One, Two, or Three Miles?

June 1, 2015

Even experienced exercisers sometimes find it difficult to know how much to do. For the beginner this uncertainty represents a significant stumbling block. Fortunately well-established guidelines and protocols exist to provide assistance to all exercisers, regardless of your skill level.

In general, the beginning exerciser requires the most instruction. The key is to build up strength and endurance slowly and not do too much too soon. In terms of strength training, the best plan is to determine at what weight you can comfortably perform three sets of eight repetitions. If you can’t do three sets of eight reps at the weight you’ve selected, it’s too heavy. If doing three sets of eight reps with the weight you’ve chosen doesn’t feel like anything at all, then the weight is too light. Overall, of course, too light is better than too heavy. The majority of strength training injuries occur when you’re attempting to train with an inappropriately heavy weight.

For example, you’ve selected 15-pound dumbbells with which to perform your bench press routine. You can comfortably do three sets of eight reps. Fifteen pounds is not too light and not too heavy. During the course of your next several weight training sessions, build up to three sets of 12 reps using the 15-pound dumbbells. When you can do three sets of 12 reps successfully, the next time you do your bench press routine you’ll increase the weight by approximately 10%. In other words, you’ll use the next heaviest weight, which is usually 17.5 pounds in a well-equipped gym. Begin with three sets of eight reps with the 17.5-pound dumbbells, and progress over the next several sessions to three sets of 12 reps. Then you’ll repeat the sequence with 20-pound dumbbells, starting at three sets of eight reps and building up to three sets of 12 reps. You’ll follow this formula with all of your strength training exercises. In this way, using a safe, smart, and graduated program, you’ll consistently build lean muscle mass, gain improved strength and efficiency of your cardiovascular system, and most likely lose several pounds as stored fat is converted to muscle.1

The same principles apply to cardiovascular exercises such as walking, running, biking, and swimming. If you haven’t exercised in a very long time, walking is a good method with which to begin.2,3 On your first day, go for a normally paced 10- or 15-minute walk. Don’t be concerned that your walk feels like it’s over only a few minutes after it’s begun. Your main focus should be on getting started, not on how much or how little you’re doing in the first few sessions. Over the course of four to six weeks, build up a minute or two each session until you’re able to comfortably walk for 30 minutes at a moderate pace. At this point you can begin to increase your pace gradually, building up to a 30- or 40-minute walk at a brisk pace. At this level, you’re going a very good, vigorous cardiovascular workout and your heart, lungs, and other components of your cardiorespiratory system are becoming stronger, healthier, and more efficient.

In this gradual, steady, measured way, all exercisers, of whatever age, prior experience, and skill level, can gain a lifetime of benefit from their fitness programs and minimize the likelihood of setbacks or injury.

1Hawkins M, et al: Impact of an exercise intervention on physical activity during pregnancy: the behaviors affecting baby and you study. Am J Public Health 2014 Oct;104(10):e74-81. doi: 10.2105/AJPH.2014.302072. Epub 2014 Aug 14
2Hanson S, Jones A: Is there evidence that walking groups have health benefits? A systematic review and meta-analysis. Br J Sports Med 2015 Jan 19. pii: bjsports-2014-094157. doi: 10.1136/bjsports-2014-094157. [Epub ahead of print]
3Varma VR, et al: Low-intensity daily walking activity is associated with hippocampal volume in older adults. Hippocampus 2014 Dec 7. doi: 10.1002/hipo.22397. [Epub ahead of print]

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Your Personal Cloud

April 28, 2015

The concept of cloud computing has become a buzzword in recent years. The notion of “the cloud” originally referred to data storage. You could backup your computer files or even an image of your hard drive to a server bank in some remote location. Now you can access fully featured software programs via the cloud, including well-known productivity and photo editing programs. Cloud computing enables you to save money you would have spent on costly software packages and frees up valuable space on your home or office networks. The only drawback involves security issues, but such issues exist on your local networks as well.

The computing paradigm has taken over more and more not only of our work day, but our recreational environments as well. As a result, it has become increasingly easy to neglect and ultimately forget about the precious components of human physiology upon which all computing systems are based, that is, our very own brain and central nervous system.

