7/03/2008

We're All Assembly Line Workers: Repetitive Stress Injuries

By Cary Raffle
The idea of repetitive motion injuries - more recently referred to as repetitive strain injuries - is well accepted for assembly line workers, but we aren't quite as aware of it when thinking about executives, professionals, or even our workouts at the gym.

Carpal Tunnel Syndrome is probably the best know among office workers. This is prevalent among people who use a mouse; the nerve in the wrist become compressed from constant pressure and can cause a shooting or radiating pain up the arm. Avoiding pressure on the wrist and using a gel pad can help prevent this problem. People sitting all day frequently develop hip pain because the muscles are flexed all day long. People rounded over the computer keyboard have shoulder pain. Sometimes it is a repetitive movement, sometimes it is from being in a fixed position or posture like when you get up from sitting on a long air plane flight. Below I will share a few stories and solutions that have helped other people with these kinds of problems.

A judge complained to me of neck pain during our training sessions. We discovered that she turned her head to the left dozens of times a day to see a computer monitor, so she began to alternate the monitor position, be mindful of straining, and incorporated chest sand neck stretches into her routine. My co-worker Alfreda complained about a pain in the neck, and she wasn't referring to her boss or an irate customer. We moved the monitor closer to her and it got better.


I overheard a member doing chest press complaining to his friend about his shoulder problems and inability do certain triceps exercises or hold his shoulders straight for overhead exercise. He described his workout program - heavy chest, lots of shoulders, almost no back. When he stood up he was exactly what I expected - a huge weight lifter of a guy with a big chest and forward rounded shoulders. His workouts had become the equivalent of an assembly line, with nothing to counter the heavy emphasis on the front of his body. He needs to stretch his chest, increase the ratio of back to chest exercises, and work on strengthening the muscles that pull the shoulder back). His program would include rear flies, rotator cuff strengthening, especially the external rotators, and abdominal core training. Crunches could exacerbate the problem he needs to get deeper into the core.

An IT worker complains of chronic back pain, and has poor posture with an arched back. He carries a heavy back with a computer and books every day and keeps his knees locked while standing and waling. He needs to lighten that backpack but until he can, it will be helpful to bend the knees to relieve the arching, stretch the back, and strengthen the core muscles - emphasizing the deep abdominals and gluteals. The program includes single leg squats, leg lifts and lots of core training.

A very fit professor has tennis elbow. (Technically, its epicondylitis and it can affect the inside in tennis elbow or the outside in golfers elbow, with pain felt in the tendons of the forearm). Is it from his workouts or is it from writing on a blackboard - or a combination of both. He uses heavy weights with exercise gloves, has been doing the same workout for about a year, and now had a forearm and elbow braces, what's next to brace? We are in the process of unwrapping this problem, including physical therapy. The general course of training for this problem involves exercises to strengthen the wrist and also some rotator cuff work, especially external rotators.


The last newsletter discussed flexibility, stretching and strengthening, and stretching before exercise. These examples show how this approach can be beneficial in your training program. It is important to vary your workouts, and avoid doing the same thing over and over again - whether its strength training or cardio. With the warm weather, its easy to mix up your cardio routine with some cross training. When it comes to strength training, focus on changing the intensity - ie, if you been working in a range of 8-10 repetitions, take it to 15 at a lower weight or do the exercises in a unstable position - and give your muscles and joints a break. Of course, if you are experiencing serious pain or pain for an extended period of time, you need to get medical attention and avoid working those muscles. Any questions, feel free to let me know.

5/22/2008

Muscle Imbalances: Which to Stretch? Which to Strengthen?

By Cary Raffle
Almost everyone has muscle imbalances. A few simple observations and movement tests tell a fitness professional which muscles are tight or overactive and need stretching and which are extended or underactive and need stretching (these are included in your fitness assessment). Below are a few of the more common observations and indicated stretches and strengthening recommendations to give you an example.

