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Play It All

How To Keep Your Child On The Field And Out Of The PT Clinic

Taylor was recently referred to physical therapy with a painful shoulder and a right hand that frequently went numb. For the last five years, she had been a year round participant in softball. At the age of fifteen, she was missing out on softball and a good night sleep secondary to the pain and limited function in her right arm.

Andy played soccer, and at the age of thirteen, he developed knee pain that prevented him from changing directions and sprinting. Andy practiced or played soccer four days a week for 50 of the 52 weeks in a year. It took four years of year round soccer to create the knee damage that required surgery and an twelve week rehab.

Many of the young athletes we treat in physical therapy are the victims of over exposure to the same training stimulus for far too long a period of time. Gymnastics, dancing, baseball, soccer, and softball are worthwhile endeavors, but a developing body needs a break in order to stay healthy. This becomes even more important as the athlete becomes stronger or more skilled.

Take a moment and read the *article by Jane Brody in the May 7th, 2018 edition of the New York Times. Jane interviews several Orthopedic Surgeons that are treating younger patients with injuries that usually occur ten or fifteen years later in an athlete’s career. The research they present is clear; year round single sports participation is not the best way to excel in athletics or remain healthy.

The recent popularity of the club system has children playing the same sport year round. In the clinic, we are treating more young athletes with old person overuse injuries. Participation in a variety of athletic activities is infinitely more beneficial and safer than single sports specialization. It is no coincidence that most successful collegiate and professional athletes are the product of multi-sport participation.

*New York Times, Jane Brody, May 7, 2018, How to Avoid Burnout in Youth Sports. View article: https://www.nytimes.com/2018/05/07/well/how-to-avoid-burnout-in-youth-sports.html

Michael S. O’Hara, PT, OCS, CSCS

 

 

Our June issue brings information on preventing neck pain by strengthening your neck.  Mike O’Hara describes and demonstrates in a video exercises that will help strengthen the muscles of your neck.  In another article, Mike tells how grip strength can be a predictor of early death in some patients.  Be sure to read Jeff Tirrell’s article on performance based training.

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100 Steps Per Minute

Step Cadence and Fitness

Exercise researchers have been studying gait cadence for years.  A cadence of 80 steps a minute is a stroll.  100 steps a minute is considered a brisk walk.  At 130-140 steps a minute, you move into jog or slow run.  Recent high tech evaluations of gait cadence has been able to predict the onset of dementia in older people.  For many people, walking is their primary form of exercise.  Gretchen Reynolds has written an excellent *article on the walking cadence that produces optimal health benefits.

A compilation of many studies has found that 100 steps per minute is the sweet spot for walkers under the age of sixty.  The data for older walkers has yet to be fully evaluated, but it appears a slightly slower cadence is a good goal.

I like evaluations of performance.  Evaluations tell you if you are getting better or getting worse.  The human body is in a constant state of adaptation and never stays the same.  Keep track of your cadence by counting your steps for twenty seconds and then multiplying by four.  Use that information to track your fitness level.  Ideally it should get easier to walk, at faster pace over a greater period of time.

15 x 4 = 60 Pokey Joe.

20 x 4 = 80 Still too slow.

25 x 4 = 100 Good job.

Michael S. O’Hara, PT, OCS, CSCS

*Walk Briskly for Your Health.  About 100 Steps a Minute, Gretchen Reynolds, New York Times, June 27, 2018

View: https://www.nytimes.com/2018/06/27/well/walk-health-exercise-steps.html

Practical Protein

During the last five years, I’ve probably written about protein more than any other topic.  That’s largely due to the fact that along with energy intake, water intake, and a solid progressive full body strength program, very little else will have such a dramatic impact on your progress, recovery, and body composition.  Most people who read fitness articles and are regular readers of our blog understand that they need to eat protein.  My experience in nutrition coaching however, shows that many people are clueless as to how to go about this.