There are serious downsides to such neglect and lack of care. Most of us are aware of the need to engage in regular vigorous exercise and eat a consistently nutritious diet. We do these things because we’ve learned the importance of a healthy lifestyle. Of course, these healthful activities support the functioning of your brain and central nervous system. But your brain requires more than mere physiological sustenance. Your brain itself requires the performance of actual work so that it can continue to do what it was designed to do.1 The critical function of your brain is to provide you with creative, innovative solutions to the challenges you face every day to the survival and welfare of you and your family.

Your brain is staggeringly complex. It is estimated there are more connections among your brain cells than there are stars in the Milky Way galaxy. Specifically, there are more than 100 billion neurons in your brain, with several 100 trillion (1014) and possibly as many as 1 quadrillion (1015) connections. This massive network is built for heavy lifting, but most of us now fritter away this priceless resource as we spend seemingly endless hours talking and texting on our cell phones and playing games on our phones, tablets, and laptops.

Now we may be developing eye-hand coordination when we lose an entire afternoon playing race car and other arcade-style games.2,3 But as the great philosophers have known for almost 3000 years, actual thinking is the best and most worthwhile use we can make of the free gift of self-awareness we receive as humans. Only thinking will provide us with the tools and techniques we require to grow, develop, and thrive in our increasingly complex and shrinkingly small global village. But the skill (or art) of thinking is based on training. Fortunately such training is available everywhere and the cost is frequently only that of time. Reading books is the primary training ground for developing the skill of critical thinking that will make a difference in our lives. Reading books that challenge you, followed by study and practice, will hone and refine your ability to actually think and make use of your brain, your own personal cloud. Surprisingly, and possibly shockingly, everything we need for such life-enhancing thinking is available right there “within” us.

1Vigliecca NS, Baez S: Screening executive function and global cognition with the Nine-Card Sorting Test: healthy participant studies and ageing implications. Psychogeriatrics 2015 Mar 3. doi: 10.1111/psyg.12104. [Epub ahead of print]
2Moisala M, et al: Brain activity during divided and selective attention to auditory and visual sentence comprehension tasks. Front Hum Neurosci 2015 Feb 19;9:86. doi: 10.3389/fnhum.2015.00086
3Banerjee S, et al: Interests shape how adolescents pay attention: the interaction of motivation and top-down attentional processes in biasing sensory activations to anticipated events. Eur J Neurosci 41(6):818-834, 2015

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Mission Impossible

April 14, 2015

Everyone knows what he or she “should” do to obtain good health. But the mere knowledge of what we should be doing is never enough. If we’ve not been in good shape for some time, if we can’t remember the last time we did any meaningful exercise on a consistent basis, and if we’ve added more pounds over the years than we care to admit, then the task of getting back in shape seems an impossible mission. But like the Mission Impossible team in the fabled television series and the hugely successful film adaptations, we too can turn the task of regaining high levels of fitness into “mission possible”.

The primary requirement for your personal restoration project is establishing a new mindset. No one wants to do what other people think they “should” do. Having your spouse tell you that you should lose weight or having your doctor tell you that you need to do more exercise is never pleasant. These admonitions never really work and only serve to create stressful encounters and interactions. Even though the people close to you have good intentions and want the best for you, they usually don’t realize the willingness to change is never sourced from outside a person. The only way you’re going to take on the time and effort of implementing new lifestyle activities is if you yourself choose to do so. Making the active choice to exercise and making the active choice to eat healthy foods will create the powerful difference by which you begin to actually accomplish the action steps necessary to change the quality and characteristics of your health and well-being.1,2

Thus, your own personal choice is what’s required to get you started. Importantly, making such a choice is not a one-time event. Circumstances always intervene and your choice to exercise and eat nutritious foods will need to be reinforced frequently. There may come a time when you choose to sleep late and skip your exercise session for that day. Or you may choose to eat a whole pint of ice cream in the middle of the week. It will be helpful to recall that such deviations from your main plan are always your choice, and returning quickly to your regular exercise routine and regular food program will also be your choice.

