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November Is Diabetes Awareness Month

The big thing to remember about diabetes is that it is a 24 hour a day, seven day a week disease that slowly and steadily robs your body of vitality.  The good news is that diabetes (especially type 2-the most common) can be managed with proper diet, exercise, and medication.  Read the information listed below and take the time to visit the website stopdiabetes.com.

Tragic Trend
•    Nearly 26 million adults and children in the USA have diabetes.
•    Another 79 million Americans are what is called “prediabetic”.  They are at risk of developing full blown diabetes.
•    If we remain on our present trend, by the year 2050, one in three Americans will be diabetic.

Health Consequences
•    Two out of three people with diabetes die from heart disease or stroke.
•    Diabetes is the leading cause of kidney failure.
•    Diabetes is the leading cause of blindness in adults.
•    About 60-70 percent of people with diabetes will have nerve damage (diabetic neuropathy) that can cause pain, disability, and digestive problems.
•    The rate of amputation among diabetics is ten times higher than in the general population.
•    A woman’s health is more intensely impacted by diabetes.

Exercise and Diabetes
A 2006 concensus study by the American Diabetic Association gathered together the most recent research studies on the effect of exercise on type 2 -adult onset diabetes.  The latest research finds that exercise activity that increases muscle mass and facilitates coordination / motor control produced the best blood sugar levels and at the same time, enhanced mobility.

Muscles take circulating sugar out of your blood stream and store it as glycogen.  If you have more muscle, you are more efficient at managing blood sugar levels.  Exercise selection that enhances motor control creates a neurologically enriched environment that permits the diabetic person to make the most of their neural connections.  While walking on the treadmill is a nice start, if you wish to optimally manage your diabetes, you need to start some strength training that challenges your balance and coordination.

I am convinced that most people are unaware of how effective exercise is in the management of diabetes and the elimination of prediabetic symptoms.  You can dramatically improve blood sugar levels with as little as six weeks of training.  Most diabetic patients think they have to exercise for months before they see any results.  You have to convince them that the proper activities, performed three times a week, for thirty minutes can work wonders.  They complete eight weeks of consistent training and blood sugar levels get better and medications are eliminated or reduced.  All of them are surprised at how quickly they improve.  We need to get this message out.

Michael S. O’Hara, P.T., OCS, CSCS

What Women Need

Needs Are Different Than Wants

Rosei The RiveterI 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.  

Bone Health
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.

Staying Independent
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

Bone Groans

The Best Vitamin D Supplements Come In A 50 Pound Bottle With A 10 Pound Lid

bone denistyIn February 2012, the U. S. Preventative Task Force recommended against the use of Vitamin D and calcium to help prevent fractures or osteoporosis in healthy women.  The panel was unable to find any research that demonstrated greater bone mineralization or fewer fractures in individuals that used these supplements.  Despite years of recommendation to take vitamin D and calcium, they simply were unable to find any data showing calcium and vitamin D supplements can prevent bone fractures.  

In October 2013, the Lancet published an extensive analysis of 23 randomized trials that measured the effect of vitamin D supplementation on bone density at four sites–spine, neck, hip, and forearm.  Four thousand healthy participants whose average age was 59 took part in these trials.  The studies used dosages that varied form 500 units to 800 units of vitamin D a day.  Not a single study or the pooled data showed a significant increase in bone density across the measured sites.  The large number of participants, consistent testing, and wide range of treatment regimens gives this recent review considerable strength.  The authors conclude that the widely believed idea that vitamin D promotes bone mineralization is probably incorrect.  

It appears that supplementation is not a viable method of insuring bone health. What we do know is that individuals who participate in consistent bone stressing exercise are more likely to lay down greater bone mass in their younger years and stay well mineralized in their senior years.  Just like muscle, bone is a living thing that grows stronger in response to the stress that is placed upon it.  The best bone building exercise activities involve short bursts of high amplitude stress that produce “bone jarring” shock through your skeleton.  Bone building exercises are easy to understand, but they do require more effort than swallowing a few pills.  Carry a forty-pound sandbag 100 yards.  Push a loaded sled fifty yards.  Perform a few sets of box jumps–jump up and step down.  Your bones will stay well mineralized, but you will miss meeting all those nice people in the nursing home.  

Michael S. O’Hara, P.T., OCS, CSCS

The Scoop On Snow Shoveling

Preventing Driveway Disasters

snow shovelingEvery winter, in our physical therapy clinics, we treat numerous snow shoveling related lower back, neck, and hip injuries.  These patients shoveled snow one time and suffered pain so intense that it required medical attention.  All of these problems could have been avoided with some preparation, alteration of technique, and common sense.  

Athletes prepare for performance with a series of warm up activities specific to their sport.  A baseball player, soccer player, or boxer would never walk into a competition “cold” because they know the risk of injury is much higher if they do not warm up.  Despite this knowledge, almost everyone shovels snow without any type of physical preparation.  They pull on their coats, grab their shovels, and charge into an extremely challenging activity for their cardiac and skeletal system.  A snow shoveling warm up takes five minutes and can greatly reduce your chance of injury.  Try some of the exercises in the accompanying video to help you warm up for snow shoveling.  

