Concussion: When Is It Safe To Play Sport Again?

What are the symptoms of a CONCUSSION? It may involve losing consciousness, changes in vision, headaches, feeling dizzy, losing memory, ringing in the ears, nausea, difficulty balancing/walking, decreased coordination.

What are the risks of returning to the game/sport too early? This puts the athlete at risk for SECOND IMPACT SYNDROME, which is when he/she gets a second head injury or concussion (prior to the resolved symptoms of the first). This syndrome involves swelling in the brain, changes in the circulation of blood to the brain, elevated pressure within the cranium, and often death.

Is it safe to play the sport if you have any concussion symptoms? No, it is never safe to practice or play sport until all concussion symptoms are absent.

What is a Grade 1 (mild) Concussion? It includes confusion but no loss of memory. The athlete does not lose consciousness. If this concussion is the athlete's:

    1st concussion: May play again once symptoms are absent for >20 minutes.

    2nd concussion: Should not return to play for the remainder of that day.

    3rd concussion: Should not play for >3 months (and then only if symptoms are absent).

What is a Grade 2 (moderate) Concussion? It includes confusion and memory loss. The athlete does not lose consciousness. If this concussion is the athlete's:

    1st concussion: May not return to play until symptoms absent for >1 week.

    2nd concussion: Recommended to stop playing for the season. Not safe to play again until symptoms absent for >1 month.

    3rd concussion: Stop playing for the rest of the season. Next season may return to play only if symptoms are absent.

What is a Grade 3 (severe) Concussion? It includes losing consciousness. If this is the athlete's:

    1st concussion: May not return to play for >1 month (but only if symptoms absent for >2 weeks).

    2nd concussion: May not play the rest of the season. Recommended to never again return to play.

If you are caring for someone with a recent concussion, what should you do?

   1. Do not leave him/her alone for at least 24 hours after the concussion.

   2. Wake him/her up every 2 hours to ensure he/she does not have unusual symptoms.

What post-concussion symptoms merit an immediate trip to the emergency room?

    1. Bloody nose/ears or watery substance coming out of nose/ears.

    2. Dilated pupils or asymmetrical pupils.

    3. Arm and/or leg weakness or difficulty coordinating arms and/or legs.

    4. Difficulty talking.

    5. Uneven/unequal facial features.

    6. Swelling on or around the scalp.

    7. Difficulty waking him/her up.

    8. Mental changes (cannot follow directions, is not alert, loses consciousness)

    9. Blurry vision.

  10. Complaining of strong headache.

  11. Vomiting.

  12. Amnesia (losing memory).

References:

1. Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation, 2nd ed. Mosby: 2003. Pages 527-530: "Return to Play after a Concussion" (Brotzman SB, Costella JD, Bohling M).

2. Roos R: Guidelines for managing concussion in sports: a persistent headache. 24(2):67, 1996. "Colorado Guidelines to Return to Contact Sports after Cerebral Concussion."

Low-Fat Eggnog on the Food Network

Low-Fat Eggnog on the Food Network

Eggplant Ricotta Bites on the Food Network

Eggplant Ricotta Bites on the Food Network

Shoulder Bursitis: How To Treat and Prevent

Bursitis in general means inflammation of the bursa, which is one of the layers of soft tissue that surrounds a joint. It can occur in almost any of your large joints. It is important to have a specific diagnosis of which bursa is inflamed.

Bursitis in the shoulder is technically diagnosed as subacromial bursitis. Shoulder pain can come from many sources, such as impingement syndrome, rotator cuff tendinitis, rotator cuff tear, frozen shoulder, muscle strain, Glenohumeral joint instability, various types of arthritis, and the list goes on. Therefore, it is not easy to develop a diagnosis unless you see an orthopedic/shoulder specialist and/or have an x-ray/MRI performed.

The first thing to know about treating bursitis (and most other inflammatory shoulder problems) is to identify and decrease the movements, positions and activities that exacerbate your symptoms. For example, you may need to stop sleeping on your right side for a few weeks-months. Or you may need to modify the position of your computer mouse. You may need to eliminate certain shoulder exercises in your workout routines. Switch your purse to the opposite shoulder or clean it out to make it lighter. Listen to your body in order to find out what aggravates your pain; then modify those things in order to function with less pain. This is called POSITIONAL AVOIDANCE.

Secondly, you may need MEDICATION. Consult your physician, who will likely prescribe an anti-inflammatory medicine. Your primary care physician will refer you as needed for imaging tests and/or specialist visits. It is important to comply with doctors' orders in order to know if the prescribed treatments are effective.

Any of your doctors (primary or specialist) may refer you for PHYSICAL THERAPY (or Occupational Therapy) if indicated.  Physical Therapy for your shoulder may include exercises, hands-on techniques, pain-relieving modalities, education, postural corrections and other interventions aimed at decreasing your pain and restoring full function of your shoulder.

ICE can also be an effective adjunct to your symptom-management routine. Put a bag of ice or frozen veggies in a T-shirt or pillowcase placed over the location of your pain. Do this for 10-15 minutes, >2x/day.

POSTURE plays a bigger role in shoulder pain that you may realize, so check this area to see how you measure up. Do you slump whenever you sit? What is your posture while working? Is there a posture you stay in for a long period of time each day that aggravates your shoulder pain? Upright posture places all your joints in proper alignment and maximizes their mobility. Try to avoid having your shoulders rounded forward. Sit or stand up tall, with your shoulders back (they should be lined up vertically with your ears).

Lastly, work to improve your BODY MECHANICS during all daily tasks. You should have an ergonomic work station. You may need to modify your computer chair, the placement of your keyboard/mouse, the amount of back support in your recliner chair, your lifting techniques, the placement of heavy objects in your home or garage, etc. The idea of body mechanics is to use your body to its advantage instead of straining your joints by doing difficult tasks incorrectly. Use large muscle groups to do harder work. Use proper lifting and reaching techniques. To prevent shoulder pain, avoid lifting heavy objects overhead. If you are carrying something heavy, hold it with both hands and keep it close to your body. Be sure your shoulders are relaxed (not shrugged up) while you are typing. Turn your thumbs up whenever you reach above shoulder height.

How To Avoid Holiday Weight Gain

With Thanksgiving this week, the season of holiday weight gain is heavy upon us. So how can you avoid gaining weight until the new year arrives? This is especially important if you have been losing weight this past year or are working hard to maintain the weight loss you have achieved.

1. Use your holiday time off to do some additional exercise. Don't just lounge before and after holiday meals but do some exercise or at least something active!
2. Limit your portions during larger holiday meals. Stick to 1 medium plateful and 1 small dessert.
3. Choose calories carefully. Be picky about which foods you really like and are willing to indulge on. Skip the others.
4. Limit your desserts. Try 1 slice of pie instead of 1 of each. Or have a small sliver of each, if you like to try the varieties.
5. Eat more vegetables and fewer carbs. And remember that veggies can taste good outside of casseroles and without bacon. They just need the right seasoning.
6. Stop eating when you are satisfied. Don't eat again until you are hungry.
7. Be sure your between-meal snacks are small and healthy. Choose the fruit or veggie tray instead of the cheese/pepperoni/crackers.
8. Drink more water and fewer calorie-filled beverages.
9. Remember that a healthy lifestyle does not have to stop during the holidays. Maintain the same healthy habits that you have been practicing.
10. Shop in stores instead of online.
11. Don't lie down if you can sit. Don't sit if you can stand. Don't stand if you can walk. Don't walk if you can run. Remember that some people are unable to do these things and they would give anything to be able to walk or run again. Don't take your mobility for granted.

IT Band Pain: How To Treat and Prevent

The IT Band (iliotibial band or ITB) is a band of muscle tissue that runs from the outside of your hip/pelvis down to the outside of your knee. It is not a very well-known muscle, so it can be easily neglected, especially by athletes. If it gets strained or injured, it usually causes pain on the outside or lateral part of the knee. This occurs most frequently among runners or athletes whose sport requires excessive running. You are at higher risk for IT band injury if you are new to running or if you are increasing your distances too quickly.

If you do any lower body flexibility exercise, which muscles do you stretch? Probably your hamstrings and calf muscles. Possibly your hip flexors, quads or various buttocks muscles. But have you ever stretched your IT band? It is not realistic to stretch every muscle group in the body daily, so first try to identify a few target areas. If you have IT band pain or have in the past, then be sure to include ITB stretching in your daily routine. The following stretch is one of the easiest ways to stretch your IT band regularly, as it requires no equipment and is done in standing.

The picture below demonstrates stretching of the right IT band. Hold the position for at least 20 seconds. Repeat 3-4 times. This should be done several times daily. You may need to stand next to a wall for arm support and to push into a deeper stretch (the wall would be on your right side for stretching your right ITB). If you are a runner or athlete, be sure to include this in your workout stretching routines. Warm up your legs for 3-5 minutes before stretching by doing some light cardio exercise. Be sure to stretch again after your workout, especially if you are recently having ITB pain.

