If you have read anything over the past few years about fitness training or athletic performance, then you have heard the term “core training”.  However, you probably have heard it with little or no data to back up why you should add it to your training routine.  Well, a recent French study demonstrated that a stronger core could help you jump higher.  During the study a group of soccer players completed an 8-week core training program after which they were able leap 17 percent higher.  Researchers think that stronger abdominals increased the “springiness” in the men’s legs and pelvises.  I like to add 5 sets of 1 minute front and side planks to my clients regular workouts.

To many it seems like more and more people are tearing their Anterior Cruciate Ligament (ACL) these days.  From professional athletes like Adrian Peterson and Robert Griffith III down to our local high school athletes and even some children younger than that now seem to be tearing their ACL at a more prevalent rate.  “Why does this happen?” and “How can this be prevented?” are two common questions that are asked when one tears their ACL.

First, let’s talk about the question as to why this injury happens.  An ACL tear can be a result of either a contact or non-contact injury.  In both contact and non-contact injuries there may be enough force produced at the knee that one’s ACL cannot handle the load placed on it therefore resulting in failure.  Here is a list of some risk factors for one tearing their ACL:

1. Females are anywhere from two to 10 times more likely to tear their ACL
2. A muscle imbalance in the thigh muscles, with the quadriceps (front) being significantly stronger than the hamstrings (back)
3. Hormonal changes during the menstrual cycle
4. Increased Q angle at the knee (Q angle is simply the angle at which the femur and the tibia articulate with each other at the knee)
5. Genetics can play a role
6. A small intercondylar notch can also have an effect (Intercondylar notch can best be described as the space at which the ACL travels through inside your knee)
7. Improper landing mechanics

Now, we can take a look at the second question of how can this injury be prevented.  There is no guarantee that one will not tear their ACL, even if prevention strategies are incorporated.  With this being said, the likelihood of an ACL tear occurring can be minimized.  The following are a few simple ways to do so.  One can increase the strength of their hamstrings so their quadriceps to hamstring ratio is anywhere from 3:2 to 4:3 ratio.  Simply stated for every 100 pounds you can lift with your quads you should be able to lift anywhere from 66 to 75 pounds with your hamstrings.  One can work on jumping and landing correctly by making sure their knees don’t come together (also called “knock kneed”).  Finally, by making sure you get your muscles ready for the activity you are participating in by doing a proper active warm-up will be beneficial.

Agnesian HealthCare’s SPEED (Sports Program Enhancement & Explosive Development) program is a great way to maintain fitness during the summer, get educated in proper jumping and landing techniques, and develop core strength which is crucial to sports performance.  See agnesian.com/sportsperformance for more information.

Author: Joel Mason, PT, DPT, SCS, CSCS
Contributing Author: Sarah Schultz, MS, LAT

Many individuals enjoy the freedom and competition that running provides. There is much to know about running to be effective and safe in this growing sport. Here are a few running myths to consider.

Running Myth One: Running barefoot will cause injuries by stepping on broken glass, nails or other sharp objects in the street.  The risk is much less than most people think and may be much less than the risk of developing other injuries (plantar fasciitis, fat pad atrophy, knee, hip and back problems, etc.).  It will get your feet dirty though!

Running Myth Two: Soft surfaces decrease the stress on our knees and will help prevent stress fractures.  When we run on a soft surface, our body tenses up to prepare for impact; leading to knee extension, which causes the heel to strike first and the body to brace itself.

Running Myth Three: Minimalist or Barefoot Running Shoes are the same as running barefoot.  Absolutely not! While Vibram Five Fingers are closer to barefoot running versus traditional shoes, you are actually more likely to get injured running in minimalist or barefoot shoes versus regular shoes if you do not modify your form (bending knees more, mid to forefoot strike, etc.). The research only says your form will automatically change with Vibram Five Fingers. However, the surest way to ensure form modification is to run completely barefoot which will give you the proprioceptive input needed to change your form.

Many individuals enjoy the freedom and competition that running provides. There is much to know about running to be effective and safe in this growing sport. Here are a few running myths to consider.

