Anti-aging is a weird term. It’s like anti-air, or anti-water. How can you be against it?
Why do we think we can fight aging?

The anti-aging logic is flawed, and preventing aging is futile.
That won’t stop researchers and product developers from aggressively pursuing”anti-aging” genes
or pills. Certainly the appetite for such cures will remain strong and ready to be exploited.

Instead, I think it is much more productive to focus on improving the quality of life.
We need to focus on adding life to years, not just years to life. This mindset shift leads us to proven solutions to living a better life.

90yr old Effie Nielson squats 80lbs, deadlifts 135lbs, benches 50, and can do 10 pushups. She weighs 105 lbs

Haven’t we done a good job by increasing life expectancy?

Advances in providing better nutrition and promoting lifestyle modifications have helped increase life expectancy, but clearly
medical advancements have had a tremendous impact on increasing life expectancy. Treatment of infections, traumas, and organ transplants are just some examples of medical advances that have significantly improved life expectancy. From 1900 to 2007, life expectancy rose from 49.2 years to 77.9. This is a huge accomplishment to be proud of. But successfully increasing life expectancy has overshadowed 2 major problems: A lack of effectiveness in treating chronic conditions and the quality of life has not necessarily improved.

Increasing life expectancy was mostly related to decreased peri-natal deaths and infectious disease. So these increases were mostly due to treating conditions that affected younger people. If we move from analyzing our impact on improving life expectancy from treating acute infections to chronic diseases, we would have to look at different life expectancy figures. The way to do this is to see how much the life expectancy increased for those living past 65 years old. In the last century, a person older than 65 increased life expectancy by only 6 years. In the last 20 years, the life expectancy for those older than 65 has increased only 1 year. Clearly our impact on extending life in the face of chronic conditions is less impressive

More years, not better years.

An alarming trend is clear when analyzing research about the aging process. Over the last several decades, while the number of years someone can expect to live has increased, the number of “quality years” has not. In fact, the number of years someone can expect to live without significant loss of function and disease has actually decreased! This is exemplified by a recent study showing that the Length of life with disease and mobility functional loss has increased between 1998 and 2008. (Crimmons, et al. J Gerontol B Psychol Sci Soc Sci (2011) 66B (1): 75-86.). We are living longer, but not better.

A key term we must understand in addressing this issue is Morbidity, which is defined in relation to aging as the existence of disease or medical condition and the burden or functional disability it causes. So morbidity is living with high blood pressure and high blood sugar requiring medical management and not being able to ascend stairs, get on and off the toilet independently or travel.

This clearly tells us that rather than seeking methods to prolong life, which we have succeeded at, we should instead focus on improving the quality of these years. This does not mean that we give up on efforts to prolong life, but rather increase the emphasis on the need to address morbidity, especially considering the simplicity and effectiveness of strategies available to do so. The questions that this raises are: how do we reduce morbidity and is there evidence that this is possible?

The compression of morbidity

It is inevitable that we will succumb to disease and disability as we near death. There will usually be some morbidity leaning up to mortality. If it was within your control, would you rather choose to be ill and unable to function for  several years as you slowly die, or have normal function before briefly falling ill for a few months before dying? I’m sure we would all strive towards the later scenario.

This concept is referred to as the compression of morbidity: shortening the inevitable decline of function that proceeds death to months as opposed to years. Interestingly, there is some great research to suggest that this is certainly possible.

Is the compression of morbidity possible?

Recent research has found that we can significantly reduce morbidity

Hubert HB, Bloch DA, Oehlert JW, Fries JF. Lifestyle habits and compression of morbidity. J Gerontol A Biol Sci Med Sci. 2002 Jun;57(6):M347-51. This study was performed at Stanford involving 418 adults over 12 years. Those who had less risk factors for disease lived more years without morbidity.

Several other studies support this concept. I recently wrote here about how strength can be improved in older men to levels similar to men half their age with proper training in 12 weeks. Other studies have seen that people can retain 100% of their muscle mass and strength from age 40 through their 80s with exercise! (Wrobelski, A. et al. The Phys and Sports Med, Sept 2011) Countless studies show how exercise plays a dramatic role in reducing morbidity. One particular study looked examined lifestyle habits of older adults who lived passed 85 and had no disability prior to death. The most significant variable associated with living without disability was level of physical activity after 65. Those who were physically active had a two-fold increased likelihood of dying without a disability. (Levielle, et al. Am. J. Epidemiol. (1999) 149 (7): 654-664)

What about those we are already very frail and deconditioned? Are they “too far gone” to reap the benefits reported on exercise to reduce disability? I sadly come across the perception held by many patients and worse by clinicians that the most frail elderly are not capable of benefiting from exercise interventions to reduce disability. Good thing there’s research to lend some insight. Researchers from Tufts showed that not only did frail older adults benefit from exercise, they actually benefited the most! They had higher improvements in strength and function. Guess what type of exercise yielded these results? That’s right – high intensity resistance training. (Fiatarone, MA, et al. N Engl J Med 1994; 330:1769-1775)

Clearly, reducing morbidity is possible and should be a major emphasis for health care policy and how we elect to take care of our selves. It is something that we should focus on whether we are young and in shape or older and deconditioned.

How do we do this?

Enhancing strength is the simplest route to reducing morbidity. Strength has been linked to mortality in older adults. It is the most important variable in reducing falls, preventing sarcopenia (loss of muscle mass), preventing osteoporosis – all conditions that plague us as we age and contribute to mortality. Resistance training has shown to be a vital treatment for preventing and managing osteoarthritis, improves glucose metabolism (the basis of type 2 diabetes), and reduces the risk or heart disease. As the most effective exercise for fat loss, it helps in managing obesity. It is the primary or one of the most effective treatments for addressing the most common causes of death (CAD, stroke, obesity) or morbidity (falls, sarcopenia, osteoporosis), especially in older adults. And considering it’s role in pain management and improving mood, it should be clear that resistance training is especially important if adding life to years is something you are interested in. If there is one thing to do to improve the quality of life as we age, strength training would be it.

