Get Sweaty and Get Smarter
The big benefit of a consistent program of exercise is the impact it has on the nervous system. Muscle strength, flexibility, fat loss, and greater endurance are the happy side effects. Immersion in a fitness program keeps the brain healthy and receptive to learning.
Anyone concerned with optimizing brain health needs to read Spark, by Dr John Ratey. In this book, he discusses how brain function is enhanced by the habit of exercise. Over the last nine years, more research has documented the positive effects of exercise on brain health and learning. Read the recent *article from the New York Times on how we learn language more readily if we exercise.
* How Exercise Could Help You Learn a New Language, Gretchen Reynolds, New York Times, August 16, 2017
Michael S. O’Hara, PT, OCS, CSCS
A Plea For Your Knee
In our physical therapy clinics, we treat patients with knee pain on a daily basis. It has become more common to train younger clients with a history of knee injury and ongoing knee pain. Jane Brody’s recent *article in the New York Times has some excellent advice on the care and management of knee pain problems. I have some further suggestions and clarifications.
The mass portion of the Force = Mass x Acceleration formula needs to be at an appropriate level for your knees to stay healthy. Carrying extra body fat creates an environment that invites knee wear and tear. The common knee pulverizing mistake is to perform high impact exercise activities in an effort to lose fat. If you are twenty pounds overweight, do not run, stadium step, soccer, tennis, or pickleball. Start with strength training and low impact cardio. Lose the fat first, and even then, the lower impact activity will be healthier for your knees. From the overweight client limping into the clinic I get the “I need to move around to lose weight” protest. I am sorry, but fat loss is primarily a function of dietary alteration. Exercise has very little impact on body fat levels if you do not eat properly.
Train the Way You Wish to Play
A properly planned fitness program makes your knees more durable (fewer injuries) when you participate in your favorite recreational activity. The training must be tailored to your activity goals. If your goal is to play tennis, then you must perform three dimensional deceleration / acceleration activities as part of your training program. Yoga will not prepare your knees for tennis. If you want to water ski, then you must perform strength training for your back, hips, and knees. Distance running will not prepare your knees for water skiing. If hockey is your recreational past time, you need to be strong, well conditioned and competent in all planes of motion. Long duration recliner intervals will not prepare your knees for hockey.
If your hips do not move well, your knees will pay the price. In this age of all day sitting and minimal physical activity, hip function is at an all time low. Physical therapy patients with knee pain nearly always present with glaring restrictions in hip range of motion and strength. If your knees hurt, dedicate some training time to restoring hip rotation and hip extension movement. Learn how to perform some remedial gluteal activation drills. Learn a proper hip hinge, squat and a pain free lunge pattern.
Participation in a single inappropriate activity can produce a lifetime of knee trouble. That box jump workout of the day- maybe not. The warrior, electric shock, mud hole, death run–bad idea. Trampoline with the grandchildren–what were you thinking!
Be Proactive and Seek Treatment For Knee Pain
“Training through the pain” can take a graceful athlete and turn them into a lifelong speed limper. The presence of pain changes the way your brain controls movement. Left untreated, it can permanently alter neural signals and produce movement patterns that linger long after the pain has resolved. Live with enough cycles of inefficient movement and you develop early breakdown in the knee.
Michael O’Hara, PT, OCS, CSCS
*What I Wished I’d Known About My Knees, Jane Brody, New York Times. July 3, 2017
Read the NY Times article here: https://www.nytimes.com/2017/07/03/well/live/what-i-wish-id-known-about-my-knees.html?_r=0
More Research On Effects of Exercise and NSAID Medications
Millions of Americans take a non-steroidal anti-inflammatory drug (NSAID) every day. Many use these over the counter drugs to reduce the discomfort / pain of fitness activities. Big Pharma marketing makes the use of these chemicals look harmless. In the commercial, the lady pops three pills and glides effortlessly through her run. The basketball player takes his gel capsules and bounds through the game with his buddies. Most of us view these drugs as harmless and beneficial. Ongoing studies have shown that the use of NSAIDs as a pre-exercise activity preparation can limit your muscle recovery and damage your internal organs. A recent New York Times *article by Gretchen Reynolds should scare everyone away from medicating with NSAIDs prior to a training session.
