aid the venous return system. With compression, the heart doesn’t work as hard to pump blood to and from your toes. You can utilize a common ACE wrap, but I highly recommend that you purchase a mild over the counter compression sock (at least thigh high) such as Jobst Relief Therapeutic Thigh High Stockings. Do not apply any compression too tightly that it causes numbness or tingling in the legs, feet, or toes. In cases of spinal paralysis, an abdominal corset (binder) may be necessary to maintain a normal blood pressure.
Stand up slowly. If you’re suffering from OH, take your time when you first sit up after lying down or after you first stand up. Moving slowly will decrease your risk of injury (should you fall) while feeling dizzy.
Perform a cardiac warm up to get the blood in your legs moving prior to standing and performing an activity or exercise. Begin with tapping your toe 15 times on each foot. Then perform a seated knee extension by moving your leg straight out 15 times on each leg. Next, remain sitting, but march in place 15 times on each leg. Once you have completed this routine, stand up slowly (if you don’t feel dizzy) and proceed with your activity. Be sure to pause briefly to insure that you’re not experiencing dizziness as a delayed response of a few seconds is typical.

In most cases, OH is a common and benign condition. It can affect anyone for many different reasons. In most cases, dizziness can be easily treated with hydration and possibly a small increase in salt intake. Elder adults should take care if they are experiencing dizziness. Seek medical advice to determine if dizziness is a symptom of a more serious condition. If the condition worsens or you lose consciousness, please consult with your medical physician as OH is just one of many forms of dizziness.

Thank you, Jill, for your question. I hope these treatment options for OH will not only help you to determine the cause of your dizziness, but that they also decrease the frequency of your symptoms. For additional information on dizziness, please refer to Q & A: Vertigo – Causes & Treatment and Q & A: How Do I Improve Balance? (Part I).

Have you ever experienced OH symptoms? Which treatments for dizziness are the most effective for you? Please share any recommendations that you may have by leaving 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!

Posted on Tuesday, February 24, 2015

Why You Should Practice Tai Chi

When was the last time you saw an American elder person perform a full squat or be able to move up and down from the ground? Now ask that same question about an elder person in China or India. The answer is much different. We notice some interesting differences in how people age when we study other cultures around the world. Many societies have fewer infirmed and immobile elders than does America. Elders in many of the Mid East and Eastern cultures tend to function at a much higher level. Lifetime participation in activities, such as Tai Chi and yoga, is one reason for this difference in healthy aging.

Aging healthfully and successfully involves integrating the body, mind, and spirit. Few activities and exercises simultaneously address all three aspects of a person’s life. Tai Chi and yoga are two forms of exercise that have an effect on all three aspects.

Tai Chi, also known as Tai Chi Chuan (TCC), is a soft form of martial arts that originated in China hundreds of years ago. Its basic movements allow for full body strengthening and balance. A focus on relaxed breathing and mental attention helps to achieve balance between body, mind, and spirit. It doesn’t require special equipment–only a small space indoor or preferably outdoor to perform. Research on Tai Chi supports many wonderful medical benefits. The major outcome of regular practice is reduced frailty.

12 Reasons Why You Should Practice Tai Chi:

Increase your lower extremity and core strength.
Improve your lower body and upper body arm control.
Improve your balance and postural stability.
Improve your flexibility.
Reduce your body fat.
Reduce your number of falls.
Utilize your practice as part of a cardiovascular rehabilitation program for prevention and/or post surgically.
To produce higher peak oxygen uptake during exercise and reduce your blood pressure.
Safe and beneficial exercise if you have diseases such as rheumatoid arthritis (RA), osteoarthritis (OA), and multiple sclerosis (MS).
Benefits your immune system and aids in hormone regulation.
Improves your bone mineral density. Regular Tai Chi exercise can help to treat osteoporosis and osteopenia (the loss of bone density and associated with fractures of bones in the elderly).
Improves your mood and reduces stress, tension, depression, anger, fatigue, confusion, and anxiety.

No wonder why Chinese doctors utilize Tai Chi to treat hypertension, stress, depression, mental strain, chronic indigestion, insomnia, and arthritis!

Tai Chi offers a wonderful method to maintain your mobility and health as you age. With people living longer, the focus should be on health span versus life span. Older adults participating in Tai Chi exercise report a sense of improved well-being, increased alertness, relaxation, an improved mental outlook, and greater confidence.