Running Myth One: I was once asked by a group of older runners if we see more injuries among runners when they get older. This is a common misconception that some people have because they may know an older runner who is now getting a knee replacement. The evidence shows less injuries and arthritis for runners, especially for those who have been doing it for a long time. Running has, in fact, been found to be protective against osteoarthritis and knee injuries in general. Two exceptions are (a): There is a higher risk when starting a new running program and for this reason it is important to progress gradually. (b): Training for greater than 40 miles/week increases the injury risk for men but not necessarily for women.

Running Myth Two: Surface is also often falsely accused of being the cause of injuries. However, quite a few studies have shown that impact force is no different on soft versus hard surfaces. One study even found impact to be higher on grass versus concrete. It has been argued that the Kenyon runners can run barefoot because they run on soft surfaces; however the terrain in Africa is actually quite hard. In fact, the issue of surface hardness should actually be irrelevant, since barefoot running done correctly decreases the impact.

Running Myth Three: Shoes are fairly new.  Actually, shoes have been found on people 7,500 years ago.  Depending on the terrain, people made shoes to protect their feet.  Soles to protect feet from rocky terrain, rubber like material on the sides to protect feet and legs in areas that were often covered in snow.

Author: Joel Mason, PT, DPT, SCS, CSCS

Contributing Author: Sarah Schultz, MS, LAT

Conventional wisdom has traditionally been that the Wet Foot Test is an easy way to figure out your foot type. The idea is that you get your foot wet and step down on a paper towel or surface that you would allow you to see the outline of your foot. Feet can be normal, pronated (flat foot) or supinated (high arch).

Historically if you went to a specialty shoe store, the clerk would put you into the appropriate shoe based on his/her observation. A normal foot needs a stability shoe, a pronated foot needs a motion control shoe and a supinated foot needs a cushioned shoe. However, as more and more studies are done on this topic, it becomes clear that there isn’t any evidence to back this up. Multiple studies show runners getting injured at a higher rate in what is supposed to be the appropriate shoe. Does this mean that every runner should reassess their footwear and purchase new shoes? Not necessarily if you run on a regular basis and never get injured; definitely if you get injured a few times a year.

A newer topic that has gotten a lot more attention is barefoot running, whether completely barefoot or using minimalist shoes (which some consider running barefoot). There are a lot of good reasons for some to experiment with running barefoot or with minimalist shoes, however, be aware that you may develop some Achilles tendon issues. Eccentric calf strengthening can prevent this from becoming a concern, and it is an important addition to your training program if you choose to try barefoot running or minimalist shoes.

In addition, it is important make a few adjustments to your form. Probably the most important is to work on changing your foot strike.

You want to land on your toes or midfoot rather than your heel. To accomplish this, you want to focus on keeping your knees bent when you run. You also want to focus on running at a higher cadence. Cadence is how many strides or steps you take per minute. To calculate this, count how many times your right leg touches the ground in 30 seconds and multiply by four. A total of 180 steps per minute is usually the preferred goal but it is not a magic number for cadence.

It seems to be more common among elites, but evidence does not support it benefiting the general running population. If your current cadence is 160 steps per minute, shooting for 168 steps per minute would be appropriate. Increasing your cadence by eight to 10 steps per minute is a good starting point and it may not be necessary to increase further. It does not imply speeding up. Rather, it means shorter strides which initially will feel like more work especially when keeping your knees bent. If you are able to do this, it will actually decrease the workload on your muscles and the stress on your joints dramatically.

A study by Daniel Lieberman in the journal, Nature (Lieberman et al. 2010, looks at foot strike patterns and collision forces in habitually barefoot versus shod runners. Nature 463: 531-535), as well as two other studies, found that if you put Vibram Five Fingers (ultra-minimalist shoes) on runners who heel strike, a good percentage will change the way their foot strikes the ground over time. In the Lieberman study, five of the 10 runners who were heel strikers became forefoot strikers within the six-week time frame of the test.

If you are interested in learning more about the history of barefoot running and what sparked the barefoot phenomenon, check out Born to Run by Christopher McDougall.  http://www.amazon.com/Born-Run-Hidden-Superathletes-Greatest/dp/0307279189/ref=sr_1_1?s=books&ie=UTF8&qid=1362082783&sr=1-1&keywords=born+to+run

Related articles:

http://ingoodhealthfdl.agnesian.com/2012/06/22/barefoot-running-no-you-are-not-crazy/

Renee Lehman is a licensed acupuncturist, physical therapist, and Reiki Master with over 20 years of health care experience in Gettysburg, PA. The following article contains information from an article she wrote about “Oh, my aching neck.” I recently wrote an article and did a YouTube video on computer neck, which covers these same topics and show you a few exercises to combat it. I also wrote an article on how these devices are changing our posture.