Exercise induced inflammation is a critical biochemical process that helps us recover from a bout of training. You do not get fitter while training, you get fitter during recovery from a bout of exercise. The inflammatory biochemicals that make you sore and stiff after a vigorous exercise session are called prostaglandins. NSAIDs work by interrupting the chemical assembly line that makes various prostaglandins. No prostaglandin production means you have no delayed onset muscle soreness (DOMS), so you feel better. Prostaglandins are the chemical signal that tells your muscle cells to get busy repairing and reinforcing your skeletal muscle cells. No prostaglandins, no beneficial adaptation during recovery. Take a NSAID before training and it’s like you never exercised at all.
Prostaglandin production creates vasodilation– more blood can get where it needs to go during a session of exercise. The studies cited in the New York Times article have demonstrated that inhibited prostaglandin production creates diminished blood flow to your kidneys. Limited kidney function dramatically blunts progress toward all fitness goals. It is very difficult to run further, get stronger, or become leaner while undergoing dialysis.
Take the time to read the article by Gretchen Reynolds and rethink that pre-exercise NSAID protocol. You can view the article here: https://www.nytimes.com/2017/07/05/well/move/bring-on-the-exercise-hold-the-painkillers.html?
*Bring On the Exercise, Hold the Painkillers, Gretchen Reynolds, New York Times, July 5, 2017
Barbara O’Hara, RPh.
Fitness Freedom For All
This election marathon drones on, and neither of our present candidates has expressed an interest in the health or fitness of the average American citizen. “Making Americans Strong Again” is the slogan of my candidacy and this is my platform. All of these programs would cut the costs of health care, battle the obesity epidemic, and more equitably share the fitness wealth.
Triple the tax on all tobacco products. Nicotine is the most addictive chemical on the planet and it produces a tremendous burden on the American health care system. Use the tobacco tax dollars and the health care savings achieved with a reduction in the number of addicts to pay for all aspects of my program. Currently 19% of the USA population admits to smoking and conservative estimates are that tobacco users add another 210 billion dollars a year to our health care costs.
Outlaw every aspect of tobacco advertising–no exceptions. Tobacco is a horror that should have been dealt with years ago. Spend some time with a patient afflicted with esophageal, tonsil, tongue, or oral cancer and you will understand.
PHYSICAL LITERACY PROGRAMS
I thank Dr. John Ratey the author of the 2008 book Spark: The Revolutionary New Science of Exercise and the Brain for the Brain Function Equation.
Consistent Exercise + Healthy Metabolism = Better Mental Function
More of the brain is devoted to movement than language. If we wish to fully develop our intellectual capacity, we need to work on maintaining optimal “physical literacy”. Dr. Ratey has documented how school programs use consistent exercise to produce better test scores in all academic subjects.
The healthy metabolism portion of the above equation is driven by nutrition. Ask any coach who has worked on body composition goals with fitness clients and they will tell you that meal preparation is a lost art. Cooking classes, instruction on portion size, and how to use an appliance other than a microwave would go a long way to improve the average American’s health.
The government should support the participation of its citizens, young and old, in health promoting activities. The school systems are too stressed with the demands of teaching standardized math, science, and the latest version of history. Americans should be given a tax incentive or vouchers toward instructional classes and training programs that are supplied by private businesses. As physical literacy improves and the average citizen’s metabolism becomes healthier, perhaps we will become capable of picking better candidates.
America’s military readiness is impacted by the physical weakness of our citizens. It is estimated that only one in four Americans between the ages of 17 and 24 meet the requirements for service. The big barriers are obesity and fitness related health concerns such as hypertension and diabetes. The US Army and Navy scaled back the physical performance requirements and are still unable to find soldiers that can pass the new standards. As a nation, we need to address the profound loss of fitness in our youth.
FITNESS AND TAXES
Allow all Americans to fully deduct the cost of gym memberships for themselves and their families. Permit businesses to fully deduct the cost of memberships for their workers. We know citizens that exercise stay healthier, require less medical care, and place less fiscal stress on the American health care system. Gym attendance makes health care in America more “affordable” by keeping citizens fit. The government should reward the good behavior of the citizens attempting to take care of their health.
Our elected officials in Washington are provided with access to fitness facilities and trainers. Separate facilities for the House and Senate complete with pools, basketball courts, saunas, and steam rooms are provided for past and present politically elected officials. Our Senators and Representatives utilize state of the art fitness centers and their constituents (you and me) subsidize the payment for these facilities and services. Our political leaders value fitness and have deemed it a necessary occupational benefit. Let them help their fellow countrymen share in the benefits of fitness.