Remember that prevention is easier than treatment! So in addition to stretching your IT bands, include sufficient warmups to your workouts, wear proper shoes, consult your physician before starting an exercise regimen, carefully progress your exercise intensity, and do not work out through an injury. If you have ITB Syndrome, you may also want to use ice, prescribed medications, massage, more ITB stretching, leg strengthening, and Physical Therapy. 

www.endurancesports.com

Healthy Game Day Menu

Here are some ideas for your next tailgating party, to replace the usual wings, pizza and other junk foods.

1. Shrimp cocktail
2. Bruschetta (diced tomatoes with olive oil and Italian spices, served on fresh bread)
3. Guacamole dip, served with wheat crackers
4. Spinach and artichoke dip, served with fresh veggies
5. Hummus, served with baked pita chips
6. Fruit salad or sliced fruit with yogurt dip
7. Turkey sliders (made with ground turkey), served on miniature wheat buns
8. Sub sandwiches (such as turkey breast, chicken breast or tuna)
9. Vegetarian quesadillas (with pinto beans, refried beans and/or sauteed vegetables)
10. Trail mix (with various nuts and dried fruits)

Physical Therapists in Columbia, SC

This is not a comprehensive list of Physical Therapy clinics, but it may help you get started. If you need Physical Therapy, it is good to know a list of therapy offices and their locations, as well as their specialty areas. Your referring doctor can also provide you with a list of nearby PTs.

Columbia Rehab (NE Cola, downtown, West Columbia, Irmo): outpatient orthopedic rehab, dry needling, TMJ

Blythewood Physical Therapy: outpatient orthopedic rehab, pediatric rehab

Total Rehab Services (Two Notch Rd near Sesquicentennial Park in NE Cola): specializes in Aquatic Physical Therapy, Pediatric Physical, Occupational and Speech Therapy

Carolina Therapy Solutions: NE Columbia: specializes in Spine Rehab

Lexington Physical Therapy (Lexington): outpatient orthopedic rehab

Drayer Physical Therapy (NE Columbia, downtown, Irmo): outpatient orthopedic rehab

Abundant Life Physical Therapy (Lake Carolina in NE Cola/Blythewood): Pediatric Physical Therapy

Carolina Physical Therapy/Sports Medicine: outpatient orthopedic rehab

Healthquest Physical Therapy (Lexington): Aquatic Physical Therapy, outpatient orthopedic rehab

Palmetto Health Richland Outpatient Pediatric Rehab (on Richland Campus, downtown): PT, OT, Speech for pediatrics

Palmetto Health Baptist Outpatient Adult Rehab (on Baptist Campus, downtown): outpatient orthopedic rehab

Sigurd Center (W. Cola): specializes in Neurological Rehab

HealthSouth Outpatient Rehab (near Palmetto Health Richland): specializes in Neurological Rehab, outpatient orthopedic rehab

Veterans Affairs Outpatient Rehab (Garner's Ferry Rd): outpatient Physical Therapy, Occupational Therapy

Please make corrections in the comments section below for changes in names, locations or specialties.

Panera Bread: A Healthy Review

One of the restaurants we frequent at the Village at Sandhills is Panera Bread for a few reasons. The first thing that draws us is the kid-friendly environment/menu since we have two young children and a third one on the way! So what do I recommend there?

1. Broccoli cheddar soup. This may not be the healthiest soup on the menu, but it is the best-tasting. It is one of the best broccoli cheese soups I have tasted anywhere. And my husband (who does not eat broccoli) loves it! He never orders a different soup for his "You Pick 2" meal.  And every time I choose something different, I always end up admitting that his soup is better. Tonight I actually ordered the new Sonoma Chicken Stew (for a taste test), but it is not nearly as good as the broccoli cheddar. That being said, if you like chicken pot pie, you will enjoy the Sonoma stew.
2. Garden vegetable with pesto soup. It is vegetarian yet has protein (with white beans), and of course is full of a wide variety of vegetables in a tomato-based broth.
3. Black bean soup or creamy tomato soup. I have not actually tried these recently, but the descriptions look good, and they are vegetarian dishes. If you really want to be extra-healthy, order your bowl of soup with a side of an apple (choices are bread, chips or apple). But to be honest, I really recommend the bread there (French baguette) unless you are on a no-carb diet.
4. Salads. There are a ton of salad options, but I never actually order salads there because many years ago, when I also was pregnant, I found a dead fly at the bottom of my salad. Usually I do not get emotionally traumatized by food, but it has been 4 years and I still have not recovered. However, the salads always look good when I see other customers enjoying them, and they are pretty big.
5. A lean-meat sandwich on whole grain bread. The turkey they serve is thick-cut and tastes more like fresh-roasted turkey than lunch meat. There are a range of healthy breads to choose from, so select something like whole wheat or rye.

Is Your Bed Causing Your Back Pain?

You have seen the ads for sleep number beds, promising that you will sleep better. But how do you know when to replace your present mattress? There is actually not one right answer, but here are some guidelines that may help to determine if your bed is causing or aggravating your back pain.

1. What is the present age/condition of your mattress set? If it is over 10 years old, likely you may need to replace it soon. If it is 2-4 years old, it is probably still in good condition. Of course this depends on the quality of the mattress, how much it has been used, and if it has been rotated/flipped regularly. If you bought it firm, does it still feel firm? Does your medium or soft mattress feel too soft?

2. What position is your spine in when you lie down on your bed? How far do you sink into the mattress? Can you get your back into its straight alignment in your sleep position of choice or is bent/twisted in one direction? A bed that is too soft makes it more difficult to sleep with a neutral back posture because the middle of your body will sink down more than your upper body and legs (especially if you lie on your side or tummy).

3. Do you sleep better on the couch, the recliner, the floor or another bed? That is a sure sign that you should find a different mattress. Traditionally, individuals with back pain prefer a firm mattress and have increased pain if they sleep too long (>7-8 hours).

4. Do you have more back pain when you first wake up than the rest of the day? There may be an easy solution, such as modifying your sleep position, changing your mattress or using additional pillows (body pillow or adding a pillow between your legs for improved spine alignment). The best way to achieve proper sleeping posture is to lie on your side with a pillow between your knees and to keep your back in a straight position (not rounded up into fetal position). Lying flat on your back is also appropriate for most individuals, as the spine is kept in a straight position (you may also put a pillow under your knees for more comfort). Sleeping on your tummy is not usually recommended.

Your sleeping posture is more important than you may realize because it places your spine in a potentially bad position for so many hours every night. So the next time you are mattress shopping, I recommend spending some nights sleeping on various types of beds, whether at hotels or friends' guest rooms. That way you don't spend the money on a mattress that you end up hating for the next 10 years.

Finally, if you have increased back pain during the night that is not present during the day and worsens every night (wakes you up), please consult your physician immediately, as this can be a sign of a more serious problem.

Asian Grilled Salmon on the Food Network

Asian Grilled Salmon on the Food Network

If you like fresh salmon fillets, this is a simple recipe with only 5 ingredients!

Physical Activity Research By CDC

 The following link shows an article by the CDC (Centers for Disease Control and Prevention) summarizing recent research about the benefits of physical activity and strength training, even among older individuals.

Physical Activity and Strength Training: CDC

Summary: Benefits of Strength Training:
1. Decrease arthritis pain
2. Improve balance
3. Decrease risk for falls
4. Increase strength of bone
5. Assist in weight loss or weight management
6. May decrease need for diabetes medication
7. Improve emotional/mental well-being

Plyometrics 101: Are Jumping Exercises Safe?

Have you ever done P90X or Cross-Fit? These workout routines involve a lot of plyometrics training, which can be safe if performed according to the following guidelines. If they are not done with caution, they can put you at high risk for injury.

WHO SHOULD DO PLYOMETRICS?
Plyometrics is most indicated for athletes. If you ever played sports in middle or high school, you likely practiced some plyometrics or jumping drills. This form of training increases your muscle power so that you can jump higher, farther and/or faster during the sports activities. So if you play or are training for a sport that involves running and jumping, you may benefit from plyometrics exercise. The purpose of plyometrics is not to increase your cardiovascular endurance; longer bouts of cardio training is required for that benefit. Similarly, plyometrics is not used to increase your muscle strength (resistance training would be required).

EXAMPLES OF LOWER BODY PLYOMETRICS:
1. Vertical jumping, either with both legs or single leg.
2. Squat jumping or lunge jumping.
3. Horizontal jumping, which may include jumping over objects.
4. Repetitive jumping/hopping in place or in multiple directions.
5. Jumping on/off boxes or steps.

HOW MUCH PLYOMETRICS IS SAFE PER TRAINING SESSION?
This depends on the intensity of the jumping. Higher intensity jumping drills should be done in smaller amounts. If you are new to plyometrics and are performing low-intensity drills, you should do no more than 80-100 jumps in each session. For intermediate levels, start with 100-120 jumps. Advanced athletes can do 120-140 jumps.

