Friday, December 12, 2014

Time saving techniques for getting strong, fit and awesome.

In today's busy lifestyle, we tend to get caught up with our day to day duties & forget to take care of ourselves.  I frequently have patients report an inability to come in to get relief from their ailments, when we do catch up we find that one of the reasons their condition has not improved is they have not found time to do their "self care" exercises and their condition has degraded.  The purpose for the self care exercises is to allow them to continue improving on their own-when there's no time for even that, you know people are busy.  It seems as if we're all in the same boat, especially during this hectic holiday season.  The workout is the first thing cut, ironically meal making is a close second.  According to WebMD many put an average of 1.5 lbs. of fat on during the holidays .

STEP AWAY FROM THE MACAROONS!!!
Several factors determine your ability to keep on track of your fitness goals;  the two main are diet & activity.  You can read my past posts on diet here and here. Activity would include daily living activities and exercise. While we should all increase the amount we take the stairs vs. the elevator, let's consider exercise in this situation. Staying on track with your exercise regiment during busy times depends on a) how long it takes to work out, b) how long it takes you to get to your gym or work out spot and c) ability to continue without injury. With so few factors that we can influence there's really only one thing we can control; how long and hard do we work out. A recurrent theme in this blog is doing more with less. In this case it's time, so here are some great ways to minimize time and maximize results. 

Superset
Pull ups either assisted with a band or performed independently


Diagonal hops in place












In a superset alternate muscle groups(push/pull or upper body/lower body) are worked with low rest intervals(~30 sec.). The superset may be popular but there's room for improvement. Those who know my blog will recall Strength from the ground up this involves compound movement (i.e. squat, lunge, step up).  Using concepts such as compound movement and plyometrics (i.e.hops, jumps, throws) you will alternate the types of muscle used and the type of energy used (creatine vs. glucose). This type of superset will allow you to recover in the lower body & strengthen the upper body, then switch that on your alternate days. Three strength exercises and two plyometric exercises for 3 to 4 sets should get the job done for medium level enthusiast. Form is always important and performing bad repetitions reinforces bad patterns so work until you see your form suffer then stop. Below are examples of exercise that could be an alternate workout.
Wall ball squat throw (plyometric)

Overhead squat (compound strength)






VO2 Max
Another way of getting the most bang for your exercise buck would be a VO2 max workout. This type challenges your aerobic system and is one of the best calorie burners you can perform when time is a factor.  Your body is consuming the maximum amount of oxygen in this workout so it burns the largest amount of calories. 
It's a challenging workout, but it can be modified and scaled back according to your exercise level. It's a superior workout  not only challenging the aerobic system (so it's heart smart), but strengthening the muscles as well (anaerobic).  The rest intervals are  shorter than supersets (~15 sec.) and the exercise performed is done for the same amount of time (~15 sec.). 
Exercise selection is important with this type of workout, it must be a compound exercise- Kettle bells are a great choice. Those who are interested in picking a great postural reinforcing exercise should check Kettle bell training out here. This workout can be performed for 15 to 30 minutes and in some of the more elite athletes up to an hour which would burn approximately 1600 calories (half a pound of fat)!

Body weight blast

The body weight blast is a simple workout but only in theory. It's one to three exercises performed as fast as you can with the only rest period being absolutely what you need. Any compound exercise will do.
A nice example is the burpee; (pictures below)
squat,
squat thrust,
push-up,
another squat thrust,
back to standing,
end with a jump.

Another variant could include a circuit like this;
Squat Jump,
Kettle bell swing 
end with a push-up.
Start with 20 reps, then 19, 18 all the way down to 5. This is an amazingly hard workout sure to wipe you out quick and burn an enormous amount of calories. These types of workouts are frequently put on in group exercise classes at places like CrossFit, we have done some work with the cross-fit organization  here in West Chester  & found them to be knowledgeable, amazing, motivating & fun.
Squat thruster or Burpee

Kettlebell swing courtesy of Pavel

Bottoms up push up
As mentioned before; time can be our greatest challenge, especially during the holiday season! With child, work and home obligations it's easy to see how we all treat our work outs like step children.  These are just a few of the intensity workouts. You're only limited by your imagination, but feel free to explore my blog & check out the links to learn more! As always, please share this with a friend if you think it may benefit them.

 Today we provided principles, so you can adapt your own protocols, don't hesitate to contact us with questions. 
Please let us know you visited our blog by liking, commenting & sharing.


Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our facebook page.

Monday, November 3, 2014

Feed Your Work out..Body Type and Sports Science

How your workout goes is dependent on what kind of pre workout nutrition you take in. It's also impacted by how fast your body can get those calories ready to be burned. Last time we discussed how changing the way you look at food can make you leaner and healthier, today we will discuss how to make your workout more energetic by addressing the timing of your pre workout nutrition and hydration. 

IDENTIFY YOUR BODY TYPE
Somatotyping has been around 80 years and was developed by a psychologist; William Sheldon. There have been many studies on this topic and while the percentages of Carbohydrate to Protein to Fat is debatable the metabolic styles seems to have been established. The folks at Precision Nutrition do a great job of breaking it down for us.


There are 3 different body somatotypes; 
Ectomorph:  The naturally tall skinny types.  This body type has a hard time adding size.
Mesomorph:  Easy to add muscle, naturally lean.
Endomorph:   Large Joint--bulky -like an NFL Lineman
mesomorph-body-type-female-diet

IT'S ALL ABOUT TIMING
Depending on which type you are dictates how fast or slow the calories you eat become available, and that in turn determines how energetic you will feel when you exercise. From the time you eat until the time calories become available can vary from 30 minutes for a ectomorph to 90 minutes for an endomorph.  Most of us lie in between types, but knowing your type is helpful in planning and training style.  Timing your nutrition will give your body the energy it needs to have a successful workout.  

Got H2O?
Hydration is another key component, the National Strength and Conditioning Association recommends 20 oz 2 to 3 hours pre workout and another 10 oz. ten minutes before the workout. This chart provided by Urinecolors.com is a great refrence to gauge your water levels. 

Dehydration is a common problem, it's essential in carrying away and expelling metabolic waste products, delivering fuel to the muscle. Your brain also has a high percentage of water (80%) and blood is also mostly water (83%).  Keep in mind how many diuretics you have taken in that day and the day before (coffee, salt and alcohol) and make sure to keep A balanced.  Hydration affects everything from how you feel to how plump your skin appears, so it's importance really can't be underrated. 

Get Pissed!
Urine color is a fast and easy way to monitor hydration-clear urine is best. Cramps, headaches dizziness, nausea and decreased performance can be signs that your may be dehydrated. Waiting for the feeling of thirst to hydrate means you're already dehydrated so make sure you get enough. As a side note; filtered tap water has been shown to be better over all than bottled water, as leeching can occur with plastic water bottles; and there is no date on the bottles you can't tell how long it's been sitting there. I have a friend that's in the business that confirmed that fact for me and also informed me that Dasani (Coca-cola Co.) was the worst offender of old water. 
I'm Dr. Gene Serafim, here to make sure your workout is the best it can be.

 Today we provided principles, so you can adapt your own protocols, don't hesitate to contact us with questions. 
Please let us know you visited our blog by liking, commenting & sharing.


Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our facebook page.

Monday, September 15, 2014

Getting healthy? It's 80% diet 100% culture..

A Very Wise Sage Once Told Me Fitness is 80% Diet. 
Having worked in and around gym's for the last 16 years I have have worked with fitness professionals, body builders and athletes. I have also  endured my own journey towards fitness and seen many patients change their physique. It's no secret diet and exercise are the cornerstones of fitness.  For me the holy grail of fit was more raw foods and high intensity interval training or metabolic training. Real changes are those that transcend your schedule and lifestyle, which brings  me to my next statement.

You MUST Change How You View Food.
Our ancestors must have gotten a completely different palate, keeping in mind that spices were reserved for the privileged. Food was most likely bland and it was most certainly sparse, my parents grew up in German occupied Greece and even one generation ago, there were people starving to death.  The take home point is that it's only until recently that our culture has put so much emphasis on eating as a social event. Historically food has been viewed as fuel.

Dinner and Drinks?
I have many patients and friends who ask how to improve their body composition(less fat or more muscle), and inevitably the conversation moves to dinning. Going out to dinner has become a common pastime and a weekly occurrence. The individual looses control of the preparation of the food and seldom asks for nutritional information, since they're going out, one may figure "where's the fun in that?" The problem is that just an appetizer alone can account for all of your daily allowance of fat and calories as explained in this Good Morning America post. Add a few beers or glasses of wine at around 150 calories each and you can see even a modest meal turns into a  4000 calorie event. 
Convenient, but obese kids make obese adults.