THE END OF DRIVING DEVICE DISTRACTION
The technology exists that will turn off a mobile phone if it is moving in a car. Please read the recent article in the New York Times* by Matt Richtel. As your new president, this app would be beamed into every automobile. The most dangerous thing an average American does in their day is climb into a car. Mobile phones have made automobile travel much more dangerous. For many people, the mobile phone is an impulsive addiction they are unable to control. We will never get compliance without blocking the device.
I know, I am a technophobe, social media hater, and an old geezer who is just now using e-mail. What I do hate is the driver who kills or injures a fellow American because they are distracted by the twitterverse. Blocking the mobile phone while traveling in a car may have the unintended consequence of restoring the lost art of conversation–you remember talking, don’t you? While cruising along on this brief bit of magic we call life, you do not want the final sound you hear to be the beep or ring from your cell phone.
There are many professions in which a person’s physical fitness is directly related to job performance. Fire fighters, police officers, emergency medical technicians, and construction workers all have physically demanding jobs that require a higher level of strength and mobility. It seems logical that maintaining a strong, well functioning body would be an occupational expense not dissimilar to many of the other permissible tax deductions currently available to business. A yearly fitness voucher for these professionals would decrease the cost of worker’s compensation, improve job performance, and enhance productivity. These vouchers could be used to hire fitness professionals or pay for gym memberships and fitness programs.
FITNESS INFRASTRUCTURE CONSTRUCTION
A “shovel ready” project that requires little in the way of engineering and creates ongoing health benefit is bicycle path construction. A bicycle path keeps riders and runners a safe distance from cars and encourages a fitness activity that is also very “eco friendly”. Most European countries have invested heavily in this infrastructure, and the use of bicycles is far more prevalent in areas that have developed a bicycle path system. I propose a USA Pathway Project that would create jobs, make Americans healthier, improve bicycle rider /pedestrian safety, and reduce our carbon footprint.
Many Americans live in what I call “fitness deserts”. There is no safe place to walk, no park, no gym, and no recreational facilities. I was fortunate to grow up in a town that had a city run summer recreation program. We had access to basketball courts, tennis courts, and playgrounds with swings, monkey bars, and slides. Elect me your next president and construction would begin on day one.
If exercise could be packaged as a prescription pill, it would be the most widely utilized medication in the history of health care. Doctors, nurse practitioners, and physician assistants counsel their patients that they need to exercise, but they are unable to provide the type of instruction and support the patient needs to be successful. Our health insurance companies face mandates for medical coverage of many diseases and illnesses that would be reduced or alleviated with consistent exercise. Insurance companies should have to pay for the medically prescribed exercise programs as part of our new “mandatory health care coverage”.
HEALTH CARE EQUALITY LEGISLATION
The elected representatives that have given us mandatory health insurance coverage should have to live with the same plans now available to the average American citizen. Let them enroll in the programs available in the states they represent. Let them pay yearly 15 – 25% increases in premiums. Let them carry a $4000 – $8000 deductible for each member of their family. Let the Congressman and Senators families wait for a pre- approval of diagnostic tests and specialists. Instead, they are provided with a lifetime of the finest medical coverage while the citizens they represent must figure out how to manage shrinking benefits and rising costs. This simple piece of legislation would greatly improve the level of attention given to the quality of health care coverage in this country
I have been sharing these ideas with politicians for years but have never gotten any response. They are probably very busy working out at the gym.
*The New York Times, “Phone Makers Could Cut Off Drivers. So Why Don’t They?” by Matt Richtel, September 24, 2016. View the article here: http://www.nytimes.com/2016/09/25/technology/phone-makers-could-cut-off-drivers-so-why-dont-they.html?_r=0
-Michael O’Hara, P.T., OCS, CSCS
I have been a standing desk evangelist for the last six years.I have converted hundreds of seated apostates to the virtues of the standing workstation. Physical therapy patients and fitness clients testify to the resolution of pain, restoration of function and a new belief in all things movement. Indeed my time on this earth will have been well spent if I can just get more people standing during their workday.
If you have a boss that controls expenditures for office equipment, he or she should read Daniel Akst June 2, 2016 article in the Wall Street Journal, “Want To Get More Done at the Office? Just Stand Up.” The author discusses recent research from Texas A & M on the use of standing desks in the work place. The big take away is that the subjects in this fairly large and long-term study were 46% more productive than their seated workmates.
REAL WORLD RECOVERY
Many times patients, employers, rehab nurses, athletes, coaches, and insurance companies have unrealistic expectations in regards to rehabilitation recovery times. It falls to the physical therapist to explain the healing and recovery “time line.” These guidelines are applicable to the patient who undergoes a rotator cuff repair, lumbar fusion, tibia plateau fracture, humeral head fracture, etc… Understanding the duration and the level of effort required to fully regain function can keep a patient focused and eliminate disappointment.
