Posted on Wednesday, December 23, 2015

Why the Squat is Fundamental to Life

Squatting is a fundamental movement. Squatting is one of the first abilities we develop as a child, and it needs to be one of the last ones we lose as we age. Your ability to perform a squat is fundamental to how you are able to function throughout your life.

Your ability to squat is critical to your ability to function independently. In my experience of working with seniors, there are two main reasons why a person will need additional care and support: 1. The person can no longer safely get from point A to point B (this usually involves walking). 2. The person is no longer able to stand up from a sitting position. This means he/she cannot get up and down from a chair, a toilet, or even the bed. If you cannot perform these activities safely and independently, then you will need additional care.

The squat is a critical exercise to maintain mobility and function as we age. For more information, please refer to 7 Reasons Why the Squat is Fundamental to Life.

Do you regularly practice squatting? If not, which modified version of the squat (as demonstrated in the video) can you start implementing? 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!

Posted on Wednesday, June 11, 2014

7 Reasons Why the Squat is Fundamental to Life

If you were born and raised in an industrialized nation (like the U.S.A.), then squatting was probably something you did as a child. As soon as you became school age, you rarely squatted again. In other countries around the world, squatting is a normal part of daily life. In countries such as India and in many Asian countries, it is common to see very aged individuals who are still perfectly capable and comfortable in a full squatting position. When was the last time you saw a 75 year old man in a full squat? (A full squat will vary from person to person, but typically your hips are well below your knees and your thighs are past a parallel position.)

Here are 7 reasons why we should continue squatting as a lifelong pursuit:

1. Maintain Lower Extremity Strength: The squat activates nearly all of the muscles in the lower leg. It is particularly effective at activating the muscles in the legs referred to as the posterior chain, which includes the hamstrings, the glutes (or buttock muscles), and the hip adductors (or the groin muscles). It also activates the calves, the stabilizing muscles in the ankles, the quadriceps, as well as the core (the abdominals and lumbar extensor muscles). In short, the squat works just about every muscle in the trunk down toward the legs. These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something.

2. Maintain Lower Extremity Range of Motion (ROM): Moving into a full squat position takes quite a bit of flexibility. Most children have no problem squatting. As we age, we tend to become less flexible which is primarily due to non-use. Physiologically, muscles, tendons, and ligaments lose some elasticity and can become stiff. The squat requires good hip mobility, knee mobility, lumbar and pelvic mobility as well as ankle mobility. It requires adequate muscle length and joint range of motion in all of the major joints of the lower leg and all of the major muscles of the lower limb.

3. Maintain Bone Density: Squatting activates the major muscles of the lower limb and trunk. The pull of the muscle against the bone stimulates the bone to grow and improve its density. Squatting is also a weight-bearing exercise meaning it is against gravity. If you add any type of resistance, then that load to the bone once again stimulates bone growth. Squatting is a fundamental movement to prevent osteoporosis.

4. Maintain Balance: Squatting activates the lower leg muscles. Adequate lower leg and trunk strength is a critical component to balance. It also activates the somatosensory system. This is the integration of the neurological system (including the brain and nerves throughout the body) with the musculoskeletal system. This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. (Please refer to How Do I Improve Balance? (Part I) and How Do I Improve Balance? Part II.)

5. Aids in Digestion: Many people in “civilized nations” might not know this little known fact, but incidences of constipation have increased since the advent of the toilet. This is because people are no longer squatting in the woods, over a hole, or some form of plumbing. The body’s colon has three major parts: the ascending, transvers, and descending colon. When you are in a full squat, the thighs put pressure on the ascending and descending colon, which stimulates the smooth muscles to move (this is known as peristalsis). When in the full squat position, the rectum (which is a short, muscular tube which forms the lowest portion of the large intestine and connects it to the anus) is allowed to straighten and unkink. Feces collects in the rectum until pressure on the rectal walls causes nerve impulses to pass to the brain. The brain sends messages to the voluntary muscles in the anus to relax, which permits expulsion. If you are experiencing constipation, take a walk and then spend time relaxing in a full squat position.

