Biomechanics Aren’t As Important As You Think

With so many variables to consider, how can anyone claim to really know what’s supposed to happen when any given individual moves?

These days it seems like everyone’s a biomechanics expert. From gym teachers to physical therapists, to personal trainers, and even fringe clinicians like chiropractors and massage therapists think they have the end all be all answer to the way we should move. With so many experts around, I had to ask myself “is anyone right?” Don’t get me wrong, I’ve spent years studying movement, so I am in no way saying there isn’t something to proper movement. But, with so many variables to consider, how can anyone claim to really know what’s supposed to happen when any given individual moves? A quick breakdown of variables to consider would include 3 independent planes of motion (never used in isolation), 46 miles of nerves, 206 bones, 100-300 major muscles (out of 700), 360 joints, and seeming endless ways of combining them to move. I would need help from a statistician just to figure out how many ways there are to move, so how can anyone really know how to move perfectly?!?! Well, one thing is for sure, we can only guess and learn from the best.
 
Biomechanical Boogymen
All too often I have people tell me that they can’t do things because their chiropractor found something on their X-ray, their trainer said it was bad for their joints, or their massage therapist said it was giving them trigger points. When I dig a little deeper, I general find that there is nothing to substantiate the claims. Why? Because I know that some practitioners use fancy terminology to sell their services knowing that less educated folks are somewhat more likely to swallow fancy-sounding bull**** (1). And because being asymmetrical and/or abnormal is normal! Neck pain is not greatly associated with neck posture (2). Sagittal (front to back) spinal curve does not relate to spinal health or back pain (3). It is highly likely that we all have disc degeneration, a bulging disk, and/or protruding disk in our back right now, and that’s normal (4). It’s not an unequal leg length that’s causing your back pain (5). Even the best athletes in the world have asymmetrical muscle size and movement patterns, and they don’t have issues caused by them (6,7). To sum it all up, movement systems seem to have reserve capacity to allow for asymmetry and imperfections to exist without failure or symptoms (8). You’re not made out of glass and tissue paper, and pain is complicated!
 
The Catch
Inline image 1
No, you do not have free reign to ignore your exercise technique and/or posture. This is because we know there are ways to avoid hurting yourself! For instance, we know that runners with weak hamstrings are more likely to be injured (9). We know that rounding your back during a deadlift is bad. But, a lot of other technique coaching tips are sort of just semantics for the deadlift. My point is, there are things that we can do to control the likelihood of injury, but seeking perfection is fruitless because it doesn’t exist. Personally, I believe that being in tune with your body is one of the best things you can to do know what’s causing you pain or discomfort. By this, I mean you should have a general sense of what your body is doing. Have proper motor planning by figuring out the actual steps involved in a movement (i.e. map out all the steps from point A to point B). Learn to have motor control by practicing perfect technique in a mirror. Gain proprioception by having a sense of knowing where your body is in space. Enhance this skill by selectively contracting individual muscles, and balancing on one leg with your eyes closed. If you don’t know whether you’re moving well, how can you tell when you’re not? Was it really that deadlift that bothered your back, or was it from sitting in hunched-over position?
What’s most important when considering all of this, is getting strong. You can’t alter biomechanics without getting strong. It takes over 1,000 lbs. of force to deform fascia by even 1% (10). So foam rolling and massage won’t change your biomechanics. Having your back cracked or hips adjusted back into place may feel good, but it’s temporary and normal for things to go back to the way they were. That is unless you get stronger overall. It’s funny how things work out when you keep the body moving. Even if you don’t have textbook technique.
References
1. Weisberg, D. S., Keil, F. C., Goodstein, J., Rawson, E., & Gray, J. R. (2008). The seductive allure of neuroscience explanations. Journal of Cognitive Neuroscience, 20(3), 470-477. doi:10.1162/jocn.2008.20040
2. Grob, D., Frauenfelder, H., & Mannion, A. F. (2007). The association between cervical spine curvature and neck pain. European Spine Journal, 16(5), 669-678. doi:10.1007/s00586-006-0254-1
3. Christensen, S. T., & Hartvigsen, J. (2008). Spinal curves and health: A systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. Journal of Manipulative and Physiological Therapeutics, 31(9), 690-714. doi:10.1016/j.jmpt.2008.10.004
4. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., . . . Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American Journal of Neuroradiology, 36(4), 811-816. doi:10.3174/ajnr.A4173
5. Grundy, P. F., & Roberts, C. J. (1984). Does unequal leg length cause back pain? A case-control study. Lancet (London, England), 2(8397), 256.
6. Hides, J., Fan, T., Stanton, W., Stanton, P., McMahon, K., & Wilson, S. (2010). Psoas and quadratus lumborum muscle asymmetry among elite australian football league players. British Journal of Sports Medicine, 44(8), 563-567. doi:10.1136/bjsm.2008.048751
7. Hespanhol Junior LC, De Carvalho AC, Costa LO, Lopes AD. Lower limb alignment characteristics are not associated with running injuries in runners: Prospective cohort study. Eur J Sport Sci. 2016 Jun:1–8. PubMed #27312709.
8. Lederman, E. (2011). The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain. Journal of Bodywork & Movement Therapies, 15(2), 131-138. doi:10.1016/j.jbmt.2011.01.011
9. Devan, M. R., Pescatello, L. S., Faghri, P., & Anderson, J. (2004). A prospective study of overuse knee injuries among female athletes with muscle imbalances and structural abnormalities. Journal of Athletic Training, 39(3), 263-267.
10. Chaudhry, H., Schleip, R., Ji, Z., Bukiet, B., Maney, M., & Findley, T. (2008). Three-dimensional mathematical model for deformation of human fasciae in manual therapy. The Journal of the American Osteopathic Association, 108(8), 379.