Unfortunately, many people are unaware as to what strength training is. Some assume that doing dumbbell curls, balancing on a swiss ball, or doing leg extensions at the gym constitutes and effective strength training program. Many are confused about how much weight, how many sets and repetitions, how many exercises, etc are best. Others have no idea how to do their program safely and effectively. It usually boils down to two issues:

1. how to design a proper program (ie the dosage: what to do, how much, when, etc) and

2. instruction (how to do it, providing cueing and feedback, etc).

Everyone needs help with these two issues, from professional athletes to the morbidly deconditioned and everyone in between. Some need less than others, but they will all need assessment, program design, instruction, and accountability. And that is exactly what we do at Spectrum. I am passionate about making sure people realize this so they receive the proven benefits a proper program can provide them. That’s why I offer a free consultation to those who are serious about optimizing their health. Click here to get started.

If you want to see some videos of some of our older clients showing some examples what proper strength training looks like, check this out.

Death to the anti-aging movement?

It seems to make more sense to focus on a proven strategy that is right under our nose to dramatically improve our quality of life, rather that hold out for hope that someone will be able to defy the cellular mechanism of aging. Although researchers seems to have found that aging occurs because cells begin to die faster than they can regenerate ( cell senescence), no one has determined how or if that can be changed. I’m sure the riddle will involve a relation between lifestyle variables amongst other things having an impact on the cellular mechanisms of aging.

In the meantime, it seems dangerous to ignore the tenant of the compression of morbidity. Ask anyone who is near the end of the life span – they will tell you the same.

It’s no wonder that obesity trends are on the rise, preventable diseases running rampant, and children are succumbing to diseases and injuries at increasing rates that were previously seen only in adults. Painful conditions like low back pain have reached epidemic proportions as well.

We are being deceived all the time about what is healthy, how to relieve pain and how to get fit. The medical community, fitness community, government policies, “fitness gurus” – they are all at least partially to blame. But this wouldn’t be so if there was an underlying belief that we are all personally responsible to seek the truth. Instead we are drawn to talk shows, infomercials, fads, and reality shows to get answers, and rarely question the same old advice that fails to get results.

People actually take her seriously?

Prevention is Everywhere, Results…Not So Much!

All these devastating conditions are on the rise in spite of advances in pharmaceutical, surgical, and  imaging sciences, as well as a flourishing multi-billion dollar fitness industry. How can this be?

The Cure for Misinformation

Whether you are an exercise newbie or a fitness freak, you likely are weighed down by a healthy dose of misinformation. In fact, the more time you’ve spent in a gym or a clinic, the more you are being weighed down by misnformation about fat loss, injury prevention, rehabilitation, and performance enhancement. The reason why this country are going in the wrong direction towards improving health is because of misinformation. We are being fed irrelevant and inaccurate information.

Knowledge is the key

Researchers wanted to know the most important factor for determining long term compliance to an exercise program.  They discovered that the most important factor was…

KNOWLEDGE!

The more the subjects knew about how and why to do their exercise program, the more likely they would comply.

I would imagine the same would relate to nutrition.

Expose the Fallacies, Get the Facts

If you want to take an active role in seeking the true solution to improving your health and fitness and you believe that people should seek out the truth from credible sources, not just listen to the loudest, glitziest, and simplest fad of the week, then I can help. And if you think you know someone who has had the wool pulled over their eyes - please send this to them. (these people are easy to spot – they go to the gym, always have aches and pains, or have dozens of tapes and fitness gadgets in their home).

In effort to tell people the truth about getting healthy and fit based on research, experience, and common sense, I am hosting a seminar at the Spectrum Fitness Consulting Studio, titled, “Fitness Facts and Fallacies” on Thursday, July 21rst, from 6-7:30pm. Admission is $25 if you register after July 14th. If you register before July 14th, registration is only $15.

Here are some of the issues we address – see if you can distinguish fact from fallacy:

• Eating late causes more fat gain
• Cardio is the best way to burn fat
• Eating eggs increases cholesterol
• Resistance training machines are safer than free weights
• 60 minutes  of exercise/day most days of the week is best for health and fat loss
• Fat intake is associated with stroke and heart disease
• Strong abs prevent back injuries
• Eating small, frequent meals is best for fat loss
• Food is not addictive
• Most fitness trainers teach safe exercise
• More fat is burned at moderate intensities, known as the fat burn zone
• Rapid fat loss is less effective in the long run

Attend for Free!

If you bring another friend or family member with you, you can both attend for free! Be sure to call Kristine at 978-927-2065 or email at schedule@spectrumfit.net to reserve your spot today, as seating will be limited.

To celebrate the Fourth of July, some attend patriotic parades, others firework displays, and many go to cookouts. Me, well I chose to hang out in the ER, then the OR at Holy Family Hospital in Methuen.

Last Sunday I completely ruptured my patella tendon as well as my lateral and medial retinaculum. For those who aren’t aware, the patella tendon is the tendon (actually it is a ligament, but referred to as a tendon because of its role in knee extension) that connects your patella and quad to the tibia, or shin bone. Without it, you aren’t able to walk, stand, or straighten your knee.

So how did this happen? Well, there was this kitten stuck in a tree…ok not really. I don’t have a good story. Unfortunately, a heated game of horse enticed me to perform a dazzling running hook shot to put my athleticism on display (count the oxymorons in that sentence). As  I  planted my leg to explode into untold heights,  my foot slipped just as  I was ready for liftoff, and I felt like I had been shot in my knee. As I clutched my knee, I saw my patella was relocated up my thigh, and knew that I had ruptured my patella tendon. My leg was in extreme spasm, and my quad was pulling my knee cap further up my thigh. Fortunately, a fellow PT was at the party and he extended my knee so that the quad could relax and the patella returned to somewhat of a normal location. After a brief stay in the ER and a night at the hospital, I had surgery the next morning on the 4rth of July.

left, where the patella goes when the tendon ruptures. Right, where the patella should be

All went well, although I was disappointed that there were no burgers or beers waiting for me in the recovery room – that’s no way to celebrate the fourth. For the next few days, my time was spent in the hospital watching bad TV, recounting my lame mechanism of injury to concerned family and friends, and interacting with the amazing staff at Holy Family Hospital in Methuen. Being restricted to no leg movement and no weight bearing for 6 weeks, hopped up on narcotics, and sans laptop, I had little to do except contemplate how I would attend to all my responsibilities being laid up like this, how miserable the rehab was going to be, and how lucky I was that I have all the resources and circumstances to deal with all this. Most importantly, I realized how this injury, although extensive, pales in comparison to what many people go through every day.  And I had the opportunity to have lengthy conversations with everyone I came across in the hospital, from Doctors, nurses, aides, janitors, volunteers, administrators, and even clergy. Those conversations were a real silver lining to the whole injury storm cloud.