I strongly recommend finding a local Tai Chi class to participate in with a group. Active engagement in your community is a critical part of successful aging as well maintaining meaningful relationships with others. If you are unable to locate a group or Tai Chi instructor, then utilize the free resources available on YouTube. Daily Tai Chi, a free instructional video, will teach you how to perform the basic Tai Chi movements. Tai Chi for Beginners discusses the origins of Tai Chi and offers a sample lesson.

America is heading into a generational change as the baby boomers move into their elder years. For a more thorough discussion on successful aging, please refer to How to Age Successfully. For an excellent read on America’s aging population and how it will re-shape our expectations, check out Ken Dychtwald’s Age Power: How the 21st Century Will Be Ruled by the New Old.

Do you participate in Tai Chi? What benefits have you experienced? Please leave your comments below.

Posted on Wednesday, February 18, 2015

Q & A: How to Self-Treat a Baker’s Cyst

Q. My knee started hurting about two weeks ago. I have noticed swelling in the back of my knee. It’s painful when I bend or straighten the knee. I looked up the symptoms on WebMD. I think I might have a Baker’s cyst, but I’m not sure what to do now. Your insight would be appreciated, thanks! –Patti

A. Great question, Patti! The symptoms you are describing sound like they may be caused by a Baker’s cyst. Another common diagnosis with similar symptoms would be a meniscus injury. I recommend that you read my previous post on meniscus pain, Q & A: 7 Tips to Get Rid of Knee Pain. Much of the advice will carry over to either condition.

A Baker’s cyst, also known as a popliteal cyst, is a fluid-filled sack that forms in the back of the knee. Synovial fluid from inside of the knee pushes out into a fluid-filled sack in the back of the knee. Sizes of the cysts can wildly vary as do the symptoms. The cyst can typically best be seen when a person is standing. It may or may not be tender to the touch. In fact, you may or may not have any symptoms at all.

Baker’s cyst symptoms include:

Stiffness or tightness in the back of the knee, thigh, or upper calf.
Swelling noted behind the knee. If the cyst ruptures, then the swelling may be also be in the lower leg and calf area.
Pain is most typically described behind the knee, particularly with full flexion (bending) or extension (straightening). A person may also experience pain in the upper calf or back of the thigh.
Another common complaint is pain when sitting due to the chair touching or rubbing the area behind the knee (known as the popliteal space).

It is not always entirely known why a Baker’s cyst will develop. In my clinical experience, I have seen them form for the following reasons:

Rheumatoid arthritis (RA)
Osteoarthritis (OA)
Recent knee injury or post knee surgery
Poor lower leg biomechanics, which can lead to other forms of knee pain in addition to a Baker’s cyst.

Baker’s cysts should be diagnosed by a medical doctor. Medical treatment of the cysts usually involves a course of anti-inflammatory medication (orally), a cortisone injection, aspiration of the fluid by utilizing a needle, and/or surgical removal. The good news is that often a Baker’s cyst will typically resolve on its own if you just give it time. Rest and treat any symptoms you may be experiencing.

Physical therapy may also be indicated, particularly if the cyst formed due to osteoarthritis pain, recent knee injury/trauma/surgery, or due to poor lower extremity biomechanics. In most cases, I have witnessed Baker’s cysts successfully and conservatively treated by both a physical therapist and a medical physician who are working together to address the issue.

The rehabilitation for a Baker’s cyst is very similar process to treating meniscus pain. The following 10 tips will help you to rehabilitate your knee. You should experience improvement of your symptoms within in a few of weeks or less when initiating this program. Depending on the severity, it could take longer for a full recovery. If your pain continues or worsens, then additional assessment and follow up is likely needed.

10 Tips on How to Self-Treat a Baker’s Cyst:

1. Rest. Initially, take extra time to rest the painful area. The pain and swelling has likely worsened due to a change in activity level. If the pain is more severe, you may choose to use a cane or a crutch initially to take weight off of the knee.

2. Ice. Apply ice to the knee and behind the knee in particular. The rule of thumb is to ice no more than 20 minutes per hour. Do not place the ice directly against the skin especially if you are using a gel pack style Cold Pack. Individuals with poor circulation or impaired sensation should take particular care when icing. A bag of frozen peas can be ideal in this situation.

