Sunday, January 6, 2013

Thursday, June 21, 2012

New link in local newspaper:

Friday, April 20, 2012

An online webinar, discussing Exercise Prescription
Recent Feature in the AARP!

Discussing the "Kinemedics" approach to treating tennis elbow

Sunday, June 27, 2010

P90X, Muscle Confusion, Playing with Kids

Lots of people ask me about P90X

There's lot to like about it.  The main benefits, as I see it are:
1. It commits you to exercising frequently
2. It varies the workout so that you create "muscle confusion," so that your muscles do not know what to expect

There is another great way to get both of these health benefits- playing with kids.  I thought about this while playing catcher for one of my nephews.  From a workout perspective, it was great- it forced me to perform what was probably several hundred squats.  I would never have done this of my own volition, but it made my nephew happy, so it made me happy.

It was a great workout, but even more importantly, it helped connect me to a very important part of my community, namely my family.

I think this is very valuable to keep in mind if you are a parent and trying to figure out how to be a good parent and devote time to your kids while staying active yourself- be active together.  It's win, win for everybody.

It also helps create a better world.  It creates a world where your kids admire your activity, public use spaces are given priority, joyfulness is connected to activity.  That's the kind of world that has downstream benefits.

Which world would you rather live in?

This blog is starting to evolve into something.  I wasn't sure where it was going when I first started writing it, but there is an underlying theme, which is ....

Creating the world that you want to live in.

When it comes to health, fitness, and wellness, we are all confronted with challenges and barriers, and have to make decisions.  Sometimes very hard decisions.

When it  comes to making hard decisions with Choice A and Choice B, I think it is helpful to think "if I am successful with either choice, which world would I rather live in- the world created by Choice A, or the world created Choice B."

I think when we make decisions with this type of global perspective, it leads to making better choices.

Sometimes these choices are relatively simple.  An example- shopping at the supermarket.  You may have a choice between buying high quality fresh ingredients to make a dinner that you know will be healthy, or buy something pre-prepared that will be more convenient.  Which will you choose?

I think the choice to eat healthy will usually be a better choice.  You may be saving yourself for time with buying the pre-prepared option, but you are also buying into a lifestyle decision- that your life is too hectic to prioritize your own health, enjoy the creation of your own meal, and for what?  What is so important that you don't have time?  Even if it's as simple as buying some fresh fruit or vegetables to prepare, that is an investment in your own health.

That's a relatively easy decision.  Some decisions are much harder.  I have a patient who inspires me every time I see him.  He was, for many years, part of the system (privacy prevents me from discussing details particular to his case).  But on one of our visits, we discussed what type of role model he wanted to be for his children, and he took that message to heart, and turned his life around.  He's not perfect, but he made the conscious, and very difficult decision, to start living the kind of life that he wanted to live in, and wanted his children to live in.

That's what being a hero is all about.

Sunday, June 20, 2010

Under Recovery

My colleague Brian White, a PM&R physician based out of Cooperstown, NY, has an expression that I really like- "There is no such thing as over-training.  It's under-recovery."

Probably the most common sports injuries I see are what I call chronic overuse injuries.  Whether it is patellofemoral syndrome, tibial stress fractures, tennis elbow- all of these are examples of not allowing the body to sufficient time and creating an optimal environment for recovery.

The body needs a few things to recover properly:
1. Rest
2. Nutrients
3. An optimized endocrine environment

Taking these 1 at a time:
1. Rest
These refers to both sleep and muscle recovery.  It's important for athletes to get enough sleep to recover.   There are indicators that let you know you are not getting enough sleep.  One is that you should feel refreshed when you wake up.  The second is that if you wake up with an elevated heart rate, your body is telling you need more time to recover.

Another form of rest is cross-training.  For example, many age-group triathletes need more time to recover between workouts than they did when they are younger.  A good indicator that you are not allowing for optimal recovery is that you feel muscular fatigue at the beginning of your workout.

2. Nutrients
The body needs building blocks to recover.  For muscle in particular, the most important resources are amino acids, which are the building blocks for recovery.

Not all proteins are created equal.  Some are more bioavailable than others.  This will be a separate post in the future, but the general hierarchy is that essential amino acids are better than whey protein, and whey protein is better than soy protein.  The commercial products I generally recommend are Benevia Strength & Energy (, or the Whey Protein formulations available at Sam's Club and Costco (which are high quality and affordable).

3. Endocrine Environment
A growing body of research shows that in order for your body to recover appropriately, you needs hormonal signals to let it know that it is safe to recover.

When the body is breaking down, this is called catabolism.  During times of stress or overwork, the body will break itself down to make sure that building blocks are available in the bloodstream.  When the body is building itself back up, it's called anabolism.

There are 3 common endocrine syndromes I see that inhibit recovery- one in women, another in men, and a third in both sexes.

