What Women Need
Needs Are Different Than Wants
I get to discuss fitness goals with women nearly every day. They want to lose weight, get rid of musculoskeletal pain problems, have more energy, and “get arms like that girl”. Many of them have been doing their favorite exercise activity for years and have been unsuccessful at achieving any of their stated fitness goals. What they tell me they want to do is yoga, elliptical training, and Pilates. What they need to do is start on a program of strength training.
Ramping Up Your Metabolism
We all know that a body with more muscle burns more calories all day long. You can get away with eating more food and not develop greater fat deposits. Much more significantly, greater muscle mass positively influences fat metabolism, insulin levels, glucose processing, hormone profiles, and disease resilience. These changes influence the “more energy” feeling you develop with strength training.
Training To Abolish Pain
Nearly every patient that comes to physical therapy with a chronic pain problem has a glaring strength deficit that is perpetuating the pain. They have gluteals, scapula retractors, or cervical stabilizers that are not functioning at a level that permit them to perform normal activities of daily living and remain free of pain. What makes these patients better is a program of targeted strength training. If you have chronic hip, knee, lower back, or neck pain, your best method of permanently resolving the problem is strength training.
All of the current research says you need bone jarring, compressive, and aggressive loading of your skeleton to enhance or prevent further loss of bone density. Over the last year, two government panels of experts have told us that taking more vitamin D and calcium does not appear to make any difference in bone density. Better bone biology requires that the exercise stimulus be strong and consistent. Low skeletal stress activities such as yoga, Pilates, and elliptical training do not create the forces needed to have a positive effect on bone density. Read Bending the Aging Curve by Dr. Joseph Signorile.
I am sorry Ladies, but muscle mass, strength, and power production all leave you at a far faster rate than your male counterparts. It is not fair, but it is the truth. As you age, training to restore these physical capacities becomes much more important if you wish to remain independent for a lifetime. Ask any physical therapist who works with geriatric clients and they will tell you that weakness is the driver of debility. The good news is that a properly designed program of strength training can work wonders.
Motivational Goal Setting
Strength training provides motivation by having clear goals. “I want to tone up” is not a clear goal. Any psychology major will tell you that reaching defined goals reinforces positive behavior. You improve from three to eight solid push ups, carry ten more pounds for fifty yards, press twenty pound dumbbells instead of tens, and it motivates you to stay with the program. Numerous psychological studies have found that a lack of goal achievement is the number one reason people fail to succeed in staying consistent with an exercise program. The girl with the arms you like has strength goals.
Michael S. O’Hara, P.T., OCS, CSCS
The Good And Bad Of Kinesio Taping
In 2008, Kinesio tape (KT) was donated to 58 countries for use during the Olympic games. Since that marketing effort, its presence in televised sports has exploded. The athletic fashion statement found at many competitions is the brightly colored strips of tape across elbows, knees, shoulders, and hips. At Wimbeldon, Novak Djokovic had green tape on his elbow. Many of the soccer players at the last Euro competitions had tape on shoulders and hips. Female beach volleyball players seem to be wearing more tape than clothes.
Kinesio tape was invented by chiropractor Dr. Kenzo Kase in the 1970s. KT is made of cotton with an acrylic adhesive that permits it to stretch 40-50% of its resting length. The website for Kinesio tape claims that it can alleviate pain, reduce inflammation, relax muscles, enhance performance, and help with rehabilitation. Rock tape, a competing product, makes similar claims and uses the slogan Go Stronger, Longer.
Does Kinesio Taping work?
A meta analysis performed by Wilson in 2011 looked at all of the studies performed with KT and found some evidence that it helped improve range of motion, but no evidence that it helped reduce inflammation, relax/activate muscles, or improve performance. There is no evidence that it “off loads sensitive tissues” or improves “lymph drainage”. The number of high quality studies was small.
How Might Kinesio Taping Work?
What we do know is that the elastic, compressive nature of any band, brace, or tape placed on the body stimulates receptors in the skin. The receptors modulate the perception of pain and as a result, pain decreases. An example is a research study in which the patients that wore a neoprene sleeve during a series of tests 12 months post anterior cruciate repair produced significantly more force and had better balance than without the neoprene sleeve. The sleeve created a constant pressure on the skin surrounding the knee.
Should You Use Kinesio Tape?
If you have a minor ache or pain and no structural musculoskeletal damage, then go ahead. The KT can make you feel better, and this will make exercise and activities of daily living easier. The tape can provide some control over the symptoms, and it has no side effects other than occasional skin irritation.
Remember that your body sends pain signals for a reason. Any type of musuloskeletal damage should be dealt with more comprehensively than just KT. It is a bad idea to use KT to reduce pain and then participate in activities that create even greater tissue trauma. A small and easy to rehab rotator cuff tear can become a big, full thickness, surgical repair tear if you tape it up and practice your tennis serves.
We do lots of things in medicine that have no solid, double blind research that proves efficacy. The manufacturers of KT products need to spend more money on research and less on marketing. I am hopeful that in time, more evidence will develop for the use of KT. If some strips of KT make you feel better, go ahead and use it. The best approach is to get to the cause of the problem and enact a treatment plan that resolves the pain or functional limitation.
Michael S. O’Hara, P.T., OCS, CSCS
The Downside Of Upside Down Exercise
Exercise activities that place the head below the heart have become more popular in fitness programs. In almost every gym you see decline bench pressing, incline sit ups, glute-hamstring developer exercises, and more recently, hand stand push ups as a regular part of many exercise programs. While these activities may have some value, you might want to reconsider training in an inverted position for some other reasons.