3. Compression. Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response. Limit it as much as possible. You could utilize a common ACE bandage wrap or you could purchase a pair of mild over-the-counter compression socks. If you utilize a compression sock, it will need to be at least thigh high like these Jobst Relief Therapeutic Thigh High Stockings. Do not use a knee high version–you may make the swelling and pain worse. Do not apply any compression too tightly as it could cause numbness or tingling in the leg, foot, or toes.

4. Taping Techniques. Kinesiological style taping has been proven to be effective in reducing inflammation. Due to the location of the swelling, you will need help from someone trained in the specific style of kinesiological taping. Many physical therapists (PTs), athletic trainers (ATCs), or chiropractors have training in these techniques. Learn How to apply Kinesiology Tape for a swollen (edema) Knee Joint by watching this YouTube video that demonstrates the proper technique. (However, the taping would be on the back side of the knee, not on the front as shown.) I have had luck using the KT TAPE, RockTape Kinesiology Tape, and Mummy Tape brands. The technique is fairly basic, so your spouse or a friend may be able to apply it for you.

5. 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 or make the knee more painful and irritated.

6. 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.

7. Improve your Range of Motion (ROM). The goal of the rehabilitation program is to regain full pain free ROM. This can be accomplished many ways. Perform heel slides by lying on your back and sliding your heel toward your buttocks. Riding the stationary bicycle can be helpful, too. Remember, the major goal is to regain full pain free ROM. If you experience muscle tightness and soreness, I recommend using a foam roller to assist with any myofascial symptoms. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation. Do not use the foam roller directly behind the knee.

8. Work on strengthening. The primary goal of a strengthening program is to work on quadriceps and glut medius (hip abduction) strengthening. These areas are commonly weak which can lead to poor knee biomechanics and cause pain and instability. Weight lifting is an appropriate choice, but you may have to initially limit your range of motion (ROM). Most of my clients begin on a non-weight bearing program, then progress to partial weight bearing, and eventually, full weight bearing. The more severe the symptoms, the longer it will take for an individual to progress to more difficult exercises.

To initiate a physical therapy program, please refer to Baker’s Cyst Rehabilitation Exercises. This exercise guide is designed to address the muscles that I find to be the weakest in most individuals. The exercises are listed from easiest to most challenging and are designed to primarily improve quadriceps and hip strengthening. Start with exercises like a straight leg raise (possibly with an ankle weight) and bridging (either one or both legs). Wall squats holding for time also works well. A Thera-Band Exercise Band can be tied around the thighs above your knees to make your hips more engaged.

Weight training exercises (with machine weights or free weights) should be geared toward general leg strengthening and may include: squats; leg press; hip abduction machine; step ups; dead lifts; and straight leg dead lifts. If further instruction is needed, search YouTube to watch the proper technique for a specific exercise. If full ROM is causing an increase in your pain, then you need to stay within your pain free limit as you work on the ROM separately from weight training.

Initially, you will likely need to taper down your activities. The speed at which exercise is performed while in group exercise classes is typically too fast for an individual who is properly and safely exercising his/her knee during a rehabilitation and recovery phase. You can still participate in group exercise classes or CrossFit WODs (Work out of the Day), but your specific knee program should be separate from any group structured activity. You will need to modify some of the activities performed in your structured class to avoid further pain.

9. 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 ROM.

10. Add a joint supplement. If you are experiencing osteoarthritis pain, you may want to consider adding a glucosamine and chondroitin supplement. CapraFlex is my preferred supplement for knee related injuries. I have recommended this supplement for years as my clients have had successful outcomes with use. It has also assisted me in recovery from my many injuries. 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 knee pain, but do not use it in combination with other traditional anti-inflammatory medications. If you are under the care of your physician, please inform him/her that you are taking this medication. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

In most cases, you should expect a complete resolution of your symptoms upon completion of the rehabilitation process. To prevent the condition from re-occurring, address any ROM or mobility restrictions as well as any weak areas that are causing altered lower leg biomechanics.

If your symptoms and pain continues or worsens after two to three weeks of rehabilitation, please seek additional assistance from your physician or a qualified physical therapist. 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 would be a good idea to seek your physician’s opinion as well).

Thank you, Patti, for your question. I hope these 10 tips will help you to rehabilitate your knee and recover quickly!