Observation
Shortened Muscles to Stretch
Extended Muscles to Strengthen
Feet turn out, shin splints, pain on bottom of foot (plantar fascitis), Achilles tendonitis*
Calves, Quadriceps, IT Band/TFL

Anterior Tibialis (shin), Gluteals, Medial Hamstrings
Shoulders round, soreness in mid/upper back, forward head
Chest, front of Shoulder, Lats, Neck, Upper Traps
Middle and Lower Traps and Rhomboids
Excessive forward lean at hip
Hip flexors and Quadriceps
Gluteals, Hamstrings, Abdominal Core

*Achilles tendonitis and plantar fasicitis are medical conditions, you should consult a doctor for diagnosis and possible treatment.
Once you understand which muscles are shortened and which are extended, be sure to adapt your program accordingly. If your calves are tight, you probably don't want to work them too hard until you complete several weeks of stretching. If your hamstrings are extended, you probably do not want to keep stretching them and extend them even more. Overstretched muscles can also be uncomfortable, they tend to have a low level or soreness that some people mistakenly believe is a call for stretching.

Should You Stretch Before You Exercise?

by Cary Raffle

You may not think that office work is physically demanding, but it takes a toll on your body!

Locked in Seated Position

Have you ever gotten up from your desk or after a long trip and felt like you were locked into seated position? Most of you spend many hours sitting. At a desk or table, hunched over a keyboard, leaning forward to see a computer screen, traveling on trains, busses and airplanes. For hours at a time, your hips are flexed, your shoulder muscles are tight, your glutes and middle/lower back muscles are all stretched out. Then, you want to come into the gym and workout or run or play ball outside. It's a setup for inefficient use of your muscles and potential injury.

A Set Up for Injury

Tight muscles can have limited range of motion and reduced blood flow, which leads to decreased work capacity

Muscle imbalances result as the wrong muscles are recruited to do the work. Here is one example: hunching over a keyboard tighten the muscles in the chest and front of the shoulders, the shoulder muscles and rotator cuff become overactive and tight, they roll forward an reduce the ability of the chest, arm and back muscles to work. It's a set you up for potential injuries such as rotator cuff problems. The same thing can happen at the neck, the hip, or any other area.

As muscles tighten they can spasm, scar tissue and adhesions form. As the muscle becomes less mobile and improperly balanced, joints don't move properly and can begin to degenerate - eventually leading to arthritis. Running with feet turned out and knees knocking, bench pressing with shoulders that are rounded in are a couple of examples of muscle imbalances that can lead to reduced performance and injury.


Before and After

It is important to get your muscles into balance before exercising to avoid risk of injury. But - and this is a big but - you have to be sure to stretch the right muscles. Just as some muscles get tight from sitting, the opposing muscles will stretch out. In some cases, they stretch to the point where they are also susceptible to injury. This often happens with some of the hamstring muscles. As the quadriceps and hip flexors tighten from sitting, some of the hamstring muscles lengthen. Yet many people who don't have tight hamstrings stretch them before exercising. After exercising, stretch the muscles that became tight during your workout, and get them back in balance again.

Does Stretching Weaken the Muscle?

One of my clients asked me to comment on an article that said not to stretch before exercise because research shows that stretching "weakens the muscle." I haven't seen that research.

Stretching sends a signal to the muscle to relax, so it might not generate as much force in the more relaxed state. However that is a very narrow view of how our bodies generate force.

Optimal force is produced by muscles working together in perfect harmony. For this to happen, we need to be in correct postural alignment, and the right muscles need to do the job. Often, a tight muscle will inhibit other muscles from doing their jobs. I have very clients at every level who - at various times - can't properly do certain exercises until their tight muscles have been released.

4/09/2008

Counting Calories. The true secret of weight loss.

by Cary Raffle

You hear about all kinds of supplements, medications and diets, but remember that the only way to lose weight is to maintain a calorie deficit. To lose weight, you have to either decrease the calories that you take in or increase the calories that you burn. Or both.

A 36 year old man who is 5 foot 9 inches, weighs 190 pounds and exercises 3-5 times a week needs about 2926 calories per day. A 36 year old woman who is 5 foot 5 inches, weighs 140 pounds and exercises 3-5 time a week needs about 2171 calories per day. (Those of you who completed a fitness assessment with me already have your own personally calculated estimate of daily calories).

