Gait training is worth a shot

I'm sitting at Atlanta International Airport waiting for a lift to some foot and ankle education. Passing time is a combination of people watching for entertainment and the typical gait analysis I do at work.

As Yogi Berra said, you can tell a lot by just lookin.'

"Excuse me, I'm a licensed physical therapist. May I offer some suggestions regarding your gait?"

While never going that far, I can't resist analyzing, scrutinizing, and pondering how and why a person moves the way they do. Wonder! I mean, each leg with 29 bones and hundreds of joints, muscles, tendons and ligaments more or less doing their job, and people are walking around like it's no big deal.

How you walk is absolutely who you are. I'm not sure if one can claim that gait dictates personality, but that often seems to be the case. You can see the worry or stuck-upness or peace in the way the heel lifts from the floor.

Or maybe that person just really has to get to the bathroom.

Clients in the clinic often say something like, "My mom walked that way and I've been walking that way for years and that's just how I walk." And they're right.

But they and mom also had prematurly osteoarthritic knees or hips, warn lumbar discs, persistant plantar fasciitis, or metatarsalgia that has not responded to a myriad of treatments. A sincere attempt at rewiring some basic movment patterns in the family system is worth a shot.

Now it may take some serious mental effort and corrective stretching and strengthening. To get the toes pointed somewhat straight ahead via the foot, ankle, knee, and hip. To improve balance or create a little more bend with less rotational torque of the knee. To increase loading of the ball of the big toe, or maybe all of the above. Some issues require a different shoe, shoe modification, or orthotic that encourages rather than hinders a person from climbing out of the old rut.

You don't have to change 100% from the old pattern to some theoretically perfect gait pattern. Even moving, say, 50% differently can have a huge impact. I've seen plenty of instances where a new gait equals a new person.

Gait training won't create a totally new you, of course. But it certainly has the potential to provide you some freedom.

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the perspective diet

[Here's a topic that's been on my mind as of late. written for submission to The Oracle Project.]

It was well over a decade ago that I decided not to buy into any nutrition movement. The organic variations. The low carb. The raw food. The blood type. The vegan. On and on they roll in and out of style.

Maybe it's because I'm not a nutrition expert. I'm not. Maybe it's because I've been blessed with relatively good health (so far) and haven't been subject to desperation. But what I am is a health conscious person who cannot do any of it.

Specific diets are justified in the name of health, wellness, or fitness. They explain illness with a clear cut nutritional imbalance. There are rules, of course. When obesity, illness, etc occurs (and it will), it's because of something you did not follow correctly regarding the diet. Pretty soon your left with drinking raw, certified organic beet juice, wondering why you're still tired and stuffy in the nose.

Many diets are bad religion.

The gurus seem to miss that what "works" are the basics that we've known for decades: most people (well, Americans anyway) eat too much, eat too many processed foods, and move far too little. They seem to forget that humans have proven relatively resilient through the ages, thriving and healing (miraculously in my opinion) on a great variety of dietary habits. Do they also forget that all of us eventually wear out and become ill and die?

It is main line science and not fringe dietary conspirists that progress our understanding. For example, it's reasonable to follow a specific dietary regimen for specific conditions like gluten intolerance or genetic predisposition to high cholesterol. We now know that starchy carbs are easy to over eat, natural sources of fat and cholesterol are good for you, and that we can benefit from more omega-3 fatty acids. Just like many other areas of life, the diet gurus take an ounce of legit science and run with it, offering answers to every malady with scant evidence for benefit beyond what generally clean living provides.

If it turns out that any of the diets do provide such above and beyond benefit, I'm skeptical that they're worth the numerous costs. I suspect that all the extreme behaviors are unnecessary at best. Maybe a dose of perspective is the perfect recipe to those of us who imagine that bananas have too many carbs, that inorganics are simply unacceptable, or one gram of protein per pound of body weight per day is really needed to achieve a certain aesthetic.

My aunt putting aside her own self, her time and money
 and comfort to serve the people of Sierra Leone.

While the majority of people throughout the ages have starved and suffered extreme malnutrition, we sit at our computers worrying about or even arguing over whether or not it's optimal to cook our carrots and homogenize our milk. I think we would all tremendously benefit from a few weeks of service in one of the many parts of the world where they eat rice for dinner and have no lunch at all.

And now I'll offer something beyond criticism.