The endocrine issue that affects women is called the female athlete triad.  Technically, the female athlete triad refers to fractures, absent periods, and an eating disorder, but the way I view it clinically is that the female athlete is not taking in sufficient nutrient content for her caloric expenditure.  Women's bodies are very well calibrated, and the body will not allow itself to have a period unless there are sufficient nutrients to support both the female athlete and a potential baby.  So if you are a female athlete and do not have a regular period, you should have this evaluated by a health professional familiar with the female athlete triad.

The endocrine issue that affects men is hypogonadism.  This under-recognized disorder is when a man's body reduces it's natural production of testosterone because it is under stress.  If you find that you have decreased energy, loss of muscle bulk, difficulty with recovery, it's possible that your testosterone level has dropped in response to the repeated stresses of exercise.  This is especially true if you have a decreased libido, which is more common in hypogonadism than in similar appearing conditions like hypothyroidism and depression.

The final endocrine issue, which can affect both women and men, is Vitamin D deficiency.  The body can get Vitamin D through both diet and sun exposure.  Vitamin D deficiency may be especially common in areas that have lots of cloud cover, including my home town of Pittsburgh.  Therefore, in patients who are not recovering as well as anticipated, Vitamin D deficiency is one of the first things I check for. 

Friday, June 18, 2010

Practicing your new normal

Cal Ripken (at least I think it was Cal) "Practice doesn't make perfect. Perfect practice makes perfect."

Whoever it was, I think this statement is important. Any time you do a behavior, you reinforce that behavioral pattern, and with time, that becomes your "new normal."

We can use this to our advantage. In Brian Wansink's brilliant book "Mindless Eating," he shows how most people eat according to scripts, rather than because they are hungry. They eat because that's what they do when they come home from work, or that's what they do when they are stressed, or that's what they do when watching a football game, etc. Those scripts are what is normal for you. But you can create a "new normal." Instead of eating something when you come home from work, you can play catch with your son as soon as you come home. Instead of eating when you are stressed, you can make a point of calling your mom and letting her know she is important to you. You can replace a maladaptive habit with a healthier habit- you can create a new normal.

I once heard an interview with Tom Arnold where he made a similar point. He was a co-star in "True Lies" with Arnold Schwarzenegger, and Tom asked Arnold for advice on how to look buff for the movie. Arnold advised him to just practice walking with his stomach sucked in, and over time his posture and abdominal tone would improve. And it worked. It's a great pearl that can help prove abdominal tone, and is an example of "practicing your new normal."

This applies in other aspect of life. I've often heard the advice that you should not dress for the job you have, but the job you want to have. While I don't follow this pearl myself (I wear both polo shirts and sportcoat and tie at work, but I wear polos more often), but the idea makes sense- the best way to earn a job is start acting the part to confirm you are ready.

The main point I want to make, though, is in regards to posture. Whenever you sit or stand, whether you think of it not, you are "practicing" your posture. This is especially true with older individuals. Many older adults walk with a slumped posture, and are practicing bending at their waist, curving their shoulders, and sticking out their neck. This is reversible, however. There are some very good exercises that can, with practice, improve your posture, which can help your appearance, improve neck and back pain, and make you feel more vibrant and energetic.

It feels odd at first, but it's all about practicing your "new normal."

Why do certain exercises work?

There are many different philosophies for exercise, particularly for low back pain.  When assessing these programs, there are two separate questions- do they work, and why do they work?

As an example, there is an older form of exercise for the low back called Williams Flexion Exercises, that have been around since 1937.  They were developed with the idea that lumbar lordosis (the natural curve in the lower back) is unhealthy, and needs to be reversed, so he developed exercises that flex the spine to protect the back.

So do Williams Flexion exercises work?  They can.  I had a patient of mine who developed back pain, was taught Williams Flexion exercises, and did them for 36 years without having a recurrence of his low back pain.  He did eventually hurt his back again, which is why I saw him, but 36 years of prevention is pretty darn good.

So, summary action points:
1. Exercise
2. Exercises that help improve the range of motion in your hips are especially good- things like Williams flexion exercises, yoga, pilates, tai chi
3. Exercises that make you have explosive contractions of your muscles are good if you fit and healthy already (like P90X)
4. Caloric restriction is helpful for losing weight, particularly by controlling the size of your portions
5. It is often easier to restrict your portions by using a structured diet
6. If you are going to restrict your food options, try to eliminate dead calories first.  Soda and juice are good places to start, since they are essentially sugar water and empty calories.

Do Williams Flexion exercises work for the reason that was claimed?  Is it unhealthy to have a lumbar lordosis?   No, the reasoning is incorrect.   The reason Williams Flexion exercises work is because they improve hip flexibility, so that you are not asking the back to more than it was designed to do, but allowing the hips to improve their range of motion.

This is true for many diet and exercise programs.  Many diets, for example, are designed with food restrictions- just grapefruit, no carb, power fasting, etc.  These diets work, at least in part, because you are reducing your caloric intake.  An all-Twinkie diet would probably help you lose weight too, since it would restrict what else you were eating.

Similarly, there are some popular new exercise programs like P90X.  There are many benefits, but a large part of the benefit of P90X is that it structures diet and exercise.  Anything that makes someone diet and exercise is beneficial, and the specifics are probably less important.