How to Enjoy Halloween Without Being Frightened By Your Scale

October 31^st has come around again. It is really the beginning of a two month season of indulgence, right? I have people ask for advice because they are in fear of the approaching coldness of the weather and fatness of the winter comfort food. However, the extra candy around the house doesn’t have to be a poltergeist to your wellness plan. Here are some tips on how to get through it.

1. With extra candy around the house, keep some extra healthy options around as well. Sometimes, I just need a snack. The candy is so easy to grab, and is ok once in a while. However, make a bowl of trail mix with healthy ingredients. Personally, I like a mixture of Kashi “Heart to Heart” Honey roasted oat cereal, raisins, and plain almonds. It is just the right combination of sweet and crunchy and fills that “candy craving” quite nicely.

2. If you can’t resist the candy temptation, go for a handful of gummy bears or sour candy instead of a chocolate bar. One snack size snickers has about 3 times the calories of a snack size package of Sour Gummies. It may not be the healthiest option, but definitely the lesser of two Freddy’s to keep you from having a November waistline nightmare.

3. Play “Hide the Pumpkin”. Studies show that people eat more cookies if they have a see-through glass cookie jar verses an opaque one. The point is, put the Halloween candy in the pantry. Limit the kids to just  2-3 pieces per day and that only after a healthy meal. Then make yourself live by the same rule. 

4. Walk with the kids around the neighborhood. I know, the “trick or treating” has passed until next year. But remember, while it may be tempting next year to send your spouse out with the kids to walk the neighborhood while you stay at home to hand out the candy: volunteer to be the chaperone next time around. After all, who do you think consumes the fewer number of calories?

Just because it is Halloween, you don’t have to turn into your own self-destructive Chuckie. With a little discipline and forethought, it is possible to enjoy the holidays without waking with regret the next day……if the spirits let you wake up at all!!!! (insert evil laugh here!)

INSANITY workout program- Weeks 2 and 3

Three weeks down on Insanity and I am warming up to, though not hot on the program for my readers.

As stated last week, I like the intensity of the program. If you are feeling lethargic (and who isn’t at 5am when Susan and I get up to do the workout), Shaun T is going to push you to get out of your funk.   I also love the creative new exercises I have learned such as bench press leg raises, power jumping jacks, standing sprints with hurdles, plank oblique knee raises, and ski jumps.  I also love that, when I am limited on time, I know I can still get a good return on my short investment.

There is one big issue about which I want to caution readers. You really need to know your body and pay attention to how you are doing the exercises. Shaun has you moving so fast that it is very easy to sacrifice form just to keep up. There are a lot of moves where you bend over and stand up while jumping.

For example, while watching my wife, I noticed she has a hard time squatting fast enough to get to the ground, so she compensates by bending forward at the back. Since she is also jumping and twisting at the same time, this can seriously compromise her back. There have been a few days where Susan has complained of her back, knees, and shoulders (in the area of the rotator cuff) being pretty painful. I recognize these symptoms as not being “normal” workout aches and soreness, so we have talked through modifying her form on some of the moves.

If you have minimal knowledge of proper body mechanics, be sure to really watch the leader, Shaun T, closely and have a mirror so you can keep an eye on your form. Don’t pay that much attention to the models, as they sometimes don’t have the best form either.

Now, I will go back to watching game 7 of the World Series. Go Cards!

Glucosamine and Chondroitin for Knee Arthritis

Mike Reinold is a PT that I highly respect as he really studies the available evidence before making a recommendation. I had been thinking of doing an article on Glucosamine and chondroitin sulfate for knee pain as my wife has commented recently, as do quite a few of my patients, on the success they have had with the product. So, since Mike did such a thorough with his blog on it a couple years ago, I just decided to repost it here. For more from Mike, you can link to his blog at http://www.mikereinold.com/.          Stan

A recent review from the January 2009 issue of the Journal of Arthroscopy reviewed the use of glucosamine and chondroitin sulfate for knee osteoarthritis.  Considering the vast amount of people suffering from knee arthritis and the increasing cost of medical care for these patients, the use of any type of supplement to reduce symptoms is welcome.
Research into the efficacy of glucosamine and chondroitin sulfate is certainly not new with studies dating back to 1969.  However, the literature has been filled with many poorly controlled studies, some of which were funded by glucosamine manufacturers!This particular paper reviewed the results of 23 studies that involved double-blind, placebo-controlled, randomized control trials as well as several meta-analyses.

The effectiveness of Glucosamine and Chondroitin Sulfate

The overall results of the review show that there are inconsistent results, but that the results do favor improvement of pain and joint function in patients with arthritis.  The authors also note that one of the most consistent trends between studies involved the length of use of the supplement.  The best results from glucosamine appear to occur after several months of use.  Studies are referenced that show positive results in 3-6 months and even up to 9 months.
In general, if you looked hard enough, you could probably find more articles that say that the use of glucosamine is effective than you could find saying it is not effective.  I realize and agree that there is not overwhelming evidence in support of glucosamine or outlined the exact mechanism of symptom improvement.  However, when we start to run out of options for our patients, I would say there is enough evidence to support it’s use, as long as the supplement is safe.