Poor mechanics when shoveling snow is often the cause of spinal injuries.  Combining spinal flexion (forward bending) with loading (shovel full of snow) and rotation (twisting) is the ergonomic “perfect storm” for lower back pain.  When you lift a big scoop of snow and twist to throw it sideways, you create the force combination that can damage the lower lumbar discs and joints.  Push the snow, and if possible, avoid lifting and throwing.  Keep the spine long and straight and bend at the hips and knees so the legs can help perform the work.  Keep your arms wide on the handle and your neck relaxed.  Frequently switching the shovel to the other side spreads the cumulative loads evenly across the body.   The loads on the shovel should be manageable.  You are better off lifting less snow and working longer than lifting more and adding greater compression to the spine.  

Choose the right equipment.  Many snow shovels are just too heavy.  I recommend using a light plastic or aluminum shovel.  Some steel shovels can weigh well over nine pounds and this extra weight can create too much stress on your body.  Wear boots that prevent your feet from slipping.  You must be able to grip the ground to properly transfer force through the legs when shoveling.  Wear good gloves, and purchase a shovel with an end handle if you have any problems with grip strength or arthritis in the fingers or wrists.   

Finally, if the heaviest object you have lifted in the last six months has been the television remote, you should just hire someone to shovel the snow.  Shoveling snow is a demanding work activity that requires a moderate degree of fitness and good body mechanics to be performed safely.  One of the best reasons to exercise on a regular basis is that it enables you to safely perform tasks such as shoveling snow.  The vast majority of snow shoveling injuries happen to people who lead sedentary lives.  

Michael S. O’Hara, P.T., OCS, CSCS

Chair Check Up

How Functionally Fit Are You?

Image chair testCoaches, trainers, and scouts all want the number of inches in an athlete’s vertical leap test.  The athlete simply jumps up and taps a lever that indicates how many inches he or she can jump straight up off the ground.  This test has proven to be an excellent indicator of how well an athlete will perform in the competitive arena.  NBA players hit impressive vertical leap numbers, so we understand how simple it must be for them to elevate over the rim.  The equivalent test for the 60-year plus population is the Chair Stand Test (CST).  The score you get on the CST is a very reliable indicator of how well you will perform in the game of life.  

Leg power, strength, and lower extremity functional mobility are measured with the CST.  The ability to repeatedly move through the sit to stand transfer without the assist of the arms pushing down on the legs or the armrests of the chair is an important skill everyone needs to maintain an independent lifestyle.  An improved CST score creates carry over to other functional skills. Patients who improve their CST scores develop better gait patterns and standing balance.  

Chair Stand Test: You need a stopwatch, a stable chair with a 17 inch high seat, and an evaluator to monitor your performance and start and stop the timer
1.    Sit in the middle of the chair.
2.    Place your hands on the opposite shoulder with the arms crossed over the chest.
3.    Keep your feet flat on the floor.  
4.    Keep your back straight and your arms against your chest.  
5.    On the order “GO”, rise up to full standing and then sit back down.  
6.    Repeat for as many repetitions as you can in thirty seconds.  
7.    If you are halfway to a standing position when time expires, count that as a repetition.  
8.    Record your results and be concerned if you score below average.

The age adjusted scores for the CST listed below are a composite of the data gathered from several research studies since 2001.  The CST has proven to be a reliable assess-ment of fitness in older adults for over a decade.  Individuals who score below average on this test are more likely to suffer falls and require assisted care in their advancing years.  For the older fitness participant, knowing your Chair Stand Test score is just as important as knowing your blood pressure numbers. 

Men’s Results
Age                    Below Average       Average       Above Average
60-64                       < 14                   14 – 19                > 19
65-69                       < 12                   12 – 18                > 18
70-74                       < 12                   12 – 17                 > 17
75-79                       < 11                    11 –17                  > 17
80-84                       < 10                  10 – 15                 > 15
85-89                       < 8                     8 – 14                  > 14
90-94                       < 7                     7 – 12                  > 12

Women’s Results
Age                    Below Average       Average       Above Average
60-64                       < 12                   12 – 17                > 17
65-69                       < 11                   11 – 16                 > 16
70-74                       < 10                   10 – 15                > 15
75-79                       < 10                   10 –15                 > 15
80-84                       < 9                      9 – 14                > 14
85-89                       < 8                      8 – 13                 > 13
90-94                       < 4                      4 – 11                 > 11

Michael S. O’Hara, P.T., OCS, CSCS

Stand Up, Walk Around, And Read This Article

I have been ranting about how damaging hours and hours of sitting is for our fitness and overall health.  More research is validating my belief that all the driving, computer time, and television watching is going to keep physical therapists, cardiologists, and surgeons working overtime for the next twenty years.  It appears that going to the gym three times a week is not enough of a stimulus to counteract the bad that happens when you sit for eight hours a day.  What we need is more general physical activity interspersed throughout our day and less sitting.  Take the time to read this article, The Marathon Runner as Couch Potato written by Gretchen Reynolds from the New York Times, October 30, 2013.