Prior to ascribing to any specific dietary rules and spending thousands of dollars on proactive or reactive health care, I thought to at least try the following:

1. Try not to over eat.  Always easier said than done where food is actually available.

2. Get the majority of daily calories from minimally processed foods.

3. Move more. The perfect diet will not accomplish for your body and mind what physical activity can.

4. Rest. As if it really matters - one of my own greatest struggles.

5. Laugh.

6. Serve others. While diet and exercise are all about me, less self focus cures many ailments.

7. Give thanks. Practice gratitude (see point number 1). Read up on it. Gratitude may be the closest thing we have to a miracle on demand.

If you disagree or simply have to narrow your focus, at least go with the final two.

Lessons at Donegal Elementary

It was a beautiful September afternoon in 1988 when I stepped onto the field behind Donegal Elementary.

About once per week, toward the end of practice, the Donegal Browns football coaches lined up the 5th/6th grade team to scrimmage the 7th/8th graders. The idea was to practice with a full team of 11, as each team alone held insufficient players to field a full offensive and defensive side of the ball. Of course this mostly meant 11- and 12 year-old children getting pummeled by raily and mustached 13- and 14 year-olds.

Parents and cheerleaders often gathered at the edge of our field to watch the action. I was the starting quarterback and defensive safety of the 5th/6th grade team, football obsessed, and loved the challenge. 

On offense, our line caved under the weight and speed of the older players. As usual. I remember one offensive series where after being sacked on three or four consecutive plays, I shirked a few defenders to gain some yards and view open field, only to be dragged down from behind by the collar of my shoulder pads. The actual tackle strained my neck. The idea of being caught from behind inflamed my ego.

Still, we gained a few yards against the big guys before our turn on defense.

I remember the play when Kevin Keslar took a hand-off straight up the middle through a gaping hole in our defensive line. I read the play unblocked, accelerated directly forward, fully committed to shutting him down. We both ran in low and  

BOOM.

There was a bright white light. Then dark orange. I found myself in the defensive huddle not knowing how I got there. I had a mild headache and drifted around for a few plays before practice ended. That was the first time I experienced damaging, educating - you are neither an exception nor invincible in this world - pain.

Nobody told me to prove something against the older players or to take scrimmages so personal. Nobody taught me to tackle by leading with my helmet. Nobody taught me about concussions. If they did I sure wasn't paying attention.

That's how concussions happen. Sure, they also occur accidentally. But this was no accident. You can advocate for rules and equipment and player education. But coaching oversight and a naive kid on center stage in a contact sport is far more than enough to create problems.

Relative risk and reward.
Glory and pain.
Not everyone wins.

This is the nature of life. It's plenty to learn for a young boy.

I still think football and other contact sports are worth it, to some extent, but that's based mostly on personal tradition. I really don't have any good answers.

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Red Bull Bull

I recently overheard conversation at the water cooler about members of a local high school soccer team drinking Red Bull before a game.

"...And I can't believe those girls can get away with that."
"Yeah, that stuff is terrible. Probably illegal." 

I held my tongue, suspecting, wondering how many gallons of morning coffee and afternoon loaded frozen coffee drinks these middle aged women consume in order to spin the rumor mill and travel from desk to copier.

Reports indicate that over 50% of collegiate athletes and over 30% of all adolescents consume energy drinks. Statistics don't indicate what percent of these are for party or X-box binges?

Are energy drinks dangerous?

If by dangerous you mean relatively safe and effective for enhancing the ability of the body to utilize fat for energy (and therefore endurance exercise performance), enhancing muscle activation at both the brain and neuromuscular junction (and therefore strength and power performance), lessening rate of perceived exertion, decreasing reaction time, and increasing concentration, focus, and motor memory...

[I have plenty of references if you like.]

58% more acceptable than a Red Bull

Then sure, energy drinks are wicked dangerous. The Red Bull police should let the coaches, parents, and athletes decide governing bodies of competitive sports decide what is admissible in their own arena. There are no bans on energy drinks, at least right now (though some committees ban caffeine in outrageous amounts).

The line is beyond grey. Ban Monster and Rock Star, but not Starbucks Refreshers energy drinks? What about having a Mountain Dew before the game? Three Mountain Dews? Ban Vegas Fuel from scholastic baseball but not ski club?

So yeah, I'm pro energy drink. I don't drink them because coffee is my caffeine vehicle of choice. Either way, restraint is definitely in order:

1. Use energy stuff only when you need an edge. Energy drinks are no substitute for consistent, smart, and intense training with appropriate rest and recovery. No, you don't need the eye of the tiger for a Game of Thrones movie marathon. Regularly using energy drinks just to get through a typical day calls for a serious life evaluation. There is something wrong (or soon to be) that you can't blame on Red Bull.