Perspectives From the Patient

All the while I wondered how this experience would lend perspectives and secrets to help my clients and patients improve their health. I have plenty of first hand experience with injuries and from each I have learned priceless lessons that have really helped those I treat. Only a few days out from surgery, I have already amassed several. So here are some lessons that will surely help you along your fitness journey:

1. Never take function for granted – always focus on maximizing your function. Being able to move and participate in basic daily activities, as well as high level work tasks and sports functions is probably the greatest gift we have. Few appreciate this until it is gone, even if temporarily. Requiring assistance going to the bathroom, not being able to get into a car or hold your kids sucks. When you are complaining about going to the gym or feeling lazy, remember that there are people who would give anything to run, jump, or simply do the basics we take for granted. If you have your function intact, consider it an obligation to take great care of it.
2. Injuries happen –even if you do everything right.  Sometimes, we simply can’t control what happens, especially if you play sports. Which is all the more reason why we should aim to prevent the injuries we know we can prevent, or at least significantly reduce the likelihood of experiencing, like most low back and neck pain, rotator cuff injuries, tendonopathies, ACL injuries, and stress fractures to name a few.
3. Technique is vital! It has been estimated that a healthy patella tendon can withstand up to 17.5 times your body weight prior to failure. So how could jumping cause a rupture? Well, several ways, but I suspect in my case it was at least partially related to my center of mass shifting well behind my base of support as my foot slipped forward and my body fell backwards precisely at the same time I applied force to jump. This significantly increases torque. Similarly, poor technique can dramatically change the physics of an exercise, such that a safe exercise becomes an injurious exercise
4. Don’t say “can’t” –  FIND A WAY! I have witnessed C5 quadriplegics transfer independently in and out of their wheel chairs to their bed. Far less extreme, from wrapping the upper end the end of a crutch around my foot and changing the furniture around  in my living room, I figured out how to independently get on and off my couch with a leg immobilizer, no quad intact, and no weight bearing allowed on my leg. The first time happened in the middle of the night – I had to go to the bathroom, was on the couch in the living room and didn’t want to wake up my wife and kids by yelling upstairs for help. It took me 3o minutes, but I figured it out. It never occurred to me that I could not do it. There are people far more disabled than I and navigated around greater challenges. When things seem daunting and they are important, you find a way. When it comes to your health, no matter your family crisis, work issues, or personal demons – you need to address your health – you have to FIND A WAY!
5. It is never as bad as you think. Our brains tend to catastrophize. Our thoughts are usually far  worse than reality. Opportunities to learn and great experiences usually hide amongst struggles and challenges.
6. Broken bones and leg injuries are the easier injuries to deal with compared to back and neck pain. I’ve herniated discs in my spine and had fractures and tears requiring surgery. The latter are much easier to deal with. First, you have visible damage, both via imaging and externally with a brace or cast and crutches that everyone can see. Everyone sympathizes and accommodates someone with crutches. No one debates the significance of the injury. The cause is usually well known by all involved. Even though the pain might be greater and the healing time is longer, the suffering is often less with these injuries compared to that of low back pain. Low back pain is more variable, the cause is more elusive, and the damage is not obvious or visible. Something to think about when you or someone you know is contending with low back or neck pain.
7. When things are bad with you, focus on everyone else from time to time. The day after surgery, I was bored as hell and sick of being drugged up and in the hospital. I knew my stomach wouldn’t take the morphine much longer, plus I needed to show Physical Therapy that I could walk independently with crutches and go up and down stairs in order to get back home that night. So, I stopped the IV, and periodically meandered up and down the hospital halls. Still bored and sick of telling people the same story about what happened to me, I resorted to talking to every single person I came in contact with. I had lengthy conversations with the nurses,  phlebotomists, administrators, janitors, aides, and anyone I came across. My goal was to find out as much as I could about them and their day. That was the best day since my injury. Although the pain was worse, I felt so great hearing the interesting stories and seeing the smiles on people when someone seemed really interested in knowing how they were doing. I honestly wasn’t trying to be a great guy, I was really bored. But I realized how good it felt to get outside of yourself and your problems and focus on someone else for a moment. Of course, don’t do so to your detriment, but rather as a means to simply feel  good, and make someone else smile.
8. Many people really want to help you:  If you know someone in the healthcare industry, odds are you know someone who genuinely likes to help those who are sick or hurt.  That is the same thing with the employees at Spectrum. My biggest accomplishment as a business owner is assembling a team of people who genuinely want to help people get more healthy and fit. When you need help, and there are people around you who desperately want to help you – let them.
9. Humor fixes most things: Getting hurt is serious stuff, but making someone laugh relieves a lot of tension and anxiety. A sense of humor is a great trait when times are tough. It is hard to feel pain when you are laughing!
10. Pain does not always come from mechanical damage: Much of the pain after a trauma, especially the days following, is from the chemical irritation as a consequence of inflammatory byproducts, the pressure on vascular and neural structures caused by increased volume if fluids, and the hypoxia and impaired tissue perfusion resulting from altered pressure gradients between cells and blood vessels. Also, the peripheral nervous system becomes hypersensitive, and even the central nervous system changes in response to pain. So even when a structure is mechanically stabilized, pain will often persist. That’s why intermittent movement, elevation, compression, ice, medication, and proper nutrition are some important things in managing pain.

Well, that’s about all the lessons I can think from my perspective as a recent patient. My hope is that you translate these lessons to help push you towards accomplishing your health and fitness goals, which can be equally, if not more so of a challenge as recovering from a major injury.

