Archive for the ‘exercise’ Category

What/Where:

Typically shin pain is sharp or aching pain along the medial or lateral border of your shin bone (Tibia) where the muscles attach to the bone. The pain is worse during or immediately after exercise, better with rest, and may be tender to the touch over the affected area. This pain is commonly known as “shin splints” and in the sports medicine world “Medial Tibial Stress Syndrome.”

Athletes or people most at risk include:

1) Runners 2) basketball players, 3) gymnasts or 4) tennis players, 5) dancers, 6) military recruits, 7) women (especially female athletes) especially if they have irregular or missed menstrual periods, 8 ) exercisers with sudden changes in training, 9) anyone with some sort of metabolic bone disorder like osteoporosis, 10) anyone taking a medication that affects bone mass

Why:

1) Too much too soon too frequently: You have recently increased your intensity, duration and frequency of weight bearing exercise like running and your conditioning, tendon, ligament, muscle and connective tissue strength do not match the requirements for this higher level. Muscles fatigue and transfer stress/shock directly to the bones.
2) Your shoes are old, you have run more than 300 miles with them, or they are too stiff to begin with
3) You are not resting long enough between runs therefore your muscles and bones can’t heal, strengthen and thicken.
4) You are not nutritionally supporting the healing/strengthening/thickening process.
5) You change surface ie grass to clay courts, or treadmill to sidewalk.
6) You have a biomechanical problem that may stem from an inherent asymmetry in your body (ex leg length difference) or you have developed a bunion, blister or tendon problem that affects how you put weight on your foot and causes an asymmetric gait.

Red Flags- You need to see your sports medicine physician if:

1) Hoping on one foot hurts your shin
2) Pain is on the outside/lateral aspect of your shin or tibia
3) Nothing helps the pain except rest
4) The pain is very focal (in one place) only.
5) Swelling in your feet or ankles,
6) Bruising
7) You have irregular or missed menstrual periods
8 ) Pain that occurs during normal daily activity.

If you have any of these signs see your sports medicine physician as soon as possible. You may have a stress fracture of the bone  or something else that requires aggressive diagnosis and treatment to help you return to your sport/activity as quickly as safely possible.

How to prevent:

1) Calf and Achilles tendon stretching after workouts and daily.
2) Heel walking and heel raises to strengthen your Tibialis Anterior muscle.
3) If running, replace your shoes every 300-500 miles. The mid sole breaks down and doesn’t give as much shock absorption therefore that force is transmitted up into your shins.
4) If you are just starting out with running, do not increase the distance more than 10% each week from the starting distance and frequency you set with your sports medicine physician.
5) Note: A recent study  reviewed 199 studies looking at prevention of shin splints. They concluded that there were no statistically significant methods of prevention. The only method that was borderline significant was using shock absorbing insoles. Most of the studies reviewed were flawed in their methodology or were not controlled. This doesn’t mean you shouldn’t do the above, it means that they need to do better studies to see what works.

Treatment:

1) Replace your shoes if you’ve run more than 300 miles on them. Go to a good running store or sports physician that can analyze your gait and recommend the appropriate shoe for you. This is critically important for both prevention and treatment.
2) Do a lot of Achilles tendon stretching after each workout and daily
3) Ice your shins after every workout 15-20 minutes. You may repeat this hourly if you feel as long as you have 40-45 minutes between icing periods.
4) Try shock absorbing insoles. A couple good examples include those made by Spenco and Superfeet.
5) Reduce your weekly mileage if you’re a runner
6) Reduce the intensity/speed and frequency of workouts. Try doing a “Run/walk” routine with 60 seconds of running and 90 seconds of walking to start. This gives the muscles, tendons, ligaments and bones a chance to recover, and you still get the full mileage completed.
7) Return to a softer surface for some or all of your training.
8 ) Start running in the pool since you are 5% of your body weight in the water, therefore less impact is felt on your bone and joints but will still get the cardiovascular benefits of running on land.
9) You may need to take time off from your sport. Try cross training.
10) If you have irregular or skipped menstrual periods, the underlying cause is often a caloric deficiency causing an lack of energy availability so try and eat more calories. You should see your physician to figure out why your periods are irregular.
11) Nutritional support: Make sure you are getting 1000-1500mg of dietary calcium per day (dairy, collards, spinach, fortified cereals or orange juice). In addition, you must have 400 IU of dietary Vitamin D (Salmon, tuna, mackerel, fish oil, fortified dairy or cereals). Eat about 0.8-1.0 mg/kg of good quality protein per day (lean meats, fish, tofu, milk, eggs, cheese).
12) If your symptoms do not improve with the above, you must see your sports medicine physician to rule out other causes of shin pain and to diagnose and treat a gait abnormality.