For starters, we need to understand what our protein intake should look like.  Many studies look at minimum requirements.  This outlook is simply looking at what is needed to avoid sickness and disease.  What we want to look at is optimal intakes to improve recovery and accumulate or retain muscle mass, as these are the metrics which will vastly improve our quality of life.  Most research in this field gives protein requirements in grams per kilogram of bodyweight.  The latest and most comprehensive Meta-analysis recommends an intake of 0.73g/lb of bodyweight.  Dr. Eric Helms presents various good points in this article which shows intakes may be able to go as low as 0.63g/lb of bodyweight and some may benefit from as high as 1.3g/lb of bodyweight.  Since most people that I talk to about protein intake are struggling to get enough, I recommend 0.6-1g/lb of bodyweight.  Leaner individuals likely need to be on the higher end, while obese and overweight individuals will probably fair just fine on the lower end.  Once you know your intake goals, you simply need to divide that amount among the number of meals you eat per day.  Here is a practical guide, with simple options if you are still under on your protein intake.  These meals can be scaled up or down based on your protein needs and will also fulfill fruit and veggie requirements for the day.

Jeff Tirrell, CSCS, CSFC, Pn1

Snack Option #1

2 oz beef/turkey/venison jerky (20-25g protein, 140-180 calories)

Snack Option #2

1 scoop Whey OR Egg OR Pea protein shake (20-25g protein, 120-140 calories)

Snack Option #3

3 string cheese OR 3 hard boiled Eggs (18g protein, 150-210 calories)

Daily Totals: 108-250g protein (1140-2631 calories)

 

You Have A Social Media Disease

There Is No App for Thumb Pain

Your thumb is made up of an intricate system of tendons that enable very precise movement.  The joints of a thumb are fairly small and yet we are able to produce an amazing amount of force with this single digit.  In this age of all things digital, the modern American thumb has been subjected to greater workloads.  Problems with thumb pain, numbness, and limited function are becoming more common complaints in physical therapy.  I have some suggestions on how to manage pain and limit the damage and embarrassment of excessive social media thumb exposures.

Thumb Tendon Troubles

Dr. De Quervain was the first to clinically described thumb tendonopathy, and we call thumb tedonosis De Quervain Syndrome.   The test for De Quervain Syndrome was created by a clinician with an equally odd name and it is called the Finkelstein test.  Place your thumb in the palm of your hand.  Make a fist with the finger around the thumb.  Hold the wrist in neutral and then deviate the wrist toward the pinkie finger.  If you feel pain it is a positive Finkelstein test.

Resolution of thumb tendonopathy pain happens quickly when you give in to the symptoms of pain and modify your activities.  Rest the thumb tendons by using your fingers instead of your thumb on that smart phone.  Avoid fitness activities that put stress on the thumb.  Lifting in front of the body with the palms facing inward is often the lift that new mothers perform and develop painful thumb tendons.  Early on in the pain onset, icing is often helpful.  In physical therapy, we are successful with soft tissue mobilization, ultrasound, and manual therapy.  A gauntlet type thumb splint you wear at night is an unattractive but provides aviable position of rest for severely aggravated thumb tendons.

The Numb Thumb

Irritation of the median nerve in the carpal tunnel of the wrist will create thumb, second, and third finger numbness and pain.  An injury of the recurrent median nerve in the front of the palm will produce numbness in the thumb and limited strength during thumb opposition–thumb to pinkie finger.  Patients with neural irritation often develop numbness, weakness, and then pain.  The pain often wakes them from sleep and disrupts hand function.

Once again, you will resolve a numb thumb with rest.  Once neural irritation gets fired up, it takes longer to resolve than an aggravated tendon.  Giving in to the numbness and resting the hands will produce better results if you start early.  Two weeks of avoiding the aggravating hand activity produces good results.  Night splints for the wrist and thumb are often helpful.  A carpal tunnel release is a common surgical alternative that takes pressure off the median nerve.