The Good News? We're Not the Fattest Country Anymore!
Mexico has surpassed the U.S. as the fattest country in the world, perhaps due to the infiltration of Starbucks. All kidding aside, our super-sized portions and Mocha-chino Grande (600 calories) have consistently ranked us among the fattest in the world. A simple way to lose excess weight is to steer clear of drinking calories. 

Prepare for the End - the Bottom End of Course.
Food preparation sounds like a big task, but it doesn't need to be. Baking 5 or 10 chicken breasts at the beginning of the week can give you all of the salad with chicken all week. Boiling 2 dozen eggs, also an excellent protein rich and calorie poor option for breakfast or snack. Put some broccoli florets in a zip-lock and grab some hummus for a balanced, low calorie filling snack!  Greek yogurt is one of the packaged foods that you can eat and feel great about.  There are tons of great ideas in magazines and online, but the sooner you appreciate the power of preparing your meals the faster you'll be feeling and looking great.

Diets Don't Work--You Need a Lifestyle Change
Understanding this is a total shift in how to live and not a diet.  Gradual changes are ones that cause less stress and will be more sustainable.  Limiting half of the starchy carbohydrate that you typically eat at a sitting will be a great stepping stone to eventually eliminating them altogether.  Gluten and sugar have a major impact on inflammation, insulin levels and cardiovascular health. Dr. Seaman did an interview that can be found here explaining how our diet is killing us slowly.



It's better to look good than to feel good
Looking good and feeling good are very much intertwined, in explaining the way to a fitter physique we also extoll the benefits of good health. Not everyone wants a beach body and by following some of the guidelines we have set forth, will not only get you looking better but also improve your cholesterol and triglyceride counts. It's important to keep in mind why we would want to change, it's not all about aesthetics.
You look marvelous darling
Everything in Moderation
We all enjoy a night out and if you're active and practicing good eating habits most of the time you can enjoy a nice restaurant, but overall, most may want to develop other forms of entertainment.  Active hobbies would have a definite impact, increasing activity levels as well as limiting outside meals. Personally, my wife and I have shed our inhibitions and frequently dance like no one is watching in a club full of people way younger(at least chronologically).

 Today we provided principles, so you can adapt your own protocols, don't hesitate to contact us with questions. 
Please let us know you visited our blog by liking, commenting & sharing.


Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our facebook page.

Tuesday, September 9, 2014

PLANTAR FASCIITIS

PLANTAR FASCIITIS

Comprehensive Strategies For Addressing Plantar Fasciitis
In today’s clinical environment, plantar fasciitis is a common and debilitating condition. “Plantar fasciitis is the most frequent cause of heel pain in adults, accounting for 15% of visits to podiatrists and approximately 9% of running injuries”(1).   The purpose of this article is to discuss comprehensive strategies that include instrument assisted soft tissue mobilization (IASTM) and functional evaluation techniques. Irritation to the plantar fascia is widely treated with immobilization and injections. Unfortunately these interventions are incomplete and short sighted.  When faced with these types of complex injuries, each provider should ask; is the treatment we are rendering comprehensive?  Many of the patients I have treated have most likely seen other types of providers before seeking our care as a last alternative. Chiropractic is touted as treating the root of the issue, but if we seek to only provide short term relief, how can we hold ourselves to that higher standard.
Form & Function;
Static analysis and Orthotic correction (shoe inserts)  is a common treatment for plantar pain. Traditional approaches to heel pain have come up short fully addressing plantar pain. It’s been brought to my attention that much of the chiropractic (and physical therapy) profession is unaware of the rehab renaissance occurring. Functional movement analysis has allowed those who utilize it to find faulty movement patterns as well as muscle imbalances that are the underlying causes of dysfunction. The work of Janda, Liebenson, and Cook have provided us with screening tests that gauge the “quality” of movement and identify areas of overuse; thereby identifying underlying causes of injury(2).
A staple of the functional testing is the squat, in its performance we sometimes note the subject’s heels lifting off as the squat gets deeper.  This would be indicative of calf/ankle hypo-mobility. Having the patient repeat the squat with the heels in the elevated position and having them perform it with greater competency would further validate calf and foot shortening.  If you cannot deep squat, it may be because of your ankle mobility and that in turn is a major underlying reason your heel hurts!
Plantar fasciitis is surely a musculo-skeletal issue. Let’s investigate the work of Tom Myers “Anatomy Trains” to see what else may be associated with the chain of soft tissue(muscle/ ligament/ tendon) known as the plantar aponeurosis.