If you have any of the physical concerns that are associated with a forward head posture, try the following exercises.

While sitting up tall on the edge of a chair, pull the shoulders back and then retract your chin keeping it parallel to the floor. Hold the chin back towards your neck and shoulders. Hold five seconds and repeat 10 to 15 repetitions. A chest stretch, again sit up tall with your back on the chair, bring your hands behind the head to support the neck, open your chest by pulling the elbows back, and extend at the thoracic back or by the shoulder blades and hold. Another standing chest stretch can be done in the corner of a room. Place each palm or forearm on each side of the corner of the wall. Place one foot in front of the other and slowly stretch by leaning the body forward towards the wall; keep your chin tucked down and back. Hold for 15 seconds and repeat three times. Lastly some reverse shoulder rolls. Stand up tall and slowly roll shoulders backward pulling the shoulder blades down and back, and holding them back 10 to 15 times, avoid lifting the shoulders to the ears, skip the top of the “circle.”

So what can you do to prevent the forward head posture? The best way to prevent forward head is to limit the use of your entertainment devices/smartphones. If you need to send a longer e-mail, consider waiting until you have access to a computer, or use an external keyboard. When using your modern technology, sit up straight with your shoulder blades pulled back/towards each other. Bring your arms up in front of your eyes so that you don’t need to look down to see the screen. Tuck your chin back and into your chest to look down rather than dropping your head forward. Place a pillow on your lap and then rest your forearms on the pillow while typing to help minimize neck tension. Make sure that you take breaks from your entertainment devices about every 20 to 30 minutes. Avoid using your modern technology while in bright sunlight. This causes you to strain to see the screen, which leads to jutting the chin forward, shifting work from the spine to the muscles that hold up the head.

Finally, and I think best of all, put the modern technology on the desk, go outside for a walk, breathe in some fresh air, and take in the  beauty of the natural world around you!  Limit your screen time and your families to two hours per day!  Look into someone’s eyes talking or playing a game rather than into a screen…it will not only save your neck and back, it will improve your personal life satisfaction with real human connection rather than overuse of social media to interact with other humans.

There are lots of excuses for not exercising…the gym is too far away; it costs too much money; I don’t know how to use any of that stuff’ it’s not open when I want to workout; I don’t want strangers looking at me, etc. Don’t let excuses hold you back.

You can exercise at home with minimal equipment. For some exercises, your body weight is all you need. For less than $50, you can buy a stability ball, and at least one pair of dumbbells or one kettlebell. A typical gym membership for one person for a year is $500.  You can save that money to buy yourself a treadmill, elliptical, row machine, stationary bike, more dumbbells or various weights, and a slew of DVDs (most of which can be played in a computer), and save more time and money by not driving to the gym, parking and walking in.

The first thing to do is develop a plan.

1)      Where can I exercise in my house/apartment? The basement, spare bedroom, office, etc.

2)      What time am I more likely to exercise? Waiting until you get home from work does not happen for most people even with the best intensions. If you like to relax and have a glass of wine after work, you may need to go to bed and get up a half hour earlier to work out in the morning instead. You will find yourself sleeping better so you won’t miss that half hour too much!

3)      What equipment do I have? Your son’s old weight bench and some used ankle weights are a welcome addition to any home gym.

4)      What do I need to buy? I think the must haves would be a yoga mat (for cushion on hard floors), a stability ball, and two sets of dumbbells (or one set of adjustable weights).  Adjustable dumbbells are an excellent investment if you can afford it. They take up a lot less space and you can actually perform exercises with a different weight in each arm. Men and women may need different amounts of weights. Here are two options: http://www.amazon.com/PowerBlock-SportBlock-Adjustable-24-Pounds-Dumbbell/dp/B000A6T9I8/ref=pd_sbs_sg_3 or http://www.amazon.com/Bowflex-SelectTech-Adjustable-Dumbbells-Pair/dp/B001ARYU58/ref=sr_1_1?ie=UTF8&qid=1362084997&sr=8-1&keywords=adjustable+dumbbells

Develop a strength training routine. Write down a routine including name of exercise, weight, reps and sets, and then make note of what you completed. The key to strength training is to challenge your muscles. If you have been doing three sets of 10 of the same exercises for years you are probably not noticing any difference in your body composition. Re-write your routine every six to eight weeks so that muscles are frequently getting a taste of new exercises. You could meet with a personal trainer to help develop a program for you to do at home, get some books from the library or look on-line.