HOW OFTEN SHOULD PLYOMETRICS BE PERFORMED?
You can do plyometrics 1-3x/week; it is not safe to do so more than 3-4x/week. High-level athletes typically do plyometrics 4x/week. You should wait 2-3 days between plyometrics training sessions for sufficient and safe recovery time. Do not repeat lower body plyometrics drills on 2 consecutive days.

HOW SHOULD I WARM UP FOR PLYOMETRICS EXERCISE?
Start with some low-intensity standing cardio exercise, such as walking, marching, jogging, stairmaster, lunges or various footwork drills. Do so for 5-10 minutes, then do stretching as indicated for your sport or workout. Further warmups may be needed, depending on the intensity of plyometrics planned for that session. Plyometrics should be done toward the beginning of your workout, immediately after the warmup.

IS IT SAFE TO DO RESISTANCE TRAINING AND PLYOMETRICS ON THE SAME DAY?
If you are not experienced, avoid performing lower body strength training with jumping drills on the same day. Athletes often combine these exercises but with proper caution and guidance. Lower body plyometrics are most appropriate on a day that you do cardio exercise and/or upper body strengthening.

WHO SHOULD AVOID PLYOMETRICS?
High-intensity plyometrics are not safe for young individuals that are still growing, as it may cause the growth plates in the bones to close early. Individuals who weigh over 220 lbs. should avoid jumps from >18 inches and should perform fewer repetitions of all plyometrics. Older individuals should do plyometrics only as needed for sports and with extra caution (lower intensities, fewer repetitions). Consult your physician before beginning any plyometrics training.


Source: Baechle TR, Earle RW. Essentials of Strength Training and Conditioning, 2nd ed. 2000: Human Kinetics. Pages 428-440.

Are Salads Overrated For Weight Loss?

I have recently talked to a lot of people who are trying to lose weight, who have lost weight, and even a few non-pregnant ones who have gained weight. There are a few common factors among those who have succeeded at losing weight: exercise and consistent diet changes. Eating only salads is not on that list, but out of my own experience (25 lb. weight gain in college and 25 lb. weight loss afterward), they are not overrated, and here are a few reasons why I like them so much!

Why salads are a good component of your weight loss program:
1. They taste good (depending on your toppings).
2. There are a ton of varieties, so your tastebuds will not get bored.
3. They are full of vegetables, which are high in nutrients, water and fiber yet low in calories.
4. You can easily add protein to give a complete meal (nuts, eggs, cheese, meat, legumes, etc).
5. The salad dressing aisle is full of salad toppings for additional flavor and crunch.
6. You will always find new and tasty salad recipes on Food Network.
7. They are a perfect opportunity for olives, artichoke hearts, heart of palm, sunflower seeds, dried fruit or even cooked vegetables.

Downfalls of salads:
1. Too much salad dressing can add excessive amounts of fat and calories to your diet.
2. Not enough vegetables. Some salads have just a little lettuce and the other toppings are all high-calorie, such as crispy chicken, bacon, cheese, etc.
3. You may get hungry quickly, if it is a low-calorie salad.
4. They usually take longer to eat than a sandwich, which is difficult if you are on the run.
5. They must be eaten fresh for best results.
6. Beware of bugs. I once ate a salad and when it was almost done, I found a dead fly in it. I have even heard of people finding a moth or bigger insect among the salad leaves.
7. Iceberg lettuce is not very nutritious, compared to dark, green leafy options.

Guaranteed ways to lose weight:
1. Cut out all sodas and sugar-filled drinks. Replace with water.
2. Cut out all desserts.
3. Decrease all portion sizes.
4. Decrease or eliminate fried foods.
5. Exercise daily, including cardio and strength training (especially intervals and high-intensity training).
6. Eat breakfast early, and stop eating late at night.

The most important part of your weight loss program is to know your weak areas and take specific steps to change those bad habits. If not, you will be on a weight loss program your whole life. Your weaknesses are different from everyone else's, so find what is most effective for you. It may mean eliminating all desserts or eating a salad a day or increasing gym time or joining Jenny Craig. I have yet to see a truly motivated weight-loss candidate that has not succeeded. True motivation requires ACTION!!!

Strength Training: Free Weights Vs. Machine Weights

Benefits of Free Weights:

1. Free weights work multiple muscle groups together. This maximizes your workout time and may provide time for additional strengthening, cardio, plyometrics or flexibility exercise.

2. Free weights include weightbearing exercise, which strengthens the bones. They use your own body weight as additional resistance (for example: squats or calf raises).

3. Free weight exercises are more functional, so they carry over to real-life activities and sports.

4. Free weights can be done at home and with less equipment. This may be most cost-effective and convenient!

Benefits of Machine Weights:

1. Machine weights are easy to learn with minimal training.

2. Machine weights produce less risk for injury than free weights. However, there still is risk, especially if you are not cautious and/or do not know how to set up a specific machine.

3. Machine weights do not require a spotter.

4. Machine weights enable you to strengthen individual muscle groups (such as the quads: leg extension machine).

5. Machine weights take less time for setup and cleanup.

6. There are a variety of machines to strengthen each muscle (for example, seated hamstring curl if you are unable to lie face-down). 

Technique Pointers For Strength Training:

1. Perform both the lift and lowering part of the exercise at a moderate pace. The release back to starting point is just as important for building strength as the initial push/pull or contraction. For non-athletes, do not perform your exercise too fast. Athletes typically weight train specifically for their sport and often vary their speeds with a purpose.

2. Try to work through your full available range of motion, which strengthens the entire muscle group more effectively than partial-range movements.

3. For machine weights, be sure to adjust the angles and positions specific to your body size. Be sure the joint performing the movement is lined up where the machine's axis rotates.

4. Choose the type of strength training that you enjoy more, which will keep you motivated!

5. Be sure to do cardio training if you are trying to increase your aerobic endurance, such as for a 10K or 1/2 marathon. An additional sport-specific strengthening program may be a good form of cross-training for you.

Source: Baechle TR, Earle RW, editors. Essentials of Strength Training and Conditioning, 2nd ed. 2000: Human Kinetics. Pages 42-45.

Combine Upper/Lower Body Strength For Weight Loss

Photo: Fitness Magazine

1. Squats with biceps curls. Select a challenging weight for the bicep curls. Perform 3 sets of 10, 2 sets of 15 or 3 sets of 15. Do not let your knees pass your toes.

Photo: ACE Fitness

2. Lunges with military press. If you have the space, walk the length of the room via alternating leg lunges. If in a smaller space, lunge in place with alternating legs. Choose a challenging medicine ball or free weights for the military press. Perform 3 sets of 10-15.

Photo: WebMD

3. Wall slides (wall sits) with arm raises. As you slide down the wall to the sitting position, raise your arms from your sides up to chest level, with the elbows staying straight. Lower the arms as you slide back up the wall. Keep the thumbs pointed up throughout the arm raises and only lift arms to 90 degrees. Repeat 2-3 sets of 8-15. Do not let your knees pass your toes.

Photo: About.com

4. Ab crunches with leg bicycling. Perform straight crunches or oblique crunches (as shown) as you move your legs in a bicycling motion. Repeat 3-5 sets of 20.

5. Intervals of push-ups and sit-ups. Perform push-ups until fatigue. Then flip onto your back and perform full sit-ups until fatigue. Repeat 3-5 sets of each. If you cannot perform sit-ups, perform with abdominal crunches.

Why Combine Upper/Lower Body Strength Training?

These exercises are effective for weight loss because they increase your heart rate (cardio), incorporate multiple muscle groups, and increase muscle tone. The greater you do these 3 things in your workouts, the faster your weight loss will be! You will quickly boost your metabolism so that you burn more calories throughout the day! If you are going to exercise for 30 minutes, work as many muscle groups as possible during that time. Why spend 15 minutes of gym time strengthening 5 muscles when you can work 10 or more muscles at the same time?!!

Will My Pain Respond To Medication?

CHEMICAL PAIN:
If your pain has a chemical component, it is more likely to improve with medication. This type of pain occurs when chemicals are released in the injured body part, and it includes inflammation. One way to know if your pain is chemical is if it is CONSTANT. This means you have pain throughout every day and it never goes away, no matter what position you are in. It may increase and decrease some, but it is always present. Chemical pain is not changeable with movement.  Typically chemical pain occurs in response to a traumatic injury or repetitive stress on that tissue over an extended period of time. If you have swelling from a new injury, your pain clearly has a chemical component. This type of pain may last for a short or long time, depending on the cause. 

MECHANICAL PAIN:
The other type of pain you may have is mechanical pain. Mechanical pain improves and worsens depending on your movements and positions. If sitting down eliminates your pain, your pain is more mechanical and likely is not chemical.  You fit into the mechanical pain category if you can identify specific activities that remove your pain, such as standing up, walking around, lying down, or stretching. Similarly, you know the specific activities that initiate your pain, such as standing, walking for 5 minutes, bending down, reaching a certain way, or lifting an object. For mechanical pain, moving a joint one way makes it feel worse yet moving it the opposite way decreases the pain. With time, as you find the symptoms improving, your overall joint movement also improves. If you have mechanical pain, it is less likely to respond to chemical treatment (medicine).