And when you need help, we are always here for you! Give us a call or request a consultation, and we will get you the results you deserve!

It is estimated that at any given time, about 65% of the population is experiencing back pain. 85% of the population will experience significant back pain at some point in their life. Back pain is the second most common reason that patients seek medical treatment behind the common cold. The economic consequence of low back pain total nearly 20 billion dollars a year.

It might seem implausible to suggest that getting rid of back pain is easy, given the severity of this epidemic. But when you consider that some studies show that most episodes of low back pain will resolve in less than 4 weeks regardless of what treatment you receive, it should make more sense.

Getting rid of acute low back symptoms is not the problem…

 Keeping back pain symtpoms from coming back is the real issue.

Studies show the recurrence of low back pain is 84%.  And the small percentage of people who suffer from Chronic low back pain account of nearly 65% of all the costs associated with Low back pain.

The key issue should be clear: We need to focus on preventing the recurrence of low back pain, not simply the resolution of acute pain. Keeping acute back pain sufferers from evolving to chronic or reoccurring back pain victims is the real trick.

Recurrent low back pain is not only more costly, but subsequent episodes tend to cause more pain and suffering, lasting longer and reoccurring more frequently. Furthermore, studies show that impairments link to low back pain can persist, even though symptoms have resolved.

The cause of low back pain must be identified if we are to prevent it from reoccurring.

Low back pain is difficult to treat, because there are so many different presentations, and thus different causes and treatment strategies. Perhaps the biggest hurdle is that there is so much misinformation about what is effective for treating  and preventing various types of low back pain.

 Fortunately, there is a ton of research to guide the informed. Unfortunately, it can be difficult to sift through the B.S. and get to what works, based on research, common sense, and experience. This is a big part of my mission lately, as I have been traveling around the eastern half of the country providing lectures to Physical Therapists regarding the causes, examination, and treatment of low back pain. It has been a great learning experience.

I wanted to pass along some of this information to my subscribers, because I’m sure many of you have had some experience with low back pain, or at least know someone who has. Accordingly, I’d like you to have this special report: The Real Cause Of Low Back Pain…and how to keep it from coming back! Click on the link to download it as a PDF.

This will give you some unique insight about low back pain that you probably have not heard, but need to know.

The more I learn about low back pain, the more I’m convinced that this issue can be solved, and at the very least managed so that low back pain does not get in the way of doing what you want to do.

I hope you enjoy this, and please reach out to me if you have any questions!

Perhaps the most interesting thing about low back pain I’ve come across  is that there is much  more than just the static and dynamic structures of the spine  involved in the pain process. In fact, it seems clear that the nervous system, including the brain, are huge players in low back pain.

I’m big into simple analogies – it is the way that I learn, and it seems others do as well. So consider this analogy to grasp why knowing that the central nervous system is a big player in low back pain is so important:

Let’s think of the spine and the nervous system like the lights in the room you are in. In the spine, we have bones, joints, discs, ligaments that are commonly source of pain. Exiting from these structures are nerves, which eventually are connected to the spinal cord and ultimately to the brain. Similarly, the light bulb is like the spinal structure, the wires are like the nerves, and the generator is like the brain. It is clear to understand how damage to the light bulb, fraying of the wiring, or a malfunction of the generator can cause problems with the lighting. Damage to one structure can compromise the functioning of the other. For example, improper light bulb wattage could short circuit the generator, or a frayed wire could eventually burn out a light bulb.

 Well, this can also happen in the spine. We are all aware that damage to the spinal structures can cause pain. Unfortunately, we seem to be excessively fixated on this, which maybe causing clinicians to miss the boat on other contributors to the pain process. It has been postulated, and even proven that the brain is impacted and actually changes in response to chronic pain. Moreover, treatment directed at  the brain (behavior modification and education) actually changes pain threshold and physical performance. What is even cooler is that these brain changes are not permanent, and are in fact reversible to some extent. Consider this recent research:

Chronic Pain Causes Brain Shrinkage – But it Can be Reversed!

David A. Seminowicz, et al. The Journal of Neuroscience, 18 May 2011, 31(20)

Researchers looked at 16 people without pain and compared their brains to those of 18 people who had chronic back pain. Those with chronic pain had 6 areas in their brains that were thinner and less densely packed. These areas were involved in attention, judgment, reasoning, as well as processing mood, pain, and judgements about others. What was even more fascinating is that 14 of the pain sufferers where studied a year later, and they were able to show that in those who had reduced symptoms, the brain thickness and their cognitive function had improved. 3 of the 14 had symptoms that were worse than before, and in these people the brain structures had not regenerated at all. Clearly, pain causes changes in the brain.

 Why back pain is not to be ignored – and we must focus on the cause!

What we must learn from this is that structural damage can involve more than just obvious damage to the skeletal tissues. This damage will in turn affect the nervous system, especially if it is not resolved relatively quickly. We must appreciate that the damage is often more far reaching than the local pathology of the spine.

 Some clinicians may flippantly suggest that acute episodes of low back pain are really no big deal, and that no matter what you do, most cases resolve in a few weeks on their own. And they may even site some research to support this line of thinking. But they are completely wrong. Here’s why:

1. 80-90% low back pain episodes  reoccur, and when they do, symptoms are usually more disabling. So while the symptoms may be fleeting, if the cause has not been identified and addressed, odds are that we will experience more severe back pain in the future.

2. A small percentage of cases of acute low back pain become victims of chronic pain. However, research clearly shows that the small percentage of chronic low back pain sufferers account for the overwhelming majority of costs associate with own back pain. And most of those costs are associated with decreased productivity and sick time, while a small percentage of the costs are related to seeing medical providers.

So perhaps we will take the cases of low back pain more seriously, and consider the far reaching impact of chronic pain. Not only does it  impact upon our economy and our suffering, but it involves more than discs and bones.

 When the brain is involved, it tends be get people’s attention. Hopefully the brains of those who treat back pain will get more involved as well!

Stay tuned for more suggestions on how to treat and prevent low back pain, as well as addressing fallacies of low back pain.  In the meantime, if low back pain is holding you back from getting fit, click here.