Gumbie Thumb Beware

Every joint has a certain degree of stability and certain degree of mobility.  Our spine, knees, hips, shoulders, and elbows must move enough to produce motion but not so much that they fall apart.  The amount of movement in our joints is largely an inherited characteristic–you can blame Mom and Dad.  The person at the extreme end of the scale (“double jointed”) needs to take certain precautions with their thumbs.

The Beighton Score is a popular screening technique for joint hypermobility.  It has been around for thirty years and is used in research all around the world.  The scoring is based on eight passive range of motion assessments and one active range of motion assessment.  One point is assigned for each of the following.

A pinkie finger that can be passively bent backward more than 90 degrees.

A thumb that can be pulled down to the front of the forearm.

Elbows that passively hyperextend to 10 degrees.

Knees that passively hyperextend to 10 degrees.

The subject can place the palms on the floor during a straight leg, forward bend.

Researchers disagree on the score that should be a threshold for concern about systemic joint hypermobility.  I have found that fitness clients and physical therapy patients that score a 5/9 or higher require modification of their training programs.  It is not uncommon to encounter physical therapy patients that have a Beighton Score of 9/9.  Hypermobile individuals need to take more precautions when they perform repetitive tasks such as texting on a smart phone.

Kimberly Salt wrote an excellent article on social media induced thumb pain in the May 19, 2018 issue of the New York Times.  Take a minute and read, Me and My Numb Thumb: A Tale of Tech, Texts and Tendons.

Michael S. O’Hara, PT, OCS, CSCS

Practical Protein

During the last five years, I’ve probably written about protein more than any other topic.  That’s largely due to the fact that along with energy intake, water intake, and a solid progressive full body strength program, very little else will have such a dramatic impact on your progress, recovery, and body composition.  Most people who read fitness articles and are regular readers of our blog understand that they need to eat protein.  My experience in nutrition coaching however, shows that many people are clueless as to how to go about this.

For starters, we need to understand what our protein intake should look like.  Many studies look at minimum requirements.  This outlook is simply looking at what is needed to avoid sickness and disease.  What we want to look at is optimal intakes to improve recovery and accumulate or retain muscle mass, as these are the metrics which will vastly improve our quality of life.  Most research in this field gives protein requirements in grams per kilogram of bodyweight.  The latest and most comprehensive Meta-analysis recommends an intake of 0.73g/lb of bodyweight.  Dr. Eric Helms presents various good points in this article which shows intakes may be able to go as low as 0.63g/lb of bodyweight and some may benefit from as high as 1.3g/lb of bodyweight.  Since most people that I talk to about protein intake are struggling to get enough, I recommend 0.6-1g/lb of bodyweight.  Leaner individuals likely need to be on the higher end, while obese and overweight individuals will probably fair just fine on the lower end.  Once you know your intake goals, you simply need to divide that amount among the number of meals you eat per day.  Here is a practical guide, with simple options if you are still under on your protein intake.  These meals can be scaled up or down based on your protein needs and will also fulfill fruit and veggie requirements for the day.

Jeff Tirrell, CSCS, CSFC, Pn1

Dinner Option #1

2-3 cups of spinach AND/OR Kale (2-4g protein, good for you)

4-6 ounces chicken breast OR Tuna (25-44g protein)

1 ounce shredded cheese (5-8g protein, calcium)

½-1 cup other veggies: broccoli, carrots, cucumbers, pepper, onion (1-2g protein, good for you)

2 tbsp oil/vinegar based dressing (no protein)

Optional:          Glass of 2% or Whole milk (8g protein)

glass of red wine

bread or potato

Total: 33-68g protein (450-700 calories)

 

Dinner Option #2

4-8oz baked Chicken breast, Salmon, Steak (25-65g protein)

1 medium baked potato OR 1 cup quinoa OR 1 cup rice (2-6g protein)

