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group of happy pregnant women talking in gym

Pelvic Floor Dysfunction in Pregnant Women and New Mothers, Preventable & Treatable

 

Pelvic floor dysfunction, or PFD, is a broad term used to describe several physical conditions that occur mainly as a result from pregnancy and childbirth. As a pre and postnatal fitness specialist for over 20 years, almost every one of my clients has had some form of PFD. What does this mean and why is it relevant to women’s fitness? I will further define PFD in detail and explain how it changes the way we as exercise professionals program design for this clientele.

First, let’s look at the pelvic floor muscles. The pelvic floor looks like a sling or hammock that forms the floor of the bony pelvis and it serves several important functions in our bodies.  The internal layer or “pelvic diaphragm” work with the external muscles of the pelvic floor to support our internal organs, stabilize our bodies, allow for sexual function, urinary and bowel movements and assist in contracting and pushing in the birthing process. These muscles are prone to trauma from the various functions they perform.  The stress of the growing uterus in the body during pregnancy coupled with the changing gravity, posture and production of the hormone Relaxin all contribute to weakening the pelvic floor muscles.

Second, consider the whole Neuromuscular Core system. Pelvic floor muscles connect to the Transverse Abdominus (TVA) and they work together in harmony essentially hold the body upright. It is almost impossible to engage one without the other. Tightness in the hips combined with weak pelvic floor muscles creates PFD.

Diastasis Recti, Symphosis Pubis Dysfunction (SPD), Urinary and or fecal incontinence, pelvic pain, chronic lower back pain, Piraformis syndrome, sciatic pain, pelvic organ prolapse are all conditions under the pelvic floor dysfunction umbrella.  Below these conditions are listed and defined in more detail.

Diastasis Recti: This is a separation of the right and left side of the Rectus Adbdominus in the Linea Alba connective tissue more than 2 cm in width

Pubic Symposis Disorder: A separation of the pubic bones, which often occurs during birth but sometimes during the third trimester.

Urinary incontinence: Uncontrollable leakage from bladder.

Fecal incontinence: Uncontrollable leakage of fecal matter from colon. Usually as a result from severe tearing during birth.

Pelvic pain: This type of pain can be during sex or when performing a movement that is irritating or uncomfortable, many possible underlying issues.

Chronic lower back pain: Unexplainable chronic lower back pain

Sciatica: Pain that radiates from lower back down one leg along the sciatic nerve as a result of compression of the sciatic nerve

Piraformis syndrome: Also a result of an inflamed sciatic nerve but more localized

Pelvic organ prolaps: When organs of the pelvis fall as a result of weak pelvic floor muscles.

These conditions can be limiting for many women and go untreated because they are embarrassed or told that they are normal “experiences” after giving birth. Until recently, very few fitness programs existed to help women strengthen pelvic floor muscles. It is my opinion that every pregnant woman and new mother should be automatically screened for PFD and treated right away. If women do not learn proper strengthening exercises of pelvic floor muscles they can potentially live in discomfort for years. The sooner preventative care is offered the better the quality of life for these women.

As mentioned earlier, many of these conditions are preventable and remedied through a combination of functional strength with corrective, posture-based range of motion exercises. When a woman becomes pregnant there is an immediate increase in pressure to the pelvic floor muscles. The body begins to produce relaxin which affects the joints throughout the body, especially the pelvis as it prepares to accommodate the growing uterus and eventually for birth. If treatment begins to help women continue strengthening the muscles surrounding the hips immediately, the pressure on the pelvic floor muscles will be reduced.

It was common practice until recently that women were advised to learn and perform Kegel Contractions. We understand more now as movement therapists that Kegel contractions are very hard to teach, very isolated, and in most cases, when examined internally by a women’s healthcare PT, women are not performing them correctly.  A more effective approach to strengthening the pelvic floor muscles is to treat the entire hip complex as “one”– or a “global approach” — as described in applied functional science.

So, how do fitness professionals help create beneficial, safe and effective exercise programming for pregnant clients and new mothers that hone in on the core and pelvic floor? We must start by helping our clients improve their posture first and foremost, then work on proper breathing techniques and lastly incorporate larger exercises that do not isolate, but recruit many muscles from the hip complex and surrounding muscles groups. By incorporating all three planes of motion instead of working primarily in the sagittal plane (forward and backward) when performing even the most basic of exercises (i.e., the squat), you must change the movement by foot placement, arm placement, direction, tempo, range of motion etc. The variety in actions creates good stress to the pelvic floor and core muscles. Additionally, increasing the adduction and abduction action simultaneously while performing various exercises will help activate and recruit pelvic floor muscles subconsciously. Anatomically speaking, everything is connected in the body. Understanding that big global movements of the upper body and lower body together affect the position and strengthen of pelvic floor and core muscles is essential. The body is most efficient at strengthening the small muscles when big muscle groups are stimulated in combination. Throughout my years, I have seen much success with clients that incorporated these types of movements into their workout regimen and were safe and conscientious not to perform exercises that added bad stress to the external abdominal muscle group or impact exercises.

Each woman is different on how quickly it takes her to recover from PFD. The most important rule of thumb is to be reassuring and provide support and remember the time line is different for everyone depending on severity of PFD, the fitness level of the client, if the client is breast feeding and prior injuries that could prolong healing time.