None of this needs to be dull, boring, or onerous. Remember that if you think you “have” to do your exercise and “have” to eat fresh fruits and vegetables, then you probably won’t do these things for very long. But if you remind yourself that you have actively made a personal choice to engage in healthy activities, then you will recreate your opportunity for powerfully participating in the ongoing restoration of your own vibrant health and well-being.3

1Sardinha LB, et al: Criterion-referenced fitness standards for predicting physical independence into later life. Exp Gerontol  61:142-146, 2015
2Hafstad AD, et al: How exercise may amend metabolic disturbances in diabetic cardiomyopathy. Antioxid Redox Signal 2015 Mar 4. [Epub ahead of print]
3Crous-Bou M, et al: Mediterranean diet and telomere length in Nurses’ Health Study: population based cohort study. Brit Med J 2014 Dec 2;349:g6674. doi: 10.1136/bmj.g6674

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The Top Shelf

March 23, 2015

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Many adults begin to develop shoulder pain, even though they may not have sustained a specific injury. It’s important to pay attention to such shoulder issues, as a healthy shoulder joint is the key to full function of the upper extremities. We all know at least one person whose ability to perform normal activities of daily living has been significantly compromised by chronic shoulder pain. Conservative treatment may be of benefit, but the key, as always, is to prevent these problems before they occur. The primary prophylactic intervention, as is the case for most musculoskeletal conditions, is exercise.

We all agree that the human body’s design is magnificent. Every component has a purpose, down to the smallest cell. Every system is deeply interconnected with every other. Miraculously, the whole is much greater than the sum of the parts. And yet, there are a few “gotchas” built-in to this ingenious design. With respect to the shoulder, the “gotcha” relates to the shoulder joint’s extraordinary mobility. The shoulder joint has the greatest range of motion of all the joints in your body. But this extreme mobility comes at a price, that is, the shoulder joint is not a particularly stable joint. For example, shoulder dislocations comprise approximately 50% of all such injuries.

Shoulder pain in the absence of a specific injury often represents damage to the rotator cuff. Again, the design of the shoulder joint and surrounding soft tissues is implicated in these rotator cuff problems. The blood supply to the bones, muscles, ligaments, and tendons of the shoulder is consistently compromised during normal motion of the shoulder above 90º, as in placing an object on or taking an object down from the top shelf in a kitchen cabinet. If much of your day is spent with your arm elevated above 90º to the front or to the side, over time you may develop nagging shoulder pain. Worse, with persistent repetitive motion above 90º, nagging shoulder pain may become chronic pain that restricts activities.

The best approach to shoulder problems is to become aware of the rotator cuff’s well-known tendency to develop degenerative changes. We can be proactive by doing strength-training exercises for the shoulder and incorporating these exercises in our weekly exercise program as soon as possible.1,2 Beginning such exercises in the teenage years would be ideal. For those of us who are older, the right time to begin shoulder strength training is now. Shoulder exercises stimulate growth of new muscle fibers, increase the size of muscle fibers already in existence, and stimulate growth of nerve fibers bringing information to and from all shoulder girdle structures.

Shoulder exercises should be done once or twice a week as part of your overall fitness program. As with all exercise that’s new to you, start slowly and gradually increase the level of difficulty over time.3 The result of all this activity is a dramatically improved blood supply to the shoulder region and a dramatically reduced tendency for rotator cuff degeneration and injury.

1Choi SH, Lee BH: Clinical Usefulness of Shoulder Stability Exercises for Middle-aged Women. J Phys Ther Sci 25(10):1243-1246, 2013
2Saltychev M, et al: Conservative treatment or surgery for shoulder impingement: systematic review and meta-analysis. Disabil Rehabil 37(1):1-8, 2015
Another example of a common issues
3Daenen L, et al: Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying science to practice. Clin J Pain 31(2):108-114, 2015

Avoiding Diabetes

February 17, 2015

The worldwide type 2 diabetes epidemic has been thoroughly documented.1,2 Yet despite extensive study and analysis, there has been little actual progress in slowing the spread of this chronic disease. Numerous medications such as metformin and glyburide are available to help counter the severe problems that result from unchecked diabetes. But if the person with diabetes doesn’t assist in the process of getting well, the disease will continue on its unrelenting course. There are many important  steps a diabetic patient can take to improve his or her health status. Better still, these same steps may be implemented by healthy persons to ward off type 2 diabetes in the first place.