Develop a cardio routine. The surgeon general recommends 30 minutes of moderately intense activity (walking, jogging, raking, swimming, cycling, etc). When the weather is a tolerable temperature for you and not slippery, try to get outside for a brisk walk or jog, ride your bike or do some yard work. If you have a road or mountain bike, you can buy a stationary trainer that allows you to ride your bike inside.  There are DVDs of walking programs that you can perform indoors.

Sample routine:

Perform a dynamic warm-up using some of these stretches, followed by 30 seconds of jumping jacks, burpees or high knees to get your heart pumping.

Supersets are a great time saver as you quickly move from one exercise to another with no rest. Perform each superset two to three sets of 10 to 15 reps. A good rule of thumb is that if you can’t complete eight reps, you need to lower the weight or start in an easier position; if you can perform more than 15 reps you need to raise the weight or make the exercise more difficult. Use items around your house if you can’t buy another set of dumbbells (i.e. soup cans, milk jugs filled with sand or water).

Superset #1: Push-ups (with hands on wall, kitchen counter, floor or stability ball) and hamstring curls

Interval: 30 seconds of mountain climbers

Superset #2: DB Rows and body weight squats (progress to holding dumbbells)

Interval: 30 seconds of butt kicks

Superset #3: YTWLs  and planks or knee tucks

Interval: 30 seconds of imaginary jump rope

The possibilities are endless! Depending on how much time you have the more exercises you can add. If you find you really like the stability ball, search for more exercises you can do with it; if you want to try something new like a kettlebell or TRX Suspension System make sure that you do some research before jumping right into it.

What are your favorite exercises to do at home?

Have you ever watched people on their electronic devices? What is their general posture while using a smartphone, tablet or other electronic technology? It doesn’t take an expert to see people with poor posture while using their devices. Look at yourself, what device are you using and in what position are you in while reading this article? Are you leaning over a table, or in a chair, slouched or slumped over? Is your head projected forward and your shoulders rounded forward to resemble Quasimodo?

Also, consider how much time you are spending each day using your electronic technology and the time that you are maintaining this unhealthy posture! The body will accommodate to the unnatural body position, and it will become normal and comfortable to you over time as the length of ligaments, tendons and muscles deform.  This unnatural body position will cause tight neck and back muscles, a stiff neck, headaches, forward rolled shoulders, and other neck and spine pain. You will also be placing chronic stress on your lungs, organs and discs causing your body to decrease its normal function even more and deform the natural curves in the spine to those of a 90 year old with osteoporosis.

Can you see it?  “Oh, my aching neck”…and back and shoulders… A national survey by the Kaiser Family Foundation found that the amount of time young people spend with entertainment media has risen dramatically. The survey showed that eight to 18 year-olds use their entertainment media an average of seven hours and 38 minutes on a typical day (more than 53 hours a week) (Generation M2: Media in the Lives of 8- to 18-Year-Olds, January 2010). This data was collected from 1999, 2004 and 2009.

So what exactly is forward head? The average human head weighs 10 pounds in a neutral position – when your ears are over your shoulders. When your head is held in a position in which your ears are forward of your shoulders, this is called forward head. For every inch you shift or tilt your head forward, the pressure on your spine doubles. So if you’re looking down at a smartphone, your neck is holding up what feels like 20 or 30 pounds. Ouch! All that extra pressure puts a strain on your spine, and can pull it out of alignment as well as deform the ligaments, discs and tendons. You could compare the forward head position to bending back your finger all the way and holding it there for a long time. As the tissues are stretched for a prolonged period of time, they get sore and inflamed. Staying in the forward head position can lead to muscle strain, disc herniations, pinched nerves and other concerns.