Danielle Spangler, C.PT, has been a fitness professional for over 20 years. Danielle is the creator of “Coremom” (Corrective Obstetrical Related Exercises) for purposes of creating a pre and postnatal small group-training program in a variety of fitness facilities. Danielle’s goal is to train other qualified fitness professionals and group exercise instructors on teaching pre and postnatal small group exercise classes using her method. Visit her website, daniellespangler.com

Personal Trainer At The Gym

Body Language, Self-Awareness and The Client Experience

As a trainer, you wear many different hats during a typical work week. In turn, you are pulled in many different directions among family, friends and clients.  If you are focusing on too many topics at once you cannot be in the moment, which can lead to a lack of client retention.

Being in the moment.

There is a lot of competition in the studio market and potential members/clients like to belong to a gym – and stay with a gym – where they feel comfortable.  That puts the limelight on personal trainers to generate the positive client experience that is so important to retention.

This is why being in the moment is vital to gaining new clients and retaining current ones. If trainers are distracted this may be apparent through body language. Members may perceive being distracted as receiving bad customer service.

Members decipher up to 93% of what is said through body language.

When you think of excellent customer service, which companies come to mind? What makes them stand out from their competition? The employees that work for these companies are mindful and in the moment. They anticipate the needs of the client and help them accordingly.  Being in the moment means that your body language and what you say conveys the same message. This is important to note for customer service and member retention.

The importance of not ‘zoning out.’

Members are constantly making decisions on how they want to spend their money. When trainers work with clients they should be mentally and physically present for each session. If a trainer zones out the trainer leaves their client wondering if the session is important to them. Trainers also miss out on potential new clients who may have wanted their services.

Clients will typically get your attention first by asking if there is “something else you need to do”. This should be a clue that they know you are not in the moment.  You want to fix this quickly before the client stops training at your facility. Potential clients also watch to see how focused and attentive you are.  I once had a member watch my training sessions for 5 months before deciding that he wanted to hire me. He said that he was looking at my training style, personality and attentiveness. He passed up two other trainers because they seemed uninterested.

When you and/or your staff have better self-awareness you are able to anticipate the needs of your members easier.  You will also notice that more clients would like to train with you. By being in the moment every day your clients feel like they had an experience that they want to share with friends and family.

Do you know what message you’re conveying?

Nonverbal communication involves facial expressions, gestures, eye contact, posture, voice, and touch -and is actually more important then what is said verbally. Trainers are communicating non–verbally with clients and members all of the time and when mixed signals are sent, clients have to try to figure out how you actually feel.  You may be speaking to your client and sound present and in the moment but is your body language  communicating otherwise?


Robyn Caruso is the Founder of The Stress Management Institute for Health and Fitness Professionals. She has 18 years of experience in medical based fitness.

References

http://www.helpguide.org/articles/relationships/nonverbal-communication.htm

http://www.statisticbrain.com/gym-membership-statistics/

 

Breast Cancer Survivor

Breast Cancer and Exercise

The most common issues that plague post-mastectomy patients are upper-crossed syndrome and range of motion limitations in the affected shoulder. Upper cross syndrome is the combination of protracted (rounded) shoulders, forward head, cervical lordosis, winged-scapula, and thoracic kyphosis. As a result of these postural deviations, mastectomy, lymph node dissection, and/or radiation, the chest muscles may become tight, shortened and spastic. This not only exacerbates the postural deviations, but may limit the ability of the patient to move their arm/shoulder through flexion, extension, abduction, and external rotation. While this is a general statement, the majority of patients will present with these symptoms. This is compounded even more if the woman undergoes reconstructive surgery. Not only with it further exacerbate upper-crossed syndrome, it will create a muscle imbalance in the area of surgery, if either the rectus abdominis or latissimus muscle are used for reconstruction.

a trainer helping a senior woman doing fitnessThe most important factor in the safety and efficacy of the exercise program is the initial assessment. At the very least this should include a comprehensive postural assessment as well as shoulder range of motion measurements taken with a goniometer. The well-trained fitness professional will be able to deduce, from the results, which muscles need to be stretched and which need to be strengthened. By selecting the wrong combinations of exercises, the results may not only be undesirable, they may in fact be detrimental. For example, if a client presents with moderate to severe upper-crossed syndrome, performing any kind of “pushing” exercise that would involve the chest muscles (chest press), could make the syndrome even more pronounced by causing the pectoral muscles to tighten and contract. Instead, the goal need to be on stretching the chest wall and strengthening the opposing muscles in the back; particularly the scapular stabilizers.

Prior to adding a load (resistance) of any kind, the patient should have close to full range of motion through the particular plane of motion. Without correcting the range of motion first, the patient will reinforce the negative movement pattern by performing strength training exercises throughout a limited pattern of movement. Therefore, initially the focus should be on range of motion exercises. These may include very basic exercises that the patient can do on their own; front wall walks, side wall walks, pendulum swings, and corner stretch, or active isolated stretching that can be executed with the assistance of a professional. The combination of both will increase the speed of improvement in most cases.

Once close to full range of motion is achieved, the emphasis can be on strength training. Not only will this help to correct the postural and range of motion deviations, it will help increase bone density and lean muscle mass. Many women will either be of menopausal age, or thrown into menopause from their cancer treatment. With estrogen no longer being produced, the risk of osteoporosis increases. To make things even more complicated, the long-term side-effects of chemotherapy include osteoporosis, diabetes, and damage to the heart and lungs; all of which can be avoided or improved through proper exercise recommendations.

