The Best Exercise?

I recently read an article online about the top exercises that you should do. I find it interesting to see what "experts" are saying about this topic even though, for one reason or another I often wind up disagreeing with what they recommend.

There are some exercises that I believe to be better than others particularly for various diagnosis, yet when we consider that individuals have; different skill levels, needs,  and most importantly bodies there is simply no "Best Exercise" for everybody.

There are some guidelines that can be given when recommending exercise to individuals

1. Do No Harm: Safety First. If the exercise is unsafe for an individual it should not be done. There are cases where a patient will want to continue with an exercise or activity that prevents their healing or because of their alignment is causing harm over time. In these cases, I usually explain why I think that the exercise should not be done and ask that they discontinue for a finite period of time to allow healing.

2. Compliance: This one of our greatest challenges with many of our patients. Unless it violates guideline 1, when I am asked  "What is the best Exercise?" my simplest answer is "The one that you are going to do". Ideally people will enjoy their exercise, realistically this is not always the case. Additionally, some people simply cannot devote an hour of their day that is dedicated only to exercise. I am one of them.  For me 20 minutes is very doable. I make up the rest of my exercise time with what I call purposeful exercise, meaning I will exercise to get somewhere that I need to go anyway rather than driving.  The exercise program in order to get done, needs to fit in with their schedule and be regarded as important enough to do.

3. Specificity of Training: This is an Exercise Principle that is violated over and over again. If you want to get better at do a particular skill or activity (ADL) you should do that skill or activity. If it violates principle 1,  then you should exercise the muscles that are involved in that skill, by mimicking the range of motion involved and the type of muscle contraction utilized to perform the activity.

5. Make Life your Exercise: One of my professors stated that "The human body is the only machine that gets better with work". I would modify that by saying "An aligned human body is the only machine that gets better with work". If the body is in its appropriate alignment every activity that one performs with good body mechanics in their daily life now becomes an exercise. Transfers and bending to pick something off of the floor are squats, reaching to retrieve an item from the refrigerator and vacuuming now become a modified lunge.

With so many choices when it comes to exercise, using the guideline above, there is simply no reason why an individual cannot discover their own "Best Exercise".

Simple Technique to Calming a child with autism

Treating children with autism is especially challenging. Getting a good subjective history from the patient is practically impossible therefore, Therapists must rely on observation and information from the parents and other caretakers.

I was at a social event with a family whose child is on the spectrum. She is high functioning and can become easily upset like most people with autism. On this occasion she became upset and went into the other room to calm down. This is not my area of expertise, but I had an idea on how to help her out and decided it was worth a try.

I also know that some people with Autistic Spectrum disorder feel comfortable with compression. I recall Temple Grandin's, squeeze machine that she constructed and used when she found herself becoming upset. For those of you not familiar with Temple, she is a writer, professor, expert in the cattle industry and also happens to have autism.  Although this child has tried weighted vests and blankets, they have done little to help. I am aware that her self soothing technique is climbing and were it an Olympic sport she would be a shoe in for the gold. (I actually witnessed her climb a door way once). Although compression to her trunk had been attempted, I know that compression to her wrists and hands had never been tried with  her before. My thought was to try to teach her position of manual stability on her wrist as climbing in particular requires significant stability at the wrist and hand.

I explained to her that I had a trick for feeling better that I wanted to teach her and asked if I could touch her wrist and show her. She allowed me to apply my force, which by design is gradual and non threatening and tried it herself. After a minute she was able to rejoin the party and did not have another episode of being upset for the rest of the evening.

Coincidence, I don't know. but worth further investigation for sure.

New Twist to a old exercise

In the past squats have gotten a bad rap. Some claim that is bad for the knees. Others state that it is too difficult for the older population. I say it is one of the most functional activities known to man. In cultures where people don't spend hours of their day in a desk or in front of a TV, squatting is their sitting. 

Before their were toilets there was squatting and current research is demonstrating that it is the most idea position to be in when you have to go. 

We are born with the ability to squat, look at any child play before the age of 4 or 5 and their mode to play on the floor or pick something up is squatting. 

Why do we stop squatting? We loose the ability simply because we do not continue to use it after the age of 4 or 5 when essentially we are put in chairs for at last 7 hours a day for the next 13 or more years. 

Most of the exercises that I prescribe and teach, including the squat incorporate core muscle contraction with movements that are functional to life and protective of our joints and other soft tissues.

Core muscles are located in every joint, not just the abs. They are small, 1 joint muscles, that are oriented in a diagonal fashion, sometimes they are a part of a larger muscle and example of this is the Vastus Medius Oblique which is a subsection of the Vastus Medius Muscle and it is a core muscle of the knee. The function of Core muscles is to provide stability to the joint and allow our moving muscles to work properly. Joint disease and degeneration is usually caused by core muscles not working properly and the inflammatory process causes core muscles to become dysfunctional. 

As I previously mentioned, all core muscles are oriented in a diagonal fashion and therefore their action is rotation. Many health and fitness professionals will falsely train these muscles by performing rotational exercises. This contradicts the fitness principle of specificity of training which states that in order to improve a muscle's function or a particular activity one should train by performing that muscle's function or activity.  The job of the core muscle however, is stability so these muscles are best trained to perform their job by using an isometric contraction with or without motion. 

Here is a link to view the exercise. I have combined it with a dynamic hamstring stretch during the 30 second rest period.  Depending on the patient,  I may skip the Dynamic Hamstring stretch and either rest or incorporate another exercise.  For myself, I do this exercise for a total of 5 minutes. I prescribe varying intervals of time for my patients depending on their fitness level and goals. With patients who I am concerned about losing their balance, I have them do this with a chair or ottoman both in front and behind them. 

http://www.youtube.com/watch?v=-QAgBJerfw0

Did I just kill my Grandma?

Did I just kill my Grandma?

It’s past midnight and I am anxiously awaiting word on my grandma’s condition. A call came to our house shortly after 11pm, when you are well past 40 years of age any call after 9pm is never good. My grandmother was complaining of high blood pressure, 200/90 and profuse sweating.  We all agreed that a trip to the ER was in order.

I am particularly concerned for several reasons: Obviously she is my grandmother; I love her very much, my grandmother is not a complainer, and lastly I treated her foot and calf this morning and my hypochondriac  tendencies are leading me to think that I may have dislodged a blood clot. I made sure that her ER docs were aware of this as a part of her subjective history.

During treatment she showed no sign of a Deep Vein Thrombosis, DVT nor does she have any of the risk factors predisposing her to developing one. Upon my research on the internet, I was informed me that 17% of people over the age of 80 who develop DVT’s do not show signs or symptoms of blood clots.

Symptoms of a DVT are:

• Swelling in one or both legs
• Pain or tenderness in one or both legs, which may occur only while standing or walking
• Warmth in the skin of the affected leg
• Red or discolored skin in the affected leg
• Visible surface veins
• Leg fatigue

Symptoms of embolus are:

• Sudden coughing, which may bring up blood
• Sharp chest pain
• Rapid breathing or shortness of breath
• Severe lightheadedness
• Also important to note that pulmonary embolism are often asymptomatic.

Thankfully all tests including CT scan were negative.  As a therapist who specializing in treating the foot it was important for me to learn of the asymptomatic incidence of DVT in seniors. Going forward I will let my senior patients know of this and be sure to monitor for any symptoms of an embolus.

On the positive side, my grandmother reported that her foot and knee felt great after her treatment and her balance and walking were improved.