Deciding to be Happy

How making day to day decisions can impact your overall happiness.

Today’s post discusses how making day to day decisions can impact your overall happiness. I often find myself caught up in the moment and making regrettable decisions. Whether it’s skipping a work out, eating the wrong food, or even having one too many beers, I usually end up frustrated with my decisions within 24 hours. I’ve recently been trying to take a step back in such moments to analyze the situation. In doing so I’ve felt better mentally and physically, been more productive, and drastically decreased stress. This article discusses some fantastic ways to exhibit self control on a day to day basis while not losing your mind. One tip in particular that has contributed to my recent success is waiting 10 minutes before giving in to a temptation. Not only does this give me time to reanalyze the situation, but typically my weakness becomes nothing more than a fleeting moment. Read the entire article for more great tips to keep yourself on the right track!

Do This Super Super Set!!!!

The dynamic duo of fitness dominance, the walking lunge and renegade row!

Today’s topic is exercise! For those of you who don’t know what a super set is, I recommend you read my prior post discussing them in detail, as well as this blog post on the basics of training for beginners. The TL;DR version can be described as exercises targeting unrelated muscles done back to back. And today’s super set is one of my favorites… The walking lunge and renegade row! So let’s dive into the details of this dynamic duo of fitness dominance!

Deconstructing The Walking Lunge

TWD giphy.gif

If you have ever seen me at the gym shuffling around and looking like I’m straight out of an episode of The Walking Dead, it’s probably because I just finished doing some walking lunges. That’s because the walking lunge uses loads of muscles including the gluteus maximus, iliopsoas, quadriceps (vastus lateralis, vastus intermedius, vastus medialis, rectus femoris), hamstrings (semimembranosus, semitendinosus, biceps femoris), calf (soleus and gastrocnemius), and all the muscles of the trunk (1).

When done properly, the lunge is an excellent exercise to increase the strength of the leg and reduce the likelihood of injury for runners, field sports athletes, and those who actually do “leg day” from time to time (1,2). But, it needs to be done properly. So let’s go over how to do it right. Then, let’s go over how most people lunge.

The Correct Form

Inline image 4

Begin By – Feet are between hip- and shoulder-width apart and pointing forward. Torso should remain erect. Keep chest out and up. Shoulders are back. Keep head and neck straight with eyes looking straight ahead. Before stepping forward, breathe in and hold it.