In type 2 diabetes, the cells of your body become resistant to the effects of insulin. Normally, the hormone insulin promotes the absorption of glucose from the blood by muscle cells and fat cells. With insulin resistance, glucose fails to be properly absorbed by these cells and blood levels of glucose rise. Over time, some of this excess glucose is converted into fat, increasing the person’s weight, causing high blood pressure, and placing undue stress on the heart. Further, prolonged exposure to excess glucose damages small blood vessels and nerve fibers, leading to significant pain along large nerve tracts (neuropathies), loss of circulation to and even amputation of a lower limb, kidney disease, kidney failure, eye disease, and blindness.

Thus, diabetes can be devastating for both patients and their families. The annual public health costs related to diabetes treatment are huge. Diabetes costs in the U.S. were $245 billion in 2012, representing $176 billion in direct medical costs and $69 billion in lost productivity. Worse, in 2012, 9.3% (29.1 million) of Americans had diabetes, up from 8.3% (25.8 million persons) in 2010. Costs of diabetes to patients, families, and society continue to rise.

The only feasible method of combating the worldwide diabetes epidemic focuses on individual initiative. Medical treatment, by definition, arrives after the fact, typically years after the diabetes process has been set in motion. Prevention is the best strategy. Adopting a lifestyle that, indirectly, leads to appropriate utilization of insulin rather than insulin resistance offers a real, effective solution to diabetes prevention. More than 20 years of research has demonstrated that 30 minutes of vigorous exercise a day, combined with a healthy diet and sufficient rest, will substantially assist a person in avoiding chronic diseases such as diabetes.3 Personal accountability and personal responsibility are called for. It is up to each of us to make such choices in the best interest of ourselves and our families.

1Vollenweider P, et al: HDLs, Diabetes, and Metabolic Syndrome. Handb Exp Pharmacol 224:405-421, 2015
2Skrha J: Diabetes mellitus–a global pandemic. Keynote lecture presented at the Wonca conference in Prague in June 2013. Eur J Gen Pract 20(1):65-68, 2014
3Orio F, et al: Lifestyle changes in the management of adulthood and childhood obesity. Minerva Endocrinol 2014 Dec 17. [Epub ahead of print]

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A Fresh Coat Of Paint

January 27, 2015

As all real estate brokers know, a fresh coat of paint will make any property look good. Whether your home is a row house in Baltimore, a Paris atelier, or even a Winnebago, a new coat of paint will bring a shine to the interior and put a smile on the faces of both residents and guests. You may find that a similar smile will appear on your face and the faces of your friends and family members when you engage in activities that provide you with a metaphorical fresh coat of paint. Specifically, you’ll obtain your “new look” by incorporating a healthy diet and regular, vigorous exercise in your daily routine.1,2

But what exactly is “a healthy diet,” and what is really meant by “regular, vigorous exercise”? A healthy diet consists in a daily practice of consuming food from all five food groups: fruits, vegetables, grains, proteins, and dairy. Importantly, a healthy diet includes at least five daily servings of fresh fruits and vegetables. Overall, the more colors on your plate, the better. If you’re consistently eating yellow, green, red, blue, orange, and purple foods such as squash, corn, grapefruit, kale, broccoli, apples, peppers, blueberries, carrots, oranges, potatoes, and eggplant, you’re well on your way toward a lifelong healthy diet.

The grains food group contains whole grains such as whole wheat, brown rice, bulgur, and barley. For those who require gluten-free whole grains, the numerous choices include amaranth, buckwheat, quinoa, brown rice, and teff. The protein food group includes beef, lamb, chicken, eggs, fish, beans and peas, and nuts and seeds. There are plenty of protein sources for vegetarians and others who don’t eat meat or other foods derived from animals such as eggs and milk. The dairy group is included to provide sources of calcium.3 These foods include low-fat and fat-free choices such as milk, yoghurt, and cheese. If you’re a vegetarian or have allergies to dairy products, other sources of calcium include kale, collard greens, spinach, salmon, sardines, blackstrap molasses, and beans. For men and women aged 19 to 50, the recommended daily requirement for calcium is 1000mg. For women over age 50 and men over age 70, the recommended daily requirement for calcium is 1200mg.

Regular, vigorous exercise means doing at least 30 minutes of exercise five days a week. Walking, running, bike riding, swimming, using an elliptical machine or treadmill, and weight training are all good choices. Lifting weights three times a week and doing some form of aerobic exercise two times a week is one example of such a program of vigorous daily exercise. For some people, walking five days a week for at least 30 minutes each day represents an optimal program. Find out what works best for you and do that consistently. Change your program every few months to keep both your mind and body challenged. Again, the specific form of exercise is not critical. What works for one person will not work for another. The key is consistency. Five days a week, at least 30 minutes a day.