If you take in more calories, you gain weight, if you take in less, you lose weight. And this is important - it doesn't matter whether the calories are from fat, protein or carbohydrates - a calorie is a calorie is a calorie. Most diets recommend a 500 calorie a day deficit which translates to a loss of about 1 pound per week. You will need to adjust this target as you continue to lose weight.

HOW DO YOU COUNT CALORIES?

One of my clients recommends The Daily Plate, click here to try it. This is an excellent free resource where you can input all of the foods that you eat and all of your activities, calculate your calorie consumption and expenditures, and maintain a dairy. The library of foods in its calorie database is amazing.

If you aren't looking to get obsessive-compulsive about it and maintain an ongoing diary, just try it for 3-7 days and identify your problem areas. In his case, we reduced red meat from two days to one day per week, eliminated a few beers, and maintained his activity level. Results: dropped 6 pounds from January 6-31.

Periodization of Strength Training: Phase 2 Unstable Exercises

by Cary Raffle

Most readers fall into one of two groups - let's say you've spent the past few weeks doing one of the following:

GROUP 1
You worked out on XpressLine or other machines- 1 or 2 sets of 12-15 repetitions. This workout familiarized your body with movement patterns, built a base of strength for muscles and connective tissue and you got into a good routine.

GROUP 2
You used free weights on bench or seated, or free weights combined with some machines - 1 to 3 sets of 8 to 15. These workouts should have improved your endurance strength and/or increased muscle mass, and improved neuromuscular control.

The Adaptation Principle
In both cases, after 4-6 weeks your body has adapted to the demands of your exercise program, and as you continue, you will experience a decreasing return on the time that you invest in exercising. You've probably increased the weights, but will still find your program plateauing.

How to beat the plateau?
There are a number of different ways to progress the program other than simply increasing the weight. This month, the recommended progression is to perform similar exercises in a less stable position. In the past, you've had a bench or chair supporting you while you worked out. Starting now, you are going to begin training your core muscles to do this work - especially your deep inner abdominal muscles and your gluteals. Yes...your glutes are very important parts of your core!

Why is this important?

Think of an overhead shoulder press and the way that you do this exercise if you use benches and chairs and machines. Think of the way that you use your strength and conditioning in every day life. You are very rarely able to stop, take a seat and then lift an item over your head, are you? By integrating some unstable or core training into your routine, you can enhance your ability to perform these movements in every day life. You'll also reduce the risk of low back pain and develop the inner stability that can take your strength beyond its current plateau.

Click here to access your unstable exercise program.

It begins with a balance and a drawing in maneuver, which trains your body to activate the deepest abdominal muscle. The program includes one representative exercise for each body part. In this phase of training, you'll generally be working with 2 or 3 sets of 12-15 repetitions. We also want to pay some attention to the 4-2-1 tempo, which will emphasize the "negative phase." Each exercise should be perromed so that the concentric phase (when you push, pull or lift) is 2 seconds, the isometric phase (fully pulled or extended) is 1 second, and the eccentric or return phase is 4 seconds.

Feel free to let me know if you have any specific questions about the exercises or program.

1/11/2008

Thinking Ahead: Periodization

by Cary Raffle

Whether you're new to exercise or you've been hitting the gym for years, a few weeks from now you might feel that your routine is getting stale, or that you aren't seeing the results that you saw earlier in your program. Periodization, which involves changing the design of your workout at regular planned intervals, can help you stay on track and reach your goals.

Around Valentine's Day, you'll be ready for a change. That's because your body adapts to the particular type of stress (exercise) that you put on it within 4-8 weeks. When this happens, you are likely to see diminishing results over time if you stick with the same exact program. Some people also start feeling aches and pains from doing the same exact movements over and over again. Effective periodization involves more than just taking the weights up every couple of weeks or using a different brand of machine that works the same muscles in pretty much the same way.