The Descent – Take an elongated step straight forward with one leg (lead leg). Keep your arms straight, with the dumbbells held firmly at your side and your torso in an erect position, as the lead foot goes forward and comes in contact with the floor. The rear leg (trail leg) remains constant in the starting position, but as the lead leg moves forward, balance should shift to the ball of the foot of the trail leg as the trail leg begins to flex. Place the lead foot flat on the floor with the foot pointing straight forward. Once balance is established on both feet, flex the lead knee to enable the trail leg to bend towards the floor. The trail leg should flex to a degree slightly less than the lead leg. The lowest finish position of the descent should occur when the knee of the trail leg is 1–2 in. from the floor, the lead leg is flexed to 90°, and the knee is directly above or slightly in front of the ankle. Continue to hold your breath throughout the descent.

Rise Up – While maintaining an erect torso, shift the balance forward to the lead foot and forcefully push off the floor with the lead foot. As the lead foot returns to the starting position, balance should shift to the trail foot, resulting in the trail foot regaining full contact with the floor. The lead foot should be lifted back to its original starting position, with

feet between hip- and shoulder-width apart and pointing forward. Avoid touching the lead foot to the floor until it is returned to the finish position (unless balance is lost).

LD;DR video

While these instructions are very specific and technical, they are important and correct (3). Of course, lunges won’t work for everyone. But, under proper supervision, you can modify the lunge to work for you even if you have pain in your knees or hips. Now let’s take a look at what most of us struggle with!

Common Mistakes

Leaning Back – When you lean back too far, your rib cage flares and your spine hyper-extends. This is so bad for your back that it hurts the guy watching you from across the gym! Work on that core control ASAP!

Side To Side Knee Movement – When your knee caves in or flops out, it is often the telltale sign of weak glutes. And there are lots of fun ways to fix that!

Poor Balance – This ties in with the knee movement because they both can be caused by weak feet. Weak and unstable feet will cause a chain reaction of instability and dysfunction throughout your entire body. Just another reason to have strong feet!

The Renegade Row

The jig is up. The news is out. They finally found me… on the floor doing renegade rows! If you don’t know what song I’m referencing then shame on you! Okay moving on. The Renegade Row is a tremendously effective exercise that develops upper body pulling strength (back and biceps), lumbo-pelvic (abs and hip) strength and control, as well as shoulder stability, a quality that is lacking in most people. In fact, it is one of the best exercises to do for the prevention of shoulder pathologies such as impingement and rotator cuff tears (4). This is because the renegade row has all the benefits of a plank while making you feel like a beast from lifting weights. But once again, if you’re not doing it right, you will pay the price!

Technique

Start – Get into a plank position with feet shoulder-width apart, maintain neutral spinal alignment for the duration of the exercise. Each of your hands should be gripping a dumbbell directly under your shoulders.

The Up – Keeping your hips and body completely neutral by actively tucking your rib cage towards your hips, row one dumbbell up to your ribs by initiating the pull with the muscles in your mid-back, not your arms. Be sure to end your rowing motion when your elbows are around the height of your ribs.

The Get Down – Bring the dumbell back to the start and repeat with the opposite hand without rocking from side to side.

TL;DR Video

Like the lunge, this technique should be simple but is often completely butchered. Here’s what’s going wrong, and how to fix it.

Poor Hip Control – If your butt is way up in the air, down near the ground, or twisting all over the place, you’re doing it wrong. The arms are the only part of the body where the movement should be occurring. Practice being a plank for a while and consider using less weight if you struggle with these issues.

Using Momentum – If your elbow travels well past the ribs during the rowing movement, body twists, or hips collapse and/or pike, you’re swinging for the fences too much. Use less weight, so you can control your body. That’s the name of the game, control.

Poor Shoulder Stability – Shoulder instability might be due to a past injury, an unbalanced training program, or weakness in general. Get your shoulders checked out by an exercise pro if they are causing you problems.

Super Set Super Ending

So, back to my original point. These exercises make for a great freaking super set. When done correctly, they both promote dynamic control of the hips, prevent future injury of almost the entire body, and burn some major calories. They are also fantastic for posture and getting out of the bad movement habits that sitting at a computer all day long creates.

If you want strong and sculpted legs, glutes, abs, arms, and back muscles, be sure to super set walking lunges and renegade rows. Four sets of 10 reps with a low weight for each should do it at first. So get moving!