Which treatments for knee pain are the most effective for you? Please share any recommendations that you may have by leaving your comments below.

Posted on Wednesday, February 11, 2015

Why You Should Walk, Not Run

Although controversial and disappointing for some, running isn’t appropriate for everyone. As a physical therapist and runner, I understand why some people cannot and should not take up running as a form of exercise. Not all bodies are built to run. An existing injury may make it unsafe to run on a regular basis. If you can’t run, don’t worry about it! Many other forms of exercise without repeated impact can help us to keep fit. Walking is a wonderful method of exercise. Out of all the possible movements we can perform, we’re best at walking! Walking daily can reduce stress, improve circulation and hormone regulation as well as benefit your overall well-being.

There are many wonderful methods to stay fit and improve your cardiovascular system, but running may not be the best choice for you if you have any of the following conditions:

Certain Forms of Arthritis – There are 171 different kinds of arthritis. Although causes and presentations vary, the most common form is osteoarthritis (OA). You can still run if you have OA, but you may choose not to if you are symptomatic (experiencing pain). Running would be ill-advised for those with other types of arthritis such as gout or rheumatoid arthritis (RA). The risk of joint injury during repetitive impact based activity (like running) is too high. For more information specifically on RA, please refer to Q & A: Exercises Beneficial in Managing Rheumatoid Arthritis.
Joint Replacement – As America’s population continues to age, total joint replacement has become an increasingly more popular method to treat pain and arthritis in joints. The procedures continue to improve and evolve. Although you may be capable of running after a total joint replacement, I don’t recommend it. Running on a total joint replacement, particularly in the knee or ankle, increases the likelihood that the replacement will wear out and/or fail prematurely. If you have had a total joint replacement, I recommend a less impactful method of cardiovascular exercise.
Morbid Obesity – Running can be an excellent form of exercise and a wonderful method to help one reach his/her desired weight. However, running may not be the safest choice initially if you are morbidly obese. Morbid obesity is defined as a Body Mass Index (BMI) greater than 40 or having more than 100 lbs. of body weight. Running with excessive body weight increases your risk of injury and permanent damage to joints throughout the body. Initially, pursue non-impact activities. As your weight decreases, you may choose to participate in a running program.
Recent Medical Procedures or Injury – The inability to run can be temporary. Often after a medical procedure, physicians will advise not to run or participate in overly strenuous exercise during recovery. The list of possible conditions is long, so refer to your physician and physical therapist regarding when to avoid activity. Once you have sufficiently healed, you can taper back into your prior level of activity or even progress into a new activity. Your physician or physical therapist can offer advice on how to safely resume your activities.
Severe Osteoporosis – Osteoporosis is the weakening of the bones. Running is not contraindicated for all forms of osteoporosis, but it is for severe cases. In mild cases, the repeated impact during running can be beneficial to bone formation if the mileage or time spent on your legs isn’t excessive. In severe cases, running increases your risk of fractures. Initially, the best course of treatment, besides dietary modification, would be weight bearing activities such as weight training and walking.

The key is to rule out possible issues which may make running unsafe. Being well informed initially allows you to tailor an exercise program which can be safe and effective in maximizing your particular goals and needs. For a more thorough discussion on the safety of running, please refer to Is Running Safe? In most cases, running is safe with proper training and a strong focus on technique.

What are the benefits of walking?

Improves circulation and blood flow to the entire body.
Releases stress reducing hormones.
Releases hormones that can control blood sugar levels for up to 24 hours.
Burns calories.
Helps to prevent constipation.
Walking in a fasted state can help your body to learn how to utilize fat more efficiently as an energy source.
We are naturally good at walking. Do it daily!
It is a weight bearing activity that can be beneficial in reducing osteoporosis.
Keeps the spine healthy. The walking motion is vital to nutrient exchange in the spinal discs.

Choose walking as an intentional exercise, and add it to your daily activities as part of a healthy lifestyle. To increase the amount of calories burned during a walk, you may need to make a few changes to your morning or evening stroll. Don’t walk at your preferred speed. The trick is to make your body inefficient by walking slower, faster, uphill, downhill, or at varying speeds. Perform a high intensity workout by walking uphill briskly or using the Fartlek method.

