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.

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

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 Waryasz^12* and Ann Y McDermott¹³

Ann Intern Med. 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.

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.

Strength from the ground up

Functional exercise
Today we are going to dive right into the  new phenomenon of "Functional Exercise" seen in many of the gyms & exercise magazines. If you look back at my previous posts your aware of the reasons we stiffen. As adults we quickly lose mobility which robs us of moving correctly, or what we in the rehab world call "Functionally". One of the primary purposes I began writing this blog was to explain the importance of movement. A big part of getting you moving again, without compensations that  harm you, is getting you back to your developmental roots.
Developing our motor skills  occurs when we are infants. We first learn to roll over, then crawl, eventually we get up on one knee and ultimately we stand. As infants we have all the mobility in the world, it's the stability that needs to be learned. In rehab we use these positions as "resets" to reestablish movement patterns that are essential to correct functional movement, and functional exercise(more on this in future posts).

Why are we doing this again? 

Many trainers are adding functional exercise, not understanding the reasoning  & it's became a novelty.  Functional exercise is most effective when used to improve a deficiency.  As a Functional Movement Screen practitioner, I use the findings of the screen as the basis for prescribing the exercise. 

This will end badly...

When we look at one of the most fundamental movement not only in exercise but in life; the squat, this concept can be better understood..

Whoa, slow down there tiger

As you can see our young friend can easily sit in a deep squat while playing, while our weight lifting friend is about to get a chance to meet yours truly (after he sees every other provider without relief). The weight lifter is trying to build strength on poor movement. While he may get away with it for a short time, this strategy is sure to fail, this is the scenario I'm attempting to save you from. The functional movement that I referred to applies not only to the squat but many other exercises & activities that will be spoken about frequently in my posts.
Baby steps
Nobody wants to have to take a step back, but in order to "Live to Move", we will need to go through prescribed corrective exercises to get the movement right, before we start adding resistance and accentuating our faults. The more the individual strengthens their faults, the more work there will be in reversing that process.  An example of stepping back to master the squat would be for someone to learn to hinge at the hips, build mobility in the hips ankle and upper back, followed by learning to master the glute bridge,  and  finally progress to face the wall squats.

 Putting it all together

By taking a step back and making sure the way you move isn't hurting you, you will create and maintain an amazing foundation to move better, feel better, work better and train better. The squat is a tremendous and fundamental movement most of us have difficulty performing.  It's also one of the best exercises for loosing fat and adding muscle when performed correctly, and when we add functional movement it's also one of the safest. 

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.

A Body in Motion Tends to Stay in Motion

How to save your back and knees! The Bad Neighbor; continued..

PART III of "It's all in the hips" 
A Body in Motion Tends to Stay in Motion

In the last post we discussed what can be done to lessen the effects of postural strain and the resultant muscle imbalance that is silently causing or contributing to the back and knee syndromes.  We also need ACTIVE strategies to move well.  
The active strategies are called corrective exercises, they can be performed for just a minute (micro-break), as part of your "dynamic" warm-up, or in the cool down phase of your workout. The moment and duration you would perform these depends on individual needs, but it's hard to overdo these. Ask your qualified health/fitness pro for clarification or call upon us for specifics. These may look familiar for those of you with a regular work out routine, however why you're doing them may have been a mystery.

The Leg Lowering Progression

Here's a great exercise from Gray Cook, found in his book "Movement" (1), it promotes the amount one hip can move in relation to another. One may wonder why that's important, until we consider some sporting activities. Start with a supported (wall or partner) straight leg raise. The athlete should be pressing hard into the floor with the hands to lock in the trunk throughout the movement. Knees should remain straight, ankles dorsiflexed, hips neutral (watch for external rotation), and trunk is rigid.

The tall half kneel

This position is an essential step in our rehab progressions, and it's also a great way to strengthen with core integration, but it's use in this discussion is to promote hip extension. Hip extension is so critical to us all, it's especially absent in so many of my runner patients, so here's the fix. In performing the tall half kneel, form is everything, the upside knee and the downside knee are both at 90 degrees and the posture is lengthened (thus the tall). While maintaining the tall posture lean in to the front knee. 5 second pulses with a second break will restore some much needed movement.  This courtesy of functionalmovement.com , an excellent resourse for anyone that wants to perform better.