References
1. Kritz, M., Cronin, J., & Hume, P. (2009). Using the body weight forward lunge to screen an athlete’s lunge pattern. Strength and Conditioning Journal, 31(6), 15.
2. Whatman, C., Hing, W., & Hume, P. (2011). Kinematics during lower extremity functional screening tests–Are they reliable and related to jogging? Physical Therapy in Sport, 12(1), 22-29. doi:10.1016/j.ptsp.2010.10.006
3. Graham, J. F. (2007). Dumbbell forward lunge. Strength and Conditioning Journal, 29(5), 36-37. doi:10.1519/00126548-200710000-00005
4. Arlotta, M., LoVasco, G., & McLean, L. (2011). Selective recruitment of the lower fibers of the trapezius muscle. Journal of Electromyography and Kinesiology, 21(3), 403-410. doi:10.1016/j.jelekin.2010.11.006

Winter {Weight} Is Coming

Because Winter is coming, we know the holiday feasting season is coming. So today I thought it would be prudent to go over some motivational, nutritional, and exercise advice to get you through it healthy and happy!

Because Winter is comingwe know the holiday feasting season is coming. So today I thought it would be prudent to go over some motivational, nutritional, and exercise advice to get you through it healthy and happy!
Step 1 – Set yourself up for success
Failing to plan is planning to fail. Don’t go into the holidays thinking “I’ll just eat healthy and be fine.” That’s not how it works… No one ever say a plate of grandmas (insert holiday of choice her) cookies and thought “Nope! I’m eating healthy!” By planning for moments like these you will be better equipped to just eat one, or handle yourself to not eat regrettably. This means you need to learn to be OK with being “not OK.”No one is perfect. You are human. You are normal. You are not a weirdo. You are not alone. Make a plan, and no matter how ridiculous you think it is, stick to it.
Step 2 – Anticipate obstacles
This goes along with step one, but has a few key differences. Instead of planning to have one cookie to let grandma know you love her and that she’s a heck of a cook, in this phase you need to make sure you don’t fall victim to the same traps over and over again. Do you skimp too much on dinner then lose it at the dessert table? Do you eat a dozen hors d’oeuvres before the real meal even starts? Crack a beer early in the day in anticipation for football? Anticipate these obstacles and set up an alternative course of action.
Step 3 – Tighten up home court
Starting NOW you need to tighten up your healthy habits. It’s much easier to maintain a good habit than it is to create a new one. So take a look at what you do well and lock down those healthy habits ASAP. So continue on with your workout routine, and start looking into delicious and healthy travel/holiday meals.
Step 4 – Adapt and adjust
During the holidays, and throughout your fitness journey, you will experience successes and setbacks. This is called learning, and it’s the only way to make long-term progress. So if somethings not working, experiment with your exercise and nutrition to figure out why. It’s not always about the “eat less and move more” formula. In fact, it is certainly possible to gain weight in a calorie deficit! Your strategies will need to continuously adapt, but the lessons you learn will stay with you. So plan ahead, stay motivate, an keep your chin up to get the most joy and the most health out of this, an every, holiday season.

Inspiring Reasons To Exercise

Everything you need to know about exercise is that setting these benefits as goals will not help you achieve them as much as finding…

There are thousands of benefits from regular exercise, and as a sports medicine and fitness professional people ask me the same question all of the time. “I heard about this new thing that can get my body the way that I want it with only a little bit of exercise. Does it work?” Regardless of the new thing that someone is trying to sell you, or what magical powers it claims to have that can get you to lose belly fat, gain muscle mass, or keep you looking youthful, I always say the same two things. The first being “probably not, but let me do some research”, and the second being “why?” I’m not here to rant on about the fads being sold to suckers around the globe, but rather ask why people buy it. Because if all you want is to lose a little bit of fat mass, stay youthful and spritely, or even prevent disease I can guarantee you that you are going to fail!

Don’t get me wrong I’m not saying that exercise or any of the “breakthrough in science” products won’t work. As a matter of fact I have helped clients drop 40+ lbs in fat through exercise alone so they can go to the beach in style. But like a boomerang some people put the weight back on in the fall and come back to see me. What the heck does any of this have to do with you?! Good question! Let me explain to you everything you need to know about exercise.