Nordic walking, which utilizes walking poles that can help to stabilize you if your balance is poor, is also very popular. The use of walking poles can reduce stress from your back and lower extremity joints, increase your body strength, and burn more calories than traditional walking!

Do you prefer to walk or run? What might be holding you back from participating in an exercise program? I encourage you to get started now by walking. You may be surprised how quickly you see results! Please leave your comments below.

Posted on Wednesday, February 4, 2015

How to Age Successfully

America’s population is rapidly changing. We are in the midst of a giant generational shift. Members of the Greatest Generation (those who experienced the Great Depression and fought in World War II) and the Silent Generation (those who were children during that time) are rapidly aging, and their population is quickly decreasing. During this shift, the Baby Boomers are rapidly approaching elder status. At the present pace, over 8,000 baby boomers are turning 65 every day! Aging baby boomers are transforming our society by re-defining what it means to age. This is affecting society at every level including health care, retirement planning, housing, community, and family life.

Baby boomers’ demands and expectations of what it means to age successfully are different compared to past generations. Baby boomers present an interesting dichotomy of desiring to live longer, stay active, and age in place. Aging in Place: An Intergenerational Priority, a recent Huffington Post article by Susan Blumenthal, addresses the new expectations and unmet needs that seniors will face. The ability to live safely, independently, and comfortably regardless of age is the greatest desire for seniors.

We are all capable of successfully aging if we are intentional about the process. The outcome will wildly vary. Successful aging has a different meaning for each of us, but commonalities exist in most scenarios. In order to age successfully and gracefully, you will need to fully embrace what it will take to accomplish this goal. To live safely, independently, and comfortably, consider your physical, mental, and emotional health as well as your community and any financial implications.

Mobility is vital to independence. Independent mobility is different for everyone. It may be through ambulation or use of an assistive device such as a cane, walker, or wheelchair. You need to maintain the ability to be independently mobile regardless of utilizing a mobility or assistive device. Aspects of maintaining mobility may include adequate balance, strength, and endurance. For more information on balance, please refer to Improving Balance by Using a Water Noodle, How Do I Improve Balance? (Part I), and How Do I Improve Balance? (Part II). For more information on strength, please refer to Q & A: How to Jump Start a Healthy Lifestyle and 15 Strategies to Make 2015 Your Healthiest Year.
Maintain sharp mental health. Regardless of age, it is important to remain engaged and mentally sharp through constant and varied mental stimulation. Proper nutrition and exercise have an impact on your mental health and can help to prevent depression, Alzheimer’s disease, and dementia. For more information, please refer to My Top 10 Anti-Aging Tips.
Share the love. Research clearly notes that those who are more loving and caring tend to live longer and healthier. Be generous with the knowledge and wisdom that you have acquired throughout the years. Love others and purposefully share that love.
Be active in your community. Active engagement in your community is a critical part of successful aging. People find community in a variety of ways including family, friends, church, civic organizations, or volunteer projects. Others may choose to continue to work. Your profession can have a positive impact on the community and your finances.
Plan for a long life span. It is likely that life spans will continue to increase if epidemics, such as diabetes and metabolic syndrome, are properly addressed. Be proactive in how you plan to manage your finances. When planning, assume that you will live well into your 90s. The fear for many will be running out of money during their elder years. The only way to avoid this issue is to be proactive and thoughtful in your planning. The sooner, the better! Seek competent financial advice from a financial adviser. Be realistic about the math as you project into the future. Plan for the worst. Expect low interest rates and high inflation. Don’t believe the rosy projected rate of returns. If you underestimate, at least you will have more money than you anticipated rather than being broke.

How we plan for this giant generational change will affect everyone at some level. As a society and as an individual, we must prepare for the changes in expectations and demographics. As the population ages in the United States, my desire is to see the most physically fit and active seniors in history. I hope over the next ten to twenty years that the paradigm of successful aging is re-written and that old stereotypes of the elderly, the aged, and seniors will be lost in the dust of a new healthier, long lived population. For an excellent read on America’s aging population and how it will re-shape our expectations, check out Ken Dychtwald’s Age Power: How the 21st Century Will Be Ruled by the New Old.

Health care costs in the United States continue to increase without actual positive change in health status. It is imperative that we all take a leadership role in our own health care by continuing to be proactive. The Physical Therapy Advisor blog will continue to the lead the way in providing useful and practical types of “how to” information, including methods to safely self-treat and manage common physical therapy related conditions. My desire is to help you address the aspects of optimizing your life while promoting well-being in order to manage pain and improve mobility.