The Safety of Glucosamine and chondroitin sulfate

A potentially more important finding of the current review was that the use of glucosamine and chondroitin sulfate appears to be safe, at least as safe as placebo supplementation.  To me, this is the most important finding for me clinically.  If we are going to recommend the use of a supplement with inconsistent findings, as long as the supplement is safe I have no problem recommending a patient try glucosamine.

Recommended use of glucosamine chondroitin

I have spent a lot of time over the last several years trying to find a consensus statement on the use of glucosamine and chondroitin sulfate.  Unfortunately, this does not appear to exist.  I have taken information from many sources, including the excellent recommendations of noted orthopedist Dr. Frank Noyes of Cincinnati Sports Medicine and information from the Osteoarthritis Research Society International to provide the following information.  I recommend that you read Dr. Noyes’ recommendations, it is a great resource.  Also, realize that you should consult with your own personal physician before taking any supplements and that glucosamine may not be indicated for you personally.  The below information are just basic guidelines for healthcare providers when considering the use of glucosamine:

• Glucosamine should be taken with chondroitin sulfate to maximize it’s effectiveness
• Supplements that include magnesium and vitamin C may help the absorption rate of glucosamine and chondroitin sulfate.
• To date, the specific brand that has received the highest recommendations appears to be Cosamin DS.
• Dosage should vary based on body weight:
  • If less than 120 lbs: G 1000mg + CS 800mg
  • Between 120-200 lbs: G 1500mg + CS 1200mg
  • If greater than 200 lbs: G 2000mg + CS 1600mg
• Supplements should be taken for at least 3 months for noticeable results.  If no response within 6 months, may discontinue.

I have found decent results from the use of glucosamine in my patients, have you?

C VANGSNESSJR, W SPIKER, J ERICKSON (2009). A Review of Evidence-Based Medicine for Glucosamine and Chondroitin Sulfate Use in Knee Osteoarthritis Arthroscopy: The Journal of Arthroscopic & Related Surgery, 25 (1), 86-94 DOI: 10.1016/j.arthro.2008.07.020

Insanity Workout Chronicle: Week 1

With fear and trepidation, my wife Susan and I started the “Insanity” workout this past week. Insanity is a 2 month program led by trainer and former pro athlete, Shaun T. For the next 2 months I will be journaling through the program and give my thoughts on this popular home workout.

Insanity is quite a bit different from P90X* in that it is VERY heavy on the cardio and sport drills training. In fact, there is very little upper body resistance exercise, in my opinion, though my legs were definitely given a good workout. The set did come with a separate upper body weights workout, but it is not a part of the official “plan”.

The great thing about Insanity is that Shaun makes you dig deep to find another level of intensity and with each set he pushes you harder and harder. If you thought you could sit on a recumbent bike and casually read a book and lose weight, Shaun tries to coach you past that natural passive attitude and show you it is necessary to push yourself to succeed.

Prior to beginning Insanity, we did know that there was going to be a lot of jumping involved, so Susan and I purchased a couple of jump mats on Amazon, and I am pretty glad we did. This workout can be very hard on your joints and if actually done on a gym floor as shown on the video, month 3 would be the “Insanity Joint Replacement Recovery Series”.

If you are trying to use Insanity to lose weight, definitely utilize the meal plan as well. Since the workouts are a bit short, you will need to keep a strong focus on nutrition and perhaps add a few resistance workouts as well.

 *see previous post rating experience with P90x

P90x: The Fitness Road Less Traveled

There are many roads to fitness. There are roads that, unfortunately, are circles and lead right back to where we started. There are roads that are possible but require a level of knowledge that some people just do not have. There are others that lead to success, but require a lot of money and/or time that are not possible at this stage of our lives.  There are other roads that are risky because they require a level of self-discipline and commitment that are difficult to come by but, nonetheless, attainable. I would place P90X in the latter category.

In case you are one of the 12 people in America who haven’t seen the infomercial, P90X stands for Power 90 (for 90 days) X (Extreme). It is a diverse series of fitness videos including resistance training, plyometrics, core strengthening and flexibility training designed to keep challenging your body in different ways to encourage positive change.

 Susan and I decided to do P90X about 6 months ago for a lot of reasons. I was a bit resistant at first because I was comfortable doing what I was doing. But, the chance to do something different and to get to workout with my life partner was enough to give it a try.

After a short period of time I was impressed. Tony Horton (the host trainer) pushed us to a level of intensity that we had not ever been able to do on our own. He also pushed me to try “new” things, such as yoga and jump training, and things I have never been good at, such as pull ups and 1-arm pushups.