Exercise is often viewed as the necessary evil by most of my clients, and sometimes even myself. People want quick fixes so they can stay at home and do whatever it is that they are going to do other than exercise. Exercise does not have to the bad guy. You know why my successful clients lose weight when they come to see me and don’t put it back on during the winter? It’s the same reason you see 70 year old men pumping iron 5 times a week, or the walking ladies in the mall, or even elaborate gardens at the retirement community. It’s because all of these people found an exercise, environment, or activity that they enjoy, and then stuck with it.

Exercise is an amazing thing. We all know by now that it can help prevent things like heart disease diabetes, and various other diseases. But being fit for life can provide so many more benefits. It can help you decrease stress and enjoy your time on earth more, it makes you smarter and help brain functions, and it can keep you looking young while living longer. It’s the freaking fountain of youth people!! But everything you need to know about exercise is that setting these benefits as goals will not help you achieve them as much as finding the person, place, or thing that makes you look forward to exercising daily.

References

  1. Deep Down, Exercise Helps Keep You Young. (2010). Tufts University Health & Nutrition Letter, 28(2), 4-5.
  2. Heir, T., Erikssen, J., & Sandvik, L. (2013). Life style and longevity among initially healthy middle-aged men: prospective cohort study. BMC Public Health, 13(1), 1-5. doi:10.1186/1471-2458-13-831
  3. Opdenacker, J., Delecluse, C., & Boen, F. (2011). A 2-Year Follow-Up of a Lifestyle Physical Activity Versus a Structured Exercise Intervention in Older Adults. Journal Of The American Geriatrics Society, 59(9), 1602-1611. doi:10.1111/j.1532-5415.2011.03551.x

4. Piazza, J., Charles, S., Sliwinski, M., Mogle, J., & Almeida, D. (2013). Affective reactivity to daily stressors and long-term risk of reporting a chronic physical health condition. Annals Of Behavioral Medicine: A Publication Of The Society Of Behavioral Medicine, 45(1), 110-120. doi:10.1007/s12160-012-9423-0

What’s Trending?

Like fashion, fitness trends seem to be cyclical. Every 5-10 years an old trend gets re-branded as something new and exciting (e.g. was Adkins now it’s Paleo).

After a brief break, I am back with a new post! This week we are taking a look at some health and fitness trends, and what you need to know about them. Like fashion, fitness trends seem to be cyclical. Every 5-10 years an old trend gets re-branded as something new and exciting (e.g. was Adkins now it’s Paleo). So let’s dive into the “new” trends and take a look at what they have to offer!
The Way You Move
The term “functional training” can mean a lot of things. Are you training to become better at a technical skill like a golf swing? Then sure! That’s functional training. But outside of getting better at a task, the resurgence of functional training has me shaking my head. You’ve probably seen the proponents of various “movement system” training at the gym or Youtube. Crazy folks standing on a wobble board to do squats, trying to mimic the movements of various animals, or doing all manner of contortionist circus tricks while standing on a physio ball attached to various bands, and so on. The people claiming that these exercises are necessary may use sciency-sounding words to justify what they are doing. In reality, there is no real standard to which functional training exists because we all move differently. There is no textbook form/function for specific exercises, but rather guidelines to prevent injuries while exercising. In all, there really is no justification for doing these crazy moves other than wanting to change up your routine. But if you’re trying to get strong and lose weight, well you may want to focus your efforts on practices that have been proven to improve those outcomes.
 
Expert Confusion
Holy crap I’m tired of seeing all these “experts” online. Everyone and anyone with an Instagram account and bulging biceps is apparently qualified to be a coach. This maddening concept is partly responsible for the resurfacing of the “muscle confusion” concept. Good lord it’s time to put that garbage term to bed. Adopting a periodized approach, rather than just winging it and doing something different every time you enter the gym, is a far superior way to see results. These coaches are also to blame for the social media fitness “challenges” that ask for both demanding and dangerous feats of athleticism. Fitness challenges may keep things entertaining, but it may come back to bite you.
 