The last part of the equation is the risk of lymphedema of the affected arm/shoulder. Lymphedema is the swelling of the extremity following the removal of, or radiation to the lymph nodes on that side. Even if someone has undergone a sentinel node biopsy, and only had one node removed, they can still get lymphedema. Lymphedema is progressive if untreated and can be very painful and disfiguring. It can happen at ANY time after surgery; one hour or fifty years. The risk doesn’t increase or decrease with time, however a higher percentage of body fat, infection, age, and poor nutrition can all increase the risk once someone is at risk. In my sixteen years of working with cancer patients, I would say this is the number one “overlooked” issue amongst cancer patients. More often than not, they will not even be told about lymphedema. Following lymph node dissection and/or radiation, the lymphatic pathways do not operate with the same efficacy that they did previously. Therefore, we no longer know what the individuals exercise threshold is. It is critical to START and PROGRESS SLOWLY. This allows for a gradual increase in frequency, intensity, and duration of the exercise program. If at any point there is swelling, the patient should be advised to stop exercising and see their doctor immediately to determine if, in fact, they do have the onset of lymphedema. They should come back with a medical clearance form and the exercise instructor should take a step back with the frequency, intensity, and duration to the point prior to the onset of swelling.

Putting all of these pieces together is very much like solving a mathematical equation. If you are missing any of the information, you will never solve the problem. A typical exercise session should begin with cardiovascular exercise. This too should be gradually increased at a rate that the client is comfortable with and their body responds favorably to. They should stay well-hydrated, they should not wear tight-fitting or restrictive clothing on their upper body, and they should not overheat (all of these factors can increase the risk of lymphedema). Following the warm-up they should be instructed to do a series of lymph drainage exercise to open up the lymphatic pathways and prepare the body for exercise. I reference these exercises in CETI’s Cancer Exercise Specialist Handbook and Breast Cancer Recovery with the BOSU® Balance Trainer Book.

Meta Slider - HTML Overlay - Women wearing pink tops and ribbons for breast cancer on white backgroundFollowing the warm-up and lymph drainage exercises, the exercise specialist should determine what the areas of “need” are for the client. Remember to begin with stretching and range of motion exercises until they have close to “normal” range of motion. At that point the goal becomes strength training and choosing exercises that will strengthen the weaker muscles and stretch the tight and shortened muscles. Weight/resistance should also be very gradually increased and attention paid to any potential swelling of the extremity. Typically I chose exercises that will stretch the chest (chest fly, corner or door stretch, assisted stretching) and will strengthen the back (low/high rows, reverse flies, lat pulldown). They often [present with winged scapula following a node dissection. If this is the case, I will incorporate exercises that will strengthen the serratus anterior. If they have undergone an abdominal TRAM procedure, core work will be of the greatest importance in preventing, or minimizing, low back pain.

Because every muscle in the body works synergistically, an imbalance in the shoulder can lead to a multitude of imbalances from the hips to the knees to the ankles etc… Choose your exercises carefully. Put emphasis on the areas of need. This is not and can never be a cookie-cutter workout. No two breast cancer patients are the same. Not only are you taking into consideration their surgery, reconstruction, and treatment, you have to also factor in the remainder of their health history and any additional orthopedic concerns. I urge anyone who wants to work with cancer patients to undergo specialized training. It is very complex and the untrained professional can end up doing more harm than good.


Andrea Leonard is the Founder and President of the Cancer Exercise Training Institute. She is a certified as a corrective exercise specialist by The National Academy of Sports Medicine (NASM), as a personal trainer by The American College of Sports Medicine (ACSM), the National Academy of Sports Medicine (NASM), the American Council on Exercise (ACE), and as a Special Populations Expert by The Cooper Institute. She is also a continuing education provider for the National Academy of Sports Medicine and The American Council on Exercise.

pain frustration

Chronic Pain – Healing with Release

Healing with release is based on the fundamental idea, backed by research, that stress, tension and trauma are both psychological and physical. Twentieth-century science is moving forward to a better understanding of the body’s deterioration. Hans Selye recognized that physiological disease could arise from psychological causes, such as stress (Somatic viewpoint). The pathology of chronic pain is associated with numerous losses such as a decline in physical fitness, disturbance of sleep, strained relationships, loss of energy and fatigue. Social isolation, loneliness and anger are often evident in people suffering from chronic pain. These negative emotions exacerbate pain and increase suffering. An estimated 33 to 35 million U.S. adults are likely to experience depression at some point during their lives.  

In 2011 in USA alone hundred million Americans suffer with chronic pain and the cost of lost wages translated to $ 600 billion due to employees with chronic pain calling in sick because of a pain–related condition such as:

  • Headache—$14 billion, only $1 billion of which consists of health care costs (Hu et al., 1999), partly because most people with migraine stop seeking medical care for the condition (Silberstein, 2010)
  • Arthritis—$189 billion, less than half ($81 billion) of which is for health care costs (Yelin et al., 2007)
  • Spine problems—$2,500 average in incremental medical costs (Martin et al., 2008); and low back problems—$30 billion (Soni, 2010) Opioid pain medication use presents serious risks, including overdose and opioid use disorder
  • Between 1999 and 2015, more than 183,000 people in USA died from overdoses related to opioids.

By having a flexible spine with strong hips and thighs, the human body is ideally designed for movement such as walking, running, squatting, and claiming- throwing objects and swimming.  Unfortunately, during the course of a person’s life, the sensory-motor nervous system continually responds to daily stresses and traumas with specific muscular reflexes. These reflexes, triggered repeatedly, create habitual muscular contractions which cannot be relaxed–at least not voluntarily.

