The View from Sports Center

Good News for Runners

You stand a better chance of living a longer and healthier life than people who don't run according to a study published last year in the Archives of Internal Medicine.

The study followed over 500 people - runners and non-runners - over a 20 year period. Although runners decreased their average amount of time per week from four hours at the start of the study to a little over an hour by the end of the study, runners had less disability and fewer early deaths from conditions such as cancer, infections, or neurologic disease.

The lead author, Professor James Fries told the BBC News, "The study has a very pro-exercise message. If you had to pick one thing to make people healthier as they age, it would be aerobic exercise. The health benefits of exercise are greater than we thought."

But, is it running that delivers the benefit or is it the aerobic nature of the activity?

Aerobic exercise is not limited to running. You can cycle, swim, or perform resistive exercise and make your heart and lungs work too. "Cardio" is no longer king. What this study shows is that people who exercise over their lifetime are generally healthier and live longer. They used running as a means to achieve those benefits.

The U.S. Department of Health and Human Services reports that the health benefits of exercise appear at 150 minutes per week and increase at 300 minutes per week. This is at least moderate intensity exercise . The more intense the exercise, the less total time is required to achieve the health benefits (for example, you can cut 150 minutes per week to 75 minutes if the exercise is vigorous). And remember, if you're not sweating, it's not exercise (yes, there are exceptions for the exceptionally fit, highly competitive athlete).

So, how many minutes per week are you investing for your self?

DK

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Is the Core Craze the Crux of the Problem?

Reader Renee points us to an article in the NY Times about the dangers and pitfalls of "core" strengthening. It's worth reading as are the comments.

I agree with most everything in the article. The transverse abdominis, while important, is not the only muscle you need to be concerned about and that hollowing the stomach by aggressively sucking it in may do more harm than good by de-stabilizing the supporting structures. Sit-ups are a poor choice for most people carrying far more risk than necessary and that goes for back extensions over the edge of a stool or a Roman Chair too.

My disagreement in avoiding using isolating techniques to activate the transverse addominis is that the stabilizing muscles, multifidus and rotatores, are inhibited following a back injury and since these muscles are not under your volitional control, you must find another way to jump start them. The transverse abdominis is the jump start mechanism. Once you learn how to contract the transverse abdominis (and this is done not sucking in the stomach but rather bracing the mid-section as if you're about to get punched in the stomach), which by the way needs only a mild contraction to turn on the multifidus, you can then move on to more functional drills incorporating the tension from the transverse abdominis.

Of course, there's no strong link between a "weak core" and lower back pain but there is evidence that suggests people with chronic lower back pain tend to have an atrophied multifidus muscle and we know that atrophied muscles are weak muscles.

Hides, J. A., C. A. Richardson, et al. (1996). "Multifidus muscle recovery is not automatic after resolution of acute, first-episode low back pain." Spine 21(23): 2763-9.
Danneels, L. A., G. G. Vanderstraeten, et al. (2000). "CT imaging of trunk muscles in chronic low back pain patients and healthy control subjects." European Spine Journal 9(4): 266-72.

Question from a Reader: PRP Not Covered by Insurance?

Hi,
I have knee cartilage problems & would love to try PRP. However, my insurance will not pay for such therapy & I cannot afford the $2,500 it will likely cost me for a self-pay treatment. I imagine the cost is an obstacle for many people with joint & tendon problems who would like to try this. Do you have any suggestions on how I might obtain a reduced rate from the provider? Do you have a sense of when insurance might cover this? Thanks!

Neil

---

Hi Neil,

Thanks for your questions. I know other people are in a similar situation.  I have some thoughts for you about your knee and, as a disclaimer, I make them only to offer you another way of looking at your situation. I'm trying to help.

I'm going to push you a little on your statement that you can't afford the fee (and I think the cost is closer to $1000 to $1500). When it comes to healthcare, one of the first things people often say is, "My insurance won't pay so I can't afford it." This perspective seems independent of one's actual purchasing power. One of the side effects of health insurance is a subconscious sense of entitlement which is completely understandable. You've paid for coverage and you expect to have a benefit. But, health insurance is merely a contract that agrees to provide you specific benefits to assist you in paying for healthcare services. It does not replace an individual's own responsibility to take care of themselves.

Here are some things to consider to help you pay for healthcare services like a PRP injection.