What does it mean to YOU to age successfully? How can I help you in this endeavor? Please leave your comments below.

Posted on Wednesday, January 28, 2015

7 Tips to Prevent Illness & Seasonal Affective Disorder (SAD)

During the winter months, most people experience more illness, fatigue, and a lack of energy. Seasonal Affective Disorder (SAD) is one particular condition that worsens in the winter months. A lack of sunlight causes decreased serotonin and melatonin levels in the body as well as a reduction in vitamin D. Lower levels can lead to symptoms of depression and fatigue. People also tend to become ill more frequently in the winter months due to the following:

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 to prevent illness. Consider supplementing with vitamin D during the winter months or during periods of heavy training.
Decreased ultraviolet radiation from the sun allows viruses and bacteria to live longer on surfaces. Consider frequently cleaning your cell phone, the coffee pot handle, 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.

7 Tips to Prevent Illness & Seasonal Affective Disorder:

1. Increase light exposure to increase energy and to boost your immune system. SAD tends to peak in the months of January and February. To prevent SAD, increase your natural light exposure or use an artificial wide-spectrum light source such as a Lightphoria Energy Light Lamp. It provides a natural glow that mimics real sunlight. (Be cautious if you have sensitive skin or a history of bipolar disorder.)

2. Exercise regularly. Exercise (when not excessive) improves your mood and your immune system response. Regular activity also helps to regulate hormone levels which can lead to improved energy levels and endurance.

3. Do not eat anything that comes in a package. Most packaged foods are devoid of the needed micronutrients. Your body tissue needs nutrients to be able to optimally perform and fight illness. 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. Eat fruit and vegetables. Choose a variety of dark greens, reds, and oranges. Eating high quality fruit and vegetables provides your body with needed vitamins and minerals as well important micronutrients, phytochemical, and antioxidants. The benefits of consuming fruit and vegetables include: helping you to maintain your health; boosting your immune system; improving your energy levels; and insuring internal body processes to function appropriately.

5. Stay hydrated. The human body is primarily made of water, which is critical for all body functions. Adequate water intake is critical for a healthy immune system and to avoid dehydration. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names that you can’t spell or pronounce.

6. Sleep more. Adequate amounts of sleep boost the immune system as well as your metabolism. Your body must rest in order to grow, develop, and fight illness. 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!

7. Wash your hands. Practicing proper hygiene is critical to avoiding illness. We touch our faces on an average of 5,500 times a day! Viruses and bacteria are easily transmitted by touching our eyes, nose, and mouth with our hands. The most effective methods to avoid illness include proper hand washing and avoiding those who are ill.

Regular activity and exercise can actually boost your immune system, but a heavy amount can actually lower it in the short run. If you are starting to feel ill, exercise may or may not be the right choice for you. Please refer to Q & A: Should I Exercise if I’m Sick?

To prevent SAD, spend time outside every day or begin using an artificial light source. Eat a well-balanced diet and exercise daily. You may also consider supplementing with vitamin D, vitamin C, and B-vitamins to increase your energy level and to boost the immune system. Stay involved with your friendships and regular activities. If you feel depressed, fatigued, and irritable the same time each year, consult your physician for recommendations for lifestyle changes and treatment.

Have you experienced symptoms of SAD this winter? What are your top tips for staying well? Please share your comments below.

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Posted on Wednesday, January 21, 2015

How to Self-Treat Shin Splints

If you have ever experienced shin splints (anterior compartment syndrome), you know how excruciatingly painful it can be. You may struggle to run or walk. The pain can linger for weeks and months–taking the fun out of running and exercise. In the previous post, I discussed How to Prevent Shin Splints. Now I will provide simple treatment options to quickly help aid in your recovery. Shin splints can typically be easily self-treated if you don’t have a more serious medical condition, such as a stress fracture, causing the pain.