If stressed, traumatized, overused and repetitively used muscles are required to continue to work, the muscle begins to tighten. Once this happens the contraction of the muscle constricts the blood vessels. This reduction of blood flow reduces the oxygen to the tissue. Once a tissue is oxygen deprived, it will shut down and tighten more. This creates a negative pattern of tension, oxygen deprivation, and more tension that ultimately results in rigid muscle tone. This results in one’s postural misalignment and muscular asymmetry with symptoms such as:

  • Chronically hard, tight muscles
  • Chronic tightness or chronic inflammation of a tendon(tendinosis)
  • Chronic joint tension or chronic inflammation
  • Limited range of motion in a joint
  • Impingement of a nerve resulting in numbness or a tingling sensation
  • Compression of a disc resulting in neck or back pain
  • Muscle weakness in one area especially if the muscle feels tight
  • Consistent muscle cramping
  • Joint instability while performing daily tasks
  • Recurring muscle strain or injury to the same muscles

Muscles needed to perform regular, daily tasks (such as sitting and standing) are what we call “functional muscles”.  It is more important in daily life to have functional muscles than it is to have big, hard muscles.  Functional muscles require more endurance than pure strength.  The focus of restoring to maintain a healthy body is to increase the endurance of those muscles which are needed to function throughout the day.

The exercises which safely activate a natural reflex mechanism calming down the nervous system which releases muscular tension are based on restoring blood flow and oxygen to tissue.

Muscular tension release can be done by manual pressure that is applied to the most superficial layer of tissue where dysfunction appears (pain, tension or rigidity). Once the tight tissue is stimulated, blood flow to the area increases and the tight tissue will become suppler. This allows the therapist to access the next layer of tissue without applying excessive pressure.  This pattern is repeated until all layers of dysfunctional tissue are restored and the tight, rigid tissue is replaced with supple and mobile tissue.  Supple and mobile tissue will be free of pain and have a greater range of motion.

The ability to release muscular tension independently one must learn how to align their body and mind while experiencing an alert but relax state of awareness. The SykorovaSynchro Method℠ is a phenomenal educational tool with positive impacts to patients mentally, physically and emotionally and has three stages/ progressive levels:

  1. To balance function of sensory-motor cortex via sensory stimulation mental imagery (sometimes called visualization, guided imagery), progressive muscular relaxation and control breathing. Result is relaxed but alert state of awareness.
  2. To enhance sensory integration/ awareness of somatic movement (movement regulated by feeling, mental imagery, sensation). Result is ability to perform somatic/ intuitive movement.
  3. Ability to perform conscious exercises – via mental imagery, sensation. Positive result is in neuro muscular conditioning/ function – postural improvement, balance, coordination, flexibility and agility.

Research has shown that when we imagine an experience, we often have similar mental and physical responses to those we have when the event actually happens. For example, if one recalls an upsetting or frightening experience, she/he may feel their heart beating faster, may begin to sweat, and hands may become cold and clammy.

In life it is very important to minimize the negative effects and maximize the healthy, healing aspects of the mind–body connection. Each person has a unique capacity for getting better, healthier, achieving peak performance and recovering from injury.

The mind-body connection means that one can learn to use his/her thoughts to positively influence the body’s physical responses, to create abilities to be aware of their own thoughts and actions in the present, without judging them self.

Physical activity has the potential to be not just an activity of the body, but a whole body-mind-spirit system. Exercise can create a unique, beneficial mental state; and the positive mental state can enhance the benefit of exercise as a part of muscular release tension plan, which reinforces the perception that exercise is just an out of body experience.  We have to remember, that our bodies are made to feel good and has abilities to heal.

A unique water exercise program based and structured on those principles will teach you to release tension, increase mobility and build endurance in muscles, tendons and joints. Those physical exercises are performed with an intense focus to utilize four principles such as breathing, proper form, control and concentration.

  • Exercise is performed with controlled breathing that utilizes full inhalations and full exhalations that follow a specific number of counts or rhythm. The goal is to learn how to breathe at a pace of 6 breaths a minute, about 3 or 4 seconds inhaling and 6 or 7 seconds exhaling. Once we have the slow, deep breathing accomplished, we don’t have to worry about counting and imagine breathing out any tension in the body or thoughts that get in the way of comfort and relaxation. The benefit of the water environment is tremendous. Hydraulic pressure increases human vital capacity in shoulder depth immersion 7x more than air, which promotes deep breathing and natural relaxation.
  • Exercise is performed with proper form or in precision. Quality of movement counts more than quantity in a mind-body exercise. Precision requires mental control. The mind has to be wholly focused on the purpose of the exercises as you perform them. The sensation of water on the skin is enhancing biofeedback’s, which helps with proper form greatly.
  • Neuromuscular exercise always involves the control and balance of your own body-weight. In water exercise we have interplay between gravity and buoyancy, weight and weightlessness. Control of the body can become challenging and at the same time very beneficial for overall success. By implementing movement patterns in a variety of directions, we stimulate and enhance balance, coordination, and flexibility, and inspire the neuromuscular system to become more expansive and creative. Moving in different speeds is an aspect of our physical capabilities that must be practiced in order to maintain a sense of health and well-being.
  • Releasing Movement is performed with intense concentration on yourself, in the present moment. The mind-body exerciser is focusing on his/her body rather than on the instructor, or on other participants. One should never be day dreaming about other things. The point-of-focus in a self- sensing exercise will differ from most other forms of physical exercise. One should be thinking about stabilizing, or anchoring, the area of the body that is NOT in motion. This is contrary to the usual Western method of trying to isolate the muscles that we perceive to be performing the movement.

Working as a health-fitness professional for the past 30 years, I am sensitive to the overall health of students/clients, and I continue to put research developments into practice. The focus in fitness these days for “Active Aging”, “Athletic Recovery”, “Chronic Pain Management”, “Healing with Release” are functional exercises – exercises that simultaneously use multiple muscles and joints to improve muscular endurance, overall strength, coordination, balance, posture and agility – to get a challenging, effective and fun full-body functional workout as well as prepare the body for every day, real world activities.