2. Know about diminishing returns / Don't be stupid. Feeling amped is relative.The more you go to the edge, the less you get out of it. If you use too much of anything too often you will want and need higher doses more frequently. Suddenly you're caught in a downward spiral that leaves you bungee jumping from an airplane into a graffiti strewn skate park for a first attempt at an ollie kick flip. Without elbow pads.



But seriously, adrenal fatigue is real. Take inventory of your overall caffeine intake. Athletes should make efforts to save any caffeine for when it counts. Check labels. Make sure that for every 4 hours hype you spend at least 32 chill.

For example, a 175 pound athlete would have the best dose response (effectiveness without side effects) at about 400 mg of caffeine. For comparison, a generic cup of coffee has approximately 150 mg of caffeine per 8 ounces, and Pepsi contains about 35 mg per 12 ounces. Most energy drinks contain about 75 to 100 mg of caffeine per serving, plus taurine and a few other ineffective ingredients.

3. Treat caffeine (and other ingredients in energy drinks) like a drug. 

Because they are. Make sure that you're using the effective, mildly addictive drug for what it's worth and it's not using you. Do you imagine there's anything in this world, much less any drug, that is healthy or beneficial in regular high doses? You are not an exception. The body knows the truth, sooner or later reveals the truth.

Otherwise I'll have to get Red Bulled up to defend you at the water cooler.

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beyond calorie burning

Most people know plenty about the idea of energy balance, calories in - calories out. What many don't fully understand, despite the millions of diet and exercise resources out there, is that exercise is an inefficient and sadistic way to work at day-to-day energy balance.

Remember that time when you huffed and puffed, strained and dripped sweat on some exercise contraption and 30 minutes later your face dropped as it reported that you burned 340 calories? You stepped down deflated, wondering if the stupid calculation accounted for boredom and hustle.

The bad news is that 340 was probably ball park accurate. And your body would have used almost one third of that to simply maintain itself on the couch. So all you profited from the disciplined effort was a measly 250 calories, and you blew nearly half of that by tasting your friends energy drink and eating two of those purple tootsie roll things.

= at least 90 minutes on the treadmill

Thirty of your limited minutes on this earth, plus preparing and driving to and from the gym, all for 150 calories? As the band Switchfoot said, we were meant to live for so much more than burning out on machines that accomplish little more than calorie burning. Or something like that.

Don't get me wrong. Activity is better than inactivity. Jogging, biking, Zumba, and elliptical...ing all pay dividends for your cardiovascular and mental health. And if you enjoy endurance activities or compete at them, have at it. The claim here is that these forms of exercise are not nearly as important as most people think for the purposes of energy balance.

Without sounding too sophisticated, not eating crap is clearly the most efficient and effective way to achieve the energy deficit required to lose weight and get in shape.

The good news is that all the time on the treadmill or stationary bike or elliptical isn't necessary. The bad news is that there will be no more weak excuses about not having time to get in shape.

Before marching over to your local gym under dark of night with torch and pitchfork, please know that exercise is important, but maybe not in the way that you thought. Exercise signals the body to retain muscle when it's dealing with a calorie deficit.

The body knows that muscle is costly, metabolically speaking. When you take in less calories than you expend, it's the first thing to go. Yet having more muscle means that the body burns more energy every second of every day which in the long-term means that you can eat more burritos without tipping into calorie surplus.  Besides, muscle is functional and looks good and is the root of all awesome.

farmers walk  !

 Now, which of these two activities sends a bigger and better "signal" for your body to retain muscle as you cut a slight calorie deficit? Which requires more time to effectively "get in shape?"

recumbent bike (zzz)

It has been shown that endurance exercise on top of a calorie deficit causes only a slight retention of muscle and decreases bone density as compared to cutting calories and doing no exercise at all. Meanwhile, all those who regularly lift relatively heavy things are enjoying diamond-like bone density, enjoying each others company over meatball subs while riding the train to Awesomeville.

So in summary, you can devote much of your life to learning how to properly take in calories and then burning those calories or you could try:

1. Be active. Find physical work that you enjoy or is productive, basically anything that doesn't involve computers or TV or video games.

2. Lift heavy things for 30 or 60 minutes, including a little corrective/prehab type work, two or three times per week.  **Do this in order to build and retain muscle so that you're not caught on the treadmill of more and more exercise and less and less food just to maintain energy balance.**

3. Eat foods that are minimally processed. Load up on vegetables (if you have to) and lean protein. Loosening the diet about once a week supposedly helps both psychologically and physiologically. So live a little too.