As we can see from the illustration above, there is a long track of fibrous tissue that runs contiguously from the plantar aspect of the foot to the top of the skull; therefore shortening  the muscle along the superficial back line would shorten the continuous chain of connective tissue-in other words not only are bones connected to bones, but muscles are connected to muscles. Tightness in one muscle can and will affect other muscles along the same line.  In my own clinical experience as well as medical literature, shortened calf/ heel chords are commonly noted in cases of plantar fasciitis (3). While almost everyone knows how to isolate the Gastrocs calf group, affecting the Soleus calf group seems to elude both patient and doctor.  Most patients that present to my office with a plantar pain issue have NOT been shown this simple and ultimately effective move. Feel free to contact us for assistance in performing the Soleus mobility drill.

Treatment;
When treating movement related conditions it's best to use everything available. Massage, Release technique, avoidance strategies, mobility drills and strengthening rehab procedures. Restoring the amount the ankle can bend upwards (dorsiflexion) is a primary goal.  Muscle energy techniques (contract/relax stretching) should also play an integral role in the muscles situated along the superficial back line as well as any tight/ overactive muscle groups. Restoring ankle Dorsiflexion through joint mobilization (Cook’s tall half kneel) of the ankle in addition to manipulation of the ankle joint will also aid in restoring proper biomechanics. Finally we need to address foot stability, as Boyle’s joint by joint approach(4) tells us, it’s an area designed for that role. 
Self care and long range goals should include activities that would affect the superficial back line (Yoga). Finally, sparing strategies cannot be ignored, as self care will move the patient towards independence in their favorite activities. There is a wealth of tools and techniques available to us, and as my father the carpenter often told me “the right tool at the right time results in the best job”.
Correct form for the tall half kneel.




1. Ranawat, Chitranjan S., and Rock G. Positano. Disorders of the Heel, Rearfoot, and Ankle. New York: Churchill Livingstone, 1999. Print.

2. Page, Phillip. "3; Chain Reaction." Assessment and Treatment of Muscle Imbalance The Janda Approach. N.p.: n.p., n.d. N. pag. Print.

3. Garrett, T., and Pj Neibert. "The Effectiveness of a Gastrocnemius-soleus Stretching Program as a Therapeutic Treatment of Plantar Fasciitis." Journal of Sports Rehabilitation 12th ser. 22.308 (2013): n. pag. Web.

4. Boyle, Michael, Mark Verstegen, and Alwyn Cosgrove. Advanced in Functional Training: Training Techniques for Coaches, Personal Trainers and Athletes. Santa Cruz, CA: On Target Publications, 2010. Print.

Wednesday, July 9, 2014

The Secret to Getting Lean & Staying Lean part II
 The first part of this post can be found here.

8Time to turn up the intensity; Part of the problem with the traditional "Nautilus" circuit is that it's very difficult to get your heart rate up. You'd think that if the  repetitions were performed quicker the intensity would increase. The reality is that the chances of injury would greatly increase while the level of intensity would stay the same. For those who have first developed capacity (post 5 months of training) adding High Intensity Interval Training (HIIT) is the ultimate calorie burner. It's also been shown to provide the the best hormonal response. This type of exercise is found in Crossfit "Cubes" as well as Russian Kettle Bell training. For the readers who still insist on doing large amounts of cardiovascular training, the training should be varied and could include Interval and Fartlek training. There are also a variety of cardio classes that incorporate compound movements, I know my wife really loves her Body combat classes, even though we did have to correct some movement patterns to avoid her getting injured by it.

9. You Can Never Be Consistent Due To Nagging Injuries; Lacking duration may be one of the biggest obstacles to consistent routines needed to achieve your fitness goals. Studies have shown that when athletes get injured they  have a 30%-90% drop out rate. Evidence suggests that injury is one of the greatest impediments to getting lean and staying lean.   
Awareness of when, why and how athletic injuries occur is paramount to maintaining your fitness routine. While my main goal is to find the "weak links" that causes or contributes to injury, I also need to educate exercise professionals in some of the risk factors. Pre-program baseline testing as well as ACSM risk stratification should be used as a screening process in ANY workout routine. I enjoy working with trainers in this regard, as well as prescribing corrective exercises.