Reprinted with permission from Dr. Maria Sykorova Pritz and the Aquatic Exercise Association (AEA). The AEA is the leading educational agency in water fitness and is reaching health-fitness professionals in aquatic field. This article first appeared in the August/September 2018 issue of their AKWA magazine. 


Dr. Maria Sykorova Pritz Ed.D earned her doctorate in education (specialty in Physical Education and Sports) from University Comenius in Bratislava, Slovakia. Maria is an ATRI faculty member, member of AEA Research Council, author of health fitness articles and FLS CE class, presenter for national and international fitness conferences. In her 32 years of professional career Maria is combining academic knowledge with hands on experience in functional fitness, pain management via land based and aquatic fitness. Maria’s unique training method (SykorovaSynchro Method℠) involves integration of multidisplinery techniques to achieve overall health and optimized performance. Maria is an ATRI faculty member, member of the AEA Research Committee, FLS continuing education developer, author and presenter.

Resources:

  1. BURDENKO I, MILLER J. (2001) Defying Gravity. www.Burdenko.com.
  2. GREGOR T., SYKOROVA PRITZ M.: (2008) Pain management and psychophysical     conditioning through water exercise. Revue Mediciny v praxi, Bratislava, MAURO Slovakia s.r.o. Rocnik 6, cislo 1, 2008, s.29, 30, 38 ISSN 1336-202X
  3. Discovery writers. (2013): Mind – Body Exercise Connection. Discovery Fit &Health; http://health.howstuffworks.com/wellness/diet-fitness/information/mind-body-exercise-connection.htm
  4. INSTITUTE of MEDICINE (2011): Relieving Pain in America. A Blueprint for Transforming Prevention, Care, Education, and Research
  5. JOHNSON, L.S.(2009):”Therapist’s Guide to Posttraumatic Stress Disorder Intervention”, Academic Press is an imprint of Elsevier, San Diego, California, USA.Page146-148, ISBN:978-0-12-374851-5
  6. RAMSEY L. (2018): As America fights opioid addiction, the healthcare system is failing people who live with chronic pain: http://www.businessinsider.com/people-with-chronic-pain-during-opioid-crisis-2018-1
  7. SYKOROVA PRITZ, M. (2007):” The effect of water exercise on selected aspects of overall health on a fibromyalgia population”. Aquatic Fitness Research Journal, October 2007, Volume 4, Issue 2, Nokomis, Florida, USA: Aquatic Exercise Association. page. 6-13
  8. SYKOROVA PRITZ, M. (2018):” Healing with Release” AKWA: Volume 32, No 2;  Brunswick GA. USA; Aquatic Exercise Association, page 31-33,ISSN: 1536-5549
  9. STOLNICK, D.:  (2000-2008) Looking for joint pain relief. Vilage Inc.
  10. VAN HOUDENHOVE, B, – EGLE, U, – LUYTEN, P. (2005): “The role of life stress in fibromyalgia”, Curr Rheumatol Rep. 2005 Oct; 7(5):365-70.
  11. THEARMAN, B.H.: (2007) Simple solutions to Chronic Pain. New Habringer Publication, Inc. ISBN-13: 978-1-57224-482-5.

NOTE: To learn more about SykorovaSynchro Method, it is recommended that you take the course “Application of Water Exercise for Health Fitness Professionals Specializing in Pain Management.” to increase your knowledge and skills.  For more information, log on to www.FitnessLearningSystems.com.

 

Gymnastics physiotherapy with dumbbells

Aquatic Exercise for Rehabilitation and Training

Water can be used as a therapeutic and healing medium for rehabilitation, swim training as well as for fun and relaxation. Aquatics therapies have been used for physical and spiritual cleansing in religions around the world for centuries.

aqua fitnessThere has been extensive research to explore the various uses, aides, restrictions, and safety measures relating to the use of water and the individual who chooses aquatics as a form of therapy or training. Included in that work is a variety of patient diagnosis, current states of health and the necessary modifications for particular swim strokes, stability, and safety.

What has been discovered is the level in which the aquatic instruction and props (if needed) would vary from not just student to student, but level of injury or skill level of the participant. Though water is a natural place to engage in healing, exercise and rehabilitation, much care is needed for a safe and beneficial experience.  Exercising in water is quite different than exercising on land.

There are different reasons for choosing aquatics as an exercise medium. Aside from buoyancy and the feeling of weightlessness that comes with it, the hydrostatic pressure and velocity of the water gives one a feeling of support while in the water.

Five Important Factors

The type of aquatics therapy that is recommended would depend on the individual and the particular circumstances specifically relating to them. There are five important factors that must be considered when working with aquatics: 1) Gender,  2) Height,  3) Fitness Level, 4) Whether or not the person smokes and 5) If there is any known disease present. Any of these factors will have an effect on the air volume capacity of a given person.

Ideally there will be a team of licensed professionals working with the patient or student on their road to fitness and wellness. This is known as the Lyton Model (pictured below). It is imperative that the aquatics instructor understand the physiological responses to the body when immersed during any type of aquatic exercise or training. The heart, kidneys and adrenal glands are immediately impacted with immersion due to the shifts in blood flow (stroke volume) caused by the hydrostatic pressure. This change will shift depending on the level of the submersion. Example; waist, chest or chin height, the effects on the body will differ.

lytonmodel

Lyton Model

Because water is so versatile, it can be used to treat injuries involving the muscular skeletal and the neuromuscular systems as well. In addition to the above mentioned properties of water, the thermal influence, viscosity, drag and turbulence can all be used and adjusted to produce: relaxation, pain reduction, edema reduction, increase nutrients and increase inflammatory mediators. Muscle tone can be improved and spasms can be reduced. The bones of the body are also said to be strengthened when immersed in water.

