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Don’t Let Arthritis Stop You: Move On

/20 February 2025/ All MFN blog/

Arthritis comes in many forms and has many manifestations, affecting almost every joint in the body. We generally speak in terms of the two most-known if not popular forms of arthritis: rheumatoid (RA) and osteo-arthritis (OA.) The essential difference is in the root cause. RA is an auto-immune disease whereby the body, for unknown reasons, attacks itself, particularly in the joints. OA, on the other hand, is often considered the downstream effect of wear and tear, over-use, prior injury, or, as we’re seeing more of as society gets more sedentary, from lack of use. In OA, typically, some insult to the joint disrupts the natural repair processes and further deterioration occurs subsequently.

Due to their differing causes, there are obviously differing treatments; but the basics of medical management are essentially the same. I am not qualified to address the specifics of the treatments available but, in lay terms, treatment usually entails some version of anti-inflammation and pain-reduction drugs, precautionary movement or positional guidance (don’t do’s, for example), physical therapy to manage pain and inflammation, and therapeutic exercises to support the structures affected as the disease itself causes not just inflammation and pain but damage to the structures that support the joints. Typically we identify arthritis as something that damages cartilage and, in truth, that is often what the standard ‘films’ – X-ray, possibly MRI (magnetic resonance imaging) – show. We now know that the synovial sacs around the joint are also affected and that these and other chemical disturbances affect the muscles and tendons that move and support the joint. In almost all cases of arthritis, pain, inflammation, reduced strength and range of motion (ROM) ensue, diminishing quality of life in many ways and, because some of the drugs used to treat it, potentially reducing quantity of life. (Gastrointestinal bleeding from non-steroidal anti-inflammatories (NSAIDs) or bone loss (osteoporosis) from corticosteroids can lead to fatal outcomes (such as spontaneous fractures leading to falls from osteoporosis) if not treated with other medications.)

When someone is potentially afflicted or actually diagnosed with a form of arthritis, the medical community goes into hyper-drive, encouraging changing one’s habits, be they the types of activities one engages in recreational, competitively, or professionally; or the types of non-activities one currently does, in particular, being inactive.

In some cases, dietary advice is offered as we are learning more about foods that are pro-inflammatory and others that have anti-inflammatory benefits. In the former category, we are learning that excessive sugar or simple carbohydrates, including processed wheat products, may exacerbate inflammation while others, such as salmon, dark, green veggies, and certain oils (e.g., olive oil) are capable of reducing the inflammatory elements circulating throughout our bodies and our joints. Furthermore, in more extreme cases, when arthritis becomes very painful and debilitating, over-the-counter and/or prescription-fitted braces may be offered to defer some of the more end-line procedures such as surgery to fuse the joint or replace it with a prosthetic device.

The most common non-pharmaceutical and non-surgical treatment for arthritis of any sort: exercise.

Note that there are several legitimate ways to integrate exercise through resistance training programs that have proven quite effective in arthritis management. Yoga, Pilates (floor or machine based), Tai Chi, Qigong and water-based, or aqua, exercise are all beneficial to many aspects of the overall arthritis program of strength, ROM, proprioception and ultimately function. Since many of these are quite technical and are often done in class formats, one should ask the instructor(s) as to their experience working with arthritis clients.

As with any form of exercise, by whatever professional instruction, you should be totally aware of your pain levels as going “through” the pain is not recommended; thus, you must assert control over the exercise sessions. There will be some exercises, however, that are not destructive and may be somewhat painful but must be done in order to maintain reasonable levels of function and independence. So long as the pain subsides within a couple of hours – preferably as soon as you stop – and there is no exacerbation of inflammation the next day, you can assume that the exercise was just enough. If symptoms flare up over the next 24 hours, however, assume you did more than you should have and alert your trainer or instructor so that he/she can avoid doing the aggravating exercise(s) as much or as hard next time. For these reasons, along with all the other recommendations so far as exercise interventions are concerned, it is best to seek the counsel and assistance of a fitness professional with a background in medical fitness. This could be someone with a more advanced academic degree, someone with a license to practice rehabilitation exercise (physical therapist, athletic trainer, etc.), or someone who’s taken several educational programs to have a greater understanding of the variety of disorders and diseases that may benefit from exercise interventions.