Pain is a powerful force. It is feared and respected. It is the most common reason for which we seek medical advice. Learning how to manage it, prevent it, and eliminate it is incredibly empowering. That’s why I’m excited to share some thoughts about pain and exercise.

It is not uncommon to suffer pain unrelated to exercise, and wonder if exercise  or certain activities will help or irritate the cause of pain. Accordingly, I want to pass along some perspectives about managing, treating, and preventing pain as it relates to exercise.

2 Pain Disclaimers

1. Don’t ignore it or trivialize it. The bravado about ignoring pain is mostly B.S. Pain is not to be ignored, it to be understood. Pain serves a great purpose in the human experience. If you aren’t convinced, then imagine what life would be like if we didn’t have the sensation of pain. Thanks to a rare congenital disease that only affects about 35 people in this country a year, we can know exactly what it would be like to be without pain. Most afflicted with this disease will not  live past 3 years old, and the longest life expectancy is 25 years. The crippling affects of infections and traumas that can’t be detected take an extreme toll. Clearly, pain is essential.

2.  Pain is a very complex and multidimensional phenomenon. Obviously, no article or instruction can possibly do justice to explaining the complexities of pain. That probably explains why I have started and stopped this post about 20 times. However, it is best to have some general guidelines. What follows can serve just as that, which I hope will be very helpful to you!

Now that we except that pain is complex, purposeful and not to be ignored, lets discuss some practical aspects of pain as it relates to exercise.

The pain traffic light: Go or No Go?

This is a very basic tool I use to help decide if a certain activity should be performed when someone has an injury or a potential for re-injury. I call it the pain traffic light, and it is really a simple grid.

So here’s how it works. Let’s say your back pain has been acting up. You have a history of disc injury. It is painful any time you sit for prolonged periods of time or bend to put your socks on. You are wondering about what activities you should do this week. Activities in question are going to work and exercising.

Let’s take going to work, which in our hypothetical case involves prolonged sitting: In most cases, you have to do this, that is – go to work. But it is high risk, because you are sitting at a computer most of the day, which is known to contribute to back pain.

So what do you do? I’ll answer this in the context of the optimization versus avoidance strategy

Avoidance versus Optimization Strategy?

If we apply the above grid, and we assume that for whatever reason staying home isn’t an option (job security, tight deadline), we can see that the issue of going to work yields a yellow light. This means we need to proceed with caution, because pain or injury is possible if you choose this activity.

In dealing with pain and injury, you have essentially 2 strategies: avoid the activity that is causing the problem, or optimize how you do the activity so as not to experience the damaging effects of participating in the activity, as well as avoiding the consequences of not partaking in the activity. Perhaps a third benefit of the optimization strategy is the ability to learn how to manage and prevent future occurrences of damage and injury. As you can imagine, most activities when applying the go or no go pain traffic light fall into the yellow light, and thus the optimization strategy of treatment.

Getting back to this specific example, let’s apply the yellow light optimization approach to our sitting at work with back pain scenario.

First, the patient needs to inherently understand the risks of prolonged sitting on disc health – so education here is key. Second, we need to understand that position while sitting can increase or decrease the stresses experienced by the spine while sitting. For example, most will typically sit with a flexed posture, thus increasing the stress the discs experience while sitting. We can minimize the stress the spine experiences by sitting with a neutral lordosis, thereby optimizing the spine’s position to disperse load across the structures of the spine. However, this doesn’t address the negatives of prolonged sitting. Even if we maintain neutral spine while sitting, we still experience stresses that can aggravate existing spine problems. Also, the ability to sustain neutral spine can be limited because of endurance issues and attention issues (we tend to lose focus on posture over time). So, we enlist a few simple strategies centered around interrupting prolonged postures:

1. Deload: briefly relieve the accumulation of pressure on the spine for several sets of 10 second holds by pushing you arms down on your seat, lessening the pressure on your spine. For a more complete description on how to do this, click here. Do this every few minutes or so. There are many alarms you can use (check google) as discrete reminders if needed.

2. Get up frequently. Simply, get out of your chair every 5-30 minutes and either stand or walk around. Just a few seconds can help. Standing to take phone calls is a good reminder to get up.

In pain: to exercise or not?

Let’s address another common scenario using this case and the pain traffic light grid. In this same example, our person with acute back pain, is also wondering whether he should exercise. At the outset, this seems pretty obvious. Exercise is risky, and you don’t have to exercise, so this is clearly a red light right? No – not right at all. Here’s why.

Quite simply, exercise is not risky, that is if you are doing it correctly. That means you have a program design that is scalable, and you have proper technique. Furthermore, we could classify exercise for many people as “have to do”, especially if you are considering the profound benefits. But even if we stay in the strict limits of the grid, we can certainly classify exercise with acute back pain in this case as a yellow light. Choosing to exercise as a means to manage and solve pain can be one of the most important learning experiences for optimizing performance and function.

It might be hard to imagine that exercising with acute back pain is a good idea, so let me walk you through a specific example. And before I go on, this isn’t going to be  “pain is all in you head” or “no pain no gain” garbage philosophy. Just real experience played out hundreds of times.

In this case, upon exam it is clear that this person has pain with flexing the spine, loading the spine, and keeping the spine in prolonged static positions. This is not a problem, because proper exercise does not require any of these stressors to be effective. Here’s how I have successfully approached this common case:

• Extensive education on the above. I would also reference issues I’ve described in depth about Low back pain here and here as well. When you are in pain, the only thing that makes senses initially is protect and avoid. Most don’t see exercise as part of this idea, but it is- it just needs some explanation first.

• Now that it is accepted that exercise will not impose the stressors on the spine that replicates spine damage and pain, we proceed to target critical movements that will make for an effective exercise program, pain management strategy, and injury prevention strategy. Here are two examples of seemingly “Red Light” exercises that are perfect options for treating, managing, and preventing back pain and how they would be applied in this case:

Squat: seeing as we must get on and off toilets and chairs, it would be a good idea to re-examine the concept of a hip hinge in neutral spine. That simply means teaching someone to bend at the hips, not the waist, to spare the spine of irritating forces. Depending on the person, we may need to completely eliminate any external load and in some cases, we may even need to deload  below body weight. This is still productive from an exercise standpoint because it hones proper technique. Pain is a great teacher, and if you do the hip hinge correctly while in pain, you will know it right away. Teaching someone how to squat while in pain is the quickest way to learn proper squatting. It is also the quickest way to reduce symptoms, because you make an everyday activity that was once painful, pain free.