6. Prevents Osteoarthritis: There are many potential causes, like trauma or infection, for osteoarthritis. Trauma can be from a one-time accident or due to accumulated trauma or over-use syndrome. Just as common as over-use causing osteoarthritis is under-use. A joint cannot remain healthy if it does not move through its full available range of motion (ROM) on a regular basis. If you never move into a full squat, then you likely never take your knees or hips through their full ROM. According to osteoarthritis statistics, countries in which people still rest and spend extended time in a full squat have the lowest incidences of osteoarthritis. Squatting does not cause arthritis; it actually protects the body from it.

7. Fundamental to All Mobility: Maintaining your ability to squat, and (more importantly), come up from a squat is vital. Your ability to do so is critical to your ability to function independently. In my experience of working with seniors, there are two main reasons why a person will need additional care and support: 1. The person can no longer safely get from point A to point B (this usually involves walking). 2. The person is no longer able to stand up from a sitting position. This means he/she cannot get up and down from a chair, a toilet, or even the bed. If you cannot perform these activities safely and independently, then you will need additional care. Typically, it is a major sign of failing health when an aged and infirmed person loses the ability to care for him or her due to weakness and other factors. (This statement is not directed at someone who has suffered a spinal cord injury or has some form of paralysis which affects his/her ability to utilize lower extremities.) The squat is a critical exercise to maintain mobility and function as we age.

Squatting is one of the first abilities we develop as a child, and it needs to be one of the last ones we lose as we age. Your ability to perform a squat is fundamental to how you are able to function throughout your life. Keep squatting!

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.

Posted on Tuesday, May 27, 2014

Q & A: How Do I Improve Balance? (Part II)

In last week’s blog post, I answered a reader submitted question from Kay regarding worsening balance and what we can do to improve our balance. The blog post addressed five different body systems which affect balance and how they work together to insure that we have proper balance and mobility in our environments. In case you missed it or would like to review the five systems, please refer to Q & A: How Do I Improve Balance? (Part I).

This week, I will offer specific suggestions on how you may improve balance in each of the five body systems. If you require specific advice, I highly recommend that you seek advice from a physical therapist or a qualified medical doctor who is well versed in balance related disorders.

Muscle Strength and Range of Motion (ROM) – Without adequate strength, you are unable to balance. These specific exercises can help to improve balance. If your balance may be due to an issue in this area, then the next step is to narrow down as to why. To effectively treat balance disorders, we have to determine what system or systems are leading to the deficits.

Stretch your calves. If your calves are tight, you are more likely to tip over backward as you age. It also affects your body’s normal ability to balance and recover from a loss of balance via what is known as an ankle strategy. Hold each stretch for at least 30 seconds twice on each leg.

Get stronger hips. An easy way to work on strengthening this area is to get into a quarter squat and walk sideways. Keep your toes pointed forward and go both directions. (Add an exercise band for more of a challenge.)

Improve your quadriceps and buttock muscle strength by doing sit to stands. This is exactly as it sounds. Sit down, and then stand up. 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. The CDC’s 30SecondChairStandTest .pdf file provides further instructions and norm values for your gender and age. Scoring below your norm values indicates you are at higher risk of falling.

Stand on one leg. I would recommend being near your sink in case you lose your balance. On average, you should be able to hold a single leg stance for at least 30 seconds.

Somatosensory – The somatosensory system is the integration of the neurological system (including the brain and nerves throughout the body) with the musculoskeletal system. This includes all the touch and movement nerve receptors in the muscles, tendons, and joints. This system will be challenged as you work through the other activities suggested. If you’re a diabetic, you must keep your blood glucose ranges within the parameters set forth by your physician in order to help minimize damage to this system. Most importantly for all of us, continue to live a healthy lifestyle.