The other positive was that every time Tony would change things up, I would end up being sore and exhausted…in a good way. I knew my body was going to make progress, and it has. Another important part of the plan is to track your progress by writing down the weight and number of reps. This is something people rarely do on their own, but is helpful in seeing real meaningful progress.

There are, however, some things that concern me about P90X. One is that the workouts are probably a bit long for some. They vary from a little over an hour to 1 ½ hours. This may discourage some to stick with it.

 It also is, after all, just a video. The trainer is not watching you perform the exercises. Therefore, due to the intensity and speed at which the exercises are performed, there could be risk for injury if not careful. Another inherent weakness with a video series is that it is a cookie-cutter approach and doesn’t take into account each individual weakness.

So, the verdict is P90X is a good, affordable option to help jump start or push you through your plateau in your fitness plan. Finishing the P90X program feels gratifying because the road we chose was the road least traveled: good old-fashioned hard work, intensity, and commitment.

Below are my "before and after" photos. Pic #1 was in around February of 2011 (note the pale shade of winter :) ) and the after was in September 2011 after 6 months of P90x.

Top PT Tips Part 2: Taking advantage of every moment: getting enough rest

Part 2 of the Top PT tips series is about getting enough rest. Ironically, I am writing this at about 9pm and my bed is calling my name after a very long day. I am truly exhausted, so I will stop rambling and get started. 

1. Sleep with a pillow between your knees- do this while sleeping on your side. It will keep your spine in a more neutral position and help you have a more restful night sleep.
2. Use a towel roll in your pillow- a pillow can cause your neck to crane upward when sleeping. It can be very effective to use a towel roll in the part of the pillow that fits under your neck. That way, the cervical spine can be supported, and the head can rest in a more neutral position. For some, a down or memory foam pillow can work better since it will conform to the curves in your head and neck.
3. Don’t go cheap on your mattress. If you are trying to save money, get a used car. Unless you are an over-the-road trucker or a salesman, odds are you will spend much more time on your mattress than in your vehicle. So, it is crucial to your well-being to invest wisely. Susan and I just ordered a new mattress that we are very excited about, although we have to wait six weeks to get it. When “trying on” mattresses at the store, we quickly realized how badly we needed a new bed. Our old one is 17 years old. Despite religious flips and turns every 3 months, eventually a mattress does not exert the same force on your body and will sag. This causes creep and strain on joints and ligaments over a long night. You wake up sore and tired because all night your body has been fighting gravity. So, look for a bed with a combination of proper support and one that conforms well to your body.
4. Get to bed early and get up early to do your work out. It’s such a timeless phrase that it is cliché, but Mr. Franklin said it best…. “Early to bed, early to rise, makes a man HEALTHY, wealthy and wise.” Getting to bed early so you can work out early will help you beat the million distractions and other priorities that prevent people from accomplishing their goals. I know for me that if I don’t get a work out in early in the morning, then it just won’t happen. If you want a critical transformation, than a good, hard, productive workout has to happen!  

Nightime for my toddlers can be a battle because they don’t want to miss anything. But we should be older and wiser and know that if we don’t get enough rest we won’t have the energy to fight the battle of the bulge. Be sure to take advantage of every moment of the day, whether your eyes are open or closed.

Top Physical Therapy Advice To Fuel Your Exercise Program

Every day I find myself handing out advice. It also tends to be the same advice over and over. So, for the next few blogs I am going to share the “tips” I find myself giving out most often that could help with your workouts, keep you from getting injured, and help maintain your focus for hitting your goals.

Part 1: Lifting and body mechanics

1. Knees behind toes- No, I am not suggesting you play Twister…although that sounds like fun. Instead, when doing squats or lunges, look down. If your knees are jutting out over your toes, there is likely undo strain being placed on your knees. Step out a little farther so when you squat your knees are behind your toes.
2. Chest and head up when squatting- if you look down when lifting an object, the tendency is to flatten out the lumbar spine and place increased strain on the back. So, think “head and chest up” when lifting to keep the lumbar spine in its naturally curved position.
3. Lift with your legs- everyone knows this one but so few do it! Perhaps it is because of lack of flexibility combined with lack of energy that people allow gravity to pull the trunk forward instead of lowering their trunk with their legs. You won’t lift with your legs if you don’t use them to get into position. You can start strengthening your legs by leaning against a wall and sliding down to do mini-squats. This can also help control dust around your house!
4. Use a wide base of support- unless you are trying to balance on one leg in the yoga “tree” pose, spread your legs apart when exercising, especially when lifting weights from the floor. It will increase your stability and help you be able to lift more weight safely.

So, there you go. Don’t worry, I’m not going to bill you for a 15 minute therapy unit. This one is on me. But now, it’s on you. As you exercise to achieve your goal, remember to use good body mechanics so you stay healthy and injury-free in the process.