As with any exercise, the way in which one breathes is extremely important and breath control should be mastered. The patient or client should not be afraid of the water or be afraid to submerge the face, ears or head under water. Though the reasons for attending aquatics therapy may be different from one person to another, certain skills are necessary as a safe practice measure.

Specific skill training; fall prevention, balance strategies, induced movement and core stabilization therapies are important activities that should be in practice when working in the water. There are different methods and props to aid in accomplishing these goals if someone is having difficulty. The treatment goal will ultimately depend on the individual in training or the prescribed rehabilitation.

man-swimmingThe modifications that have to be made for an individual with an upper body amputation will differ from the modifications that need to be made for someone with a lower body amputation. The location of the amputation of the limb is also relevant to the necessary adjustments. The adjustments and aides for someone who has suffered from cerebrovascular hemiparesis will be different from someone who suffers from arthritis pain or who is a paraplegic.

The trained aquatics therapists will recognize whether or not a patient or client is in need of a supportive aide (and which one in particular), if the patient needs to work longer on a specific exercise or if they are ready to progress. It is important for the therapist to be “hands on” in the water not just as a means of safety and to assist in recovery strokes but also as needed, physically change the dynamics of the water that is in close proximity to the client and his/herself as a therapeutic aide.

Talk to your healthcare provider to see if aquatic therapy or aquatic rehabilitation is the right option for you.


Michelle D. Talbot-Bey, BCTMB specializies in Personalized and Functional Medicine which includes Prevention, Diagnosis, and Treatment. She owns Pleasures II Wellness Natural Health Center in Woodbridge, VA, based on the ancient teachings and practices of Ayurveda. She offers therapeutic massage, mind/bodywork therapies, in depth consultations and natural pharmaceutical approaches and recommendations for Holistic healthcare, prevention, maintenance, and relief from chronic diseases.  She has also completed the AFPA Aquatics for Rehabilitation and Fitness course.

 

Physical Therapy

Healthy Aging: Don’t Underestimate the Power of Strength Training

Do you have hip pain? Knee pain? Do you think it is simply because you’re getting older? Or are you recovering from hip or knee surgery, have finished PT and now you don’t know where to turn to learn how to benefit from proper strengthening exercises? Maybe you also need to get back into shape after some down time. Either way, you want your life back. This is where strength training specific to your needs comes in.

ludlow-strength-trainingI had my first hip surgery, hip resurfacing, in 2006 when I was 49, and then in 2010, I had hip replacement surgery at age 53. My surgeon told me that life caused these problems plus a high tolerance for pain and hyper-mobility. You see, I was an athlete my whole life. I have also worked as a personal trainer my entire life and have had many clients with a variety of injuries. I know how it feels to be in pain and I got my life back.

Specializing in hip & knee strengthening for people in their 40’s, 50’s and older is what I am most passionate about. Often, these adults suffer from various chronic diseases like arthritis, diabetes, and other conditions and often all it takes for them to be pain-free is to strengthen joints by targeting specific muscles in the right way, and to lose weight so that joints can last. I know from personal experience and as a personal trainer what it takes to get back to normal again after you’ve had surgery and how important regular strengthening exercises are in addition to easing into overall body conditioning exercises for weight loss and general fitness.

All too often, as we age, training tapers off in frequency and intensity, or altogether, people eat and may drink a little bit more, and boom! There’s suddenly an extra 20+ pounds. Often, your friends have also done the same thing. So you think, ‘I’m not so bad.’ But the aches and pains set in quickly due to inactivity. Truly, so many aches and pains can be alleviated with getting back into or starting a smart, consistent strength training program targeting knees and hips in addition to a cardiovascular program. Sound daunting? It may but people simply need to start with shorter but consistent workouts when you have to in between the longer sessions. It is well worth the time investment to be able to get back to being able to walk briskly, jog, hike, ride a bike, ski, play tennis, etc., and do the things you’ve always loved to do.


Mary K. Ludlow has a BA in Athletic Training, is a Certified Strength & Conditioning Specialist, a Certified Nutrition Coach, and a Certified Golf Injury Prevention Specialist. She has spent her life loving the outdoors as well as various sports including swimming competitively, gymnastics, skiing, hiking, backpacking, and surfing. At age 31 she used her 2 years of eligibility to return to college to run track and cross country. She also volunteered as an Athletic Trainer for the 1984 Olympics.

Mary K. has worked as a personal trainer most all of her life and developed programs for Sony Pictures Entertainment and Amblin/DreamWorks. She is passionate about her clients and takes a personal interest in each and every one. She thrives on seeing them get fit, get their lives back on track, and feel young again.

Portrait of smiling women wearing pink for breast cancer in parkland

Training Cancer Survivors

Once a virtual death sentence, cancer today is a curable disease for many and a chronic illness for most. With continued advances in strategies to detect cancer early and treat it effectively along with the aging of the population, the number of individuals living years beyond a cancer diagnosis can be expected to continue to increase.

Approximately 15.5 million Americans in the United States are cancer survivors. By 2026 that number is expected to reach 20 million. Anyone who has been diagnosed with cancer, from the time of diagnosis through the rest of his or her life is considered a cancer survivor.  And while not all cancer survivors are older adults, many are simply because of the cumulative effect of years of lifestyle issues that are risk factors for their disease. Survivors less than or equal to 19 years old comprise 1% of the cancer survivor population, 6% of survivors are aged 20–39 years, 33% are aged 40–64 years and 60% (more than half) are aged greater than or equal to 65 years.