10. You're Obsessing Over The Scale; It's true, we all do it, but is there something to be learned from our bathroom nemesis? Body composition analysis is a very big part of planning a nutritional plan. A popular way of figuring out your muscle mass/fat content is Bio-impedance, having this test performed before you start a fat loss program provides a baseline AND your metabolic rate. If you remember in our first blog item 1 and 3 in Part 1 then you know the caloric equation must be less or equal to the Metabolic rate. The number on the scale can be a poor barometer of progress when trying to get lean. The more muscle you have the better you burn calories, starving yourself because "it's not working" is just keeping you from getting stronger and ultimately leaner!! 
A better barometer is  anthropometric measurements or simply how your clothes fit.

We can run a bio-impedance test at our office, it makes that scale a lot less scary!

11. A Time for Every Season;  Periodization is a major component in how we, as strength specialist design a program. Professional athletes have 4 distinct periods in their training, it's improves their effectiveness and reduces the amount of injuries. Preseason, In-season, Post-season, Off-season-- all have their specific purpose and what works at that level should work at any level. This could have been number one, because everyone, everywhere has likes and dislikes. Some love cardio and just run all year round, some love the gym and all they do is weight train. They never change a thing and when they plateau, they wonder......what happened???  The truth is that the more we do something, the easier it gets; because like a hot bath, we accommodate to it.

12. Patience, No worries; We as American's are a fast food society, we want everything convenient and we want it 10 minutes ago. That being said, getting and staying in shape is a long road. Knowing the correct direction certainly lessens the travel time, personally I struggled for years until my muscle mass increased and my workouts got more intense (HIIT).  Patience and stress are mental components that can greatly alter the success of an individuals program. Cortisol is a stress hormone that can trick the body into not burning belly fat, as noted in a study done by Yale University. Resistance training has a positive effect on stress and fat loss, for more on cortisol response and high intensity training click here.

I'd love some feedback from my fitness professional friends on this post, the links to the local fitness establishments are some of the few quality establishments in the area.


Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our facebook page.


 

Thursday, June 19, 2014

The most common reasons you haven't lost fat(notice I didn't say weight).

 The Secret to Staying lean; Part one
We need to start our path to fitness somewhere,  for many of us the emphasis is on getting leaner. After a lifetime of personal struggles, I have found the "secrets" of staying lean year round.
1.  A SIMPLE EQUATION 
CALORIES IN  must equal CALORIES OUT.
If you exceed your caloric intake it's stored as fat.
If your caloric intake is insufficient you burn fat.
The key to this is to know and adhere to your BMR (Basal Metabolic Rate).
Initially calorie counting will be a necessary evil, but most get an idea of portion and amounts very quickly. 

2. LACKING FREQUENCY; I often relate the way metabolism works to a furnace, the more you stoke it the hotter it burns and the more calories are expended. How can we affect our metabolism?
Our metabolism can be increased by any increase in our activity. Spacing out activity is a great way of elevating our metabolism several times a day, whether it's taking the stairs instead of the elevator, taking a afternoon stroll or giving a piggy back ride to the kids. The more instances you can build in the faster you will lean out. Frequency can also be impacted when you can't get to your work out place, so I really stress adding alternative exercise techniques that require no equipment, when you can't make it to the gym.
This is only trumped by those who circle the parking lot looking for the closest spot.
3. COMPACT vs. FULL SIZED; compact cars are very fuel efficient, but in the case of getting lean we want to be fuel INefficient.
Muscle mass burn calories at a rate of: 10 calories per pound/ per day at rest.
Greater muscle mass also burns more calories during activity (exercise or activities of daily living). So the more muscle we can put on our frame, the more calories are burned.  Women sometimes worry about getting too muscular and so they avoid working with weights, without the increase in muscle it's that much more difficult to get lean.
Don't worry ladies, no one is looking like a bodybuilder without the help of male hormones(steroids). Recent studies have shown that women have a good capacity for building muscle, it's just that the distribution is different(larger % in the lower half)1.
My guess is that she's been exposed to male hormones..
4. FEARING THE FAT; If you fear the fat, you may not loose the fat. As per Barry Sear's The Zone, your body has a capacity to burn a certain amount of fat, protein and carbohydrate.
If an individual over indulges in any category, it gets stored as fat. Sears calls for a 40% carbohydrate 30% fat and 30% protein. The Atkins diet is another system that touts increasing fat intake over carbohydrate intake, but some who use Atkins seem to overindulge in the fattier proteins
and saturated fats(which wasn't the original intention) .









