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.
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 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 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