There are any number of variables that you can change or progress:

Number of sets and repetitions

Tempo or time and type of muscle action, ie, emphasizing the isometric, eccentric (negative) or concentric phase to hit different muscle fibers

Frequency of training and organization of routines, change the exercise order and reorganize your split routinesl Even better, progress to a totally different mode of training

Unstable exercises to build core strength, if you're usually on fixed machines or benches

Plyometrics to build explosive power and deceleration

Consider a phase of muscle building, ie, heavy weights if you usually train light
Try incorporating different activities like yoga or an alternate form of cardio training. Often, these changes can reenergize your routine, keep you interested and on track, and serve as a springboard for getting to the next level with your fitness program - no matter if your goal is losing weight, gaining muscle, sports performance, or anything else for that matter.

When you think of it, Spring is just around the corner, so start thinking of Periodization now, and feel free to let me know if you need any help. I'll include some specific ideas in the next newsletter that comes out just before Valentines Day.

Is your workout wasting your time?

By Paul Scott, Best Life
According to this author, it's likely that most of what you're doing at the gym is nearly useless - and might be ruining your chances of getting fit. With all the fancy equipment and with all the desire out there to look good, why can't we keep the weight off? Why can't we stick to our gym workouts? Is it our fault? Or does the fault lie elsewhere?

"The health-club culture tries to create a dependency on machines," says Vern Gambetta, a trainer with 38 years of experience training professional and recreational athletes, and the author of Athletic Development: The Art & Science of Functional Sports Conditioning. "If you have a limited amount of time to work out, you're better off ditching the machine to do different kinds of body-weight and whole-body exercises. You'll get more caloric burn for your time spent." Critics also charge that a traditional machine-centric regimen has other downsides.

There is potential for pain in any workout. The key to preventing injury is to find your weak links and then modify your exercise to fortify your weak links, while also not putting stress on them, says Nicholas DiNubile, an orthopedic surgeon specializing in sports medicine and author of FrameWork: Your 7-Step Program for Healthy Muscles, Bones, and Joints. The most common strength-training-related injuries Dr. DiNubile sees are rotator-cuff problems, knee issues, and lower-back pain. While these are not exclusive to machine-based training, the nonfunctional movements that some machines require, coupled with heavy loads and less-than-perfect form, can cause problems - especially in men over 40 whose joints are getting creaky.

Research from the University of Kentucky studied 23 patients with knee pain to see what made them stronger: a step-up test or doing leg extensions. They found that both became stronger at doing leg extensions, but only those doing the step-ups became stronger at stepping up and functional activities. Chris Powers, a biokinesiology researcher at the University of Southern California, determined that the mechanics of the leg-extension machine doesn't simulate functional activity (e.g., walking, running, or going down steps). "The leg-extension machine puts a lot of strain on the knee ligaments and the patella," says Tim Hewett, PhD, a professor in the departments of biomedical engineering and pediatrics at the University of Cincinnati. "I would never consider letting our athletes use a leg-extension machine."

Bottom Line: Machines are a great way to get your exercise routine started and can be incorporated into any routine ... but a risk in any exercise program comes from repeating the same motion over and over again. The fixed path of the machines can exacerbate the problem, and machine workouts don't burn as many calories as total body exercises.


To read the full story, click here for MSN Health and Fitness.

12/14/2007

Get Ready to Hit the Slopes

from the American Council on Exercise

There are several ways to begin a sports-specific training program. The simplest way is to include several new exercises in your regular workout schedule.
For example, performing wall sits that require you to ''sit'' against a wall will help build up the isometric strength needed for the tuck position in skiing. Squats and lunges will build lower body strength for skiing tough terrain like moguls.

Exercises to work your abdominals are essential in creating a solid ''core'' for balance and agility.

It is important to train your body to withstand and absorb the impact associated with skiing. Plyometric movements, such as hopping from side to side, develop muscle power and strength as well as improve agility.

A great way to integrate these elements into your existing routine is to create a circuit training program, which involves rapidly moving from one exercise to the next. You can set up a circuit in any large room, or at your club's aerobic studio.

Try these stations to help you gear up for the slopes: use the slide for lateral training, perform one-legged squats to develop balance and strength, and use a step-bench platform to improve power.

To improve agility, create your own slalom by running between cones.