As you can see, there is much you can do to prevent and treat shin splints but remember the “red flags” and see your physician if you have any of them or you don’t improve with the modifications I discussed. I hope this helps! Get out there and shape up!

References:
1) Stress Fractures of the foot and ankle- http://orthoinfo.aaos.org/topic.cfm?topic=A00379
2) Craig, D. Medial Tibial Stress Syndrome: Evidence Based Prevention – http://www.nata.org/jat/readers/archives/43.3/attr-43-03-316.pdf. Journal of Athletic Training. 2008;43 (3):316-318

Science has long known that visceral fat, the fat surrounding your abdominal organs, aka the “beer belly”, is the worst place for you health. Fat in this location has been associated with increased rates of heart attack, stroke, diabetes, hypertension and potentially even cancer.

Beer Belly fat releases inflammatory molecules like c-reactive protein (CRP) that are released into your bloodstream, resulting in damage to your heart, blood vessels and other organs over time. This is less true with fat deposited on your hips or other parts of the body.

Now a new study from the University of Illinois, published in the American Journal of Physiology, Endocrinology and Metabolism, shows that modest exercise alone will decrease visceral fat inflammation, even without a change in diet. Mice were stuffed with a high fat diet for six weeks, then put in four different groups. These included a sedentary group, an exercise group, a low fat diet group and a a group that combined  exercise and a low fat diet.

Interestingly, the exercise alone group performed almost as well as the combination of diet and exercise group. The exercise routine comprised a  1/4 of a mile 5 days a week which upscaled to humans would be around 30-45 minutes of exercise 5 days a week- precisely the recommended exercise routine by the American College of Sports Medicine  (ACSM) and the American Heart Association (AHA).

So does this mean that as long as you are exercising regularly you can pig out at your local fast food joint? Absolutely not.  Remember that this study only looks at inflammatory levels. There are numerous published good studies that show that weight loss reduces the risk of heart disease and stroke, not to mention a reduction in diabetes and cancer, and plenty of studies that show that obesity people have higher rates of diseases along with poorer quality of life.

This study does show however that if you have difficulty controlling your diet, don’t despair and stop exercising- you can still benefit from regular modest exercise alone. Eat sensibly and exercise five times per week and you may prevent all of these illnesses from happening to you!

Source:

This study is funded by the National Institute of Health (NIH) and was published in the American Journal of Physiology, Endocrinology and Metabolism. Co-authors are V.J. Vieira, R.J. Valentine, K. Wilund, N. Antao, T. Baynard, and J.A. Woods

Via Medical News Today: http://www.medicalnewstoday.com/articles/147483.php

As a sports medicine physician, I often get asked how to start an exercise program and how to keep up with it. While there are many recommendations regarding this seemingly simple task, my experience is that too much information can be daunting to those just starting out. Therefore, I will attempt, with the help of the American College of Sports Medicine (ACSM), “Exercise is Medicine” initiative, and the American Heart Association (AHA) to boil it down to ten practical tips.

To preface however, patients with chronic diseases, cardiovascular disease, diabetes, or any medical concern should see their physician before starting an exercise program. Specifically, The American College of Sports Medicine (ACSM) and The American Heart Association (AHA) recommend that men ≥45, and women≥ 55 with two or more major cardiac risk factors symptoms of coronary artery disease, or those with coronary, pulmonary or metabolic disease need symptom limited exercise testing before starting. The major cardiac risk factors are being male, increasing age i.e. >65, heredity including race, smoking, high cholesterol, high blood pressure, physical inactivity, obesity, and diabetes.

In talking with patients, a lot of them will be initially motivated to start exercising but will quickly burn out and stop. They may be overwhelmed with the intensity of exercise, succumb the “too much too soon” phenomena, and build a barrier to going back to exercise in the future.

Here are my Top 10 tips to starting an effective, sustainable and most importantly enjoyable exercise program.

Tip 1: Block out time for exercise every day. Make it a no choice appointment for yourself. Don’t give yourself the chance to back out. For example, if you are exercising in the evening or at lunch, pack your gym bag, running shoes, etc and go straight to the gym after work. If you are exercising in the morning, lay your exercise clothing out and set your alarm across the room so you are forced to get up early.