If you have systemic health issues such as rheumatoid arthritis, diabetes, etc…. your recovery will take longer. The older you are, the longer your recovery will take. That professional athlete who went back to basketball, three weeks after a knee arthroscopy—he is 24 years old and you are 48 years old. It is going to take you much longer. The weaker you are at injury onset, the longer your recovery will take. If this is a second, third, or fourth injury of the same joint—the recovery will take longer.
Consistency is king in recovery. The individual who follows the program and performs the work will recover sooner. Many patients want to order off the rehab menu—I will have this and this but none of that. In these cases, recovery will take longer and be less effective.
You will probably have to work on more than your injured / post surgical joint during your recovery. The body is an interconnected machine and weakness / limited movement in one area can create the tissue breakdown in other areas. The post ACL repair patient often needs extensive strengthening of the hip. The shoulder pain patient will have to address postural issues in the neck.
Very often you have to change your lifestyle during the recovery period. Yoga after a back surgery may be on hold for nine months. Road running after a surgical repair of your ankle can be off the program for up to a year. After a reverse total shoulder replacement, you may not be able to chop firewood for twelve months.
Progress is never linear. You have good days and bad days—this is normal. You feel and move better for three or four therapy sessions and then you have a few sessions of greater symptoms and more limited function. Do not collapse, despair, call the president–stay with the program and realize that time is on your side.
Onset – Three Months
This is the in the physical therapy clinic rehabilitation phase.
The inflammatory phase of the injury / surgery resolves.
Active and passive movement of the joint improves.
Depending on the injury / surgery, pain resolution occurs later in this phase.
A protocol of rehabilitation activity may be in effect for certain surgical procedures.
Most patients have regained 60-70% of the function at the end of three months.
People with sedentary work can return to their occupations. More strenuous occupations will require further conditioning.
Three – Six Months
You exercise three or four times a week. Ideally, you visit the physical therapist for progressions of the training program.
You can expect some level of discomfort. The post surgical shoulder will still not feel like the non surgical shoulder. The lower back will have days of stiffness. These episodes are normal and part of the recovery process.
Strength is still limited and you will have to work on corrective exercises for the next three months. Resist the temptation of an early return to your Olympic lifting, Warrior Run, or Zumba class.
Individuals with strenuous occupations undergo a work conditioning program.
Most patients have regained 85-90% of their function at the end of six months.
Six – Nine / Twelve Months
This is the point that most people stop all formal rehab exercise activity.
The more active you are and the more demanding your lifestyle the more you need to continue to train through this phase.
I personally believe this is the most important recovery phase for spinal patients. You never completely recover from a spinal injury—you actively manage the problem.
I encourage everyone to work with a trainer on your fitness program. Exercise is like medicine. Take the proper dose for your specific problem and the results are magic.
The focus of your training should be to get stronger.
Nine / Twelve Months – Death
Consistent maintenance of the machine that carries you through life can dramatically improve the quality of that existence.
The biggest predictor for a future injury is a prior injury. Stronger individuals are less likely to get injured and have to travel back through the nine month rehab process.
Michael S. O’Hara, PT, OCS, CSCS
A recent article in the New York Times by Gretchen Reynolds* covers the latest research on lower extremity function and aging.
As any physical therapist can attest, the older you are, the more likely you are to suffer a tendon injury or an overuse pain problem in the foot or ankle. Movement analysis of older runners reveals that they use the lower aspect of the leg less than younger runners. Forward propulsion and deceleration become more hip dominated activities. Based on the movement analysis data, the researchers in the article suggest older runners preferentially strengthen the muscles that control the ankle and foot.
The research validates the need to train your legs with the foot in contact with the ground. In rehab and fitness, it is called closed chain training and it produces the carryover to real life performance and durability (no injuries) you need to age gracefully and stay independent. Many older gym goers have balance deficits and mobility restrictions that draw them to strength training in a non-weight-bearing seated position. They miss activating the muscles that are crucial for walking and moving well. Step ups, lunges, and squats all involve the muscles of the foot and ankle and should be a big part of every training program. Knee extension, leg curl, and that hip in and out machine –- not much help…
To read the article, click on the link below:
-Michael O’Hara, P.T., OCS, CSCS
*“Why Runners Get Slower With Age (and How Strength Training May Help)”, Gretchen Reynolds, September 9, 2015, New York Times.