Lose Weight Fast!!!!
Losing weight is easy. Just sweat a bunch, and you will lose weight. But because most people are looking to improve their body composition, it’s not weight loss that matters. That’s why the “lose weight fast” movement drives me crazy. Here are the tag lines of many “coaches” and/or companies that are essentially scamming us:
You don’t eat enough meals in the day to help your metabolism
You skip breakfast, which means you don’t “turn on” your metabolism to start the day
You don’t do intermittent fasting, which means your hormones are messed up
You eat too late at night and those calories are more likely to become fat
You eat “starchy” carbs, which are transformed into sugar
You eat white foods, such as white rice, which make you fat
You eat gluten or non-organic food sources, which pollute your body
All of these statements are laughably wrong (feel free to ask me for more info if you have questions). But millions of people waste money on products and services each year because these ludicrous statements are branded so well that they become social facts.
One Simple Trick!
It takes years of education and experience for fitness professionals to be able to properly help those they serve. So the insinuation that there is “one simple trick/plan” to help everyone is insulting and maddening. So when you hear/read some of the following statements, think “crap”:
Obesity isn’t a complex disease at all. It’s simple!
Calories don’t count; you just need to balance your hormones.
Hate exercise? There’s a wrap for that, and It Works!
Do fasted cardio to burn fat!
IIFYM bro
When it comes down to it, if you’re not eating well and regularly moving, then there really is no reason for you to even consider these trends. Try to master the basics of eating lots of fruits and vegetables and moving for at least 30 minutes every day. Because like everything else in life, achieving your fitness goals takes patience, dedication, and effort. If it’s truly meaningful to you, shortcuts are not an option.

Core Concepts

The core is the keystone to a strong body, but there is so much more to it than that.

Today we are talking the importance of the core!!! I get a lot of questions about the core and why it’s important. In general I say that it is the keystone to a strong body, but there is so much more to it than that. Today’s article was published by the prestigious National Strength and Conditioning Association and does an excellent job in describing what the core is, why it’s important, and what we can do to make it stronger.
Here are a few highlights:
1.Core stiffness is essential for injury prevention and performance enhancement.
2. Stiffening the core between the hip and shoulder joints, produces higher limb speed and force.
3.Core training to enhance stiffness is the foundation and underpinning of one of the most fundamental laws of human motion.
A great quote from the paper describes what the core actually does “proximal stiffness enhances distal mobility and athleticism.” An example of this importance involves the pelvis when walking. If you can’t sufficiently stiffen the lumbar spine with quadratus lumborum (QL), your whole body will simply bend to the side the stance phase (foot on the ground part) of the walking cycle. This is because the QL is an essential core muscle forming the outside core. “What else can core training do” you ask? Well not much I guess. Except reduce the risk of back injury, enhance performance, reduce the risk of groin injury, sportsman’s hernia, and knee injury, particularly to the anterior cruciate ligament (ACL). Essentially, noone can afford to neglect this building block of function. So work on your core to enhance stiffness by doing things like suitcase carries, farmers walks, and planks.

Tech Time

Although technology wont make you any more fit, they can provide you with a plethora of information and motivation.

Today we are talking tech! By now most people have heard of fit bit, my fitness pal, or one of the may other apps and fitness equipment that can be worn to track your level of activity. Although these utilities wont make you any more fit, they can provide you with a plethora of information and motivation.
This weeks post is inspired by Dr. Geier, an orthopedic surgeon I follow and highly recommend you do too. In an article for Reuters he, and others, talked about some of the benefits of fitness technology. Here are a few highlights:
According to the CDC, 30 minutes of moderate activity most days of the week can reduce the risk of obesity, cardiovascular disease, diabetes, and some cancers as well as help strengthen muscles and bones
In other words we are looking to walk about 10,000 steps a day
Although tech can’t necessarily help you reach that goal, it can be a great motivator and help you realize just how much (or little) you are actually moving throughout your day
When talking about smart phone apps and step counting, Apple tends to over count steps and android tends to under count steps
If you don’t have a smart phone, try investing in a $10 to $30 pedometer before you decide to buy a $100 fitness band
While these factor are important for self realization of activity, I think it is also important to harp on the nutrition side of things as well. In simple terms, when you are in a hypocaloric diet (eating less calories than you’re using in a day) following the minimal guidelines can result in fat mass loss as found by a recent study. I attached the study for those of you with an eye for scientific research, but I will say that these data are not conclusive for every individual.
The bottom line is that for most people hitting the minimum 10,000 steps per day while in a hypocaloric diet is enough to produce meaningful results over a few months. See the article for more on technology, and the research for information on diet and exercise combined (warning, it is not an easy read for all).

