Sunday, December 30, 2018

How to Take a Fitness Class

Orange Theory circuit style cardio 
Thinking about your New Year’s Resolution?  If you are like most, getting healthier is at the top of your list. Even the fittest among us use a New Year to motivate self-improvement or try something new.  If that something new is a fitness class, read this first..
Circuit classes like Orange Theory are ubiquitous in the fitness world. Yoga classes are also everywhere and range in intensity from teaching meditation and balance to intense aerobic power moves.  Functional fitness classes involve activities such as running, stairs, and climbing.  Cycling or spinning classes continue to evolve and are a great blast of aerobic or cardiac fitness activity.  Boxing, treadmill, and rowing classes are also popular.  

Unlike the first fitness dance aerobics classes such as Zumba and step classes, most modern-day circuit fitness classes change forms of weights with each exercise. These include stretch bands, dumbbells, kettlebells, bars and balls.  Mixing it up keeps you interested and challenged and is less likely to cause a repetitive use injury.  Still, whenever weights are added, risk of injury increases due to speed of motion, improper form and too much weight

Strength training classes and adding weights to aerobics class are both likely to continue to gain popularity.  To meet the updated exercise recommendations by the CDC to include 2 sessions of moderate to vigorous strength training sessions per week, strength training in classes may take the form of kettlebell swings, box jumps, and squatting, lunging, or walking with weights. Moving with weights and throwing medicine balls are also common exercise techniques.  Any of these exercises may increase risk of injury as balance is challenged by the weights, causing twisting moments and off-center joint imbalances of major joints such as the knees, hips, neck and lower back. 

Ideally, watch a class before you take it.  Ask members if they like the instructor and feel that she or he is someone who is paying attention to the class.  Both the music and instructor style should be upbeat and motivating but not so quick you can’t keep up.

As you enter a class for the first time, choose a position you are comfortable in. For a first class I prefer standing in the back so that when I modify the motions to prevent injury I don’t throw anyone else in the class off.  Others might prefer a position in the front, closer to the instructor who will hopefully demonstrate and watch for good form.  When you choose your equipment, find the lowest weights and resistance bands. This is not wimping out, it’s avoiding injury and overstressed muscles.  With repetitions, proper form, and light weights, you will get results! Most classes have much more repetition than you need; 30 is always plenty.  

sample of some classes offered at LA Fitness
Don’t necessarily do as the instructor does.  I have witnessed many demonstrate poor form.  Instructors are usually young and strong with much less risk of injury.  Remember you can always leave if you feel pain or are too frustrated trying to avoid pain.  Again, be very careful moving your body while holding weights.  This can throw out your back, your neck and your hips.  When weights go overhead, shoulder, neck and back are at risk of injury.  Keep the motions in front of you, never behind you where your shoulder stability will be compromised. 

Most importantly, listen to your body.  If it hurts, don’t continue.  If you are sore more than 2 days later, choose lighter weights next time.  And if you have sharp  pain that doesn’t resolve with ice or anti-inflammatories over a few days, see your doctor or a physical therapist.  Remember, there are so many ways to get fit;  a strength training class by 1 instructor can be very different from another’s.   Keep searching until you find what thrills you and does not hurt.  Happy New Year!

Friday, November 30, 2018

Better Fitness Through Travel

Whether you are a regular, rare, or never exerciser, exercising while travelling should be on your to-do list.  In fact, there’s no better time. Even if your travel schedule is packed, just dedicating 30 minutes to exercise will improve how healthy you feel while travelling and after.  The benefits include:

Unwinding your body from hours of sitting
Relieving spine stress from carrying luggage
Burning extra calories to make up for restaurant meals
Exploring a new type of exercise
Improving sleep (exercise always improves sleep quality)
Consider heading to your hotel gym or pool, a walking trail, a fitness studio, or renting a bike.  When it comes to hotel gyms, while they may look intimidating, they are not.  Often, they are empty which takes the pressure off of knowing what you are doing, dressing in the latest fitness wear, or looking like you are working hard on a machine.  There are rarely rules in a hotel gym.  In fact, if you forgot work-out clothes, just wear what you have. 