UPCOMING WEBINAR

Dr. Irv Rubenstein graduated Vanderbilt-Peabody in 1988 with a PhD in exercise science, having already co-founded STEPS Fitness, Inc. two years earlier — Tennessee’s first personal fitness training center. One of his goals was to foster the evolution of the then-fledgling field of personal training into a viable and mature profession, and has done so over the past 3 decades, teaching trainers across through country. As a writer and speaker, Dr. Irv has earned a national reputation as one who can answer the hard questions about exercise and fitness – not just the “how” but the “why”. 

emotional

Training Clients Through Crisis

/7 January 2025/ All MFN blog/

*Before we begin, it is essential to look at your accrediting agency’s ‘Scope of Practice.’ Remember, as a Certified Personal Trainers, we DON’T diagnose, prescribe, treat injury or disease, rehabilitate, counsel, or work with patients. We DO perform fitness screenings, design exercise programs, coach, give general health information, refer clients to medical health professionals when needed, and work with clients.

I have been a personal trainer for over 30 years and have had clients with me for decades. You cannot work that closely for that long with human beings and NOT come across a crisis.

How do we define “Crisis”? The dictionary defines crisis as a time of intense difficulty, trouble, or danger. It includes but is not limited to death, divorce, health scares and medical diagnoses, job loss, financial struggles, family struggles, mental health journeys, injuries and illness, surgeries, car accidents, and so on.

The research is solid.

Exercise is proven to release positive endorphins and happy hormones. Exercise can be a tremendous stress and anxiety release. Exercise will not FIX the crisis but is an excellent way to cope with the problem, clear the mind, and settle the body to be in a better place to navigate the situation.

The good news is as personal trainers, we have a unique opportunity to be in the room where it happens. Physical exercise can be very cathartic for clients going through difficult situations. I cannot count the times I have had a client break down and cry in our sessions. In my own experience, numerous doctors and friends recommended I start yoga classes when dealing with high anxiety. I walked into a class taught by one of my dearest friends and almost had to leave because I was sobbing so audibly I was afraid to disrupt others’ experience. Something unlocked in me during that class. Yoga did not fix my situation or my anxiety, but it did help me navigate my situation better and soothe it for the time being.

I count it a privilege to walk alongside my clients when they are going through a crisis. But it is essential to do so professionally and avoid getting tangled in their situation yourself.

There is a visual picture that many supporting agencies or groups use when training to work with people in crisis that can also be helpful to personal trainers. The image is a large pit or hole in the ground, and the person in crisis is at the bottom of the pit and cannot get out on their own.

The dilemma is how to help that person without getting pulled down in the hole with them, but instead giving them the assistance and support to get themselves out of the hole. 

Initially, we should provide a safe place for our clients to share what life is offering them at that time. It is crucial to their physical health and can affect their performance during the training sessions.

Avoid judging the story and offering advice, but rather asking questions. “What do you think is the next step to solve this issue?” Often our clients want to be heard and seen. Giving them the space to share can often lead them to the solution or the next step or provide them with the freedom to move through the grieving process, whatever the situation may be. Of course, direct your client to professional help if you feel they are in danger or experiencing extreme levels of depression, anxiety, or hopelessness. You should have referrals on hand for anything a client needs outside of your Scope of Practice! It takes a village to keep our health in check. 

How do we do this and still train our clients? I certainly do not intend for you to have an hour-long listening session instead of training them. Quite the contrary; the training will help them through the crisis.

Here are some of my tricks:

  • Keep them moving. I use timed exercises instead of counting reps so they can speak, be quiet in their thoughts, or listen to music.
  • Allow them to have their feelings. Try to avoid telling them to feel differently than they do.
  • I keep my movements simple and familiar to them to avoid overcomplicating things. 
  • I will pause their story, give the instruction, set the timer, and ask them to continue where they left off.
  • This is also a great time to ask what music they want to hear while working out. Music has been proven to add to the enjoyment of physical exercise.
  • Another trick is the slam ball. If I sense anger or frustration my client is experiencing, I offer them to take 60 seconds to repeatedly throw the slam ball as hard as they can against the floor. Depending on the privacy you have, I also allow them to vocalize their frustrations while doing it: excellent cardio work AND a massive release of stress. This is however, inappropriate in a crowded gym, but it works well if you have your own private space.
  • I make them sweat! This can be helpful to clean toxins out of our system and aid in those happy hormones and endorphins. 