Your fresh coat of paint is not merely metaphorical. Once your new lifestyle changes take effect, probably within three to six weeks, you’ll begin to develop an inner glow and an outer glow that will be visible for all to see.

1King DE, et al: Impact of healthy lifestyle on mortality in people with normal blood pressure, LDL cholesterol, and C-reactive protein. Eur J Prev Cardiol 20(1):73-79, 2013
2Lopresti AL, et al: A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise. J Affect Disord 148(1):12-27, 2013
3Nachtigall MJ, et al: Osteoporosis risk factors and early life-style modifications to decrease disease burden in women. Clin Obstet Gynecol 56(4):650-653, 2013

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When the Cure Is Worse than the Disease

January 20, 2015

Chronic diseases such as hypertension and diabetes have increasingly high prevalence in world populations.1 Such prevalence is rising despite extensive use of prescription medications. Problematically, many people have two or more concurrent chronic disorders and are taking multiple medications. But frequently the various physicians are not in contact and are not aware of the patient’s complete list of current prescriptions. No single physician or nurse is managing the patient’s array of medications. As a result, potentially harmful drug interactions are a common occurrence.2,3 Mistakes are made and patients may suffer serious side effects. In such adverse circumstances, the cure in fact may be worse than the disease.

In today’s health care systems, people as patients need to be good custodians of their own care. In many health systems, a patient is lucky if he or she is able to spend more than five uninterrupted minutes with their doctor. Physicians are rushed and harried by numerous responsibilities related to management of their offices, all of which take precious time away from patient interactions. In such an environment, patients need to be proactive to do their best to ensure that recommended treatment is actually going to be helpful, rather than potentially harmful. This is a very difficult task, as most people do not have backgrounds that will help facilitate understanding of such decision-making. But especially for those with a chronic disease, it’s critically important to master at least a basic level of information regarding their condition and various types of treatment.

In addition to expanding one’s knowledge base, an important long-term strategy is to begin to make lifestyle choices that will support good health. Appropriate and effective lifestyle choices include regular exercise, a healthy diet, and sufficient rest. All three of these key components of good health can be started right now. An exercise program should consist of five 30-minute sessions of vigorous exercise every week. A healthy diet consists of daily selections from all five major food groups: fruits, vegetables, grains, proteins, and dairy. A daily diet should include at least five servings of fresh fruit and vegetables every day. Regarding sufficient rest, 7-8 hours of sleep per night is a good average for most people. If you’re not waking up feeling rested and refreshed, you’re probably not getting enough sleep.

Ultimately, each of us is responsible for our own health and well-being. Prescription medication may be necessary, but of course such treatment is primarily directed toward the effects of a person’s disease or disorder. Changes in lifestyle are required to address the underlying causes of such conditions. Beginning to institute and maintaining healthful lifestyle choices will provide long-term benefit for the welfare and well-being of our families and ourselves.

1Bauer UE, et al: Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet 384(9937):42-52, 2014
2Rotermann M, et al: Prescription medication use by Canadians aged 6 to 79. Health Rep 25(6):3-9, 2014
3Marengoni A, et al: Understanding adverse drug reactions in older adults through drug-drug interactions. Eur J Intern Med 2014 Oct 10. pii: S0953-6205(14)00282-9. doi: 10.1016/j.ejim.2014.10.001.

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Home Improvement

December 16, 2014

You’ve finally decided to paint your kids’ bedrooms. Not only that, but you’re going to do it yourself. Congratulations. Or your rooftop gutters have become so filled with leaves that the only place for overflow rainwater to go is down the sides of your house and seep into the foundation, and you’ve decided to install a gutter protection system. And you’re going to do that yourself.

These may be great choices. DIY projects are self-affirming and self-empowering, and often provide real opportunities for personal growth and development. There may be substantial cost savings, or you just want to reconnect with your high school self who loved shop class. Regardless of the numerous possible motivations, the most important consideration in any home improvement project is safety.