Tim Lincecum, a pitcher for the San Francisco Giants displays incredible hip "dissociation" which allows him to generate speed from his core, not his shoulder.

While we're not all MLB pitchers, the same principles that make these guys great in their movements,  help us be proficient at the activities we love also.  The opposite is also true, if we lack this movement, it's part of the problem. Hiking, surfing, soccer, racket/club sports and many other activities rely on this essential movement to generate power from the core. 

The Dynamic Warm up

The latest research on warming up before your work out supports moving stretches done briskly and briefly. These new stretches are called dynamic warm ups. The general rule is 10 to 20 paces, moving in a range that is only slightly challenging. We're not looking for the deep burn you may experience in Yoga, this gets the ligaments, tendons and joints ready for activity. The warm up you choose should mimic the target activity.

These two activities are literally the tip of the corrective exercise iceberg, I don't want to overwhelm you, just provide a deeper understanding of the many options that are becoming popular in the world of rehab and sports science. Contact us with any questions and consider getting some instruction on activities such as these.

1-Cook, Gray. Movement: Functional Movement Systems ; Screening, Assessment and Corrective Strategies. Santa Cruz, Calif: On Target Publications, 2010. Print.

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.

The bad neighbor..

PART II of "It's all in the hips"
The body is a mobile object
The body needs to move in every direction to accommodate our daily living activities, as well as any other activities we put it through. Each portion of our body contributes to the overall movement , as each instrument plays it's part in an orchestra. The body will steal from adjacent joint to accommodate the movement. In rehab, we call this "substitution". It's a normal event that occurs all day every day with each of us, whether we are "in shape" or not so much. When substitution occurs, the hips refuse to move causing the lower back to move too much to accommodate it, the hips become what is essentially a "bad neighbor".

Everything in moderation is all right
We all need to sit, but altering the position needs to become a priority. Substitution in excess will lead to poor biomechanics, so it's important we do what we can to avoid letting the hips get stuck in that seated position. In my last entry we discussed hip mobility and the effects static positions have on the hips. Any body part left in the same position for too long will soon loose it's ability to move, because of neurologic motor control principles.  An extreme example is where a joint is cast/immobilized for weeks and the patient has little to no movement when it's finally removed.

Ergonomics; fitting the individual to the workstation
No two people are the same, each individual has unique needs and characteristics that must to be taken into consideration when dispensing ergonomic advice. In general terms, we can look at what ergonomic help we can get to lessen the effects of prolonged postures.

In a kneeling chair or in a perched position (sitting at the edge of your chair) we improve not only is the hip angle, but also restore the natural and beneficial low back curve. Another beneficial effect is the glutes will "turn on" in this position, as sitting typically turns the glutes off forcing other muscles to overwork in a majority of the lower back pain syndromes.  Other chair substitutes in the past have included sitting on a physioball, however a recent study showed no improvement in posture and an increase in discomfort.(1).  As we stated earlier, changing positions has been shown to decrease physical stress and improve pain patterns.  There are some wonderful apps you can use as a reminder to take a "micro break", 30 seconds to a minute to perform some yoga like restorative stretches. For those who are confined to a car; the seat back should be altered often to alleviate the stress being placed on the hips. 

Get up stand up

In a similar vein, standing work stations are now being offered for some when your doctor recommends them to your HR department. The newest of these stations are actually adjustable putting the user at an optimal position in either the standing, perched or seated position. OSHA provides these guidelines to standing work stations, in this example it's for food handlers but it applies to any type of work. (2).  

Next post we will be discussing active sparing strategies and corrective exercises of the hips and lower back. 

1.Stability ball versus office chair: comparison of muscle activation and lumbar spine posture during prolonged sitting.

Gregory DE1, Dunk NM, Callaghan JP.

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.