December 2008: Suggestions to Keep Your Back Away From the Doctor's Office

Low back pain may be the most common diagnosis made by doctors and physical therapists. Back pain is the most common cause of work-related disability in the United States, and a leading contributor to job-related absenteeism, according to the National Institute of Neurological Disorders and Stroke. . It is amazing how much we abuse our backs! An article published by the American Academy of Family Physicians states that in the United States, approximately 90% of adults experience back pain at sometime in their lives.

Next time when you go out to eat at a restaurant, look around and see how many people are slouched over. Those are the same people that end up coming to our clinic. The main thing that I always emphasize to my patients and our athletes is good postural habits. I call this a behavior pattern; just as poor posture is a bad habit, you want to train your body and the mind to maintain good posture.

Here are 7 guidelines I constantly advice my patients to follow:

1. Proper Standing Posture

When standing:
• Head should be held up straight with the chin in. Do not tilt your head forward, backward or sideways.
• Shoulder blades should be back and the chest forward.
• Stretch the top of your head toward the ceiling.
• Stomach should be tucked in without tilting the pelvis forward or backward.
• Weight should be distributed on the arches of the feet.
• A lumbar roll can be used to help you maintain the normal curves in your back.
• Distribute your body weight evenly on both hips.

2. Proper Ergonometric Work Station and Sitting Posture

At work, adjust your chair height and workstation so you can sit up close to your work and tilt it up at you. The top of the monitor should be at or just below your eye level. Shoulders should be relaxed and elbows close to the body. Feet need to be flat on the floor and the lower back should be supported.

3. Proper Body Mechanics Such As Lifting

Most back strains occur when people are focused on something other than their backs (such as when reaching into the trunk of a car to retrieve a briefcase). When lifting objects, keep your spine erect to stabilize your back before lifting. Some correct lifting technique as listed below:
• Stand with a wide stance close to the object you are trying to pick up and keep your feet firm on the ground. Tighten your stomach muscles and lift the object using your leg muscles. Straighten your knees in a steady motion.

4. Correct Bra Support or Back Support

Doctor of physical therapy Kim Stepien, at the Sports Therapy and Rehabilitation (STAR) clinic in Washington DC recommends being fitted for appropriate bra wear. Women's bras can provide a great deal of support, if chosen correctly. Unfortunately, too many women are wearing the wrong type of bra for both daily activities and sports and suffer from mid and low back pain as a result. Bra style and size combined with increased body awareness may eliminate pain originating from too heavy of a forward load. A correct fitting and supportive bra will allow for a more equal distribution of load and rely less on back muscles to maintain a healthy posture.

5. Sleeping Habits

Sleep smart. People with back pain have commonly been told to use a firm mattress, but recent studies indicate that a medium-firm mattress might be better. Use pillows for support, but don't use a pillow that forces your neck up at a severe angle. When it comes to disk pressure, lying down inserts the least amount of pressure on the disk. Therefore, if you are having any type of numbness or aches when you wake up in the morning you should evaluate you sleeping position and the mattress.

6. Improper Shoes Clothing, especially shoes affect posture. Poor foot mechanics or structure forces the pelvis to tilt forward/backwards, causing curvature of the lower back and tightening of the lower back muscles. Wearing proper shoes and support devices such as orthotics should help. Shoes that provide good support for the arches and heels are important for a healthy spine. High heels are counterproductive to maintaining a healthy back.

7. Prolonged Static Posture

Your body can only tolerate being in one position for approximately 20 minutes. This is why driving or sitting at your desk can become uncomfortable after a short period of time. Holding the same position slowly stretches the elasticity out of tissues and as stress builds up, it causes discomfort. The solution? Change positions frequently. Sit down if you've been standing for a while, and move around if you've been standing. Take short breaks throughout the day and alternate posture and if you must sit or stand for long periods of time.

Preventing and minimizing back pain is a very easy task and you have all the tools you need to succeed. The difficult part is preventing the fault behavior patterns that we are all used to. It takes effort to keep a watchful eye on body mechanics. Looking at the big picture, it will be worth it for you to pay attention to these above tips at least for a minute here a minute there to prevent back pain.

Take responsibility and necessary precaution to prevent back pain rather than trying to cure pain that has occurred over the long term due to bad posture.

October 2008: Losing Weight Is As Easy As Second Grade Math!

One of the most frequent questions that I get asked on a daily basis is “what can I do to lose weight?” My answer is “it’s all simple mathematics”. If you want to maintain your current weight, you have to eat the same number of calories you burn.

Losing weight while being able to engage in normal daily activity is like emptying a gas tank. When you are trying to empty your gas tank, don’t keep filling it up. Simply put, find your daily calorie expenditure for your body to function and only eat that amount of food calories. Then exercise to burn the extra body fat.

When you go on extreme DIEts you are killing your body. Depriving the body of its proteins and other important nutrients will cause irregular heart beat, heart failure, muscle weakness and even death. We need food, like a car needs gas to get around. With the formula below you can lose weight in a healthy manner from eating the adequate amount of calories and exercising.

The first part of the equation is getting a rough estimate on how many calories you need.

The Harris-Benedict Equation will give a good ballpark figure of how many calories you need a day or your daily energy expenditure. You use energy no matter what you're doing, even when sleeping. This formula will calculate your Basal Metabolic Rate (BMR); the number of calories that your body needs to function.