 5. NOT ENOUGH WHOLE FOODS; Most of what we truly need from the super market can be found on the perimeter of the store.  MOST of the processed food and snacks occupy the center isles. The majority of processed and snack foods are high in carbohydrates, including the "diet food". Whole foods on the other hand, are high in macro-nutrients (vitamins from foods not encapsulations), are typically a lower glycemic index and overall lower in calories. Whole foods also have a smaller caloric footprint with a higher volume, so they are more filling and less fattening.
Sure it's sugar free, I bet it's not calorie free

6. GET YOUR ZZZZZZ's; Many of us are not getting restful deep sleep, and there are some important hormonal implications here.  MANY studies show that hormones responsible for the growth and repair of muscle occur in deep sleep.  Even if you're doing everything right --if your not sleeping, you may be robbing yourself of muscle growth.   We discussed how greater muscle mass burns more calories in #3; but greater muscle mass (and muscles used) also cause a larger hormone response, therefore positively affecting muscle growth.  All of these factors lead to the same premise; 
use exercise movements that recruit as much muscle as possible--tire them out AND get some sleep!

7.  KEEP IT SIMPLE? Eh no; Exercise can be classified into two major categories, simple and compound. The typical gym is geared towards simple exercises, any exercise using one muscle is simple (i.e. bicep curl). Compound exercise uses multiple muscle groups and many times the whole body (squat, plank). The body's response to these two types of exercises is very different. Without getting too technical, your body grows a lot more muscle by doing compound movements, compound movements are also functional  (mimics daily activities) and are discussed here.  
There is a definite movement in the fitness industry towards compound and functional movement. In our area there are several of these types of workout centers that are extremely knowledgeable and reputable. While each center is different, each is qualified and use a graduated approach (not letting you get too far over your head).  Functional movement awareness exists in these establishments and is discussed here. 



In part two of this series we will discuss the paradigm shift in fitness towards compound movement and the differences in our fine local establishments that provide such services.
  
In conclusion I should go back to my opening statement, here I am with my kids after some good ole' fashioned functional exercise (digging in the sand). 
(Advanced apologies for the excessive display of me.)


Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our facebook page.


 
  
1.American College of Sports Medicine, ACSM Fit Society® Page, Summer 2004, p. 4-5.

Tuesday, June 3, 2014

Is it the end of the Ice Age? When to use heat and or ice...

Written by Dr. E. Serafim

"I can never get it right Doc, when it hurts, should I put heat or ice on it?"

"But there was shrinkage!"

This is the most common  "modality" question presented to me on daily basis & I  always answer the same way...It Depends.  

 There are several items to consider;
-type of pain (chronic vs acute)
-why is it hurting (trauma vs overuse)
-is there any nerve involvement  
we'll address all of them in this week's blog.......

Chronic Vs. Acute
The amount of time your injury has been bothering you will  often help us discern which type of pain you are experiencing.  Acute injuries usually involve trauma while  Chronic pain is defined (but debated) as any pain pattern present for longer than 6 weeks.
The take home message here is that if you just injured yourself (acute) and the area is showing signs of "Acute inflammation" DO NOT USE HEAT on the affected area. If you have one or more of these signs (compliments of nature reviews), you're experiencing a acute episode of pain. In today's busy world many of us choose to ignore pain, but if you Live to move,  read on...
"I'm tough, I can take it"
Pain affects us in ways that both benefit and cause us harm, pain is our body's alarm system. It tells us when something is wrong and limits our movements to prevent furthering the damage that has already been done.  Limiting movement may seem like a good idea, but keeping the theme of the blog should give you an idea of what I'm going to say next. Painful movements change your movement for the worse, creating force multipliers secondary to poor/improper biomechanics, changing your muscle length and causing joint degeneration (arthritic changes) 1. The faster an injured individual can eliminate pain, the less of a chance it has to become chronic (learned).