PHYSICAL THERAPY VS. PAIN MEDICINE:
It is possible for constant pain to be chemical or mechanical. But if your pain is not constant, you can rule out the chemical component! In that case, find a good Physical Therapist near you! If you suspect both components of pain, you may benefit from both medicine and Physical Therapy.

A new injury will have a chemical/inflammatory component for several days-weeks but as the healing process occurs, the constant pain will decrease so that it is no longer constant. Then the pain will occur mostly with movement of that tissue. If it is stressed excessively during that time (too much exercise or movement), it may cause more inflammation. It is important to follow your healthcare provider's instructions after a new injury. If you do not know when/how to start moving the body part after an injury, you would benefit from Physical Therapy.

Remember that these are not the only components of pain. Be sure to consult your physician about your pain so he/she can assess and diagnose the problem and refer you wherever is most appropriate for treatment.


Source: McKenzie R, May S. The Human Extremities: Mechanical Diagnosis & Therapy. 2000: Spinal Publications New Zealand Ltd, pages 61-72.

Top 10 Healthy Desserts: Made With Fruit

Photo: Ralph and Jenny (Creative Commons)

1. Chocolate-covered strawberries

2. Caramel apple

3. Peaches and cream

4. Banana split

5. Berry/yogurt parfait

6. Strawberry shortcake

7. Fresh fruit w/cream cheese dip

8. Apple crisp

9. Pumpkin pie

10. Carrot cake

If you like sweets yet need to cut calories, this is a perfect combination! Some of us have the willpower to cut out desserts completely from our diet for weeks-months or more, but the rest of us need at least some healthier options to choose from.

One of the single, best ways to lose weight is to eat more fruits and vegetables, which are low in calories and high in nutrients! So why not fit in that extra serving of fruit as you feed your sweet tooth? My husband, kids and I go to the mall (Village at Sandhill) at least once a week for dinner and dessert, so we are very familiar with all the local ice cream shops (Rita's, Marble Slab, Yogenfruz), cafes (Nestle Tollhouse, Panera, Books a Million, Starbucks), and my 3-year-old's favorite: candy stores (The Peanut Man). So whenever we end up at The Peanut Man (they sell popcorn, boiled peanuts, snow cones, candy, chocolate, etc), I have quite a decision to make! Thankfully, they sell chocolate-dipped strawberries and caramel apples, which I love! They taste great and have some nutritional value! 

For those ice cream lovers out there: Marble Slab has a lot of fruit toppings to choose from and even serves frozen yogurt. Yogenfruz sells frozen yogurt that actually tastes like yogurt (not ice cream), so if you are in the mood for ice cream, it may not satisfy your craving. Rita's and Nestle Tollhouse likely do not sell anything with nutritional value, but their desserts are pretty awesome, and you can always order a kid-size serving, which should be enough to make your sweet tooth happy.

The last strategy for dessert-lovers like me is to modify your dessert recipes to add fruit. Bake a cake with applesauce instead of oil (it turns out fluffy and light). Add mandarin oranges (without the juice) to a yellow cake mix. Bake oatmeal raisin cookies instead of sugar or chocolate chip. Let fresh fruit be the star of your dessert tray; no one will turn down juicy strawberries with a dark chocolate dip!

Best Treatments For ARTHRITIS Pain

There are two forms of arthritis: osteoarthritis (OA) and rheumatoid arthritis (RA). This article focuses on osteoarthritis, which is the most frequent form.

Osteoarthritis causes pain in the joints, especially the knees, hips, shoulders and back. It can affect almost any joint in the body. It is most often associated with aging, a long-term result of joint injury, and/or it is genetic. It can also occur as a result of repetitive work tasks, a sedentary lifestyle, or unknown causes.  If you have been diagnosed with this form of arthritis, you likely have been prescribed medication. This is effective for managing many arthritis symptoms but may not be the best or only treatment for you. 

Treatment Options For Arthritis Pain:

Medications

Glucosamine Chondroitin supplements

Fish Oil supplements

Other joint supplements

Physical Therapy

Exercise (in the water may be the most tolerable)

Injections

Bracing/Wrapping/Taping

Surgery (last option, only if all other treatments have failed and pain limits daily function)

How Movement Affects Arthritis Pain:

Even if you have joint pain, it is important to keep that joint moving! If not, it will get progressively stiffer and lose the ability to move in its full range of motion. The joint likely will hurt more if it is not moved for an extended period of time. Exercise is a big part of Physical Therapy treatment of arthritis joint pain. There are some options to make exercise less painful: ice, heat, in the water, and/or with medication. It is important to exercise without worsening the problem. For example, replace jogging with walking, bicycling or swimming. Or replace basketball with yoga or upper body weight training. 

Components of Arthritis Exercise:

1. Range of motion exercise: Move the joint in its full available motion, even if it is painful.

2. Strengthening exercise: Strengthen the muscles surrounding the painful joint, for added stability.

3. Flexibility exercise: Stretch the muscles and tendons to increase their length and allow for better joint motion.

Remember that your pain may be effectively managed with 1-2 months of Physical Therapy treatment! The arthritis does not disappear, but the symptoms may improve significantly. There may be some movements, exercises, postures, or strategies that significantly reduce your joint pain and enable you to do more activities with less pain! Aquatic Therapy (water therapy) may be ideal for you, especially if exercise out of the water is too painful to tolerate. If you belong to a gym, water aerobics may be your best option. Land exercises you may prefer are the stationary bike, walking, or the elliptical machine.

Can Arthritis Be Prevented?

The best way to prevent arthritis pain at an older age is to be healthy and active starting at a young age. Avoid traumatic injuries if possible. Maintain a healthy weight throughout your lifetime. Exercise regularly, including moving all your joints in their full available motions. Practice good posture in your youth and adulthood. Wear proper and supportive shoes with all exercising. Get routine physicals and notify your physician of all minor joint pain. Start a lifelong habit of healthy eating. 

Please comment below if you have found another effective treatment!

Gym Workouts For Beginners

I highly recommend joining a gym, if you can somehow add it to your budget. It is actually not that expensive, compared to other areas of spending, such as cell phone bills and eating out. You should be able to get a membership for $20-$25 per month, which is very reasonable, considering it is an investment in your body. If you are a newcomer to the gym world, it can be very intimidating because you may not know what to do or how to do it. So here are some basics that can help you.

1. Start with CARDIO. All cardio equipment is easy to start. Find the big green button that says Start or QuickStart, and you will start to move. Some cardio machines require that you start moving or pedaling before you press start. The easiest setting is MANUAL, which allows you to increase and decrease your resistance level throughout your workout. It saves you from having to select workout specifics or input your height and weight. Slowly increase to >30 minutes of cardio at a moderate-high intensity (you may need to start at 10-15 minutes at low intensity and progress over several weeks-months). Try to do some cardio every time you are at the gym, even on your strength training days.

2. Don't be afraid of the MACHINE WEIGHTS. They may look complicated, but most of them are very simple to operate. There are instructions written on each machine that explain your seat and angle adjustments. Then you select your weight/resistance. Try different weights until you choose the appropriate amount (moderately challenging; you should be fatigued by the last few repetitions of each set). Then perform 2-3 sets of 8-15 repetitions. For example, start with 2 sets of 10. Progress to 3 sets of  10 in a few visits. Then increase to 3 sets of 15. Once you can do 30-40 repetitions at one weight, you can progress to the next level. Do not be afraid to ask the staff to show you how to use a piece of equipment. I'm not sure why, but there are usually at least 5 staff members at the front desk of my gym.

3. Choose a WORKOUT SCHEDULE. This will help to guide your daily exercise and strengthen all your muscle groups. If you are using the machine weights, each one states which muscles you are working. Do not strengthen the same muscle group on two consecutive days. It may help to divide the strength training into groups, such as arms, shoulders, chest, upper back, lower back, abdominals, legs. Then choose which days of the week you will exercise each muscle group. Try to strength train each body part at least 1-2x/week.

4. Try out some of the GROUP EXERCISE CLASSES. These are ideal for those of you who need extra instruction or are new to the gym. If the class does not make you sweat, it is likely too easy for you.

5. Lastly, borrow exercises from other people. You can get some great ideas from the exercises trainers give their clients. Or find the ab corner of the gym; you will see people doing much more than just crunches and sit-ups.

Weightlifting Safety: How Do I Avoid Injuries?

Photo by:  Official U.S. Navy Imagery

1. Do a 5-10 minute cardio warmup first. If you will be strengthening the legs, warm up on the treadmill, bike, stairclimber, elliptical machine, etc. For upper body warmups, try the arm bike, row machine or elliptical (using both arms and legs).

2. Warm up strength exercises with light weights.

3. Exercise muscles in their full range of motion and at a slow-moderate pace.

4. If performing a new exercise, start with lighter resistance and higher repetitions.

5. Do not lift through joint pain. Either decrease your resistance or select a different exercise to strengthen that muscle group.