For Men: BMR = 66 + (13.7 × weight in kg) + (5 × height in cm) – (6.8 × age in years)
For Women: BMR = 655 + (9.6 × weight in kg) + (1.8 × height in cm) – (4.7 × age in years)

Once you’ve calculated your BMR, multiply it by your activity factor to get the Daily Calories Needed (DCN):

Sedentary: BMR × 1.2
Moderately active: BMR × 1.55
Very active: BMR × 1.725

Using the Harris Benedict formula, an active 30-year-old woman who weighs 70 kg (154 lbs) and is 170 cm (5'7") tall would need to consume:

BMR= 655 + (9.6 × 70) + (1.8 × 170) – (4.7×30) = 1492
DCN (Daily calories needed to maintain same weight) = 1492 × 1.55(Moderately active) = 2238 calories

If you are trying to lose weight, do not eat more food calories than this number.

In order to lose weight, Mystics Team Physician Dr. April Barbour recommends consuming up to 500 less calories a day than the DCN. The healthiest way to do this is by exercising more to burn 500 more calories daily. Generally with this formula you should see a 1-2 pound weight loss a week while gaining strength, cardiovascular endurance and a good energy level throughout the day without stressing your vital organs.

Personally I am a big fan of strength training/weight training incorporated with cardiovascular/aerobic exercise. For example, you can walk up and down stairs for 5 mins and then do a set of 10 pushups. Continue this routine for 2-3 times and then follow up with another exercise. This type of cross training will not only work your cardiovascular system it will also strengthen your body.

The main thing you have to do when exercising and trying to lose weight is to be consistent on your exercising. You have to stress the heart to 65% or above you max heart rate (MHR). But, for regular exercisers, the typical way we calculate MHR is with the Kievelan formula. This formula is a bit controversial because it doesn't reflect the differences in heart rate according to age. A more accurate formula is described in a study published in the Medicine & Science in Sports & Exercise Journal in May 2007. However, this Karvoen formula is still effective for recreational purposes.

Kievelan formula:
220- Age = Max Heart rate.
For example, a 25 year old’s max heat rate would be 220-25= 195
65% of that number (127) is the target heart rate to workout.

At the end of the day, the goal should to eat only the amount of calories that are calculated as your DCN. If you know that it’s a day that you would not be able to exercise, you might want to cut out that 400 calorie apple muffin or drinking the cola can. If you don’t burn those calories it will get stored up and you will GAIN 1-2 pounds a week.

I am a big believer in eating nutritionally valued food. Don’t just eat donuts to get your calorie content or to scratch your hunger. Eat nutritious snacks such as bananas that will give you a good source of vitamins, fiber, and etc. It’s just like filling up your nice car with cheap gas or putting poor quality oil; it will take its toll on the long run. So no matter if you want to maintain, lose or gain weight, your numbers have to match.

September 2008: The Best And Cheapest Massage In Town

People always ask me about new technology or any miracle therapy machinery that the Wizards or Mystics use to cure our athletes. As a clinician, one of most effective tools that I have been using in our training room for the past few years is the Foam Roller. With the Mystics, we use the foam roller prior to practice as a part of our warm up to improve tissue quality, increase the pliability of the tissue and to release the trigger points. This improves flexibility, function, performance and reduces injuries. Our athletes use the foam roller again after practice as a part of our cool down. During this regeneration phase, the foam roller helps re-circulate lactate acid and aid in quicker recover time. A form roller is an incredibly effective tool that everyone can use in their own living room.

A joint is unable to move though the full range of motion with tight or restricted muscles. This is the main cause of muscle injuries. Tight and restricted muscles also put unnecessary stress to the joints. One of the things that I check daily with our players is the "timing"/ muscle firing patterns. This is known as the neuromuscular efficiency. If the "timing"/muscle firing pattern is not synced it would lead to micro trauma of the muscle skeletal system and poor performance on the court. With the use of the foam roller you will be able to diminish soft-tissue tension, decreases pain, restores normal muscle length-tension relationships, and improves function.

To give you an example, before a NASCAR race, the mechanics make sure all the belts in their car are working precisely. One minor fault in a belt would jeopardize the car's performance in a 500mile race. This is very similar to our athletes playing 40minutes or you going for a 20minute walk. Minor muscle fault could jeopardize the performance or could lead to injuries. By using the foam roller under the guidance of your healthcare practitioner, you will be able to minimize or eliminate most of the muscle restriction in the soft tissue system. First you need to get the guidance from your healthcare practitioner before using the Foam Roller. He/she will be able to show you the necessary techniques, good posture and frequency of use. Therefore, using the Foam Roller a few minutes a day will enable you to keep your muscles working to perfection. You could also use a tennis ball to get similar results.

The pictures to the rightshow two of the most frequently used positions by the Mystics players. The first exercise is for the Latissimus dorsi muscle and the other is for the calf muscle.

August 2008: Basketball Running Form

One of the training techniques that I try to emphasize with the Mystics is proper running form. The correct running form will make the athlete very efficient and economical while minimizing overused injuries. Efficiency enables the athlete to get from point A to B fast with no wasted motion. Economy enables the athlete to use the least amount of energy to get from point A to B.

Elite sprinters are known for their efficient motion. They are very quick off the ground and they rapidly fire their feet to the ground with consistency – similar to a “piston” in a car. Newton's law states that for every action there is an equal and opposite reaction. Similarly, what you put in to the ground is what you get out of it. A runner exerts a force in to the ground and this creates an equal and opposite reaction force which moves the body over the ground.

The Basketball court is about 30 meters (90 feet) long. Therefore basketball players are always in driving posture accelerating from one end to the other end and then decelerating and changing direction.

During the accelerating mode, these are some of the proper postures I focus on: