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Bad Man Break

Men Need To Be More Aware Of Bone Density

Allen was getting out of his fishing boat when he twisted his left leg and fractured two bones in his ankle.  Six weeks after ankle surgery, he landed in our clinic with considerable pain and a very limited lifestyle.  Allen reported lower back pain that he attributed to his limping and use of the boot on his left leg.  On recommendation from his physical therapist, Allen had further medical assessment of his lower back pain.  An x- ray of his lumbar spine revealed two lumbar vertebrae fractures.

On a recent vacation, Mike went on a horseback ride with his grandchildren.  During the ride, he developed pain in his upper back that “took his breath away”.  A visit to the emergency room with what he thought was a cardiac issue revealed a three-level compression fracture in his thoracic spine.  Further assessment showed significant osteoporosis in his hips, pelvis, and lumbar regions.  Allen started on some bone rebuilding medications and physical therapy.  It took over four months to fully recover from this injury.

Randy was working on his garden and fell onto the lawn.  He had right hip pain and was unable to stand.  His wife called the ambulance and he was diagnosed with a hip fracture.  Four days after the surgery to repair his hip, he suffered an embolism and at the age of seventy-one, he passed away.

All three of these older guys had testing that revealed a significant loss of bone density.  Unfortunately, the tests occurred after and not before injury onset.  We are getting better at keeping men alive longer–less smoking and better medications.  As men get older, the need to monitor bone density becomes a crucial aspect of healthy aging.  Men need fewer commercials for the latest in testosterone replacement and ED medication and more awareness of how brittle their bones can become.

The general public views osteoporosis as a “women’s health issue”, but management of osteoporosis is just as important for men.  Although men are less likely than women to sustain an osteoporosis related fracture, they are much more likely to become permanently disabled or die from the fracture.  Since 2008, the rate of osteoporosis related hip fracture in the American male population is going up at an alarming rate.

Osteoporosis is a silent disease.  Most people do not realize they have a problem until something breaks and they are in the middle of a medical crisis.  Even after a fracture, many physical therapy patients are reluctant to follow up with a bone density screening.  Being proactive is the only method of managing osteoporosis.

We know that individuals that participate in consistent resistance training exercises are more likely to have better bone density.  Just like muscle, bone is a living thing that grows stronger in response to the force that is placed upon it.  The best bone building exercise activities produce a stimulus through your skeleton.  Bone building exercises are easy to understand, but they do require more effort than swallowing a pill or having an injection.  Everyone can perform some form of bone reinforcing exercise.  Proper exercise prescription and consistent progression can work wonders.  See the trainers and physical therapists at Fenton Fitness.

Jane Brody of the New York Times wrote a helpful *article on bone density testing. It covers the latest medical guidelines for testing and the when and why of testing for both men and women.

Michael S. O’Hara, P.T., OCS, CSCS

*New York Times, July 16, 2018, Jane Brody, When to Get Your Bone Density (View Article:here)

Biomarker Reminder

Drs. Evans and Rosenburg are Tufts University researchers interested in the measurable parameters that keep humans healthy and fit over an entire life span.  They have determined that the top four biomarkers are:

  1. Muscle Mass.  The percentage of your body that is made of muscle.
  2. Strength.  Can you use that muscle to push, pull, lift and carry.
  3. Basal Metabolic Rate.  The number of calories your body expends at rest.
  4. Body fat Percentage.  What percentage of your body is composed of fat.

The authors named these top four biomarkers, the decisive tetrad.  They are the prerequisites to maintaining healthy numbers in all of the other essential biomarkers.

  1. Aerobic Capacity
  2. Blood Sugar Tolerance
  3. Cholesterol / HDL ratio
  4. Blood Pressure
  5. Bone Density
  6. Internal Body Temperature Regulation

Drs. Evans and Rosenburg coined the term age related sarcopenia in their 1991 book Biomarkers.  It refers to the gradual loss of muscle mass that occurs as we age.  The keys to aging well, staying durable–no injuries, and maintaining control of all health parameters is maintaining or improving muscle mass / strength and eating properly.  An ongoing program of strength training and nutritional discipline are the foremost components of fitness and health.

Michael S. O’Hara, PT, OCS, CSCS

PDFStanding desks are great for posture and health, but many people have difficulty when they first start using them.  In this issue, Mike O’Hara, PT gives exercises that can help you stand for longer periods of time.  Watch the video for instruction on these exercises.  In his article, “The Biomechanics We All Need To Know, Mike agrees with the advice given by Stuart McGill.  Be sure to read about Fenton Fitness Member Jan Pilar and her success with her program.

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PDFIn this issue, Mike O’Hara, PT gives ten reasons to love lunges.  Video of lunge exercises/progressions are included.  In Going Grizzly, Mike presents the exercise combination of Crawls and Sandbag Carries; a combination that helps you train more efficiently and move better.  Watch the video for instruction on these exercises.