Tip 2: Choose cardiovascular activities that you enjoy. Studies show that you will stick with your program longer if you pick something you love.

Tip 3: Vary your activity. Prevent burn out by rotating through 3-4 different cardiovascular activities. Mine are cycling, elliptical, running, stair-stepper, basketball, and swimming. If you “feel” like doing one particular activity more than the others on a certain day, go ahead and do it, even if it’s a lower intensity activity.

Tip 4: Consistency is the key: It matters less what you do, but you HAVE to do it at least 5 days a week once you reach your goal! The more you do it, the more it becomes habit, and the more “addicted,” in a good way, you will become to exercise. Make it a part of your new healthy lifestyle initiative.

Tip 5: Start off slow. Too much too soon will likely result in undue soreness, possibly injury and you being discouraged. Build up intensity, length of activity and number of work outs per week. A good starting point is 10-15 minutes every other day at low to medium intensity. Every week add 5 minutes to the workout until you are at 45 minutes per work out. Later you can start filling in the days you’re not working out with a goal of 5 days per week.

Tip 6: Don’t over-train! There is too much of a good thing. Your body needs to recover and especially initially, 7 workouts a week may not give you enough time to recover. Don’t forget to sleep. Your muscles and connective tissue build and heal at night almost exclusively. Without good quality sleep, you’ll breakdown and get injured.

Tip 7: Incorporate strength training. The goal is to do 8-10 strength training exercises, 8-12 repetitions, twice per week.

Tip 8: Do balance exercises: While not obviously going to give you cardio-protective or weight loss benefits, balance and proprioception (the ability to know where a body part is in space) exercises can help prevent injury. This is critical if your exercise of choice is something like basketball and tennis, as well as outdoor running.

Tip 9: If your goal is to burn fat, the best time to exercise is first thing in the morning. Through the night, your body has burned through much of your muscle glycogen stores (your muscle’s storage form of energy), and you can burn up to 300% more fat in a shorter time than if you exercise with the same activity in the afternoon or evening after you have eaten. It may take 30 minutes to get to the fat burning stage in the evening, and then another 10-20 minutes to actually burn the fat.

Tip 10: Eat within 20-60 minutes of exercising. Your muscles have an open door for glucose and nutrients during the first hour after exercise. Eating something healthy like a glass of milk or a protein shake right away and again 3 hours later will help you recover faster, and will help you have a more effective work out the next day.

Bonus: Set realistic goals. Give yourself enough time, and smaller “stepping stone” goals to build up to them. My wife and I had never run a marathon but we both had run shorter races including half marathons before we attempted to train for the San Francisco marathon. It still took us around 8 months to get there.

Sources:

http://www.exerciseismedicine.org/documents/StartingExercise4_000.pdf

http://www.exerciseismedicine.org/physicians.htm

http://circ.ahajournals.org/cgi/reprint/CIRCULATIONAHA.107.185649

So you tore your meniscus, the cartilage based shock absorber between joints, and your knees are painfully locking, catching, maybe buckling, and likely throbbing or aching.  Your orthopaedist has said you may need surgery to take out or repair the meniscus.  Before committing to a procedure, ask your doc about  a new meniscus implant called Menaflex™.

Menaflex™ is a new collagen meniscus implant  that was unveiled at the American Academy of Orthopaedic Surgeons (”AAOS”) annual meeting February 25-28 in Las Vegas, Nevada. It is the first device of its kind and has been used in Austria by orthopaedic surgeons for many years.

It has been approved to be used as scaffolding and reinforcement for repair of soft tissue injury of the medial meniscus, the cartilaginous shock absorber in the knee. Once damaged the tissue may be removed surgically, and Menaflex aids in the regeneration of new meniscal tissue.

Traditionally, once damaged meniscal tissue is removed, new meniscus is not likely to grow back in its place, and while the pain and mechanical catching and locking may be improved, the patient may be at risk for developing arthritis in that area. The new meniscus implant may enable new meniscus tissue to grow over the scaffold, perhaps improving shock absorption and preventing osteoarthritis.

So far, few if any U.S. orthopaedic surgeons have been trained in this procedure so unfortunately, you domestic choice for meniscal repair with this implant is limited and you would have to travel to Europe to have this procedure done but hopefully in six months to a year, this will be a more established option for patients.