Lunge: the same concepts as above apply, except you are now increasing load on the legs without increasing load on the spine. With a lunge, you are putting nearly your entire weight on one leg, so it is more of a stress on the leg muscles, but you don’t have to add any more weight to your spine, so it is a better fitness stimulus without the penalty. Also, it gives you another pain free movement strategy to move down to and up off the ground, and further ingrains the motor pattern of the hip hinge.

There’s much more to this, but the point is to get an appreciation for the go or no go application of the pain traffic light, especially by illustrating a common example.

Again, I hope I can impress upon you that there are no simple explanations of pain and accordingly simple rules to follow in all cases. But hopefully these pain traffic light grids can help you in deciding whether you should do an activity and if so how to proceed. At the very least, it can give you a frame work to apply some good decision making as you learn more about your body, and a better appreciation for the science and art of interpreting your body’s signs. which brings me to one final point…

Listening to your body

I want to finish this by addressing a common suggestion for deciding how to manage pain as it relates to activity. I always hear the people saying “Just listen to your body”, and it conjures up the same feeling when I hear “Just eat right and exercise”, or “save money and spend less”. My response is always, “gee, thanks, but the issue is how the heck do you do that!”

Listening to your body is really a skill. Their are 2 types of people who are particularly gifted with this skill: 1.) Athletes or highly active and motivated people that have experienced multiple types of pain from injury and pushing the body to the limits and 2.) Clinicians who have studied the body and are charge with the responsibility of interpreting, treating, and managing multiple types of conditions and people producing and experiencing pain. And sometimes, there is a third type of person – someone who is both 1 and 2! I have the somewhat dubious distinction, yet priceless perspective of being that person!

So the best way to listen to your body, if you don’t want to become a clinician, or are not a highly trained athlete, is to spend some time with someone who can teach that skill. Like an auto mechanic that makes sense of the mysterious squeaks and squeals your car makes, the right professionals can turn your pain complaints into a treatable plan to optimize your function. Click here to learn how.

The list of benefits of exercise is staggering. Reducing inflammation is yet another one you can add to the list.

Inflammation is not just something that happens when you sprain your ankle. Inflammation is the response your body takes to heal any tissue in our body that is damaged; bones, skin, muscles, nerves, cartilage, organs, blood vessels. Although a normal reaction to damage, if inflammation is chronic it can be a big problem.

Chronic inflammation is linked to a host of diseases. There is a well known link between chronic inflammation and Cardiovascular disease.  When blood vessels are damaged, the inflammatory process begins. There are markers in our blood that indicate the level of inflammation in our body. This is measured every time you have a standard blood test by your PCP, and it is called your C-reactive Protein level.

Clearly, reducing C-Reactive protein levels is beneficial, and research indicates that exercise does this.

Anti-inflammatory effect of exercise training in subjects with type 2 diabetes and the metabolic
syndrome is dependent on exercise modalities and independent of weight loss
S. Balducci, et al Nutrition, Metabolism & Cardiovascular Diseases (2010) 20, 608e617

Researchers found that those who exercised were able to reduce elevated C-reactive Protein levels. The interesting finding was that this reduction was not dependent upon weight loss. Many have thought that it was that fat loss that was responsible for C-Reactive protein level improvements, however this study shows that exercise, independent of weight loss, is responsibly for the C-reactive protein improvements. The other interesting finding is that these improvements existed only if the exercise was high intensity and supervised combining both aerobic training and resistance training. As a side noted, markers of insulin resistance also improved.

This is a recurring theme repeated in the literature, whether it’s about fat loss, cardiovascular benefits, performance training, diabetes prevention, osteoporosis management, etc: supervised high intensity comprehensive training is critical to reap the profound benefits that exercise offers.

The problem for many is individualizing that prescription, especially for those who have difficulties with intense exercise. This is our specialty. Click here to learn about how we can do this for you

Most would consider that 2 weeks following a spinal surgery would be a bad time to start a drastic fat loss program(I’ve written about quick versus slow weight loss here). Especially considering very little, if any significant calorie burning exercise was involved, because this is contraindicated after such surgeries.

However, I think anytime is a great time to drastically improve your health, and the best time is when you are ready.  And this past May, only days after her spinal surgery, Laura C. was ready!

Laura knew she needed to make some changes, but was a bit uncertain how, given that her diet was not awful, and aggressive exercise wasn’t in the cards given her back issue. Knowing that she was getting great care in Physical Therapy, we turned her attention on doing some tests and measures, analyzing her current diet, and designing a meal plan for her. She was advised to follow-up every few weeks, then monthly to re-assess.

Every time we followed up, we noticed a few trends. First, in spite of a significant calorie reduction, she noticed a huge spike in energy, and she wasn’t starving. This is actually a common finding with many of our fat loss clients. Second, she made dramatic improvements in fat loss. And third, she was remarkably compliant – not veering off her plan but for one or two “audibles” she called at cookouts here and there.

By the end of the summer, she had made impressive improvements, and was able to begin incorporating more aggressive exercise beyond physical therapy.

Her recent reassessment revealed her remarkable progress:

• Fat loss: 43.6 pounds
• Body fat % loss: 16.73%
• Muscle gain: .77 lbs
• inches off waist: 6.75 inches
• inches off hips: 6 inches

Not bad for 5 months time! Amazing work Laura!

The key lessons here are that you can be aggressive towards reaching your fat loss goals even if the conditions are not ideal. Don’t wait until the perfect time – there is no such thing. Make a decision, and move forward. As long as you have a sound plan, backed by research and real world experience, and reinforced with accountability and commitment, you will make amazing, life changing progress.

If this is something you want, click here to get started.