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Fracture Facts For Men

osteoporosisJane Brody of the New York Times wrote a great article on the risks men have for osteoporosis related fractures.  The general public views osteoporosis as a “women’s health issue,” but management of osteoporosis and prevention of falls is just as important for men.  Although men are less likely than women to sustain an osteoporosis related fracture, they are much more likely to become permanently disabled, or die, from the fracture.

In 2012, an international team of researchers and clinicians launched Too Fit to Fracture, an initiative aimed at developing optimal exercise recommendations for individuals with osteoporosis.  In October of 2014, they released a booklet that is available through osteoporosis.ca on managing osteoporosis through exercise.  Everyone should read this booklet and osteoporosis patients should follow their exercise prescription.  Their work brings clarity to an issue that is currently clouded with poor understanding and a lot of bad fitness advice.

The Too Fit to Fracture researchers recommend that individuals with osteoporosis (with or without vertebral fractures) should engage in a multi-component exercise program that includes resistance training in combination with balance training.  Balance train for ten to twenty minutes every day of the week and strength train for 30 to 45 minutes twice a week.  Make sure your strength training teaches you how to move correctly and improves the endurance in your back muscles.  If you have mild to moderate osteoporosis, balance train and strength train first and foremost, and use any extra time on some low impact cardio training.  If you have been told you are at high risk for fracture, keep your focus exclusively on balance and strength training and keep the cardio activities to a minimum.

We know that individuals who participate in consistent resistance training exercises are more likely to have better bone density.  Just like muscle, bone is a living thing that grows stronger in response to the force that is placed upon it.  The best bone building exercise activities produce a growth promoting stimulus through your skeleton.  Bone building exercises are easy to understand but they do require more effort than swallowing a pill or having an injection.  Everyone can perform some form of bone reinforcing exercise.  Proper exercise prescription and consistent progression can work wonders.  See the trainers and physical therapists at Fenton Fitness and Fenton Physical Therapy for guidance.

-Michael S. O’Hara, P.T., OCS, CSCS
View the NY Times article here: http://www.nytimes.com/2016/10/04/well/live/men-get-osteoporosis-too.html?_r=0

02misconception-bones-superJumboI recently received an email on an article in The New York Times.  The article stated that moderate exercise did not produce an improvement in bone density.  The article went on to state that only medications have been found to be effective at reversing bone loss.  The fitness client that sent me the email was understandably concerned because the article presented information that was dramatically different than what she had been told.  In her battle against osteoporosis, she had placed a lot of faith in exercise and dietary modification.  She had been given advice from her doctor, physical therapist, and trainer that she was on the proper path to better bone health.   I read The New York Times article, looked up the referenced research, and I have a reply.

The New York Times author is correct that moderate weight bearing activities do not produce a change in bone density.  Walking, running, yoga, and Zumba do not produce enough bone stress and muscle tension to improve Continue reading

Whether you are trying to maximize bone density at a young age or simply maintain it at an older age, your choice of exercises will be the key to your success. Select exercises that allow for large amounts of force and power to be displayed. Also, choose exercises that effectively stress multiple muscle groups as muscle preservation is highly associated with bone density.

The last two exercises in our series of six are listed below:

Power Clean

The power clean is a great exercise to stress the bones of the feet, lower/upper legs, hips, spine, clavicles, and even arms to a smaller degree. Power Cleans are a great movement for improving full body power, but they are a bit more advanced. You should probably refrain from this exercise if you have under one year of weight training experience. This exercise offers some of the highest power outputs of any exercise.

BetterBonesWk3

 

 

 

 

 

 

Split Squat

This is a good exercise for everyone, but especially for those who have low back issues (degenerative discs, bulging/herniated discs, etc.) and those at risk for osteoporosis often do. It places very little stress on the low back, incorporates a large amount of lower body muscles, works on balance and, most importantly, allows for very heavy loads to be used.

Click on the link below for step by step instructions and video demonstration on how to perform a power clean and split squat:

 

-Jeff Tirrell, B.S., CSCS, Pn1

Ten million people in the U.S. have osteoporosis. An additional 18 million are at risk to develop it. An additional 34 million are at risk to develop osteopenia, or low bone mass. These ailments lead to higher incidents of fractures which lead to lack of physical activity and a quick decline in the fitness and health of affected individuals.

Last week, we talked about the vital role our diet plays when it comes to preventing osteoporosis by providing the needed nutrients to build and maintain strong bones. It should be noted that over half of our bone mass is accumulated during adolescence (12.5 years for girls and 14 years for boys) with peak bone mass being achieved in our mid 20’s. It is, therefore, very important for people of all ages, especially younger individuals, to incorporate appropriate activities and nutrition and not wait until we are in our 50’s and beyond to start trying to modify diet and activity.