Start with the bike to warm up your legs, move on to the elliptical, and even try the treadmill.  Just 5-10 minutes on each piece of equipment will keep you motivated and moving.  Limiting time to less than 15 minutes per cardio machine also reduces risk of overuse injury which can happen when doing too much too soon.  Weight machines are also fun to try, just start with the lowest weights.  Don’t forget to take 5 minutes to stretch and add a few crunches for your core.  Try laying on your back and sides on the fitness ball or foam roller with arms overhead and rock back and forth for a gentle massage and stretch.  Don’t forget to hydrate!  Gyms are also usually great sources of bottled or filtered water if you don’t want to drink from the tap. 
If it is a nice day, explore your surroundings.  Ask the front desk if there is a walking trail nearby.  Lace up your sneakers, grab a water bottle, bring your phone for navigation and photos, and go.  If you are feeling energetic, try alternating walking and jogging.  Keep your eyes open for pretty sculptures, buildings and tiny parks.  You will be surprised at the beauty you find.  Reward yourself at a coffee shop on the way back!

If you choose to rent a bike, make sure the seat is high enough so your knees don’t come above hip height on the upstroke but also not so high you can’t reach the ground.  You should be comfortably sitting upright.  If you feel you are straining your back or neck, choose another bike.  The rule with all new exercise is that it should feel good.   A feeling of muscle strain and being out of breath is not necessary but is a sign you have pushed your body to a better fitness level.  You also achieve fitness benefits by breaking up an exercise session, such as riding a bike or walking to and from a destination. 

Consider trying a different fitness activity for each of the first three days of your trip. Repeat the activities you enjoyed most or even schedule in more time for them. You will end your trip healthier and energized with new enthusiasm for exercise.  Wouldn’t that be a great souvenir?    

Wednesday, October 31, 2018

Knee Surgery, head injuries, cortisone injections, NSAIDS and Harry Potter: Updates from the American Academy of PMR Annual Assembly 2018

Just back from my specialty’s annual conference, I’d like to share my favorite topic headlines from the sessions I attended in the 2 days I was there.  While most of this information reconfirms what I already know, hearing that cortisone injections may protect cartilage in small and limited doses was wonderful to hear.  Read on for a brief summary:

1) Surgery for meniscus tears are a last resort.  There is rarely need to have arthroscopic knee surgery to “repair” or remove a damaged meniscus.  Over the age of 35, this surgery is contraindicated due to a 20-40% failure rate, the degenerative nature of the meniscus, and the fact that after meniscus surgery, only 50% of patients get symptom relief.  In the US, the rate of meniscus surgeries far surpasses those of other countries.  Treatment standards include icing, exercises without pain, physical therapy treatments, and cautious activity for 8-12 weeks.  For meniscus tears that remain symptomatic, conservative treatment may include Platelet Rich Plasma (PRP) and Stem Cell Therapy.
2) Head Injuries in kids and adults can happen without a concussion.  Repetitive microtrauma cumulatively leads to concussion symptoms.  More specifically, sports medicine’s attention is on heading the ball in soccer as a cause of brain injury.  Symptoms include poor focus, slower cognitive functions and impaired memory and executive function.  As an injured brain ages, it will be more prone to dementia and chronic traumatic encephalitis.  Women and smaller athletes are more at risk.  US soccer rules since 2016 are that children under age 10 should not head the ball ever, and between the ages of 10-12 only limited to games and 30 minutes practice a week.  The age group leagues organizers, referees, parents and coaches are the ultimate enforcers.  They need to be educated!!

3) Non-Steroidal Anti-inflammatory medications (NSAIDS), most commonly ibuprofen, naproxen and diclofenac, should not be taken at high doses or continuously.   Because they cause easier bleeding, both the muscles and stomach are at risk. Athletes and others who take repeated NSAIDS can develop large collections of blood in muscle or under the skin (hematomas) with even mild contact injury. Life threatening kidney damage is a rare but real occurrence with the risk increasing the longer they are taken; the high blood pressure that can be secondary to these medications makes kidneys even more susceptible. In athletes, dehydration makes kidney damage worse.  While NSAIDS are very effective for pain and inflammation relief, limiting their use to the shortest time possible, or just taking them as needed, is prudent. 

4) Corticosteroid (“steroid”) injections in small doses in humans are actually not as bad to the cartilage as previously thought. Some steroids are actually protective to the cartilage in small amounts, about 1/4 the usual dose.   Steroid injections are very effective for pain and inflammation relief, and can provide a window of irritating symptom reduction that allows for more effective physical therapy, faster return to strengthening, and more balanced use of muscles around the joint that can contribute to long term healing. 

5) Physiatrists are Harry Potter geeks!!!!  There was a private event at Hogsmeade in Islands of Adventure, Universal, and you should have seen us run through the park.  Why do we love Harry Potter?  Because the series is about never giving up, always seeking better, and always moving forward;  stories of tenacity similar to those of  PM&R patients and doctors work together towards recovery . 
“Understanding is the first step to acceptance, and only with acceptance can there be recovery.” –The Goblet of Fire