Over time, it can even flatten the natural C-curve of your neck and getting to and maintaining good/upright posture will not be possible. What is the C–curve? It is the natural curvature in the neck with the open part of the C directed toward the back of the neck. This curve is important to be maintained so that you have proper flexibility and range of motion with your neck. Also, a nice C-curve in the neck creates a relaxed spinal cord. Flattening it out straight creates tension. This tension causes stress to the spinal cord, and therefore inhibits nervous system function.

Rene Cailliet, MD, former director of the Physical Medicine and Rehabilitation department at the University of Southern California, has written that “forward Head may result in the loss of 30 percent of vital lung capacity. These breath-related effects are primarily due to the loss of the C – curve, which prevents the muscles of the neck to properly lift the first rib during inhalation. The entire gastrointestinal system (particularly the large intestine) may become agitated from Forward Head, resulting in sluggish bowel movements” (Cailliet R, and Gross L, Rejuvenation Strategy, 1987).

So, along with spinal issues, what are the other issues that forward head can lead to? In some of his brain research, Roger Sperry, PhD (Nobel Prize Recipient for Brain Research), found that “only 10 percent of the brain’s energy output has to do with thinking, metabolism, and healing; whereas, the other 90 percent of the brain’s energy output is used to relate the physical body to gravity.” Dr. Sperry also discovered that “90 percent of the stimulation and nutrition to the brain is generated by the movement of the spine.” Our modern posture of forward head will incapacitate normal spinal movement. Therefore, “a forward head posture will cause the brain to rob energy from thinking, metabolism, and immune function to deal with abnormal gravity/posture relationships and processing.”

To evaluate yourself for forward head do the following: place your heels against a wall. You should be able to touch the wall with your tail bone, your upper back and the back of your head without projecting your chin forward. Stay tuned for what to do about your forward head and aching neck!  Check out my YouTube video with exercises to assist this called computer neck.

When setting up a training program for one of our fitness members I heard a familiar question.  “How do I motivate myself to keep coming”.  It’s a question that all of us ask ourselves during workouts or even in our daily lives.  The answer isn’t simple, it’s not about willpower or rewards.  It boils down to accountability.  Finding someone that you can share your goals with will help, then when you fail to make it to the gym or do your workout, someone other than you is there to remind you about your promise.    Use Twitter or Facebook to tell your followers you’re going to work out.  In a recent study at USC, a group of obese participants put their activities on twitter.  The group using Twitter lost significantly more weight than those that didn’t.  In fact,each tweet correlated with a half a pound of weight loss!

Margie Anderson, APNP
Fond du Lac Regional Clinic-Waupun
Orthopedics & General Surgery

Author: Margie Anderson, APNP at the Fond du Lac Regional Clinic in Waupun

Osteoporosis is a silent disease that is preventable and can progress for many years without detection. Sometimes one doesn’t know they have a fracture until they start having pain. Our bone mass peaks between the ages of 18 and 35. After our bone mass peaks, we can lose more bone than formed and bone can start to become thinner. The good news is the more bone mass we have, the less likely the possibility of breaking a bone or getting osteoporosis later in life. Remember osteoporosis can affect both men and women, but mostly women.

Let’s look at risk factors for developing osteoporosis. They can include: thinness or a small frame, family history of osteoporosis, being postmenopausal or having early menopause, abnormal absence of menstrual periods, prolonged use of certain drugs like prednisone, low calcium intake, smoking and excessive alcohol intake.

How do I know when to get a bone density test?

A bone density test may be recommended by your doctor when you start losing height, fracture a bone, take certain drugs, receive a transplant or have a drop in your hormone levels. The bone density testing can be done by a central DXA machine. You probably have heard it called “DEXA” ( Dual-energy x-ray absorptiometry). It is the most accurate test to estimate the density of your bones and predict your chances of breaking a bone.  Quantitative ultrasound of the heel and other tests are available to help predict a fracture, estimate how fast you are losing or making bone.

Check your insurance policy to see if it is covered. Medicare part B covers the entire cost of bone mass screening at age 65 and older if criteria is met. If you are diagnosed with Osteoporosis your doctor can order a bone density test to evaluate the effectiveness of treatments according to your T-score every 2 years.

Prevention or progression of the disease can be accomplished through a healthy lifestyle and a diet rich in calcium and vitamin D as well as walking, swimming, low stress yoga and tai chi.