Great Spinal Health Article

I wrote a chapter detailing the essential elements of spine health geared towards those who want optimal functioning, including high level athletes and weekend warriors. This was part of the LiftStrong project. I detail the causes of LBP, prevention, and treatment strategies. You ave but the CD to get the article, and it is way worth it: you will get over 800 pages of info written from the top names of the fitness industry, and 100% of the proceeds go to the Leukemia Society, al for $25.

Exclusive Interview: Michael Stare

As you’ve probably already surmised by now, I’m always looking to meet new physical therapists who are effective at bridging the gap between healthy and injured athletes. The sad truth is that just as there aren’t many trainers/coaches who really understand musculoskeletal dysfunction and the resulting pathology, there aren’t many PTs who really understand what an athlete puts his/her body through on a daily basis.

Let’s just say that I’m lucky to have found Mike Stare, and it’s just my luck that he’s right up the road from me here in Massachusetts. Mike is a brilliant PT and trainer from whom you can expect to hear a lot more in the months and years to come; we’re already brainstorming on some projects together. Here’s a small sample of the great information Mike has to offer; as I told Mike, I think it’s some of the best information we’ve had in any interview at EricCressey.com thus far.

EC: Hi Mike, thanks for taking the time to join us today. Before we get cracking with the interview, could you tell us a bit about who you are, where you’ve been, where you are, and where you’re going?

MS: I’m a Physical Therapist and a CSCS, practicing with Orthopaedics Plus in Beverly, MA, as well as Director of Spectrum Fitness Consulting, also in Beverly.

My early years as an oft injured and undersized athlete landed me in the orthopedists’ office far too often. After a serious neck injury from football, I found myself in Physical Therapy for several weeks. That experience really opened up my eyes and I decided that I wanted to pursue a career as a PT.

I studied kinesiology at the University of Illinois, and began working as a personal trainer for the division of campus recreation. I also worked with the spinal cord athletes there, and had an opportunity to travel to the 1996 Paralympic games to work with spinal cord injured athletes.

I moved East to pursue a Masters of Science in Physical Therapy at Boston University. I continued to work as a personal trainer with the Boston Sports Clubs and obtained the CSCS while I was in grad school. I also had the opportunity to help develop and teach a training curriculum for the trainers at BSC.

After graduation, I worked in an outpatient rehab hospital where I saw the full spectrum of conditions. I treated a C5 quadriplegic who was more athletic the most people I know, a lady who had both legs amputated from her pelvis (best pair of arms on a 60 year old I ever saw and a heart of gold), bodybuilders with overuse injuries, chronic low back pain – you name it – I saw it. It was a phenomenal learning experience, but I knew that I needed to focus in order to hone my expertise. So I choose to concentrate on orthopedics, and jumped on board with Orthopaedics Plus.

I returned to graduate school part-time while working full time as a clinician to finish my Doctorate in Physical Therapy, and then completed a two-year fellowship in orthopaedic manual therapy. That was an invaluable experience; I learned from what I truly believe to be the greatest minds in Physical Therapy.

I had moved away from personal training while pursuing my post-graduate studies, and I really missed it. As a clinician, I grew frustrated with the fact that many of my patients were seeing me for injuries or conditions that could have been prevented if they had received the proper training or education. I thought I was going to lose my mind if I saw another 16-year-old girl with excessive genu valgum and the glute strength of a mosquito limping in after ACL reconstruction waiting to get back to her three soccer leagues.

I decided that I needed to provide a service that would not only help people recover from their injury, but also reduce their injury risk and enhance their performance and health. As a result, in partnership with Orthopaedics Plus, I formed Spectrum Fitness Consulting this past January. We focus on providing personal training services, as well as sports conditioning for young athletes. Our studio is located adjacent to the PT clinic, which facilitates me working as both a clinician and a trainer.

We are rapidly growing and have some excellent new programs coming soon. I’m looking forward to finding some quality trainers to help us grow, as well as expanding our reach throughout the North Shore region, developing more of a web presence, and hopefully perform some research in the near future

For now, I’m trying to stay focused on getting things done right, keep my head from spinning off, and enjoy hanging out with my new baby and my wife as often as possible.

EC: You’ve done quite a bit of research on preventing elbow injuries in young pitchers; what have you got for us?

MS: Last fall I had the opportunity to mentor a Doctoral Student from BU. We found some great info about elbow and shoulder injuries in young baseball pitchers. Among some of the most notable findings:

• Injuries in young pitchers most often involve the growth plates, as opposed to the rotator cuff, labrum, or ligaments commonly seen in adults
• The growth plates are the weakest link in the joint complex in young pitchers.
• Growth plates in the elbow are open until about 16 and until 19-22 in the shoulder.
• Injury to the growth plate is very difficult to detect, except in severe cases. Thus, early and appropriate response to pain is critical.
• Pitch counts and pitch types are associated with risk of elbow and shoulder injury. Researchers from the American Sports Medicine Institute (ASMI) have given specific recommendations for pitch type and count based on their findings. For example, a sample of 476 9-14 year olds who threw curve balls had a 56% increased risk for shoulder pain and those who threw sliders had an 86% increased risk for elbow pain. A sample of 330 9-12 year olds showed increased incidence of elbow and shoulder injury occurred with:
  • Those who threw >75 pitches/game or 600/season
  • Pitched in multiple leagues
  • Experienced arm pain during the season
  • Pitched less than 300 pitches per season.

EC: Very interesting; we often hear about throwing too much as being a problem, but some kids were actually having problems from not throwing enough pitches and then going out to “turn it loose?” In other words, is that 300-600 pitches/season number precedent for a “golden pitch count rule?”

MS: No, I don’t consider it as a golden rule. Rather, it should provide a basis from which coaches, clinicians, and researchers can begin to establish the boundaries between what is too much stimulus for a developing arm, and what is not enough stimulus to facilitate enhanced motor skill and optimal conditioning.

The research from ASMI and others is merely revealing initial data about factors that correlate with shoulder and elbow injury, not cause the injuries. Pitch counts are a convenient way to quantify arm stress, but they are far from perfect. The research regarding this topic is still very new and continues to evolve. Pitch counts are just one of the many factors related to increased risk.