Click here to read and download the whole article at the American Council on Exercise.

Fit Facts are reprinted from ACE FitnessMatters magazine. Permission granted.

10/22/2007

Stand Tall: Corrective Exercise for Your Upper Body

by Cary Raffle

One of my clients called it "The Wall Street Roll." You know the look, shoulders roll forward, they may seem shrugged, in some cases the head is forward and the back of the hands face forward instead of towards the side of the body.

Some of this may be inherited, but most of it comes from sitting hunched over a keyboard all day. Your shoulders get pulled around in front of you and they just don't go back to where they belong. Down the road, you might experience pain or injury as a result. Common problems include rotator cuff injuries, tendonitis and even headaches. At a minimum, you're not really working the right muscles when you train in poor postural alignment.

The corrective exercise strategy for this posture in pretty straightforward: stretching the muscles that pull the shoulders forward and strengthen the muscles that pull them back. Click here to link to a mini program that you can incorporate into your exercise routine. It is very important to use proper form with these exercises, so please pay careful attention to the notes in the program and let me know if you need some help with them or want a more in depth and personalized program.

Stay away from exercises that are going to make this worse. Earlier editions of this newsletter have covered the "ban" on behind the neck pulldowns, upright rows and behind the neck shoulder presses. Do these exercises over time, and you can kiss your rotator cuff goodbye. You generally also want to avoid incline chest press, front and side raises and overhead shoulder press, depending on the severity of the posture. In some cases, biceps curls - especially hammer curls - can cause pain if the biceps tendon is inflamed where it attaches to the shoulder. If you missed this report or want a refresher, scroll down.

Cary Answers 5 Nutrition Questions

Here they are, based on what I've seen and heard from clients and members over the past few weeks. Names are not named to protect the innocent.

When Should I Eat?
Always eat breakfast. Whether you're trying to lose weight or gain muscle, it is the most important meal of the day. Your body is starving and will look to your muscles and internal organs for energy, so you can't lose fat or gain muscle.
Have a big meal 3-4 hours before working out, a snack about 60-90 minutes before. You can't workout as hard or as long without nutrition.
Don't eat or drink supplements while you're working out. It takes energy away from your muscles and sends it to your stomach to digest what you're eating.
Eat a snack or light meal within about an hour after exercising to replenish the lost energy and help your muscles begin to repair and rebuild.
What about fluid intake?
Have about 2 cups of fluid in the 2 hours before exercising, about a quart during an hour of exercise, and a cup 30 minutes after.
Drink two cups of fluid for every pound of body weight lost after exercise.
Water is the beverage of choice when the exercise or athletic event lasts less than an hour; when it lasts longer, beverages with carbohydrates and electrolytes are beneficial (such as Gatorade). But make sure that you've tried these before the day of the big race or game because they don't agree with everyone.
How many calories do I need?
For men and non-pregnant women: Recreational Athletes need about 15-17 calories per pound; Endurance athletes range from 16-23+ calories per pound; Strength athletes need up to 28 calories per pound. To lose weight, reduce daily calories by about 500 and you'll drop about a pound a week.
For a calculator that lets you plug in you actual activities and food intake and create a personalized plan, visit www.mypyramid.gov.
How much protein do I need?
For endurance training, 1.2-1.4 grams of protein per kilogram of body weight; for strength training, up to 1.7 grams per pound. Consuming more protein is not beneficial and may be harmful. (According to the American College of Sports Medicine, American Dietetic Association and Dieticians of Canada joint position stand).
What's the best supplement?
If you are already getting enough nutrition from your current diet, you don't need a supplement. If you are getting enough protein from real food and add a supplement, you could be adding unnecessary calories. The question should be what nutrients do I need and what is the best way of getting them. (Usually that's real food). Want a great fat burner and muscle igniter? Have a cup of coffee or green tea for the caffeine.
Amino acids are the building blocks of protein, so if you had eggs for breakfast and a turkey sandwich for lunch you've already had plenty of amino acids.
Creatine has been shown to have some beneficial effects in short term strength, but the FDA recommends checking with your doctor and not exceeding recommended dosages.

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