6. Prepare appropriately for high-level or maximal lifts. Do not perform without adequate training and strictly proper technique.

7. Use ice after a challenging workout (for example: knees or shoulders).

8. Strengthen opposite muscle groups to maintain balance between front/back/sides of each body part. Use various exercises to strengthen each muscle.

9. Beware of risk for knee injury if squats are performed incorrectly. Do not let your knees go forward past your toes (imagine a vertical line coming up from your toes).

10. Beware of risk for back injury with squats and dead lifts. Do not perform unless you know proper technique.

11. Avoid using wraps and braces for stability. If you train without them, you can slowly increase your weight without needing external supports.

12. Lifting belts are not necessary for back safety if you learn the proper techniques and train without using them. However, if you have trained with a belt, do not attempt a heavy lift without it.

13. Do not neglect strengthening of the rotator cuff, back extensors, hip abductors/adductors.


Source: Baechle TR, Earle RW, editors. Essentials of Strength Training and Conditioning, 2nd ed. 2000: National Strength and Conditioning Association. Pages 48-52.

How Do I Manage Chronic Pain?

First, know your diagnosis. How can you treat a problem that has not been diagnosed? You will not know your traditional or alternative medical treatment options unless you have a specific diagnosis. Whether the condition is fibromyalgia, arthritis or cancer, there are treatment options available for you. Without a diagnosis, you will not receive adequate treatment. So pursue finding the answer for why you have chronic pain, which gives you the opportunity to accept the truth about your body. In that case, you can learn to live and thrive despite a painful diagnosis.

Second, know your body. You must identify the specific activities and movements that increase and decrease your pain and symptoms. You should be able to readily list your aggravating and relieving factors. That is helpful first for your physician, therapist or other healthcare practitioner as they develop your diagnosis and treatment plan.

Third, modify your lifestyle based on your list from #2 (aggravating and relieving factors). Here are some examples. 

a. Lie down on on your back for 10 minutes without a pillow and place ice on the painful area. This may give enough pain relief to get you through the afternoon of chores.

b. Avoid the chair that causes your back to hurt. Find another chair. Or if sitting in that chair for 1 hour causes your back to hurt, stand up and stretch every 30 minutes.

c. Sit in the back row of church so that you can stand up as frequently as needed. This may be the modification that enables you to get back to church again.

d. Do a specific exercise that decreases your pain, and repeat it every hour.

e. Consistently walk for 30 minutes per day because that keeps your pain better controlled.

f. The next time you buy a car, get one that is higher off the ground because getting in and out of a low car always aggravates your pain.

g. Cook for 15 minutes at a time if standing too long aggravates your pain.

Fourth, take medication as prescribed for a time period. If it is ineffective, follow up with your doctor to see what other medicine may be appropriate. Some medicine is most effective when taken consistently, so do not skip doses or days.

Fifth, comply with doctor's orders. This includes lifting restrictions, activity restrictions, lifestyle modifications, prescriptions and other medical treatments (such as Physical Therapy or chiropractic care). If you truly want to get better, what are you doing to make that happen? Are you doing the home exercise program from your PT?

Sixth, be sure you have exhausted your treatment options. Have you tried Physical Therapy, Aquatic Therapy, Chiropractor, Accupuncture, Massage Therapy, Exercise, Weight Loss, Medication, Natural Remedies, Vitamins/Supplements, Topical Rubs/Creams, Ice/Heat, Over-the-counter treatments, Injections, Diet changes, etc? 

Lastly, do your own research and be your own advocate. If you know the answer to #1, then find support groups, websites, books and articles on your diagnosis. Find out the best local or national specialists in your area of chronic pain.

Chronic pain is very difficult to live with, but you ARE still alive! God has blessed you with this life, so learn to best manage your pain so that you can fulfill your purpose for living!

Pregnancy, Exercise and Weight Gain

What Exercises Are Safe During Pregnancy?

The ideal form of pregnancy exercise for you depends on your exercise routines beforehand. In general, cardio is important to continue. Arm/leg strengthening is beneficial. Core strengthening, with some modifications, can remain part of your routine. Prenatal yoga/pilates are ideal forms of exercise to do at least 1-2x/week, in combination with cardio and strength training. The biggest guideline is your heart rate; keep it around or below 140 beats per minute. So if you used to do sprinting intervals, you will have to give those up, at least for these 9 months. Jogging is typically not recommended unless you jogged consistently prior and can slow down your pace appropriately now. Seated exercise of almost all types is appropriate (including leg and arm strengthening with machine weights or free weights). Lying on your side is ok, which may be a position you can do in yoga/pilates or with core strengthening instead of lying on your back or tummy. Standing exercise is good, including leg/arm strength training with free weights. Swimming is ideal, especially if you are having joint pain or discomfort. Most gym cardio equipment is appropriate during pregnancy. Walking is one of the easiest and safest forms of exercise you can do.

Exercise Guidelines based on Prior Fitness Level:

1. If you were minimally exercising prior to pregnancy, then stick to low-level choices such as walking, water aerobics or prenatal yoga/pilates.

2. If you were exercising 1-3x/week consistently prior, then continue the same type of exercise (such as stationary bike, elliptical machine, aerobics class, etc). However, be sure to modify the intensity to keep your heart rate below 140 beats per minute.

3. If you were consistently working out 4-5x/week at a moderate-high intensity prior, then you should be able to continue similar forms of exercise but with modifications. Decrease the intensity/speed in order to keep your heart rate at 140 beats per minute. Remove all plyometrics (jumping) exercise from your routines. Eliminate supine (lying on back) and prone (lying face-down) exercises.

4. If you were an exercise-aholic prior, you obviously will not let pregnancy keep you out of the gym. Let the heart rate of 140 beats per minute be your guide. As long as you are not having morning sickness or joint pain, you should be able to exercise most days per week for an hour or even more, depending on the type of exercise. For example, if you are doing a 1-hour yoga class, you should be able to do 30 minutes of cardio on the same day. Your body/baby will tell you if you are overdoing it. It is urgent to drink more water than you think you need. Do not worry too much about your weight gain; let your OB monitor it and give any needed advice in this area. Most likely, if you love to exercise, you will easily lose all your baby weight after he/she is born.

What Exercises Should Be Avoided During Pregnancy?

You should not lie flat on your back, which eliminates some upper body exercises, core exercises and yoga positions. You should not lie on your stomach, which eliminates some core exercises and yoga positions. Avoid plyometrics or jumping drills. Avoid dangerous exercises/sports that would put you at fall risk. Avoid exercise at high intensities (such as high-intensity interval training). Avoid exercise that causes back pain or joint pain. Do not exercise outside in hot weather. Avoid sit-ups and abdominal crunches. 

How Do I Maintain My Fitness Level During Pregnancy?

You will likely lose some of your cardiovascular endurance and muscle strength/power during pregnancy if you abide by the recommended guidelines because it is not safe to exercise in the pre-baby intensity and manner. However, consistent exercise 3-6x/week at a low-moderate intensity has countless benefits. It will keep you moderately fit, prepare you for childbirth, help to limit your weight gain, and prevent some prenatal medical problems. The most important thing to remember is the safety of your baby, which matters more than how much weight you put on. 25-35 lbs of weight gain is the usual recommended amount, but your doctor's orders may vary depending on your pre-pregnancy weight and other factors.

How Do I Avoid Excessive Weight Gain During Pregnancy?

First, avoid overeating! You only need ~300 extra calories per day during pregnancy. Try to make healthy food choices that are filled with nutrients for you and your baby. Next, stay active! Do not put yourself on bedrest unless your physician does. Do not become a lazy glutton simply because you are pregnant and have people willing to do whatever you ask. Try to continue working or doing your usual daily activities throughout these 9 months. Lastly, exercise regularly! Do so several times per week, as much as possible throughout your pregnancy.

SHIN SPLINTS: Can They Be Prevented?

Photo: by jpo.ct (Creative Commons)

If you are a runner and have experienced SHIN SPLINTS, you know how painful they can be and how much they can inhibit your running. The good news is that they can be prevented, and it is actually much easier than treating them once they occur.

How To Prevent Shin Splints:

1. Warm up well before running. This may include walking, stretching, and/or slow jogging.

2. Stretch your lower legs well before running. Stretch your calf muscle, soleus muscle (lower part of calf), and the front of your ankle (by pointing your toes downward/inward and downward/outward). Hold each stretch longer (30 seconds) if prior stretching routines have not been effective.

3. Avoid running on hard surfaces. Find trails, sand, grass, or a padded track to run on.

4. Be sure to wear proper shoes. Replace running shoes every 300 miles.

5. Consider using orthotics (over-the-counter or custom-made).

6. Slowly increase your training schedule, especially if you are new to running or returning after an extended time away.