When traffic is actually a good thing..
Ice (cryotherapy) is a great natural way of turning off the bad effects listed above, which in turn gets the individual one step closer to pre injury status. Pain is carried to the brain mostly on our smallest and most abundant nerve pathways( C fibers). The way cryotherapy works on pain is that if the small fibers carrying pain signals are flooded with signals carrying cold, the pain signals cannot get through for the brain to perceive. This process known as Lateral Inhibition and it's is a great way to intervene in the pain pattern and provide a "reset" for the body. Pain can be learned and that's a contributing factor for chronicity.
.Ice, Ice baby?
For ages the industry standard for controlling the sings of inflammation would be the R.I.C.E. (Rest- Ice- Compression- Elevation) protocol. Recent studies are debating that (2,3,4,5,6) ice decreases edema and speeds healing, and that rest is  detrimental. There's also evidence that rest and ice may actually delay healing. There are new emerging standards for inflammation, like movement tape and cold laser, but stay tuned, because new trends in rehabilitation are becoming the norm. While ice is a great natural way to control pain, we should start moving away from it as a way to alleviate inflammation.

"We've seen dramatic results with our taping"
-Dr. Gene
Heat then?
Any time we can warm up the tissues of the body, they tend to be more pliable. There's consistencies with patients in chronic pain.  Heat can be useful in managing and improving some of the underlying "functional" movement deficits. Muscle imbalance is frequently present; causing improper weight bearing, leading to overuse. With the exception of nerve based pain, heat can be a great way to treat the symptoms of many chronic issues. Nerve pain is typically radiating or a pins & needles experience ,  the only way to know for sure is to be evaluated by a health care professional to avoid permanent nerve damage.


The take home message..
Most of your nagging pain can be helped by mobility activities (mentioned here)  heat is one way to prepare the tissues and provide relief. Most of your "acute" pain can be managed with short periods of ice (10 minutes) followed by a 20 min break. If your pain is shooting or going down an arm or leg, get it checked out (we can help)! Ice can be a natural way of breaking pain patterns & helps to ensure your pain isn't altering your movement, because after all we Live to move!



Please share if you know someone who could benefit from this post!




Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders, and is level 2 functional movement screen certified. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our Facebook Page page.




1.Page, P. Frank, C. Lardner, R. Pg. 41-45 

Assessment and Treatment of Muscle Imbalance: The Janda Approach Pg. 41-45


2.Forsyth, A. L., Zourikian, N., Valentino, L. A. and Rivard, G. E. (2012), The effect of cooling on coagulation and haemostasis: Should “Ice” be part of treatment of acute haemarthrosis in haemophilia?. Haemophilia, 18: 843–850. doi: 10.1111/j.1365-2516.2012.02918.x

3.Rajamanickam, M., Michael, R., Sampath, V., John, J. A., Viswabandya, A. and Srivastava, A. (2013), Should ice be used in the treatment of acute haemarthrosis in haemophilia?. Haemophilia, 19: e267–e268. doi: 10.1111/hae.12163


4.Forsyth, A. L., Zourikian, N., Rivard, G.-E. and Valentino, L. A. (2013), An ‘ice age’ concept? The use of ice in the treatment of acute haemarthrosis in haemophilia. Haemophilia, 19: e393–e396. doi: 10.1111/hae.12265

5.Kaminski TW, Hertel J, Amendola N, et al. National Athletic Trainers’ Association position statement: conservative management and preventing of ankle sprains in athletes. J Athl Train. 2013;48:528-545

Wednesday, May 21, 2014

Ok Runners, how far can you drive on a flat tire?

Have you ever driven on a flat tire?
I did once, we were stuck in the middle of nowhere and the only way to get help was to stick it out. The faster we went the harder the car shook. I thought the whole thing was coming apart, but thankfully we didn't have to go far. In this post we're going to relate the flat tire to the muscle imbalances/functional limitations that living in today's society creates (which were discussed in this post).
Why do I see so many "Runner's knees"?
It's no secret we are a sports based practice, and as such we see all types of athletes. One of the injuries we address on a daily basis is "Runner's Knee" (Patellofemoral Pain Syndrome or PFPS) which is a problem with your knee cap/knee joint.
The back side of the knee cap (patella) is lined with soft and smooth cartilage, exactly like what you see on the ends of chicken bones. The patella fits right in to the groove in the front of the knee, "Runner's knee" occurs when the patella is pushed out of position from imbalances in the thigh (quadriceps) muscle over a long period or overuse (1). Since the knee cap is designed to operate in it's groove, when it doesn't the cartilage gets inflamed and degenerates.