Aside from basic rules such as using protective goggles and always having a buddy supporting and stabilizing the ladder you’re up on, safety around the home often depends on your own level of physical fitness. For example, if you’re relatively out-of-shape, it’s easy to strain a neck, shoulder, or lower back muscle when you’re trying to apply paint evenly to a corner of the ceiling. Similarly, if you haven’t done any vigorous exercise on a consistent basis in a while, do-it-yourself activities such as changing your car battery or even mowing your lawn can cause a lower back injury or even a twisted ankle or knee.

Doing regular vigorous exercise provides many benefits In addition to preparing you for real physical work. Also, supporting your exercise and physical work is a specialized system of nerve endings known as proprioceptors.1 These nerve cells play a significant role in whether physical activity is done easily and well or, instead, results in an injury. Stated succinctly, proprioceptors tell your brain about your body’s position in three-dimensional space. For example, if you’re bending over to pick up two one-gallon cans of paint, your brain needs to know that you’re ankles are bent at 20 degrees, your knees are bent at 80 degrees, and your hips are bent at 70 degrees. If this information isn’t transmitted accurately or isn’t  received fairly instantaneously, you may suffer a lower back injury even though the paint cans themselves only weigh 8 pounds each.
Proprioception becomes a critical system any time you go up on a ladder.2 Maintaining your balance depends on a moment-by-moment, two-directional stream of information between your brain and your bones, joints, muscles, and ligaments. Your nerve system and your musculoskeletal system do all the calculations required to enable you to work safely from the top step of your ladder. But if your proprioception system hasn’t been optimally trained in a while and is, in a sense, out of shape, your balance and overall safety are at risk. Bad things can happen.

From all points of view, including that of safety in the home, it’s important to maintain your proprioception system in peak condition. You can easily do this by engaging in regular strength-building activities such as strength training and yoga and regular aerobic activities such as running, walking, swimming, and biking.3Proprioceptor training is built-in to all forms of vigorous exercise. Safely and successfully completing your home improvement projects is one of the many benefits.

1Judkins TN, Scheidt RA: Visuo-proprioceptive interactions during adaptation of the human reach. J Neurophysiol 2013 Nov 20 [Epub ahead of print]

2Suetterlin KJ, Sayer AA: Proprioception: where are we now? A commentary on clinical assessment, changes across the life course, functional implications and future interventions. Age Aging 2013 Nov 14 [Epub ahead of print]

3Maitre J, et al: Chronic physical activity preserves efficiency of proprioception in postural control in older women. J Rehabil Res Dev 50(6):811-820, 2013

This article is sponsored by Dr. Nill of Nill Family Chiropractic & Wellness Center, LLC 

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Repairing an Injured Rotator Cuff

November 11, 2014

As we get older, rotator cuff injuries become more common, a result of the natural aging process. A similar mechanism operates in the discs separating the vertebras in your lower back. These cartilaginous structures lose water over time, becoming less flexible and more brittle as the decades roll by. In the case of the shoulder, the rotator cuff tendon is pulleyed to and fro as the arm swings forward and back and up and down. As the years pass, this constant motion may cause fraying in the rotator cuff tendon and inflammation in the muscles that comprise the rotator cuff. Eventually, partial or full thickness tears may develop in one or more of these musculotendinous units, causing pain and some loss of function. Importantly, conservative care may be all that’s needed to reduce pain and restore needed motion.

The shoulder joint is beautifully designed and a marvel of engineering. Its construction makes possible a full 360-degree arc of motion in both the sagittal and frontal planes. In other words, you can swing your arm in a complete circle from front-to-back and to-the-side-and-up-and-around. In the third, horizontal, plane, 180 degrees of motion is available. The overall combination of movements in three-dimensional space makes the shoulder joint the most freely movable joint in your body. However, as with all freedoms we enjoy in this life, there is a price. The shoulder joint’s great mobility is countered by its very limited stability.

The shoulder’s lack of stability needn’t concern us in our average day-to-day tasks. Protection to the joint is built-in by way of the rotator cuff muscles, which form a strong hood that envelops the intersection of the arm bone and shoulder blade. Falling on an outstretched arm may result in a dislocated shoulder, so we need to have some care in this regard.