Eyesight – My first and most obvious suggestion is to visit your ophthalmologist to make sure your eyes are healthy. If you are using corrective lenses, confirm that they are functioning effectively for your needs. You can also work on Vestibular Ocular Reflex (VOR) by performing the following exercise. Hold your thumb or colored object out in front of you and practice moving your head up and down, to the left and right, and at diagonals as you keep focused on the object. Then practice moving the object while your eyes track it in all directions. Finally, try moving the object opposite the direction you move your head while still keeping focused on the object. If you are advanced, try reading a few words while you perform these.

Vestibular – If you’re experiencing vertigo or dizziness, ask your physical therapist to screen you for Benign Paroxysmal Positional Vertigo (BPPV), which is fairly common and easy to treat. Otherwise, it’s best to continually challenge your vestibular system by remaining active, and in particular, moving your head more. Try the VOR exercises described above. Try moving your head while you stand on one foot. Moving your head, jumping, and any bouncing activity in general not only stimulate the musculoskeletal system, but also the vestibular system.

Central Nervous System – Live a healthy lifestyle and move more. The brain needs to be challenged. Think “heart healthy” because anything that keeps the vascular system healthy is also good for the brain. Also, don’t forget to drink plenty of fluids. Like other systems in the body, the brain is primarily water. Dehydration affects your balance in many ways (including the vestibular system) and also increases your risk of blood clots and strokes. Discuss with your medical practitioner any changes, new onset of dizziness, or poor balance as it can be a sign of something more severe or could be a side effect from a new or old medication.

The key to helping someone improve balance is to understand why his/her balance is worsening in the first place. Balance is affected by any one or a combination of the body systems listed above. The brain integrates the information within one’s environment. To effectively treat balance disorders, we have to determine what system or systems are leading to the deficits. That is usually the most difficult part. If a person spends time evaluating why his/her balance has worsened, then an effective treatment program can be designed to address the issue.

If you have a question that you would like featured in an upcoming blog post, please email contact@thephysicaltherapyadvisor.com.

Posted on Tuesday, May 13, 2014

5 Ways to Improve Range-Of-Motion (ROM)

Most of us think stretching is stretching is stretching. Who likes it? Why do we need it? Yes, some days I’m personally still in that camp! Stretching is actually more nuanced than that. The real question is: why are you stretching in the first place?

There are potentially different reasons to stretch. One reason is to decrease pain. Stretching an ailing muscle or muscle spasm can activate internal stretch receptors in the muscle tendon unit, which helps the muscle to relax. It can also change the blood flow to the area or affect the input on the nerve–all resulting in some pain relief.

We instinctually want to stretch. Consider yawning. Our outward arm motions during a yawn are nothing more than primitive stretch reflexes. Babies begin stretching in utero! We continue to voluntarily stretch for the rest of our lives (or in the case of a yawn, involuntary). Animals (dogs, cats, horses, and even birds) also stretch daily.

Stretching releases positive endorphins and neurotransmitters in the brain which helps us to feel better. Depending on the location of the stretch and the intensity, it can cause relaxation or alertness.

Stretching is used to improve range-of-motion (ROM) of a joint, but why? The most common reason is that the joint ROM is limited and is somehow affecting performance of a desired activity.

Stretching is also used as a preventative measure. For example, if ROM is limited asymmetrically (unequally) in the hamstrings, then it could lead to a pelvic torsion and low back pain. Another example is a shoulder which has limited ROM, yet a person continues to reach up overhead or perform an overhead weight lifting technique. If the individual doesn’t have adequate ROM to perform the lift, then either he or she will perform the lift incorrectly (risking injury). The body will be forced to compensate somewhere for the lack of shoulder mobility (again, likely leading to injury).

As a physical therapist, I work weekly with people who have injuries from compensating for lack of ROM and mobility in the body. This problem is prevalent due to current American culture. We spend most of our day either sitting (driving, working on the computer, watching TV) or hunched over while sitting or standing (washing dishes, picking up children, general slouching). As a society on average, we don’t move or stretch enough to live healthfully. A joint must go through its full ROM on a daily basis to remain healthy. Without the full ROM, a nutrient rich and internally lubricating fluid known as synovial fluid cannot properly circulate and coat the joint surface. Over time, this will lead to stiffness, dysfunction, and joint deterioration such as arthritis.

One potential issue to address is that all stretching methods aren’t created equal and certainly aren’t appropriate in every circumstance. The research indicates that stretching, when done improperly or at the wrong time, can either help or inhibit performance.

Let’s review five different methods of stretching or improving ROM:

Static Stretching – Static stretching is basically holding a tissue in an elongated form. This can be performed across one joint or multiple joints, depending on the muscle or tissue being stretched. The minimum length of time should be 30 seconds to around 60 seconds at a mild to moderate discomfort. If you want to maximize results, then the stretch should be held for a longer duration of at least five minutes. Typically, this is not practical for most people. Static stretching before your athletic performance causes loss of performance. If the goal is to gain ROM, then static stretching should be performed, but only after the activity or at a separate time.

Dynamic Stretching – This is a more active type of stretching where you are moving in and out of your available range of motion. This can be progressed into ballistic stretching, which is taking a joint actively and usually quickly, through its available ROM and into a near end range stretch without exceeding the physiologic maximum ROM for the joint or muscle/tendon tissue. As a warm up, dynamic and ballistic stretching can improve performance and joint ROM. If the goal is to prepare for an activity, then a dynamic warm up should be performed. Ballistic stretching is not indicated for novice athletes or beginning stretching. It is definitely not indicated when recovering from injury.

Myofascial Release with Foam Rolling – Research is limited presently, but it indicates that foam rolling can help improve joint ROM without the deleterious effects of static stretching. It can be performed prior to athletic performance and not provide a negative effect. Clinically and personally, I find foam rolling to be an effective method in improving ROM. Foam rolling should be a frequent post-workout activity, and at times, it would be indicated as a pre-workout activity. It is also a fantastic way to release stress and tension, and it may improve recovery times. (Please refer to a recent post, Does Foam Rolling Help or Hurt Your Performance?)

Proprioceptive Neuromuscular Facilitation (PNF) – PNF stretching is a very quick and effective method of utilizing the body’s neurologic stretch receptors within the muscle and tendon units to assist in producing increased ROM. There are many different types of PNF stretches and exercises. The most basic and easiest to utilize individually is a technique known as Hold/Relax. Move the extremity and joint to a point of feeling a mild stretch, and then lightly resist any further stretch for approximately 10 seconds. After 10 seconds, progress further into the stretch and hold for approximately 30 seconds. I tend to work in sets of three to four when performing this technique. It is also important to remember that it should never result in pain, only a stretching sensation.

Neuromobilization or Neural Gliding – This is probably the least understood of all methods to improve ROM. There are many factors to consider regarding neural mobility. First, the nerves are covered in a protective sheath which is meant to be very flexible. Unfortunately, when the sheath is irritated or damaged, it tends to lose its flexibility. This typically leads to neural pain. Sciatic nerve pain from a bulging disc is an example of when this may occur. Trying to directly stretch a nerve is a bad idea as it usually makes it worse. Specific neural gliding and mobilization techniques have been developed to assist with improving ROM and pain. As a physical therapist, I use clinical signs to help guide my treatment diagnosis, which ultimately can help guide the treatment for the client. If you are experiencing neural tightness and pain, please seek medical advice to insure you are getting proper care. There are times when neural tension can be present without pain or other symptoms. It may be caused by poor spinal alignment, poor posture, or other medical illnesses.