You can be the missing puzzle piece that helps get them through.

It is a fine line between ushering your client through crisis and getting involved in their situation, but it can be done, and one size doesn’t fit all. Find the things that work for you and your client. But see them, hear them, and continue to point them to the positive benefits of working out during a difficult season of life. Their physical and mental health will benefit dramatically. It may not be the time to set huge fitness goals, but maintaining their fitness, assisting their immune system under intense stress, and helping with sleep during these times are critical to success.

In closing, I said earlier that I am privileged to walk with my clients through a crisis. And my favorite part of my job is seeing the light at the end of the tunnel. Then celebrate with them when the situation is over, or the grieving is complete. Don’t forget to point out how strong they are, how resilient they are, and not only where they were but how far they have come! 

Shannon Briggs is a multi-passionate fitness professional and educator. She brings 30-plus years of experience in the dance and fitness industry. Shannon is the Personal Trainer to the Kilgore Rangerettes and helps Collegiate Fitness and Wellness Directors fill in the gaps. She leads continuing education workshops in multiple group fitness formats and topics specific to personal training.

trainer-senior-client-stretch

Functional Movement Patterns in Exercise For MS

/2 January 2025/ All MFN blog/

You’ve heard the terms functional exercise, functional movement or functional movement patterns… but what do these terms actually mean?

The term “functional movement patterns” is confusing because it is really not a specific term. Trainers, especially those putting MSers on exercise programs, will usually take them through a program of upper and lower body exercises incorporating compound movements that ask your body to do several things at once. They tell you this is a functional exercise routine and that it’s the best way to help you with your MS limitations. Every exercise is NOT considered a functional one. So what’s the difference?

Functional, by definition, means, “of or having a special activity, purpose, or task; relating to the way in which something works or operates”.  In this case, the task is being a functional MSer with the ability to use your body to do what you’d like it to do like you did before your MS diagnosis.

And even though being “functional” is different from one person to the next—for instance, a triathlete needs to be able to run, bike, and swim without limitation or pain, while a homemaker (male or female) needs to be able to do household chores such as lifting groceries out of a car, moving a vacuum cleaner and loading and unloading a dishwasher without limitation or pain—the actual movement patterns required for these activities aren’t really that different.

When you think of functional movement patterns, you should see them as movements that engage your whole body in a variety of different active ways that involve coordinating your upper and lower body with areas that alternate from being steady to moving, and back again.

So where exercises like squats are considered functional because they require full-body coordination, strength, and stability exercises like biceps curls aren’t considered functional because they lack the full-body mental and physical engagement that comes into play with basic motion.

The main difference between functional training and other exercises that work each muscle is that exercises such as biceps curls or leg extensions attempt to isolate that muscle. When doing these movements we’re working individual body parts as separate from the others creating stimulus within those parts. Functional movements put the emphasis on using your whole body at once. 

The focus on functional movement patterns, in theory, is to train your body to move effectively as a fully connected single unit so it is able to sit, stand, bend or change direction effectively when you need it to.  Some of the functional exercises I use are squats, lunges, and pushups. These movements effectively engage the whole body in the exercise although they emphasize specific muscles as the main force of action.

I believe in functional movement patterns and agree there is a place for them in MS training BUT without the individual muscle-specific training it would be impossible to do a functional movement. If your legs are so weak from MS limitations how are you going to perform a proper squat that uses all the muscles in your legs?!  You won’t be able to. This is why specific muscle training is so important. And the only way to get muscle-specific strength is through resistance training. But it doesn’t end there…

You must strength train each major muscle group, individually and specifically to gain the ability to “function”.  I know you keep hearing about functional exercise for MS and how important it is. You are told that you MUST be in a program using functional movement patterns to help your MS limitations.  I HAVE MS and I have been a fitness expert for more than 40 years. The real FACT is that functional movement patterns are secondary to strength training. They are important but more important to your physical abilities are training methods that incorporate resistance exercises with principles that cause “thought-based training” ™ which create muscle fiber activation, neuroplasticity, and brain to muscle reconnection. 