7. Slowly progress to running on hills.

8. Do not run through shin splint pain!  

9. Do regular ankle Range of Motion and ankle strengthening exercises.

10. Cross train from the beginning of your jogging or running program.

Source: Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation, 2nd ed. 2003: Mosby. "Shin Splints in Runners" (Casillas MA, Jacobs M), pages 522-526.

Great-Tasting Salad from Zaxby's

Yesterday I went to Zaxby's for lunch, hoping to find something both healthy and flavorful. Typically salads can get boring if you eat them often, and some really do not taste that great (even health nuts will admit it). I saw a new "zalad" on the menu, so I ordered it even though I had no idea what was on it. Some fast food restaurants do not have good descriptions of their food on the drive-through menu, which makes it hard to make a healthy choice! But I ordered the Roadhouse Salad, hoping it would have some new and different ingredients, and I was happy with the result!

The Roadhouse Salad has your typical healthy ingredients plus a few surprises, such as black beans, corn, and some crunchy potato sticks. The Roadhouse salad dressing has a southwest flavor that is not spicy. It also has some shredded cheese, which is a must for a good-tasting salad (even though it adds a few calories). It is served with grilled chicken (you will not be asked if you want it grilled or fried), which is well-seasoned. And, of course, you get a slice of heavily-buttered Texas Toast.

It may not be the healthiest salad out there, but it will satisfy your hunger, and it has some various flavors that make it stand out from your usual Grilled Caesar Salad. Zaxby's is one fast-food chain where you can always find a decent-tasting salad. 

Protein Bars: Are They Really That Good For You?

The other day as I was leaving the gym, my 3-year-old spotted a box of free goodies on the front desk, so he ran straight to it to, somehow knowing the ingredients included chocolate. They were chocolate mint "Builder's" protein bars. Having never tasted a protein bar before, I was curious to try it and was sure to steal a bite from each of my toddlers. To my surprise, it looked and tasted like a chocolate bar. Had I eaten it without seeing the wrapper, I would have assumed it was some form of candy. Only later did I look at the ingredients and nutrition info to see if it was healthy at all.

You would assume protein bars are healthy, right? While they are packed full of protein and vitamins, I would not consider them healthy for most of us, and here is why. The biggest rules of healthy eating are to eat fresh and lean: fresh fruits and vegetables, lean meats, lean dairy, and whole grains with minimal sweets and fats. The only things from this list that fill protein bars are sweets and fats. Processed foods are full of preservatives and a ton of questionable ingredients that you have never heard of. So if you are new to eating and cooking fresh, the first step is to shop around the perimeter of the grocery store (fresh breads, fresh produce, fresh meats, fresh dairy). A strict, fresh diet would exclude all processed foods and pre-made frozen meals. So, unfortunately for chocolate-lovers, protein bars should probably not be a regular part of your diet. Instead, get your protein from lean meats, legumes, nuts and dairy. And get your vitamins and minerals from a fiber-filled, balanced diet.

There are a few groups of people that could likely benefit from regularly indulging in protein bars. These tasty  bars could be a decent meal replacement for those who are extremely busy. They provide protein, vitamins, calories and fat to hold you over until your next meal. Protein bars also may be a good addition to the diet of someone who is calorie-deficient, such as an elderly person who does not eat well. Obviously hard-core athletes could benefit from the extra protein and calories. Athletes trying to gain weight might want to add protein bars to their high-calorie diets.

In many ways, a protein bar is similar to an "Ensure" shake or a "Slim Fast" shake if it is used as a meal supplement or replacement. But if you are using meal replacements (such as a protein bar or protein shake) to lose weight, you may need to consider which weight loss program will be most effective long-term. I would argue that a healthy, balanced diet and regular exercise will more likely help you to lose weight and keep it off than eating a protein bar every day for lunch. Likely you may enjoy the taste of a protein bar as I did, but I recommend you spend your grocery money on salmon and avocados.

10 Most Effective Strategies To Boost Your Workouts!

Do you do the same exercise routine every week? Do you go to the same machines every gym session? If so, this may be why you are not seeing the dramatic results you want from your weight loss program. So here are some suggestions to increase the intensity of your next workout! Not only will these boost your metabolism but they will make your gym time much more interesting and fun.

10 Most Effective Strategies to Boost Your Workouts:

1. Increase your speed. What is your present exercise pace? If you are not sweating profusely 5-10 minutes into your workout, then you may simply be exercising too slowly. Know your body and your fitness level before you turn up the speed too high (which could risk injury). If you have never increased your pace before, simply increase it in small increments. For example, if you walk at 3 miles per hour, try 3.5 miles per hour next time. Of if you jog at 6 miles per hour, try to increase to 7 mph in the next 2 weeks. Another example is the stair climber (one of my favorites). Try to increase your steps per minute so that you are not at the same pace for more than 1-2 weeks. You may start at 60 or 70, but work up to 100 or more in the next 1-2 months. If you cannot tolerate a faster pace for the entire workout, then do some faster intervals between bouts of your normal pace.

2. Increase your intensity level. A good example is riding the stationary bike. I commonly see fellow gym-goers pedaling slowly at level 1. And after 30 minutes, they have not even broken a sweat. If you are 80 years old, and both your knees have been replaced, then you have my blessing to stay at level 1. For everyone else, steadily increase your intensity by one level at a time. You likely can tolerate a higher level than you think. When was the last time you increased your weight amount for biceps curls or overhead press? Do you always do 3 sets of 8 on your leg weights? Each of these needs to increase periodically for maximum results.

3. Add a new form of cardio. Cross training helps to strengthen various muscle groups, provides rest for stressed tissues and boosts your overall fitness. So even if you are training to run a race, you should not run every day. Do another form of exercise that builds your endurance but that has less strain on your knees or feet. Or if you usually do the elliptical machine, try the stationary bike or stair climber next time. Do not do the same form of cardio every day unless you have no other options. For example, if you do not belong to a gym but walk in the neighborhood every morning, then continue to do so as you have been. To spice up a walking program, add more hills, a faster pace or walk-jog intervals.

4. Add strength training. I hate to say it, but there are some stairmaster hogs at our gym. There are only 3 stair machines, and they are almost always full. And I often see the same people on the same machines for a full hour. If you normally do cardio for an hour and then go home, then add strength training to your workouts. Here are some options. Do your normal cardio, then do 20 minutes of strengthening. Decrease your cardio to 45 minutes, then do 15 minutes of strengthening. Do 10 minute cardio intervals with 10 minute strength intervals (alternate back and forth). Do 30-40 minutes of cardio and 30-40 minutes of strengthening. Do all strengthening with high intensity cardio intervals (1 minute fast cardio for every 5 minutes of strengthening). If you belong to a gym and don't know what strengthening to do, try the machine weights or a strength class (such as body pump). A personal trainer can really help in this area (if you can afford it). Otherwise, do your own research to find websites, books or resources to give you new and various strength exercises. Building muscle tone increases your metabolism because muscles burn calories even when you are not exercising.

5. Work toward a goal. The type of goal depends on your reason for exercising. If you joined the gym in order to lose weight, then you should have some short-term and long-term weight goals. If you exercise for the cardiovascular benefits, then your goal may be to decrease your blood pressure or cholesterol levels. If your exercise is training for a race, then set a completion time goal. Without a goal, you can easily get into a workout rut. Any goal is appropriate as long as it challenges you to get the most out of every workout minute!

6. Find a challenging exercise partner. Do you find yourself clueless as to how to exercise? You don't know which machines to use or even how to use them. The easiest person to help you is a family member or friend that exercises regularly at a location close to you. The next option is asking someone at the gym to guide you.  Most gym members are happy to help a newcomer. Of course a personal trainer is the ideal person to give you 1 on 1 attention and to really challenge you to reach and exceed your goals.

7. Join a new exercise class. If you only do Zumba or step aerobics, then try a new class sometime. You may love it even more than your present workout. Spinning class is likely one of the most challenging gym classes available. If you usually do a water aerobics class and do not have any injury, then you should progress to out-of-water classes to steadily improve your fitness level. This is especially true for young or middle-aged individuals. Join a class where the other students look fit and thin; there is likely something about their workouts that is effective! I also highly recommend body pump/body bar classes, which incorporate both cardio and strength training together.

8. Check your 1 rep max. This takes me back to high school weightlifting class with Coach Mac (Go Capitals)! To determine how much weight to lift on each strength exercise, first find out your 1 rep max. How much weight can you lift only once? If you can do it more than once, keep increasing until you know your maximum. For muscle bulking, you will do 70-80% of your 1 rep max and perform 3 sets of 10. For muscle toning, do 50-70% of your 1 rep max and perform 3-4 sets of 12-15.

9. Increase your gym time per session. If you normally exercise for 30 minutes, then increase it by 5-10 minutes or more! 30 minutes is the minimum recommended amount, but doing the minimum will likely produce less results. To achieve greater weight loss, increase your workout time! I recommend 60 minutes, 5-7x/week. Just be sure to increase it slowly. If you have not exercised in 10 years, start with 10-20 minutes. Then slowly work up to 30, then 45, then 60 minutes.