If you’re a young athlete and have suffered a rotator cuff tear, surgery may be an appropriate option.1 But for the vast majority of people, especially for those over age 40, most rotator cuff injuries are chronic rather than acute and can be treated with rest and rehabilitative exercise. Again, if you’re a 60-year-old skier who has torn his or her rotator cuff in a downhill accident, surgery could be indicated. For the rest of us, rehabilitative exercise is the key.2,3

Four or five primary strength training exercises are involved in shoulder or rotator cuff rehabilitation. The three basic shoulder exercises are (1) seated overhead press, which trains all the shoulder girdle muscles simultaneously; (2) standing side [lateral] raise; and (3) seated or standing bent-over raise. The lateral raise specifically trains the middle deltoid muscle and the bent-over raise specifically trains the posterior deltoid muscle. Specific rotator cuff strength training exercises include internal rotation and external rotation on a flat bench using very light dumbbells. More painful injuries with greater loss of mobility may require (1) Codman pendulum exercises and (2) finger-walking (up a wall) to the front and to the side.

The goals of rotator cuff rehabilitation, as for any mechanical injury, include decreased inflammation, decreased pain, return to more full active range of motion, return to more full muscular strength, and restoration of function.

1 Plate JF, et al: Rotator cuff injuries in professional and recreational athletes. J Surg Orthop Adv 22(2):134-142, 2013

2 Escalmilla RF, et al: Optimal management of shoulder impingement syndrome. Open Access J Sports Med 5:13-24, 2014

3 McMahon PJ, et al: What Is the Prevalence of Senior-athlete Rotator Cuff Injuries and Are They Associated With Pain and Dysfunction? Clin Orthop Relat Res 2014 Mar 12. [Epub ahead of print]

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Replacement Parts: What You Need to Know

October 29, 2014

If you’ve ever been involved in a motor vehicle collision, you’re probably familiar with the term “replacement parts” or “crash parts”. Your auto insurance company will usually offer to repair your car using after-market bumpers, door panels, wheel assemblies, and other parts. Or, you may prefer to have the repair done with parts from the original manufacturer. Regardless of the source of the parts, your car will not be the same as it was in its original condition. It’s important to bear the auto analogy in mind if a surgeon has recommended a hip, knee, or shoulder replacement as a solution to a problem of chronic pain.

The frequency of joint replacement procedures of all types is dramatically on the rise within the last 20 years.1 For example, in the United States there has been a 58% increase in total knee replacements from 2000 to 2006. There has been a 50% increase in total hip replacements from 1990 to 2002. Unfortunately, the revision rate (repeat procedures) for total knee replacement more than doubled and revision total hip replacements increased by 60% within the respective, above-noted intervals.

The simple fact is that although your body may appear to be a machine, it is rather an exceedingly complex entity whose whole is much greater than the sum of its parts. Thinking of your body as a machine may be a useful metaphor, one that may aid considerably in medical practice. But the metaphor is not the reality, and forgetting this crucial distinction may lead to substantial and possibly irremediable problems for a patient. Manufactured joints are never as good as your actual physiological structures, no matter the quality of the replacement components.

Of course, there are many circumstances in which joint replacement is indicated and provides great benefit for a patient. However, such procedures should probably be a last resort and never considered standard of care. A best practice would be to reserve joint replacement for situations in which pain is unrelenting and the person has failed several forms of conservative care.

Optimally, in most cases measures are available to avoid such radical outcomes. The best steps for each of us to take is to begin ongoing programs of regular vigorous exercise and healthy nutrition.2,3 Regular exercise, a healthy diet, and sufficient rest will assist all our physiologic systems to achieve peak levels of performance. By making such beneficial lifestyle choices, we help diminish the likelihood of chronic, debilitating pain and loss of function. As a result, we help ourselves avoid the need for replacement parts.

1Singh, JA: Epidemiology of Knee and Hip Arthroplasty: A Systematic Review. The Open Orthopaedics Journal 5:80-85, 2011
2Marley J, et al: A systematic review of interventions aimed at increasing physical activity in adults with chronic musculoskeletal pain–protocol. Syst Rev 2014 Sep 19;3(1):106. [Epub ahead of print]
3Tanaka R, et al: Effect of the Frequency and Duration of Land-based Therapeutic Exercise on Pain Relief for People with Knee Osteoarthritis: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Phys Ther Sci 2014 Jul;26(7):969-75. doi: 10.1589/jpts.26.969. Epub 2014 Jul 30

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