When you invert your torso, the contents of your stomach can more readily travel back up into your esophagus. Head below your belly with a hiatal hernia, a little extra mesenteric fat, and some strong contractions from the abdominal muscles, and you have the perfect environment for gastroesophageal reflux disease (GERD). Millions of Americans (14%-20% depending on the study) take medications to manage the symptoms of GERD—heartburn, chest pain, persistent cough, difficulty swallowing, hoarseness. Prilosec and Nexium are the biggest moneymakers the pharmaceutical industry ever created. Many Americans (10%-15%) have GERD, but are unaware of the problem because the tissue damage has not reached symptomatic levels. Erosive esophagitis or Barrett’s esophagus is a clinical finding of cellular change in the esophagus and a precursor for esophageal cancer. Esophageal cancer is one of the more deadly types of cancer.
Glaucoma or Retinal Disease
The head down position raises pressure inside the eyeball. As little as 30 degrees of decline has been shown to increase intraocular pressures. It is estimated that 2.2 million Americans have glaucoma, but only half of these know they have the problem. Individuals with glaucoma already have elevated intraocular pressures and should avoid these positions. The back of the eye (retina) is susceptible to changes in vascular pressures, so if you have any retina issues, avoid the head down position.
High Blood Pressure / Hypertension
Your heart, lungs, and arteries are conditioned to pump blood with your body in an upright position. Many vascular alterations occur when we flip into a heads down position. When you assume the head below your heart position, the arterial pressures inside the skull increase. Elevated cranial blood pressures can lead to headache and much more severe problems such a stroke. One in three Americans are walking around with high blood pressure. Add in an exercise induced elevated heart rate and some less than pliable carotid arteries and you have the ideal environment for a big bad brain event. If you have hypertension, I would not go about using any inverted positions in the gym.
Apart from going blind, having a stroke, and developing an incurable cancer, you should be fine.
Michael S. O’Hara, P.T., OCS, CSCS
Multi Directional Power Training
We have recently added a new training tool to our physical therapy clinics. The Surge 180 is a simple and incredibly effective training device for rehab patients. The patient stands on the platform, grasps the handle, and works against resistance provided by three pistons. The physical therapist can use the Surge 180 to improve many different areas of performance.
Safe and Effective Power Training
Most physical therapy patients are severely underpowered. Not only do they need to get stronger, they must also get better at creating force quickly. The patient can accelerate against the handle of the Surge 180, and because the overall mass is so small, there is no damaging inertia to overcome. The mass of a weight stack, barbell, or dumbbell creates so much inertia that when you attempt to move the load quickly it creates damaging joint stress.
In life and athletics, our bodies move in all directions. The Surge 180 handle moves forward–backward, right–left, diagonally, and into rotational movement patterns. The handle excursion is big enough to accommodate patients of all heights.
It Demands You Stand
Rehabilitation is all about getting better at functioning in standing positions. Patients need to learn how to efficiently transfer forces from the ground up through their body. On the Surge 180 platform, the patient can be positioned in-line, split, straddle, or single leg stance. Connecting the shoulder to the opposite side hip, through an active core is the essence of rehabilitation training.
The coordinated performance of the team of muscles that control the hips, pelvis, and spine is more important than simple strength. Standing, walking, climbing stairs, and carrying all require the synchronous transfer of forces from right to left and back again. The resistance provided by the Surge 180 creates the neural feedback to fire those reciprocal motor patterns.
Michael S. O’Hara, P.T., OCS, CSCS
KICK THE KICKBACK TO THE CURB
In our physical therapy clinics, we get to treat elbow pain every day. The pain is usually brought on by some kind of repetitive activity. Tennis players get pain on the outside of the elbow. Throwers and golfers get pain on the inside of the elbow. Fitness clients commonly end up in physical therapy with complaints of elbow pain. The cause of the pain is usually some sort of triceps isolation training, and the biggest offender is the “triceps kickback” exercise. The kickback is a Shape magazine standard that appears to be a favorite with female gym goers. The triceps kickback is more likely to give you elbow pain, than to produce thinner and more shapely arms.
Three things make this exercise problematic for the elbows. The kickback exercise creates a bad force curve. The resistance is the strongest when the triceps muscle is at its least advantageous position, and this places the majority of the load on the elbow joint in a fully extended position. When I see this exercise performed in the gym, it is usually executed with a swinging of the dumbbell. The momentum of the weight forces the elbow into excessive end range extension. Kickbacks are often performed for high repetitions. It is not uncommon to witness someone perform three or four sets of twenty repetitions. That is sixty to eighty high speed, end range repetitions under a stressful force curve on each elbow.
From the elbow pain patient I hear, “But I don’t feel any pain when I perform the kickback exercise.” Most golfers, tennis players, and throwers don’t feel pain during their participation in sports. The elbow pain usually sets in later that day or the next morning. Another common concern is that they will not be able to reduce fat on the back of the arm without direct triceps work. This is the “spot reduction myth” that just won’t die and keeps many a physical therapists employed. Avoid the trainer that tells you a specific exercise will take subcutaneous fat off an area of your anatomy.
Elbow irritation that creates scar tissue and inflammation is often difficult to eliminate. The pain in the elbow can get so bad that it limits other training activities. The good news is that elbow pain is often self-inflicted, and with a little education, we can avoid the pain. Watch the video, dump the kickback exercise, and start training your triceps with some push ups and presses. Your elbows will thank you.
Michael S. O’Hara, P.T., OCS, CSCS