In addition to giving our bodies the needed nutrients of calcium, vitamin D, and protein, the most effective way to stimulate our bone density is through activity. Ultimately, putting our bones under large amounts of force gives them the stimulus they need to get dense and strong.como

There are two main ways we can put stress on our bones where the requisite force is being absorbed or transferred which in turn stimulates bone density. One such way is through weight bearing exercises which force your body to absorb impact. These include walking (on hard surfaces), running, sprinting, jumping, and various upper extremity plyometric exercises. The potential drawback to some of these exercises is that they can be hard on your joints (knees, hips, back, ankles), especially for those with preexisting conditions in these areas. This type of training should be used 2-3x/week for 15-30 minutes.

The second form is that of resistance training. This can be done with machines, bands, body weight, or free weights. It has been demonstrated that free weight activities using barbells, dumbbells, and kettlebells (especially at heavier weights/intensities) lead to greater force production. It would stand to reason, therefore, that utilizing primarily free weight exercises with moderate to heavy weights would be most effective at increasing/maintaining bone density. Resistance training should be performed 3-5 times per week for 30-60 minutes.

It should be noted that low/no impact activities such as swimming, water aerobics, yoga, elliptical trainers, and biking provide little stimulus for improving bone density. Also, even with the best training protocol, appropriate considerations must be made in regard to nutrition to be sure the needed nutrients are available to build up our bones.

Click on the link below to see video demonstration of one of our members in action:

-Jeff Tirrell, B.S., OCS, CSCS

Whether you are trying to maximize bone density at a young age or simply maintain it at an older age, your choice of exercises will be the key to your success. Select exercises that allow for large amounts of force and power to be displayed. Also, choose exercises that effectively stress multiple muscle groups as muscle preservation is highly associated with bone density.

Try the two exercises listed below and look for more next week.

Push Press

This exercise is one of the easier to learn “power” movements out there. It stresses the bones of your arms, clavicle, and spinal column. It is also great for developing power without the technique required for some other power movements. Most importantly, this exercise lends itself to the use of heavier weights. For those with restricted shoulder mobility, using a Landmine is a great alternative.

Better_Bones_Wk2

 

 

 

 

Hip Thrust

This exercise is fantastic for all of the lower extremity musculature, but it especially emphasizes the glutes and hamstrings. There are low amounts of stress to the low back which make it a safe exercise for most populations while still eliciting some strengthening of the lumbar vertebrae. The femur and hips will be the primary bones strengthened with this exercise. You can progress or regress this exercise to accommodate a wide range of populations but have the potential to use large loads which is important for maximum bone density.

Click on the link below for step by step instructions and video demonstration of how to perform the push press and the hip thrust:

-Jeff Tirrell, B.S.,CSCS, Pn1

Skeletal Strengthening

Exercise Training That Prevents Osteoporosis

bending_the_age_curveI recently heard a talk by Dr. Joseph Signorile on the latest and greatest research in regards to exercise that prevents and reverses osteoporosis.  Dr. Signorile is a professor of kinesiology at the University of Miami.  He is an expert on fitness for older adults and conducts research in the field of geriatrics.  Based on what field proven research is telling us today, Dr. Signorile has these suggestions:

Bone reacts best to dynamic mechanical stimulation.  The best bone building exercises create a stress that changes as we move, rather than a static force.  Progressive resistance training involves moving your body against a resistance.

If a bone is to respond to training, the stimulus must be at a suprathreshold level.  The participants in the studies that got the best results carried, lifted, pulled, and pushed some serious loads.  “Suprathreshold level” means it has to be physically challenging.  Elliptical training and those five pound chrome dumbbells will not produce a bone building response.

Optimal bone building skeletal loading.  What the research studies have found is that the best gains occurred with forty repetitions of loading at each skeletal region per training session.  Less than forty is less than optimal.  More than forty repetitions have no further bone building benefit.  Two or three properly executed exercises can take care of loading the entire skeleton.  An appropriate skeletal training session can be made up of 80-120 repetitions.  You can get that done in fifteen minutes.

The response of bone to exercise is improved by brief but intermittent exercise.  Loading your skeleton more frequently creates a stronger mineralization response in the bone.  Five or six training sessions per week will produce more bone density than two or three sessions per week.

Bone responds best when you employ a loading pattern that differs from the usual loading pattern.    I have been ranting about this for years.  Bone only adapts–gets stronger–when the exercise stimulus is a challenge beyond what you have subjected the bone to in the past.  If you have been performing the same activity at the same load for months on end, the bone building stimulus is minimal.   To improve bone health, you should alter the exercises you perform every three to four weeks.

What the research recommends….
Based on what the research is telling us, Dr. Joe recommends you perform a program of dynamic weight training that delivers forty repetitions of loading at each section of your skeletal system.  You will see better results with more frequent training sessions and consistent alteration in exercise activities.  Pick two or three exercises and load them aggressively for forty repetitions each.  Perform your exercise three to five times a week and change your exercises every month.  To learn more, talk to our trainers for some bone building exercise suggestions.
Michael S. O’Hara, P.T., OCS, CSCS

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