I think focusing on a firm pitch count for the season may be a problem in that it relieves the coaches, parents, etc., of responsibility of considering other variables that may also indicate increased risk, essentially, providing a false sense of security.

It still isn’t clear why pitching less than 300/season was associated with risk of arm injuries. Perhaps those who threw less had less skill, and thus imposed greater stress upon their arms. Maybe they were less conditioned. Or perhaps, as you mentioned, they progressed their volume of throwing too quickly. The higher risk with throwing greater than 600 seems more obvious – perhaps it was just too much?

Regardless, I think the problem is not simply about too many pitches or too few pitches in games over the season. There seems to be a trend towards kids playing in less informal settings, and more often in competitive settings. This has some significant implications. Less informal play means less opportunity for honing the motor skill of throwing. Motor learning is best developed by practicing frequently, in small chunks of time, at initially lower intensities. This is what is typically done through informal play.

There is a big difference between how you throw in a competitive game situation versus while practicing or playing catch with friends. Thus, kids are in more frequent situations that place higher stresses on the arm, while spending less time improving their motor skills. Given this trend, I think it becomes clear why the incidence of arm injuries is one the rise.

Improving their conditioning and responding to the early warning signs of injury would substantially offset this higher risk. Combined with coaches focusing more on teaching the skill of throwing, while gradually increasing the volume and intensity of throwing, the incidence of arm injuries could be greatly reduced. Rather than just focusing on the pitch count, I suggest coaches and parents also simply rate velocity and control each inning, as well as observe any other signs of a change in mechanics or taking more time between pitches. This will be more effective than just quantifying pitch count.

EC: Great stuff – sorry to interrupt. What else have you got?

MS:

• Certain flaws in pitching mechanics will predispose the shoulder or elbow to greater stress. For example, excessive shoulder rotation at initial contact of the stride leg, and a more cross body horizontal arm follow-through leads to increased torque on the elbow.
• The humerus rotates up to 7000 degrees per second in from late cocking phase to acceleration phase, and the arm experiences a distraction force of up to 1.5 the athlete’s bodyweight during the deceleration phase
• Clinicians and surgeons are reporting a 5-6 fold increase in pitching related elbow and shoulder injuries in youth pitchers.

I’ve seen too many kids devastated by realizing that their throwing careers are over at age 15, recovering from their second arm surgery. There’s too much information out there; we need to apply it.

EC: Agreed! So why aren’t more trainers and coaches putting this information into practice?

MS: Although we found some great info about kinematics, kinetics, and epidemiology, there was very little information about conditioning or training strategies. It was implied by almost every researcher, but never thoroughly discussed. That is were my “Young Guns” program comes in. Our program will be the only that I’m aware of that will emphasize not only the preventative strategies via pitch count, pitch type, and throwing mechanic alterations, but also implement specific conditioning strategies. As with so many other conditions, the ability to generate and translate force through out the entire kinetic chain, as well as efficiently decelerate, correlates with improved performance and reduced injury. I think this reasoning applies perfectly to throwing athletes, and they should be trained accordingly.

EC: Great stuff; I’m sure it’ll be fantastic. How about correcting injuries once they’re in place? Any rehab tips for those who already have bum elbows?

MS: The injured tissue must be identified first. This is especially important for young athletes, as growth plates are particularly vulnerable. Treating a growth plate injury will be much different than treating a lateral epicondylopathy. Seeing an orthopedist who specializes in elbows and shoulders – together with a PT with a manual therapy background – is your best bet.

Next, identify the cause of the problem. It’s always easier to investigate a crime closest to when it was committed. The irritating factors must be modified or avoided.

Look at the shoulder, thoracic spine, and hips for mobility deficits. Inadequate mobility at any of the joints along the kinetic chain can result in greater compensatory mobility demands upon the more vulnerable elbow joint, leading to excessive strain and ultimately injury.

If soft tissues of the elbow are involved, such as is the case with tendonopathy of the common extensor (lateral epicondylopathy) or common flexor (medial epicondylopathy) tendons, deep tissue massage is very effective. It doesn’t feel so good initially, but it works. Usually, you can do it yourself; just follow the tendons starting about ½ inch from the origin, and deeply massage with small amplitude parallel and perpendicular to the tendons.

Joint mobilization is also very effective at restoring normal mobility and promoting joint healing – but you’ll need a skilled therapist for that.

For less acute injuries, very high repetition, low load exercise can be effective at improving tensile qualities and promoting healing.

The common practice of applying ice shouldn’t be overlooked. Ice massage is very easy and effective. Freeze water in a Dixie cup, peel back the edges, and rub the effected area for about 5-10 minutes.

EC: My favorite part is that you never recommended non-steroidal anti-inflammatory drugs (NSAIDs). We know we’re dealing with degenerative, not inflammatory conditions, so these interventions have little merit aside of pain relief, which is better accomplished with ice anyway. All those NSAIDs are just inhibiting the healing process and giving people a false sense of good health, leading them to throw the tissue back into the fire much too soon. Would you agree? (You’re not allowed to disagree, for the record; this is my newsletter!)

MS: I absolutely agree, and not just because I fear being chastised like your friend Hugo from a few newsletters ago! Soft tissue injuries have often been labeled as tendonitis, the –itis suffix inferring an inflammatory pathology. However, histological studies consistently fail to find markers indicative of inflammation with these conditions, leading to the increasing use of the appropriate term tendonopathy instead.

This is more than a semantics issue. As you mention, taking an anti-inflammatory to treat something that does not have an inflammatory pathology may yield unnecessary risks and hinder healing. Recent research has demonstrated impaired bone healing in conjunction with NSAID usage. This is particularly important if bone pathology is suspected, as often is the case with young pitchers having a high incidence of growth plate injuries.

EC: This has been fantastic stuff, Mike; thanks for taking the time. Where can our readers find out more about you?

MS: It’s my pleasure Eric, anytime. I can be reached at mike@spectrumfit.net, and your readers can learn more about Spectrum Fitness Consulting, the Young Guns program, and myself at www.spectrumfit.net.