2 cups  green beans, asparagus, brussel sprouts (4-6g protein, good for you)

Optional:          Glass of 2% or Whole milk (8g protein)

glass of red wine

Total: 31-84g protein (360-860 calories)

 

Lumbar Spine Fitness Guidelines

Janet injured her lower back while exercising in her local gym.  She was taking a trip through her favorite “ab ciruit” when she felt a snap in her lumbar spine.  The next day she was unable to stand up straight.  Two weeks later, we met her in physical therapy for her initial evaluation.  She was ready to return to her fitness program three weeks later.  Janet was very concerned she may suffer another exercise induced back injury and requested some advice.  These are the simple guidelines I give to physical therapy low back patients returning to exercise.

Mobilize the Thoracic Spine and Hips

Movement is supposed to happen at the thoracic spine and hips.  Unfortunately, prolonged sitting, deconditioning, and poor training choices tends to restrict mobility in these areas.  If you are unable to rotate and extend at the hips and thoracic spine, your brain will use other joints to make up for the deficit.  Pushing extra rotation and extension forces into your lumbar spine is never a good thing.  Dedicate some training time to improving thoracic spine rotation and hip extension / internal rotation range of motion.  If you sit for a living, work on your mobility everyday.

Make the Lumbar Spine Stable

Most fitness clients believe that more lumbar spine movement is a good thing.  They perform toe touches, back twists, and the many breeds of up and down dogs.  Unfortunately, greater lumbar spine range of motion is positively correlated with a higher incidence of lower back pain.  The incidence of low back pain escalates even further when we move those hypermobile lumbar spine segments against a resistance.  What does keep lumbar spines healthy is high level of lumbar spine strength endurance.  Can you hold the lumbar spine stable and prevent movement from occurring at the pelvis and five lumbar vertebrae.  Your lumbar spine stays happy and healthy when you focus training efforts on planks, roll outs, crawls, carries, and Pallof press exercises.  Avoid the sit ups, crunches, sidebends, toes to bar, and other assorted “ab” exercises that create lots lumbar spine motion.

Avoid Muscle Isolation Exercise Activities

The muscles that support the lumbar spine work together as part of a neurally connected team.  Training activities that support better communication between the team members will create optimal performance.  The neuroanatomy saying is “What fires together, wires together”.  Ditch the “upper abs”, “lower abs” baloney and sprint away from anyone who trys to strap you into a machine in an effort to “isolate your obliques”.

On her discharge from therapy, Janet was unable to perform a single roll out and fatigue fairly quickly with a twelve pound suitcase carry.  For the last three months, she has followed the guidelines and her progress has been excellent.   Janet is currently performing a suitcase carry with fifty pounds and has worked up to ten full reps on an ab wheel roll out.

Michael S. O’Hara, PT, OCS, CSCS

The Cumulative Effect of Activity

Many people are put off from starting an exercise routine because they are overwhelmed by the time commitment they feel is necessary.  Fitness magazines, exercise experts, and everything on youtube preaches–

–30 minutes of cardio three times a week

–45 minutes of strength training twice a week

–150 minutes of exercise per week

Most of this well-intentioned advice is wrong.  Nearly everyone can derive significant benefit from short bouts of fitness activity that are performed on a consistent basis.  Walk for five minutes twice a day.  A simple routine of two strengthening exercises will take no more than five minutes.  Climb the stairs in your home three times once a day.  Practice getting up and down of the floor.  Stay consistent with a routine of short exercise bouts and you will be healthier and stay independent for a lifetime.

More research has demonstrated the beneficial effect of short exercise sessions interspersed throughout the day.  Read the March 28, 2018, New York Times article by Gretchen Reynolds, Those 2-Minute Walk Breaks?  They Add Up.  View the article: https://www.nytimes.com/2018/03/28/well/move/walking-exercise-minutes-death-longevity.html

Mike O’Hara, PT, OCS, CSCS

In our May issue, Mike O’Hara discusses the importance of walking.  If you have pain or difficulty with walking, there are things that help.  Mike demonstrates some exercises to get you ready.  Be sure to read Jeff Tirrell’s article on squatting, and read about Afterburn–a new class at Fenton Fitness that uses heart rate monitors while training.