The return of the bad neighbor.
In a recent post we discussed how glutes get "turned off" (It's all in the hips), from sitting too long or overdeveloping the front of our bodies(muscle imbalance), and it's effect on lower back pain.  Guess what-hip weakness also causes our knee to react and  over time develop incorrectly, that's right MUSCLE IMBALANCE strikes again! 
This illustration shows the effect of a weak glute on the hips and subsequently the medial collapse (valgus collapse) at the knee..
A. Normal glute support B. Weak glute 
The body makes it work, even if it's bad for it.
We cannot build strength on poor movement, but the body will sacrifice quality for mobility.
Endurance is a form of strength and the body will adapt to the new, poor movement. Unfortunately the result is over development of the lateral knee muscles (IT band syndrome) and improper tracking of the knee cap (patella). This situation in essence is "driving on a flat tire"; sure, you can run on it but how fast are you going to drive? How far? When will you "car" finally call it quits?


Anyone have a spare tire?
Knee problems are very common and are on the increase (2). The answer to maintaining your running/exercise routine lies is finding the faulty link through functional testing. Surgical intervention or knee replacement is devastating to any workout routine  (and has a low success rate).  Since we don't have interchangeable parts, consider making muscle balance a part of your over all workout.

We welcome shares, the more we can reach with this knowledge the less will suffer and anguish. 



Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders, and is level 2 functional movement screen certified. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our Facebook Page page.

1.Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

Gregory R Waryasz12* and Ann Y McDermott13

 2011 Dec 6;155(11):725-32. doi: 10.7326/0003-4819-155-11-201112060-00004.

2. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data.


Wednesday, May 14, 2014

How movement analysis helps us help you

Once upon a time..
Like most doctors/P.T.'s, I used to use a standard process of finding what was wrong with my patients. It usually consisted of testing the affected area with orthopedic tests.  As I pursued my rehab specialty I found that there is more to consider, that the hip bone is indeed connected to the thigh bone. I was taught to look at the whole, as opposed to the sum of it's parts.  In previous posts I mentioned how the hip can be a major contributing factor in lower back and knee issues(see "The bad neighbor"), today I want to share how we find just that.
Our body is a moving chain?
At least that's what I used to tell everyone, but really it's alternating series of mobile and stable links. Life is dynamic, and we ask our bodies to move and conform to every imaginable task we set out to perform (sit, stand, crouch, squat or crawl).  There is a  new approach in manual medicine(Chiropractic and Physical Therapy) called Functional Movement Analysis is a new approach that we use to figure out why certain movements, or lack thereof, are causing the body to overuse and break down. It tells us if the areas that should be moving are moving & if the areas that are supposed to be stabilizing are stabilizing.  These patterns are universal to all of us and when disrupted or absent create undo stress to certain critical body parts.
What's in a test?
Any movement can be a functional test, something as simple as watching someone rise  from a chair, squat down or jump down off of a box.  Lets consider the squat. By analyzing figure 1 the squatter on the right needs to work on the amount her upper back can bend backward (extend). She could also use some lower back stability training and ankle mobility as well. Hopefully it's easy to imagine the squatter on the left being able to endure more squatting without injury over the squatter on the right, because that is the case.

Figure 1 courtesy of NASM
These female athletes were asked to drop off the box and then jump as high as they could, you can see that the athlete in figure A maintains the space between her knees while the athlete in figure B collapses. The second athlete has a much higher rate of ACL tears because of the hip weakness, she shows in this movement test. Finding and correcting that flaw may save her athletic career.
figure 2
figure 2
The news is getting out.
Several recent studies performed by orthopedist are being published supporting this theory of "the bad neighbor". That shoulder problems and knee problems are greatly affected by related body parts, and that just treating the affected area is just sweeping the dirt under the rug. Study on how shoulder pain is connected to hip issues. As well as a great post on the influence of hip and ankle on knee pain.

Good enough for world champs?
These "functional" testing procedures not only allow for detection of impending injuries but we also use them as a baseline to measure future progress.  After finding these underlying problems, specific corrective exercises are prescribed to correct it. (mentioned in this post). In fact we usually see improvements in the first treatment. There are many systems of testing out there, all of them have merit and while we favor a select few, we use most of them in some form or another.  The Super Bowl winning Seattle Seahawks use this as a guide for off season training and injury prevention, and if it's good enough for them, well you know how that goes...





Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders, and is level 2 functional movement screen certified. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our Facebook Page page.