Breast cancer survivors are the largest constituent group within the overall population of cancer survivors (22%), followed by prostate cancer survivors (19%) and colorectal cancer survivors (11%) (3). Gynecological and other genitourinary cancers each account for 9% of cancer survivors, followed by hematological cancers and lymphoma (7%) and lung cancer (4%). Other cancer sites account for much smaller percentages and together are responsible for 19% of the total number of survivors. In terms of stratification by gender, more than two thirds (69%) of all female cancer survivors have a history of breast (41%), gynecological (17%) or colorectal (11%) cancer. For male survivors, two thirds (66%) have a history of prostate (39%), other genitourinary (such as testicular or renal) (14%) or colorectal (13%) cancer.

Not surprisingly, cancer survivors are often highly motivated to learn more about things like nutrition, supplements and herbal remedies, and exercise that might improve treatment outcomes and ultimately their survival and quality of life. For many of the most important nutrition and physical activity questions faced by cancer survivors, the scientific evidence comes only from observational and laboratory animal data, or unreliable reports from poorly designed clinical studies. Moreover, the findings from these studies are often contradictory. Very few controlled clinical trials have been done to test the impact of diet, nutritional supplements or nutritional complementary methods on cancer outcomes among cancer survivors.

In an effort to identify and evaluate the scientific evidence related to optimal nutrition and physical activity after the diagnosis of cancer, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity and cancer. The findings of this group guide healthcare providers, cancer survivors and their families through the mass of information and help them make informed choices related to diet and exercise.  The Expert Committee reviewed all of the scientific evidence and best clinical practices for different types of cancer and “graded” both the quality and certainty of the scientific evidence for factors affecting the most common cancers. As was already mentioned, there are few clear answers to many questions, a wide range of sources and often conflicting information. But, these experts agree that even when the scientific evidence is incomplete, reasonable conclusions can be made that can help to guide choices in the areas of nutrition and physical activity.

Physical activity may help cancer patients build up their physical condition; decrease the number of comorbid conditions (like heart disease and diabetes); reduce drug interactions; help cancer patients cope with treatment; restore good health; improve quality of life during and after treatment; and help cancer patients and survivors maintain independence as long as possible

Physical rehabilitation programs similar to those for cardiac rehabilitation may be effective in managing, controlling or preventing adverse medical and psychosocial outcomes manifested during cancer survivorship. For example, exercise programs are being developed as interventions to improve the physical functioning of persons who have problems with mobility as a result of therapy and are also being shown to be efficacious for weight control after breast cancer treatment, lessen the effects of chronic fatigue, improve quality of life, prevent or control osteoporosis as a result of premature menopause and prevent or control future or concurrent comorbidities.

Diet, weight and physical activity interventions carry tremendous potential to affect length and quality of survival in a positive manner and prevent or control morbidity associated with cancer or its treatment.

General Physical Activity Guidelines for Cancer Survivors

In general, physical activity is likely to be beneficial for most cancer survivors. Recommendations on the type, frequency, duration and intensity of exercise should be individualized to the survivor’s age, previous fitness activities, type of cancer, stage of treatment, type of therapy, and comorbid conditions.

Particular issues for cancer survivors may affect or contraindicate their ability to exercise. Effects of their cancer treatment may also promote the risk for exercise-related injuries and other adverse effects.

The following specific precautions are from the American Cancer Society:

  • Survivors with severe anemia should delay exercise, other than activities of daily living, until the anemia is improved.
  • Survivors with compromised immune function should avoid public gyms and other public places until their white blood cell counts return to safe levels.
  • Survivors who have completed a bone marrow transplant are usually advised to avoid exposure to public places with risk for microbial contamination, such as gyms, for 1 year after transplantation.
  • Survivors suffering from severe fatigue from their therapy may not feel up to an exercise program, so they may be encouraged to do 10 minutes of stretching exercises daily.
  • Survivors undergoing radiation should avoid chlorine exposure to irradiated skin (e.g., swimming pools and whirlpools).
  • Survivors with indwelling catheters should avoid water or other microbial exposures that may result in infections, as well as resistance training of muscles in the area of the catheter to avoid dislodgment.
  • Survivors with significant peripheral neuropathies may have a reduced ability to perform exercises that use the affected limbs because of weakness or loss of balance. They may do better with a stationary reclining bicycle, for example, than walking outdoors.

For the general population, the ACS and other health organizations recommend at least 30 minutes of moderate physical activity at least 5 days per week to reduce the risk for cancer, cardiovascular disease and diabetes. These levels of activity have not been studied or tested specifically in cancer survivors, however. For the general population and for cancer survivors, any movement is likely beneficial. Therefore, although daily and regular activity may be preferred and may be a goal, any steps that are taken to move from a sedentary to an active lifestyle should be encouraged. For survivors wanting maximum benefit, the message should be that the health benefits of exercise are generally linear, with benefit related to higher intensity and duration, although extremely high levels of exercise might increase the risk for infections.


Tammy Petersen, MSE, is the Founder and Managing Partner for the American Academy of Health and Fitness (AAHF). She’s written a book on older adult fitness and designed corresponding training programs. SrFit Mature Adult Specialty Certification is used nationwide as the textbook for a college based course for personal trainers who wish to work with mature adults. SrFit is also the basis for a specialty certification home study course that qualifies for up to 22 hours of continuing education credit with the major personal trainer certification organizations.

park-walk-biking

Heart-brain connection: Fitness now protects your brain in your 70s and 80s

Stay fit today; avoid dementia tomorrow

It’s well-known exercise plays a vital role in your physical health, and now studies propose staying fit in midlife may protect your brain as well, avoiding mental deteriation in later years.