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Triathlon Success: Hamstring And Glute Togetherness

To keep a triathlete healthy and resilient, the hamstrings and gluteal muscles must work together as a team.   The athlete fires the gluteals and hamstrings simultaneously to stabilize the pelvis and produce force through the lower leg.  When you run, bicycle, or swim, these muscles work at a team to produce efficient propulsion and reduce stress on the lumbar spine and knee.  A triathalon is the ultimate long duration physical endeavor.  Triathletes need hamstrings and gluteal muscles that can stay on and strong for a long time.

Most fitness programs do not properly train the muscle of the posterior chain.  Fitness center exercise generally involves training the hamstrings as knee flexors on some type of “leg curl” machine.  Gluteal training rarely occurs past neutral hip extension, with little effort on improving overall hip range of motion.  Any type of seated gluteal training is inappropriate for an athlete.

The term physical therapists and strength coaches use for butt muscles that are non- responsive is “gluteal amnesia”.  Our sedentary lifestyle involves very little of the glute recruiting sprinting, deep squatting, and climbing that activates the gluteal muscles.  We mistreat our gluteal muscles with hours of compressive sitting and little in the way of full range hip movement.  Many fitness clients and most physical therapy patients need some remedial gluteal training.  Give these three drills a place in your triathalon training program.

Single Leg Bridges

Lay supine with the arms braced against the floor to stabilize the upper body.   Bend the knees and place the feet flat on the ground.  Lift the right leg up off the ground.  Using the muscles in the back of the left leg, lift the hips up off the ground.  Push up through the heel of the left foot and drive the left hip into full extension.  Hold at the top for three seconds and then lower in a controlled manner.  Perform ten repetitions on each leg.  Common mistakes are allowing the pelvis to tilt and not fully extending the hip.  Hamstring cramping is an indication that you are not using the glutes enough and need to focus on creating a better mind to butt connection.

Goblet Squat

The squat movement pattern is a skill that is easier to teach if you add some load.  You can use either a dumbbell or a kettlebell for this exercise.  It has been my experience that the exercise is easier to learn with a kettlebell.  Hold a kettlebell by the horns, with the elbows down, and the kettlebell close to the chest.  Keep the chest proud and pull the abdominal muscles tight.  You may have to experiment with foot placement as everyone has different hips.  The position you would place the feet if you were going to jump is a good starting point.  Initiate the squat by pushing back the hips.  Keep the torso tall and descend.  Let your pelvis fall between the hips. The elbow should drop down between the knees.  Nothing will inhibit your progress more than thinking about how you are moving during goblet squats.  Keep your brain quiet and get in some repetitions.  Effort has amazing capacity to improve motor control.   Perform ten repetitions.

Mini Band Monster Walk

Your will need a mini resistance band–a nine inch loop of resistance band, (two dollars from performbetter.com).  Most fitness clients will do well with a green or yellow mini band.  Place the mini band loop around both legs just above the ankles.  Assume an athletic stance with the feet straight ahead, knees bent, and hips flexed.  The band should be held taught throughout the exercise.  Imagine your feet are standing on railroad tracks.  Walk forward for ten steps on each side, keeping the feet over the railroad tracks.  Walk backward for five repetitions on each leg.  Try to keep the hips and shoulders level throughout the exercise.

Once you have mastered all three exercises, build your gluteal and hamstring performance by traveling through the program for two or three trips.

  1. single leg bridges  R and L x 10
  2. goblet squats x 10
  3. mini band monster walk x 10 each leg

View video of the exercises here: https://youtu.be/QeteeLPF4AU

Kat Wood, DPT, ATC

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