10. Increase your weekly gym sessions. Exercising 1-2x/week will not produce the benefits you seek, so increase your frequency! Depending on your schedule, see which day(s) you can add a workout. It is important to exercise daily if possible. Build it into your weekly routine so that you will not neglect it. Otherwise, it will easily fall off your to-do list. If you cannot exercise 5-6x/week, then do 4-5x/week. Every time you do, you are investing in your own body, which is the only one you have. So make it a priority because no one else can do it for you.

The Best Deli In Northeast Columbia: A Healthy Review

Crossings Deli!!!  I highly recommend this little deli located in Northeast Columbia near Providence Hospital Northeast. If you live or work in the area, try it the next time you eat out for lunch!

There are a ton of healthy options, which is what I always look for. Of course, there are various not-so-healthy sandwiches too (Crossings Special is a known favorite). For those of you looking for a tasty, nutritious meal, try the minestrone soup, full of vegetables and a variety of beans. It has an exceptional flavor, perfect thickness and stocked full of good-for-you ingredients! Or you can always find a good salad, whether traditional or Greek. Another favorite of mine is the Vegetarian Platter! I have also tried the veggie burger, which I always like more than beef. For those of you with larger appetites, try a club sandwich on wheat bread (3 slices).

Some sandwiches are served on pita bread, or you can order a side of warm pita to accompany your soup or salad. There are also great wraps! So whatever kind of deli food you like, you are sure to be pleased here. It is family-owned and open for lunch only (weekdays only as well). To avoid the lines, I usually call in my order and pick it up within 10 minutes.

What can be better for a weekday lunch than a fast, fresh meal from a local deli? It far outweighs your fast food options (Wendy's, Sonic, Bojangles).

Blood Clots While Traveling: Prevention Is Key!

Traveling puts you at increased risk for blood clots (DVT or deep venous thrombosis), which can lead to a more serious pulmonary embolism (PE). But you can help to prevent blood clots by doing some simple exercises while you drive, ride or fly to your summer vacation. These can be easily remembered because they start at the feet and slowly work up to the shoulders.

7 Traveling Exercises To Prevent Blood Clots:

First, move your ankles up and down frequently. Do at least 30-50 repetitions every hour that you are sitting. You can also move your ankles in circles both directions for variety. Be sure to exercise both legs! Another variation is to keep your feet on the floor and lift your heels (calf raises), then lower them back down. Repeat 30 times. Do the same with your toes (toe taps) for 30 repetitions.

Second, kick your legs up and down. Keep your thighs supported on the seat and extend your knees fully, then lower them back down. Repeat 30 times on both legs. You can do both sides together or alternate sides.

Third, squeeze your thighs together and hold for 5 seconds, then release. Repeat 30 times. It is helpful to place a pillow between your knees/thighs as you do this exercise.

Fourth is glut squeezes! Squeeze your buttocks together and hold for 5 seconds. Repeat 30 times. 

For the abdominals, draw in your ab muscles as if tightening a belt. Hold for 10 seconds. Repeat 10-20 times.

For the upper body, do shoulder circles (up, back, and down) for 30 reps. 

To stretch the shoulders, reach overhead fully and hold for 5 seconds. Repeat 3-5 times.

More Blood Clot Prevention Tips:

Stand up as frequently as possible. If you are driving, try to stop every 2 hours. Walk around during this much-needed break! If you are in a plane, stand and walk at least once every 1-2 hours. Tell your doctor that you will be traveling, in case he/she recommends you take medicine to prevent clots. Try to keep moving whenever you are out of the vehicle.

For more information about blood clots, see:

http://thinklikeapt.blogspot.com/2012/04/blood-clots-can-kill-who-is-at-risk.html

Zumba: Is It Worth The Wait?

I frequent the gym during the busy hours of the early evening, when it seems everyone is there. So as I ride the bike or climb the stepper (if it happens to be open), I can't help but notice the ever-growing line waiting for Zumba class. The class starts at 6 pm, but ladies start arriving at 5:30! I presume they either want to be guaranteed a front-row space or they have nothing else to do between 5:30 and 6. Obviously each Zumba class at that hour gets filled to the max, so I can understand someone wanting to arrive a few minutes early. But let's consider why you are doing Zumba to begin with: to get fit and/or lose weight in a fun way. So what better way to jumpstart your workout than to WORK OUT!!!

Imagine the calories you could burn, the muscle tone you could build and the metabolism you could boost in the half hour that you stand in Zumba line twice per week?!! Maybe I'm just a fitness nerd and care way too much about exercise, but is it not common sense to spend your time at the gym actually exercising? You drove to the gym, planned Zumba into your day, yet you stand there in the hall outside the Zumba classroom for what totals hours every month.

Don't get me wrong: I'm not saying to skip Zumba or to do any less of it. Instead, simply add a little workout into your Zumba wait. Hop on the bike or do some free weights. Jog on the treadmill! Don't waste valuable gym time standing in line for more than a few minutes. That is how you will really get fit and see the greatest weight loss possible.

To be fair, I have never actually done Zumba, but it looks like a fun-filled form of aerobic exercise. Nowadays you can find it anywhere for a good price, so I encourage you to try it, especially if you have difficulty motivating yourself to exercise. But to make the most of your time, do some exercise while you wait for class to start!

Finally, I never see a line for the much-more-strenuous spinning class, so give that one a try next time. I suspect it will work you harder than Zumba.

Do you agree or disagree? Please post in comments!

What Should I Do For Chronic Back Pain?

First, you should see your primary care physician. He/she will decide if you need a referral to a specialist. 

Second, consider your most conservative treatment options, such as medication and Physical Therapy (PT). There are several types of Physical Therapy options. If you have seen a Physical Therapist before and still have chronic back pain, maybe you need to find a therapist that specializes in the spine. 

There are three main forms of specialty PT that are most effective for chronic back pain. Mechanical Diagnosis and Therapy (MDT), Manual Therapy, and Aquatic Therapy. Your primary doctor, spine specialist or pain specialist may prescribe PT for you and refer you to a specific PT clinic. But do not hesitate to do your own research on local PTs in order to find the clinic that will best meet your needs. It is your choice where to get your Physical Therapy once it is prescribed (just like you choose your pharmacy). Just remember that not all PTs are the same. Some clinics specialize in orthopedic rehab, neurological rehab, pediatric rehab, spine rehab, aquatic therapy, geriatrics, etc, so select carefully in order to maximize your time, effort and cost. Getting the proper Physical Therapy could help you to prevent injections or even surgery. 

Third, if you are still not getting better, follow up with your doctor/specialist. You may be a candidate for injections or other treatments. Injections are effective for some back patients. Some get short-term relief, some get long-term relief and some get no relief, depending on your diagnosis and other factors.

Fourth, increase your fitness level. Get on a weight loss program if you are overweight or obese. Start exercising regularly. This, by itself, could drastically decrease your back pain. It is urgent that you start to do cardio exercise 5-7x per week. Work up to at least 30 minutes per day of moderate to heavy cardio exercise (a walking program may be the easiest, cheapest and most convenient option).

Fifth, if you have done all of the above and still have chronic back pain, see your specialist again, or get a second or third opinion. You should at least know your diagnosis, prognosis and treatment options. If you do not know these yet, ask more questions until you get the answers you seek.

As a PT, I obviously recommend PT over other treatment options. I recently saw a patient with chronic back pain for >20 years and radiating leg pain for >1 year. Within 1 PT session his leg pain was gone and within 3-5 sessions, his back pain was gone! A PT will help to find the cause of your pain, the proper treatment(s), and the best ways to prevent future episodes. 

What Your Toothbrush Tells You About Back Pain

Where do you store your toothbrush? Most of us store it right on the bathroom sink. Why do you store it there? Why don't you store it up on the top shelf or down in the bottom drawer? Your answer gives a simple example of BODY MECHANICS! You store your toothbrush within close reach to make life easier and more convenient. Why bend if you don't have to?

BODY MECHANICS is using your body to its advantage so that you don't have to work harder than necessary for whatever task you are doing. Here is another example. Ladies: why don't you carry your heavy purse by holding it with 1 or 2 fingers? You have naturally learned that the easiest way to carry a large handbag is strapped over your shoulder. 

We all practice good body mechanics with things like where we place our cups/plates/silverware in the kitchen, where we put our socks in our drawers and where we position our debit cards in our wallets. We want easy access to the objects that we use the most every day. So good body mechanics comes naturally...until we deal with our backs. We use our backs for things that our legs and arms should do, such as lifting and bending. Our leg muscles are massive and powerful and can do much heavier lifting than our back muscles. And our shoulder and arm muscles are very strong and able to lift, carry or hold significant amounts of weight.

So to prevent back pain, keep your back straight and use your legs more. Try squatting down using only your legs (maintaining a straight spine position) the next time you need to reach down toward the floor. Here is one easy way to demonstrate bad body mechanics: hold one arm straight out in front of you (with elbow straight) and place a dictionary or phone book in your hand. Time yourself to see how long you can keep it there.