The science of stretching is as diverse as the reasons why you may want or need to stretch. Stretching is critical to maintaining flexibility. Flexibility is a critical component to a healthy and optimally functioning body. Although flexibility and stretching are often overlooked, they are truly critical to optimize health, prevent injury, and maximize performance. Stretching should never be done to the point of causing pain. It is possible to cause injury by over aggressively stretching. The best results are usually through consistency and a mild to moderate stretching sensation.

Please email contact@thephysicaltherapyadvisor.com if you have a question that you would like featured in an upcoming blog post.

Posted on Tuesday, April 29, 2014

Does Foam Rolling Help or Hurt Your Performance?

Let’s set the stage. Imagine that you have been training hard for weeks. Your muscles are sore, and your body is achy. You are definitely pushing into your overreaching phase and fast approaching over-training. Then your overly helpful friend and neighbor mentions, “Hey, I just got this foam roller—it’s great! My buddy says it helps him run faster, jump higher, and he never hurts. You need one!”

Is foam rolling another gimmick or does it really help? All of the local gyms and sporting goods stores have them. Should you use one?

Surprisingly, the actual research on foam roller use to improve performance has been minimal. The foam roller is traditionally used as a method of self-massage or self myofascial release. By using the foam roller, it is thought that the fascial system can be changed and manipulated. Hopefully, improving either performance or recovery by affecting how the neuromusculoskeletal system functions.

The standard definition of fascia is soft and sometimes fibrous connective tissue system that penetrates and surrounds muscles, bones, organs, nerves, blood vessels and other structures and extends from head to toe, from front to back, and from surface to deep in an uninterrupted, three-dimensional web binding some tissues together while allowing others to slide smoothly over each other, though all layers are connected there are distinct layers with differing function (LeMoon, 2008, and http://en.wikipedia.org/wiki/Fascia).

Research indicates the following regarding the use of the foam roll for performance:

Foam rolling likely has a positive effect on arterial stiffness and can improve arterial and vascular function while also positively affecting joint range-of-motion (ROM).
The change in arterial and vascular function may in part be why foam rolling (after training) seems to have a positive effect in reducing muscle soreness.
Foam rolling may promote more blood flow to the area, which allows the body to eliminate waste more efficiently while providing much needed nutrients to aid in recovery.
Improved recovery is important if you plan to participate in multiple events over multiple days such as a relay or weekend tournament.
Improved recovery may also allow for more intense and frequent training while (hopefully) reducing injury.
It may aid training during certain cycles when the intensity or volume may be higher or during an overreaching phase of training. Overreaching is typically a very short and deliberate phase in your training when you have a spike in training volume for a week or two followed by a return to baseline or below which can lead to improvements in performance. Care must be taken though because overreaching can easily turn into over-training.
Foam rolling also appears to have a beneficial effect on ROM, and more importantly, it can help improve ROM without negatively affecting performance. In contrast, static stretching can impede performance.

As a physical therapist, I highly recommend using the foam roller for athletic performance because:

It appears to help improve joint ROM and doesn’t impede performance.
It can likely help with recovery, either by reducing soreness or reducing post work out tightness. By promoting improved blood flow, it allows for improved nutrient delivery which can improve recovery times.
Improving recovery may allow for more intense or frequent training sessions or prepare you for multiple events with little rest.
Alleviating soreness prior to activity can have a psychological boost, which shouldn’t be overlooked as an important outcome.

How should I use the foam roller?

I typically recommend one to three minutes of body weight rolling (if it is tolerated) per extremity, and the same for the thoracic, low back, and buttock area.
A good rule of thumb is to roll out an area that is tender and sore, or recently worked, until it no longer feels tight and sore.
Again approximately one to three minutes per area although this may vary based on your size. Increased time will be needed the more developed your muscles are.
Foam rolling is generally not advised for anyone on blood thinning medications or with blood clotting disorders.

What has been your experience with using the foam roller? Is it worth the effort? Can you notice any specific improvements in performance? Please share your comments or questions!