A new study, published in Neurology, that followed Swedish women for more than 40 years,  suggests one’s level of physical fitness predicts the amount of protection from dementia decades later.1

Swedish dementia/exercise study began 50 years ago

At the onset of the study in 1968, 191 Swedish women ranging in age from 38 to 60 took part in a vigorous stationary cycling test to measure their exercise work capacity. Based on work capacity, women were split into low, medium, and high fitness categories. The women were followed from 1968 to 2012, and dementia diagnoses were recorded.

The measurement of exercise capacity is an important aspect of the strength of this study –  it was based on the participants’ actual performance rather than relying on participants’ subjective reports of how much, how vigorously, and how often they exercised.

Strong association between fitness and likelihood of dementia decades later

Dementia incidence correlated with fitness level, the greater the fitness level, the less the dementia: 32 percent, 25 percent, and 5 percent of women developed dementia in the low, medium, and high fitness groups, respectively.1 This particular study is one of the longest, following participants for up to 44 years, but shorter studies have come to similar conclusions.2-4

Another very interesting finding: in the subset of women whose initial exercise tests had to be stopped because of issues such as excessively high blood pressure, chest pain, or an abnormal EKG change, almost half (nine out of twenty women) developed dementia. Fit women who did develop dementia did so much later in life. Among the five percent of fit women who eventually developed dementia, the average age of development of dementia was eleven years later compared to the medium fitness group – age 90 vs. 79 – an extra eleven years of dementia-free life.

Midlife fitness also linked to brain volume 19 years later

In another study, the effects of midlife physical fitness on the brain were visualized with MRI. Participants at an average age of 40 performed a treadmill test to determine their exercise capacity. Lower exercise capacity at midlife was associated with smaller total cerebral brain volume 19 years later, suggesting having a higher fitness level helps prevent brain shrinkage with age.5

Diet determines your propensity for fitness

Important to note, one’s fitness level is strongly linked to what you eat.  People who are overweight  as well as those who don’t eat healthfully, do  not have the will, energy or capacity for regular exercise.  When you eat right, you’re more likely to get fit; when you don’t eat right it is very difficult to get fit.

A nutrient-dense, plant-rich diet (Nutritarian) is the most critical determinant influencing whether one gets dementia or not.  When you eat right  you automatically crave exercise and it becomes pleasurable to do so.

This study also demonstrates the wide variety of health benefits, including reduced risk of cardiovascular disease and several cancers when you get fit. Mixing together nutritional excellence and exercise is when the magic happens to protect yourself from the common diseases of aging.  Exercise offers additional benefits to cardiovascular health and insulin sensitivity, as well as some direct effects in the brain, such as the release of protective compounds called neurotrophins.6,7

At any age, fitness is vital for your present and future brain health.

It is never too late to start exercising and you are never too old. Studies have documented cognitive benefits from exercise (strength training and aerobic training) in all age groups, from children to the elderly.6-9  Today is the day to make sure you do both; eat right and get fit.

Originally printed on DrFuhrman.com. Reprinted with permission.


Joel Fuhrman, M.D. is a board-certified family physician, six-time New York Times bestselling author and internationally recognized expert on nutrition and natural healing, who specializes in preventing and reversing disease through nutritional methods. Dr. Fuhrman coined the term “Nutritarian” to describe his longevity-promoting, nutrient dense, plant-rich eating style.
 
For over 25 years, Dr. Fuhrman has shown that it is possible to achieve sustainable weight loss and reverse heart disease, diabetes and many other illnesses using smart nutrition. In his medical practice, and through his books and PBS television specials, he continues to bring this life-saving message to hundreds of thousands of people around the world.

References

  1. Horder H, Johansson L, Guo X, et al. Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women. Neurology 2018.
  2. Defina LF, Willis BL, Radford NB, et al. The association between midlife cardiorespiratory fitness levels and later-life dementia: a cohort study. Ann Intern Med 2013, 158:162-168.
  3. Liu R, Sui X, Laditka JN, et al. Cardiorespiratory fitness as a predictor of dementia mortality in men and women. Med Sci Sports Exerc 2012, 44:253-259.
  4. Willis BL, Gao A, Leonard D, et al. Midlife fitness and the development of chronic conditions in later life. Arch Intern Med 2012, 172:1333-1340.
  5. Spartano NL, Himali JJ, Beiser AS, et al. Midlife exercise blood pressure, heart rate, and fitness relate to brain volume 2 decades later. Neurology 2016, 86:1313-1319.
  6. Kandola A, Hendrikse J, Lucassen PJ, Yucel M. Aerobic Exercise as a Tool to Improve Hippocampal Plasticity and Function in Humans: Practical Implications for Mental Health Treatment. Front Hum Neurosci 2016, 10:373.
  7. Kirk-Sanchez NJ, McGough EL. Physical exercise and cognitive performance in the elderly: current perspectives. Clin Interv Aging 2014, 9:51-62.
  8. Fiatarone Singh MA, Gates N, Saigal N, et al. The Study of Mental and Resistance Training (SMART) study-resistance training and/or cognitive training in mild cognitive impairment: a randomized, double-blind, double-sham controlled trial. J Am Med Dir Assoc 2014, 15:873-880.
  9. Mavros Y, Gates N, Wilson GC, et al. Mediation of Cognitive Function Improvements by Strength Gains After Resistance Training in Older Adults with Mild Cognitive Impairment: Outcomes of the Study of Mental and Resistance Training. J Am Geriatr Soc 2016.