Link to article: http://well.blogs.nytimes.com/2013/10/30/the-marathon-runner-as-couch-potato/?_r=0

Michael S. O’Hara, P.T., OCS, CSCS

The Lunge Matrix

Three Dimensional Leg Training

Twenty-five years ago, I participated in a three day “functional movement” seminar given by physical therapist, Gary Gray.  Gary got the entire class involved in a morning exercise class he called Pump and Praise.   One of the activities he taught was the lunge matrix.  I was 30 years old and had been exercising fairly regularly, yet I found the lunge matrix much more challenging than expected.  Since that time, I have used the lunge matrix with physical therapy patients, fitness clients, and in nearly every session of my own training.  Almost everyone can benefit from a little lunge matrix training.

The muscles in our trunk and hips are inter-twined, aligned in a spiral and diagonal fashion.  They are neurologically connected and work as a team to drive movement in three dimensional patterns.  The lunge matrix neurologically activates all of the muscles in all of the possible movement patterns.

The lunge matrix is ideal for anyone involved in a multi-directional sport.  Tennis, volleyball, basketball, soccer, and football require efficient transition in all directions. Injury prevention is the most important aspect of any athletic training program.  Your gym program should make you more bullet proof on the field of play.

The lunge matrix can be used as a movement preparation activity with just bodyweight (my favorite) or as a stand-alone strengthening exercise.  When performed as a strengthening exercise, use functional level loads, dumbbells, or medicine balls that equal the weight of the bag of groceries or the grandchild you are going to lift.  The loads should not alter the quality of movement or shorten the range of your lunges.  Choose shoes with flatter soles as some of the more cushioned running shoes can make lateral and rotational movement patterns difficult.

Lunge Matrix Series
1. Anterior lunge R / L
2. Lateral lunge R / L
3. Rotational lunge R / L
4. Posterior lunge R / L

Watch the attached video, and then give the lunge matrix a try.

Michael S. O’Hara, P.T. OCS, CSCS

Throw Old Gracefully

Powering Up The Older Athlete

Exercise is like medicine—administer the correct prescription at the proper dose and the patient thrives.  Different patients require dramatically different medications.  The “exercise medicine” for older adults is a consistent dose of power training.

Fitness Age Changes
Between the ages of 65 and 89, explosive lower limb power production declines at a rate of 3.5% per year.  Strength, on the other hand, declines at a slower 1-2% per year rate in this same group.  Power is the ability to create force in a short period of time and is different than raw strength.  Power is the component of fitness that makes you able to react to a fall or sudden disturbance in balance.  As power recedes, falls and injuries increase.  As falls and injuries increase,  mobility and independent living decrease.

Speed Specific
The implication for older athletes that want to prevent falls and remain independent is that training is speed specific.  You must find exercise activities that make you move at faster tempos.  Seated or supine, slow-paced activities may be beneficial in other ways (strength, cardiac endurance), but they will not improve muscle contractile speeds.

Medicine Ball Wall Throws  
Adding a velocity component to your training is not complicated.  Nearly everyone can throw a medicine ball at a wall.  Throws will improve your balance, proprioception (positional awareness), core stability, power production, and overall coordination.  Watch the accompanying video of some of our favorite wall throws.  Choose a medicine ball of appropriate weight—most people go too heavy—and add three or four sets of throws to your gym program.

Michael S. O’Hara, P.T., OCS, CSCS

 

The Best Training Partner For Endurance Athletes

A Stronger Immune System With Probiotics

A study published in the International Journal of Sport Nutrition and Exercise Metabolism* found that athletes who took a probiotic supplement during the winter had fewer colds and other upper respiratory tract infections.

LactobacillusThe study included 84 athletes that trained an average of ten hours per week in endurance sports such as running, cycling, or swimming.  They were divided into two groups: a probiotic group and a placebo group.  Over the course of sixteen weeks, the frequency of upper respiratory tract infection (URTI) was measured, as well as markers of immune function in the blood and saliva.

Research Findings
People in the probiotic group had far fewer cases of URTI (66%) than the placebo group (90%).

When they did get an URTI, the probiotic group reported fewer days with symptoms and spent less time on medications for the symptoms.

People taking probiotics who did get sick were less likely to have their training schedule interrupted by the URTI.

The probiotic group had higher levels of infection- fighting antibodies in their saliva.

The probiotic bacteria that was used in this study was lactobacillus casei Shirota.  There are 125 known lactobacilli species and many of them have been studied for their positive effects on health.  How can you get and keep more of these helpful training partners in your gut?

Eat foods that are cultured or fermented with lactobacilli.  These include yogurt, beer, wine (yeah!), cider, sourdough bread, and some sauerkraut (bleah!) and kimchi.  Eat foods that lactobacilli thrive on–the fibers in fruits and vegetables.  Lactobacilli are especially vulnerable to antibiotics, so take them only when necessary.  If you are going to supplement with probiotics, choose a quality product.  Keeping bacteria alive in a store and on its pathway to your gut involves some special handling.

*International Journal of Sport Nutrition and Exercise Metabolism 2011, 21:55-64

B. O’Hara RPh

Stripe Hype

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?
Serena Williams with Kinesio TapeA 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

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