Symptoms of meniscal injury are many including mechanical locking, painful catching, popping, pain with deep knee bending and often swelling and aching. Meniscal injuries tend to occur with planting and twisting injuries to the knee. It is important to see your sports medicine physician as soon as possible so that if you do have a torn meniscus that may be salvaged rather than cut out, this surgical procedure may be done early. In general, the longer you wait, the less chance it may be salvaged depending on where the tear is. Thankfully, Menaflex gives patients the ability to regrow meniscal tissue but you have to find someone that does this procedure first!

FYI, I have no financial connection to this company or product.

http://www.menaflex.com/en-us/en/

A recent study by Texas A&M and the University of Pittsburgh showed that women on oral birth control pills had a decreased ability to build muscle compared to women not on the pill. 73 women ages 18-31 were followed for 10 weeks, and underwent a standardized and supervised weight-training regimen. Their recommended dietary intake of protein was 0.5 mg/kg. After 10 weeks the women off the pill gained 60% more mass than those on the pill. Body composition was measured using very accurate hydrostatic weighing.

In addition they measured pre and post workout anabolic and catabolic (muscle building and breakdown respectively),  hormone levels. The women on the pill had lower resting/fasting anabolic hormone levels while cortisol (catabolic) levels were higher. The study was presented this weekend at the American Physiological Society meeting in New Orleans.

So are you a woman on birth control and trying to build muscle? Should you go off your pill?  The answer is “it depends!”  The difference in terms of absolute mass is actually quite minimal though the percentage difference is 60%. The women on the pill gained 1.0±1.0kg vs. the women not on the pill who gained 1.6±1.4kg. This was statistically significant but is it FUNCTIONALLY significant?

It should be noted that the study found no difference in STRENGTH gains and arm/leg circumference.  Mass is not a functional measurement whereas strength is. So functionally, both groups improved equally with weight training and a protein diet as above even if the absolute mass was less in the group on the pill.  I’m not convinced that 0.6 kg difference would manifest a performance difference in the recreational athlete though it may in an elite athlete.

When making a decision about stopping or staying on the pill, consider a couple hypothetical scenarios.  There are two ends of the spectrum. Are you taking it simply to improve your acne? Or are you on it to regulate your menstrual cycle because off the pill you had irregular, heavy and frequent periods that gave you anemia which decreased your energy level and performance anyways? Are you taking it to prevent a pregnancy? If it’s for the first reason, and your acne is under control, you could consider talking with your doctor about going off the pill if you are an elite athlete. However if it’s the latter two reasons, I think this would likely be a bad idea for obvious reasons.

Bottom line is that this is a personal decision that should be discussed with your doctor before stopping.

Source: Oral Contraceptives Impair Muscle Gains In Young Women

Welcome to my new blog “Shape up!” As a sports medicine physician, an athlete and a huge proponent for preventative health, I am naturally interested in bringing practical fitness and well being knowledge to you, my readers. In my years in the medical world, I have noticed that much of the focus of medical training and patient care is based in “reactive” medicine- that is, the problem has occurred, and the goal of therapy is damage control, and if possible to cure.

Many of the cases I see clinically, I realize could have been prevented or controlled with healthy living based in regular physical activity, stress reduction, striving to be at an optimum weight and healthy nutrition. Unfortunately obesity is an epidemic that results in numerous health risks and conditions and is a direct result of poor nutritional choices and a lack of physical activity as well as genetic predispositions. I hope to, in small part, prevent obesity and promote physical activity in you, my readers.

Please understand that Kosmix, and myself are not liable for anything that may happen to you and that this blog does not substitute for regular medical advice, diagnosis or treatment from your personal physician or health care provider. Never delay seeking medical treatment based on anything you read or see on this blog. Your use of or reliance on any information on this blog is solely at your own risk.  Please consult with your health care provider before attempting anything described in this blog and call 911 in case of emergency.

My hope is to present the latest news in the world of exercise, fitness, obesity and preventative health, as well as “core topic” posts about common sports medicine problems that I see in my clinic. Hopefully we can together learn and promote the underlying truth that “an ounce of prevention is better than a pound of cure!” The result is more cost-effective health care for you and the country, and a happier, productive life. I hope you enjoy my posts, and I am open to feedback. Let’s “Shape Up!”

–Sincerely, Rowan Paul, M.D.