Local to Mechanicsburg, I would suggest the knowledge and accountability over at http://www.synergyfitnesspt.com/
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kinesio tape - what's the deal

Do you want to know what's the deal with kinesio tape? Me too, especially with all the recent proof positive that it makes you a cool and attractive Olympian.

I've read the sparse amount of peer review research on kinesio tape. The two decent studies that I came across were not terribly well controlled and found marginal improvement at best. Let me know if you'd like the references.

But I hear things about kinesio tape. I've tried it on my patients, giving a total disclaimer something like "This is an adjunct treatment for your condition but this is why I would like you to try it." Sometimes I've even plainly stated that I'm skeptical but some people report good results. Then I've answered questions to the best of my ability, and watched.

Most clients like it. When I ask them an intentionally open ended question like "What do you think?" they almost always say that it helps. The clear results in my highly nonscientific study is point number one in the case for kinesio tape.

Point number two in the case for kinesio tape is another experiment from when I severely tore my pectoral tendon in mid May. Now this was an injury that would clearly require reparative surgery. There was a massive amount of internal bleeding that crept down my arm at a rate of inches per day, ballooning up my bicep and showing through the skin.

Two or three days after that injury, I applied the tape to only half of the bruised area. "Chew on this, kinesio tape, if you're so great at decreasing myofascial friction and intramuscular adherence and improving lymph and blood circulation."

I could hardly believe my eyes the next morning. The tape turned a huge blotch of underlying hematoma into broken up bands that corresponded exactly to the tape placement. The whole area felt less blocked up. Yes, there was, oh, 23.45% less blockiness, if you want it scientifically.

I've carefully considered various aspects of this treatment. I've done some research and personal experimentation. There's one primary reason as to why I remain skeptical on the legitimate clinical effectiveness of kinesio tape. And I've found that the number one point against kinesiotape is...

CUTE COLORS.

And a close second point against kinesio tape is...

NEEDLESSLY ELABORATE TAPING PATTERNS.

Really? If kinesio tape is to be taken seriously, the promoters need to lose the cute colors and simplify the process. Don't tell me for a minute that the difference in the elastic properties of sky blue versus black versus pink tape result provides a minimum detectable effect on fluid or soft tissue variables beneath the skin. And there's simply no circulatory, lymphatic, or muscular anatomical justification for that cool octopus tattoo thing running down your abs.

Conclusions:

Since the side effects are nill, there may be some benefit (including psychological and looking cool), and there's no cost to me beyond a roll of tape, I'll keep the experiment rolling. I'll give clients full disclosure so they know their roll in helping me find what's the deal with kinesio tape.

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Spartan Race Review

Some friends and I signed up for the PA Spartan Sprint, supposedly 3 miles of various obstacles. Five miles of mountainous terrain that takes the average participant well over two hours to complete is not a sprint.  

Map of actual race course.

A freakin Gatorade at the 45 minute mark would have been paradise. But no, the guys and I (and everyone?) produced 90 plus minutes of intense activity in the heat on four dinky cups of water.

This race was a marathon of misery and awesomeness.

Yes, 5+ miles is much different than 3, when every mile includes carrying and dragging buckets of rocks and cement blocks, tire flipping, creeping through gravely mud, and (the worst) running, walking, crawling, collapsing to evaluate your existence, on double black diamond ski slopes under the July sun.

There was much climbing and carrying and pulling, me with 1.5 arms. Just a few months ago I estimated that this event was out of the question following another little event known as Torn Pec and Surgical Repair.

There were hoses and hecklers. Hill-mud, hill-mud, hill-mud. There were walls to scale, some of them 8 feet tall. No one told you not to lunge down rocky terrain. There were no warnings about wiping out on the balance logs.

Some of the hundreds of spectators should have been participants. Some of the thousands of participants would have made better spectators.

There were many people trying to make it over the walls, failing horribly at stacking and stepping and boosting. Not even close. Many were sitting on the ski slopes, head hung between legs, unable to go on and too far to turn back. The task was nothing for the faint of heart and lets just say that there were many who signed on with a false sense of their abilities.

Make no mistake, merely completing this race is definitely an accomplishment.

The guys and I came in the top tier of the Open Division contestants. Our times would have placed us ahead of the middle of the one Elite Division that took place earlier. For our first race, for any race, I'm extremely proud of Kyle and Cort and Ben, and of our showing.

If we do it again next year, we will take specific training a little more seriously and enter the "elite"  heat. We may actually have to try doing more hill endurance type misery.

Arrooo.