Feet On The Ground – Balance Training

Staying on your feet and keeping balance is crucial for staying healthy throughout your life.

Do you know what the leading cause of death is for those over 55? It’s not heart disease, cancer, or spouses. It’s actually complications due to falls! Staying on your feet and keeping balance is crucial for staying healthy throughout your life, even more so as you age. That’s why today I am going to go over some strategies to keep your feet on the ground and your butt out of the hospital!
 
The Major Issues
There are several key factors to think about when considering a balance and stability training program. Muscle weakness, especially in the lower body, and problems in the feet such as foot pain, loss of sensation, or even improper footwear (slippers without traction, high heeled shoes, etc.) are at the top of the list (1). Additionally, medications and their side affects, declines in vision, and environmental factors like clutter or unsecured throw rugs can play a roll in falls. Today, we are going to focus on the former topics. Of primary interest, the strength of the lower body is paramount. Focusing on strengthening the lower body not only builds up the ability to resist gravity, but it also enhances our ability to know where our body’s at in space (proprioception).
 
The Exercises
No matter what your age or skill level is, there are exercises you should be doing to enhance your natural abilities. Today, I will be breaking things down into a beginner and advanced category.
Beginner
These exercise can be done by just about anyone. You can choose to do them standing, with assistance, or even seated if needed.
Hip extensions (back leg raise) – This exercise builds strength in the hamstring and hip. Perform this by slowly lifting one leg straight back without bending your knee or pointing your toes. Try not to lean forward. The leg you are standing on should be slightly bent.
Side Leg Raise – This glute exercise is a standby for seniors and professional athletes alike. Perform by slowly lifting one leg out to the side. Keep your back straight and your toes facing forward. The leg you are standing on should be slightly bent.
Knee Curl – This hamstring exercise is a classic. Perform by slowly bringing your heel up toward your buttocks as far as possible. Bend only from your knee, and keep your hips still. The leg you are standing on should be slightly bent.
Calf Raise – This calf exercise can be done just about anywhere and any time. Perform by slowly standing on tiptoes, as high as possible.
 
Advanced
Plank for core stabilization
Bird dog (Quadruped arm raise) for core, hip, and rotator cuff strength
Floor bridges for glute strength
Floor bridges with march for hip strength and balance
Medicine ball slams for hamstring and abdominal strength

Finally, working on activities that include some form of agility should be done. Dancing, playing with pets, or even simply doing yard work are great ways to build strength. 

Balance Training
Balance specific training is different from exercising to build strength. Like any other skill acquisition, it takes patience. However, we know that the best outcomes are when balance training is used in combination with strengthening exercises (2). You can enhance your balance by using a progression of challenges to enhance the difficulty of your exercises. Try the following progression of challenges:
Start by holding on to a sturdy chair with both hands for support.
When you are able, try holding on to the chair with only one hand.
With time, hold on with only one finger, then with no hands at all.
If you are really steady on your feet, try doing the balance exercises with your eyes closed.
Finally, when you have mastered all the previous steps, you can try standing on unstable surfaces like foam pads, BOSU ball, or even pillows
You can also work on other exercises specifically for balance. For instance, you can try simply standing on one footwalking heel to toe, and walking in a straight line. In other words, perform a sobriety test. In the end, anything you can do to challenge yourself while on your feet will help (3). The moral of the story is if you never stop moving, you won’t end up on the ground.
References
1. Centers for Disease Control and Prevention. Important facts about falls. Accessed online September 20, 2016. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
2. Penzer, F., Duchateau, J., & Baudry, S. (2015). Effects of short-term training combining strength and balance exercises on maximal strength and upright standing steadiness in elderly adults. Experimental Gerontology, 61, 38-46. doi:10.1016/j.exger.2014.11.013
3. Baudry, S., (2016). Aging Changes the Contribution of Spinal and Corticospinal Pathways to Control Balance. Exercise and Sport Sciences Reviews, Vol. 44 – Issue 3: p 104–109

Hip Pain Part 2 – Fixing The Problem

Hip new ideas on dealing with that pain in the butt.