So where am I going with all this?

Please be careful with who and what you take in as being the right fitness information for MS, especially coming from fitness “experts” who do not understand MS.  There is much more to proper exercise for MS than jumping into the next repetitive functional program.  And any trainer who says he/she is teaching you how to place mental attention on your workouts but only tells you to concentrate on what you are doing does not understand the significance of proper focus. It is not just a simple matter of paying attention to your exercises and form. It is the training methods you use that force that focus and concentration that is of key importance in your MS exercise program.  Exercise programs pushing functional pattern movements with no focus driven process or training method behind them other than the standard and cookie-cutter, “do 10 reps of 3 sets”, are of little value in bringing results to our MS bodies.

Continued Education for Fit Pros

Learn what you need to help MSers… check out the Multiple Sclerosis Fitness Specialist online course for fitness and health professionals!

David Lyons, BS, CPT, is the founder of OptimalBody, which touches the lives of fitness enthusiasts of all kinds. OptimalBody has been named The Most Comprehensive MS Fitness Program worldwide since its release. His book, Everyday Health & Fitness with Multiple Sclerosis, was a #1 New Release on Amazon at its release. He is the 2013 recipient of the Health Advocate of the Year Award; in 2015, he received the first ever Health Advocate Lifetime Achievement Award, and the Lifetime Fitness Inspiration Award in Feb 2016. In 2017, David received the Special Recognition Award from the National Fitness Hall of Fame.

foot-pain

Plantar Fasciitis: Heel to Toe Pain

/26 November 2024/ All MFN blog/

Overly stretched, tiny tears can lead to inflammation and pain in the arch of the foot. This condition, called plantar fasciitis, accounts for nearly one million doctor visits per year. Our foot has a thick band of tissue called fascia that runs from our heel to our toe. This troublesome foot issue is actually more common in women than men. We need to spend time on our feet moving, so this foot problem, if left untreated, can cause excessive pain and greatly limit our mobility.

Contributing Factors

Plantar fasciitis is more common as we age (specifically between ages 40 and 60), but is also more likely to occur in someone who is overweight or constantly on their feet. It is very common in runners. Activities that are known for high rates of plantar fasciitis include ballet, dance, long-distance running, and ballistic jumping. There are a few other contributing factors which include wearing shoes that are worn out and have thin soles or wearing high-heels. The mechanics of how you walk (your stride) involves your foot position. If you have flat feet or a tight Achilles, the body will compensate for these dysfunctions which can lead to injury of the fascia.

Pain

Pain starts to occur near the heel towards the bottom of the foot. Most people feel the pain in the morning right when they get out of bed. This is known as “first-step pain”. This can also occur if you have been sitting for a long period of time and then stand up. The plantar fascia acts like an absorbing shock spring in our foot. Repetitive stretching and tearing of this area results in a stabbing pain.

Treatment

If pain persists, seeing a doctor can help detect this condition. He or she will check the tender areas of the foot. The good news is that plantar fasciitis does normally go away on its own. There are several treatment options. A doctor might prescribe anti-inflammatory medication or a steroid injection. Physical therapy and massage can help as well as shock wave therapy to stimulate blood flow. A Tenex procedure can remove scar tissue in the area or surgery can be done to remove the plantar fascia off of the heel bone. Wearing the right shoes or using shoe inserts oftentimes does the trick, so be sure to try these simple fixes first. Ice and soaking the heel can also help alleviate pain .

A good home remedy is freezing a foam cup of water then rubbing the top of the cup on the heel for 10 or so minutes. Stretching the calves and Achilles tendon can help over time and there are ways to tape the area of the foot to position the heel correctly with each step. Night splints worn to hold the foot at a 90 degree angle help when stretching the fascia.

There’s no doubt that we use and abuse our feet, bearing vast amounts of weight on them while performing all of our daily functions. As we walk from point A to point B, getting those 10,000 steps in, we must practice self-care from head to toe to heel. Sometimes foregoing that cute pair of shoes even at the gym is worth the fashion sacrifice to walk without pain.