How to Self-Treat Shin Splints:

Ice. Although shin splints can occur insidiously, they are often associated with a specific event. An active inflammatory process typically occurs. Apply the ice to the anterior tibialis muscle (the muscle right next to the shinbone). 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 cold pack. A bag of frozen peas can be a cheap alternative. Individuals with poor circulation or impaired sensation should take particular care when icing.
Rest. If you are experiencing an episode of shin splints, then you will need to rest. Avoid running (particularly downhill). At the very least, taper your training intensity and avoid exercises that place undue stress on the shins, particularly the anterior tibialis muscle. Utilize this time to incorporate cross training activities, such as yoga, to improve flexibility as shin splints can be linked to poor mobility.
Consider changing 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 can lead to shin splints as well as IT band syndrome or other hip, knee, or ankle related issues. Shoes only last 350-500 miles. If you are nearing those miles, then it may be time to change.
Add an orthotic. Additional foot control is often needed to normalize gait mechanics. Many running stores sell 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. Seek assistance from a professional who is a runner and has experience with treating other runners.
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 prepares the tissues for exercise. Consider using a self-massage tool to roll up and down the anterior tibialis as part of your warm up. My favorite self-massage tools for this area include the Thera-Band Standard Roller Massager and The Stick Self Roller Massager. I also recommend using the massager on your calf muscles. Perform calf stretches, but be mindful that prolonged static stretching before exercise may worsen performance.
Cool down. After performing your exercises, take extra time to cool down and stretch. Focus on calf stretching as well as general lower extremity mobility stretches. Use the same self-massage tools as you did during your warm up. If you are prone to developing shin splints, I highly recommend regular massage and mobilization of the anterior tibialis muscle, as well as the calves. Tightness in the calves and Achilles tendon are a risk factor for developing shin splints. Be sure to emphasize stretching your calves. Hold each of the following stretches for at least 30 seconds, 3 times on each leg, 2-3 times a day. (These stretches shouldn’t cause more than a mild increase in pain or discomfort.)

Self-mobilize the tissue. Be sure to mobilize the tissue of the anterior tibialis. For this particular area, you may want to use one of the self-massage tools referenced above. You could also use a tennis or lacrosse ball to aggressively work out the tissue along the shin. Remember that mobility issues and myofascial restrictions in the lower legs are highly correlated with the development of shin splints. Use the foam roller to address any lower leg tightness or restrictions. I tend to use the foam roller for the larger parts of the leg including the thigh, back of the leg, calves, and buttock muscles. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
Work on the stabilizing muscles of your hips and ankles. As part of a comprehensive rehabilitation protocol, I almost always have clients work on keeping the muscles of the pelvis, hips, and ankles strong. This will help to maintain normal gait mechanics during exercise and running. Not only will this help to prevent shin splints, it will likely help to prevent developing other orthopaedic issues such as plantar fasciitis and hip or knee pain. Please refer to Ankle Resistance Exercises and How to Safely Self-Treat Low Back Pain for my recommended hip and lumbar stabilization strengthening exercises.
Work on 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. I always include balance work as part of my recommended rehabilitation protocol. Please refer to Improving Balance by Using a Water Noodle, How Do I Improve Balance? (Part I), and How Do I Improve Balance? (Part II).
Kinesiological taping. The purpose of the tape is to assist the anterior tibialis muscle with its contraction and to possibly help with swelling and nutrient exchange by assisting the lymphatic system. I have had luck using the KT TAPE and Mummy Tape brands. When treating shin splints, I recommend following these step by step instructions for Kinesiological Taping for Shin Splints. For application and removal tips, please refer to Skin Care with Taping.
Use a compression sleeve or stocking. This condition is often associated with swelling and inflammation in the anterior compartment of the lower leg near the shinbone (tibia). The compression sleeve/socking can help to limit the amount of swelling and promote blood flow back out of the lower leg. This insures better nutrient exchange, waste removal, and can limit the swelling. I particularly recommend wearing a pair while you are in the rehabilitation phase or tapering back into full activity. There are many different styles of compression socks and sleeves, but I prefer Vitalsox Graduated Compression Socks. If you prefer a sock style, then I recommend choosing a pair that is at least knee high.
Start a supplement. Many herbs help to reduce inflammation and pain. One of my favorites is called 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.)
Ask for help. If you’re still experiencing pain after implementing these self-treatment strategies, then it may be time to seek additional help. Your medical physician can help to determine if your pain is associated with a stress fracture. He/she could also prescribe stronger anti-inflammatory medication if necessary. 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).

Have you ever experienced shin splints? If so, which treatment techniques have you found to be the most effective? Please leave your comments below.

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