Is Your Sleep Position Causing Carpal Tunnel Syndrome?

Think about the position of your wrists/hands when you are going to sleep. Do you ever curl up in fetal position with your hands and wrists curled inwards around your chest?

One of the treatments for carpal tunnel syndrome is a wrist brace/splint, which keeps your wrists in a straight or neutral position throughout the day or night. So if you can learn to keep your wrists in that position now, you may avoid dealing with carpal tunnel syndrome in the future.

Carpal tunnel syndrome can come from excessive writing, typing, repetitive wrist bending (for example, sewing activities), or anything that puts continual stress on the inside of the wrist. Even improper body mechanics with repetitive smart phone use can put you at risk. 

Symptoms of carpal tunnel syndrome are pain on the palm of the hand (more on the side of the last few fingers and not the thumb-side), and may include tingling in the palm and 3rd-5th fingers.

Very simple stretching can treat carpal tunnel, if you do it consistently to treat and prevent symptoms. The wrist flexor stretch video in the previous post is a very effective stretch. Hold each stretch for at least 10-15 seconds  (you may hold up to 30 seconds). Repeat at least 2-3 repetitions every hour that you are having pain. If it decreases your symptoms, you can do even more repetitions.

Finally, be sure to find a neutral or straight position for your wrists during your daily activities, including sleeping.

PTBuddy.com - Elbow, Wrist & Hand Injury - Wrist Flexor Stretch

Dealing With Chronic Pain

Chronic pain can affect every aspect of your life, but it does not have to take over your life. Here are some practical tips to help you deal with chronic pain.

1. Know your treatment options. What treatments have you tried (medicines, therapies, surgeries, injections)? What doctors/specialists have you seen so far? Do not be afraid to get a second and third opinion, especially if you have unanswered questions about the diagnosis and treatment options for your condition. Be sure to ask your healthcare providers all your questions about your symptoms, concerns and needs. 

2. Exercise! Find a form of exercise that is most tolerable and do it frequently. Exercise produces natural feel-good hormones in your body called endorphins! There are countless exercise benefits for your heart, lungs, muscles, metabolism, digestion, mind and every system of your body, so do not stop exercising or moving because of chronic pain. More than likely, exercise will make you feel better and lack of exercise will make you feel worse.

3. Modify your postures. Look at your posture and find ways to improve it. Use upright chairs, lumbar support rolls, extra pillows, etc to improve and maintain good posture. Start standing and walking with upright posture. Use assistive devices (cane, walker, crutches, braces) as needed to help improve your posture and balance.

4. Modify positioning. Do you sit all day in your recliner chair or sofa? Are there certain positions that aggravate your symptoms for an extended time that you can avoid? Change positions frequently. Stand up and walk around often, even if it is only for a few minutes at a time. You may need to avoid certain chairs, beds, or couches. Be picky about where you choose to sit when you are in public. 

5. Find a hobby. Give yourself something to wake up for every day. Choose something that promotes activity and movement, such as gardening, yoga, or cooking. Having an active hobby will benefit you both physically and mentally.

6. Stay social. Do not isolate yourself because of your pain. Spend time doing activities with your family and friends. Or find ways/places to make friends. Find a local support group for individuals with your condition. 

7. Do not neglect the power of prayer. Jesus performed miraculous healings, and God still does miracles today!

Healthy Recipe: Grilled Chicken With Guac & Salsa

Healthy Recipe:  Grilled Chicken With Guacamole and Salsa

First, season and grill your chicken breasts. Set aside.
Chop up green pepper and tomato. Add fresh lime juice, salt, pepper and cilantro. Set aside.
Mash avocado and mix with fat free sour cream and seasoning of choice.
Slice the chicken breast. Cover with guacamole. Then top with fresh salsa.

If you are trying to cook healthy foods, you may get tired of grilled chicken. This is an easy way to add nutrients and flavor to your plain chicken breast, and it beats the usual side garden salad. For your convenience, this meal is easily prepared in ~20 minutes! I made it last night for supper, and it looked/tasted so good, I had to post it!

To make yellow rice, I add a little Turmeric powder and chopped, fresh or frozen vegetables. For seasoning, I like to use a little salt and garlic powder.

For juicier chicken breast, I grilled it with a little Worcestershire sauce.

Choosing Your Ideal Weight

There are several things to remember about your ideal weight.

First, it is a number that YOU should choose. There may be lists, charts and guidelines for your ideal weight based on your height, but those are only tools to help you make your own weight goals. There is nothing wrong with being a few pounds over what a list says you should weigh as long as it is a weight that you are completely happy with. Your body type and shape is different from everyone else's, so do not expect yourself to fall perfectly into the 50th percentile. 

Secondly, your health matters more than your weight. There are a lot of unhealthy, skinny people out there. If you focus more on health and less on weight loss, you will likely lose more weight! Weight loss is a natural result of healthy lifestyle decisions. On the other hand, starving yourself is bad for you, no matter what size you are. 

Thirdly, try to appreciate your body type and shape instead of hating your curves (or lack of them). Do not expect that weight loss in itself will make you love your body. Even when you lose weight, you likely will still have physical characteristics that you love and hate. They all are your God-given features, so at least accept them as part of who you are. 

Finally, do not compare yourself to others, whether friends, siblings or movie stars. This is an issue for most women and some men. Only a few women in the world look like models, but the rest of us are beautiful as well! And if we spend our time trying to be someone else, we miss out on our own life, beauty, talent and purpose. 

In your weight loss journey, it may be more effective to make goals for clothing size or waist size instead of pounds. Or select goals based on exercise instead of your weight (such as jogging 3 miles or exercising 40 minutes per day). Don't let the number of your weight become an obsession because it can fluctuate daily. Instead, weigh yourself once per week or less. Focus more on what you are doing to improve your health than the numbers on your scale. As you become healthier, you will feel great physically! And the weight will come off as a result (and stay off)! 

The Best Single Exercise For Knee Pain

If you have knee pain of almost any type, one of the first exercises you would learn in Physical Therapy is a Straight Leg Raise (SLR). This exercise is done to strengthen the quadriceps muscle (quads) of the thigh and to provide stability for the knee joint. An added benefit is that it also strengthens the hip flexors (muscles on the front of hip). 

The following link (~30 second video) shows a modification of the Straight Leg Raise. It is performed with the leg rotated outward, which emphasizes the medial or inner part of the quads muscle (VMO). 

http://www.youtube.com/watch?v=OmB1ck20IfA

With a basic Straight Leg Raise, you first bend the knee of the good leg to keep your back safe and comfortable. On the affected or painful side, straighten the leg completely and lock the knee. This is an isometric contraction for the quads muscle (quad set). With the knee straight, slowly raise the leg up about 10 inches, hold it for a few seconds, then slowly lower it back down to the surface. Repeat at least 10 times and work up to 30 repetitions by practicing a few times daily. Once you can do 30 reps, add a 1-pound ankle weight and practice with that resistance until you can do ~30 reps without stopping. Then progress similarly, 1 pound at a time, until you get to 10 lbs (it should take you 2-4 weeks if you do it 2-3x daily).

This can cause fatigue or strain to the front of the hip, so do not progress too fast if you are getting pain or discomfort there. It is important to do the exercise slowly in order to use muscle control and not momentum. Also, do not raise the leg too high, which would draw in other muscle groups. Do not forget to keep the knee locked the entire time. 

For resistance ideas, you can use adjustable ankle weights, which range from 1-5 or 1-10 lbs and have removeable 1-lb weights. You could also use resistance bands, starting with light resistance and slowly progressing to harder ones. However, I recommend ankle weights more than therabands for this exercise so that you can keep your good knee bent. 

Losing Weight By Eating More

If you are overweight but you do not eat very often, that may be part of your weight problem. Here are some helpful tips to help you eat more and still lose weight.

1. Do not skip breakfast. Eat a healthy breakfast very soon after waking up. Some ideas are 1 serving of whole grain cereal with 1/2 cup of skim milk, 1 slice of whole wheat toast with peanut butter and 1 cup of skim milk, 1 granola bar with 1 banana, or cottage cheese with peaches.

2. Do not go all day without eating. Likely you will overeat in the evening, which is the worst time to do so.

3. Eat something small every 2-3 hours, such as a piece of fruit, a serving of nuts, yogurt, etc.

4. If you eat little volume of food, be sure whatever you do eat is healthy. You need 5 servings of fruits/vegetables every day. Protein and dairy are also important.

5. If you are going to eat more volume of food and still lose weight, you must minimize sweets, junk food and fast food.

6. If you already eat well and still need to lose weight, you must exercise more. Your minimum should be 45 minutes per day, 6-7x/week. The more you exercise daily, the more you will lose (weight, inches and clothing sizes).

7. Change your daily routine to eat breakfast early and to exercise in the morning. You will lose more weight if you wake up early and go to bed early. For example, eat breakfast at 7 am instead of 10 am, and eat supper at 6 pm instead of 9 pm.