Megan Johnson McCullough, owner of Every BODY’s Fit in Oceanside CA, is a NASM Master Trainer, AFAA group exercise instructor, and specializes in Fitness Nutrition, Weight Management, Senior Fitness, Corrective Exercise, and Drug and Alcohol Recovery. She’s also a Wellness Coach, holds an M.A. Physical Education & Health, and is a current doctoral candidate in Health and Human Performance. She is a professional natural bodybuilder, fitness model, and published author.

 

References

https://journals.lww.com/jaapa/Fulltext/2018/01000/Plantar_fasciitis__A_review_of_treatments.4.aspx
https://journals.sagepub.com/doi/full/10.1177/2473011419896763
https://academic.oup.com/occmed/article/65/2/97/1488760

Pregnant-woman-at-gym

Building Strength is an Important Component in a Prenatal Fitness Routine

/20 November 2024/ All MFN blog/

You may have heard people warn that pregnant women shouldn’t raise anything over their heads or lift objects that are heavier than ten pounds when pregnant. These are warnings that still make the fitness trainer rounds when working with pregnant clients, yet these warnings aren’t based on science.  In fact, there’s no evidence for warning pregnant women to avoid lifting over their head unless it causes discomfort or balance issues, and the ten-pound limit is even more questionable, as ten pounds would be too heavy for some women and as easy as a feather for others.

It’s important to always remember that each pregnant woman has a specific fitness level and ability, so setting arbitrary limits is an ineffective way to provide guidelines for this population. In addition, when confronted with statements such as these, always review the research that supports the claim before implementing the information into your training guidelines.

Many women choose to continue their pre-pregnancy strength training program while they are pregnant, and most women may safely start strength training during their pregnancy as long as they are cleared for exercise by their healthcare provider. When developing a pregnant woman’s fitness program, you should take into account her current level of fitness and strength and pay close attention to how she feels during and after exercise. The key to maintaining a safe and effective routine is through consistent modification of the exercises for comfort as pregnancy progresses.

Strength training is an essential prenatal fitness component, providing the muscle power needed to compensate for posture adjustments and weight gain that occurs with pregnancy. Women who continue or even start a strength training routine during pregnancy can help prepare her body for all the lifting done with a new baby and reduce the risk of low back pain. Strength training has not been shown to pose any harm to either the fetus or the mother as long as these general guidelines are followed:

  • A gradual reduction in weight loads from pre-pregnancy will likely occur as the pregnancy progresses.
  • Women may continue their pre-pregnancy strength training routine (wt/reps/set) as long as they modify the exercises for comfort as pregnancy progresses.
  • If training causes muscle soreness during the pregnancy, it is recommended that overload be progressed by increasing the number of repetitions versus the resistance/wt.
  • Monitor exercise techniques carefully by mirror observation or supervision in order to correct for progressive postural changes that occur with advancing pregnancy. Improper lifting techniques may aggravate back problems and increase soft tissue injuries.
  • Avoid maximal static lifts. They may cause a sudden increase in cardiac output and blood pressure and employ the Valsalva maneuver. During the Valsalva maneuver, there is a significant diversion of blood from the internal organs (such as the uterus) to the working muscles.
  • Maximal lifts may also place extreme stress on the lumbar spine and other joint areas. Never overload an unstable or weakened joint.
  • Modify supine positions after the first trimester of pregnancy by using an incline board or wedge.
  • A strength-training workout involving all the major muscle groups should be performed three times per week, with a rest day between each muscle group training bout.
  • Machines, free weights, resistance bands, and body weight
  • are all options for building a strength training routine.
  • Remind client that she should exhale with the lift and avoid holding her breath or bearing down and straining as she lifts.
  • If a particular exercise continues to produces pain or discomfort are modification, it should be discontinued. If pain persists, the client should consult with her healthcare provider.

As always, all pregnant women should check with her healthcare provider before starting or continuing an exercise program during pregnancy.

Catherine Cram, MS started her company, Prenatal and Postpartum Fitness Consulting, in order to provide current, evidence- based guidelines maternal fitness guidelines to health and fitness professionals. She was a contributing author for the textbook, “Women’s Health in Physical Therapy” and co-authored the revision of “Exercising Through Your Pregnancy” with Dr. James Clapp.  Her company offers the certification course, “Prenatal and Postpartum Exercise Design” which provides continuing education credits for over 30 health and fitness organization, including ACSM, ACE, ICEA, and Lamaze.