As we found out last week, lots can go wrong within the hips. And while figuring out the problem can be difficult, finding the right solution may be a little bit more simple. For many of the issues that we have discussed the solution may ultimately be a surgical or pharmacological intervention. However, today I wanted to go over some exercise interventions that may be worth a try. So let’s dive into some hip new ideas on dealing with that pain in the butt.
The Big Three
There are three main domains that are thought to lead to hip pain including sitting, muscular imbalances, and skeletal imbalances. Sitting for long periods of time can lead to the latter two issues, but in a more direct sense, it can cause problems all on its own. Primarily, sitting causes compression within the hip joint itself and can, in a sense, squish the muscles, nerves, and blood flow. If you have ever had a “dead leg” from sitting on your wallet too long or one leg crossed over the other then you will know how troublesome sitting can be. Muscular imbalances can be described as building strength in some muscles while neglecting others resulting in an unnatural amount of strain on particular muscles. Runners, for example, often ignore the muscles used to move the body from side to side. Finally, skeletal imbalances are the uneven stature or movement patterns that many individuals have due to things like genetic bone differences, old injuries, and leg-length discrepancies.
 
What Should You Do?
Every person and every issue is unique and deserves a unique solution. This is due to the fact that pain is complicated. Pain can be caused by the various tissues (sprains and strains), by the nerves (sciatica), and other issues that aren’t understood yet (fibromyalgia, chronic low back pain). More often than not, however, movement is paramount to success. So let’s take a look at what you need to do for the specific issues discussed in last week’s post!
Femoroacetabular impingement (FAI) – FAI is unique because it is a combination of bone structure problems and hip tissue problems (1). These issues are far from uniform so the specifics of what needs to be done to fix the problem will change from person to person. However, some keys to success include hip-specific function and lower limb strengthening, core stability and postural balance exercises (2).
Inline image 1
Piriformis Syndrome, Trochanteric Bursitis/Snapping Hip – These issues are common among runner, and as you can guess, are generally thought to be caused by muscular imbalances. You can try to alleviate these problems by foam rolling the piriformis, quadriceps and IT-Band, statically stretching the piriformis, biceps femoris and hip flexors, and performing exercises such as leg slidesfloor bridgelateral tube walking and ball squats.
 
Sciatica – Because sciatica can be caused by at least 6 underlying issues, there really is no one true way to best treat it (3). For best results, skip the exercise and talk to your doctor about medication options (4).
Strains – When it comes to strains of the groin and/or hip flexor, the general recommendation is to regain full range of motion, and restore full muscle strength, endurance, and coordination. You can prevent these injuries by doing programs similar to the one seen bellow (5).
Inline image 2
Summary
One of the best ways to avoid injuries of the hips is to strengthen the hips. Because we sit on our butts all day long, we tend to lose the ability to use our glutes. This can lead to all sorts of problems in the long run. This is why I recommend you start by strengthening the glute muscles. Here is a great resource for learning how to strengthen the glutes. If you’re looking for pain relief, your best chance of seeing results quickly is to consult your doctor.
References
1. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement
Br. J. Sports. Med. 2016;50:19 1169-1176
2. Wall, P., Dickenson, E., Robinson, D., Hughes, I., Realpe, A., Hobson, R., Griffen, D., Foster, N. (2016). Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. Br J Sports Med, 50:1217-1223 doi:10.1136/bjsports-2016-096368
3. Verwoerd, A. J. H., Luijsterburg, P. A. J., Lin, C. W. C., Jacobs, W. C. H., Koes, B. W., & Verhagen, A. P. (2013). Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica. European Journal of Pain (London, England), 17(8), 1126.
4. Lewis, R. A., Williams, N. H., Sutton, A. J., Burton, K., Din, N. U., Matar, H. E., . . . Wilkinson, C. (2015). Comparative clinical effectiveness of management strategies for sciatica: Systematic review and network meta-analyses. The Spine Journal : Official Journal of the North American Spine Society, 15(6), 1461-1477. doi:10.1016/j.spinee.2013.08.049
5. Tyler, T. F., Silvers, H. J., Gerhardt, M. B., & Nicholas, S. J. (2010). Groin injuries in sports medicine. Sports Health: A Multidisciplinary Approach, 2(3), 231-236. doi:10.1177/1941738110366820