• Analyze your "Latte money". My wife and I call frequent, seemingly low cost expenditures "Latte money". It's the money you would spend if you went to Starbucks everyday and bought a Latte for $3 or $4. Over a month that's about $80. In one year that's nearly $1000. If you find your "Latte money" and cut it out of your spending, you could very likely pay for a PRP injection.
• Call the provider and ask if they have any payment plans. Most do.
• Pay your self first. Out of your paycheck, transfer a small amount of money into a savings account. This works best if it is transferred before you get the check. If you could save even as little as $50/month, in ten months, you would have enough money that you could at least get the injection and if the provider has a payment plan, pay off the remaining balance in another ten months.
• Get a loan. While I'm not a fan of consumer debt (like buying a 65"plasma TV and paying it off for 48 months), we're talking about your body and your quality of life. Good health is the source of all personal freedom. It is truly priceless. If you have to borrow the money to get healthy, it will likely be worth every penny. Interestingly, many people will not think twice about spending $3000 on a 65" TV but shudder at spending that same amount on their health.

As for getting providers to reduce their fees, you certainly can ask. Most won't reduce their fees on these types of procedures because they take such huge reductions on the procedures that are covered by insurance. For example, a urologist I know of recently decided to stop performing kidney transplants and instead has decided to perform more vasectomies. Why? He was paid $500 to perform a kidney transplant and $1500 to perform a vasectomy. Kidney transplants are more work not only in terms of the surgery but the follow up care and carry more risk for both patient and surgeon. Boggles my mind. He's paid more to prevent life from starting that to prevent a life from ending.

Insurance comes late to the game on things like PRP. It's relatively new so until there is enough proof that the procedure will reduce the need for more expensive procedures and longer term care, insurance will sit on the sidelines. I have no idea when or if any companies will cover it.

Finally, PRP is not a panacea. You still need to go through a rehabilitative process which, if you have not tried this already, may help you. You may find, with the correct program, that many of your symptoms will subside. Managing a knee problem is a lifestyle shift. You have to not only do the right exercises, you also have to find the positions and activities in your daily life that overload your knee and remove them or alter them until your knee is healthy enough to tolerate those activities.

DK

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Back Pain and Giving Up

Eighty percent of people will have low back pain in their lifetime bad enough to seek medical care. For some, the symptoms fade within six or eight weeks. But, for over half, the pain returns within one year and often becomes a most unwelcome and rather permanent house guest.

And, what type of care do people get? To find out, a group of researchers in North Carolina contacted 5,357 households and found 732 adults with chronic low back pain*. Of the 732 people, 590 had sought medical care. Here's what else they found:

• 31% had taken a muscle relaxant in the last 30 days.
• 60% had taken a narcotic in the last 30 days.
• Greater than 33% had some form of imaging study done (MRI, CT SCAN) in the past year.
• Less than 30% had seen a physical therapist.
• 3% had been in a spine rehabilitation program.
• Levels of depression were high.

Depression is a common finding in people with chronic back pain and is compounded by a feeling of hopelessness about the situation. Chronic back pain carries a very high emotional tax (and, yes, all pain has an emotional tax but back pain seems to be one of the worst types. Nearly, 54% of people are depressed prior to the onset of their pain.). You worry. You wonder if you'll ever feel better or do the things you once loved to do or even come close. Day after day you get caught in a vortex of anxiety and discouragement. Life is grey.

The passive nature of treatment - drugs - for so many people with lower back pain can unintentionally add to the weight of hopelessness. Sometimes the drugs are helpful and needed to get people moving but as this study shows, few of them ever land in a program designed to help get them moving in the right direction. Instead, they take medication and hope until their hope is so thin and frail it cracks. Some fill the cracks with despair; some bitterness; others use resentment. The fix is as fragile as the crack itself.

What do you do? If you like your doctor and trust him or her, ask for a referral. Tell him you need to see someone who can help you get moving again. Some physical therapists and chiropractors and massage therapists focus their work on movement. Other practitioners who can help are trained in Feldenkrais Method or Alexander Technique. Yoga and Pilates can also be quite effective in the hands of a skilled teacher. If you can't get a referral and your state (or your insurance) requires one, switch doctors. Friends, family, colleagues may also be able to suggest someone that can help you.

Just don't quit. Fight. After all, what's the outcome of giving up?

DK

*Carey, T. S., J. K. Freburger, et al. (2009). "A Long Way to Go: Practice Patterns and Evidence in Chronic Low Back Pain Care." Spine 34(7): 718-724

---

You can comment on any post by clicking "COMMENTS" at the end of the article. Share your opinions and ideas!

**

For the latest on MY TRAINING ROUTINES, click here .

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New to the View? Consider subscribing to my RSS feed: Subscribe to this blog's feed. Or sign up to get email updates in the box at the top left hand corner of my blog and then share this blog with your friends.

**

Did you know I have another blog? If you enjoy the science and art of getting and staying fit, you might enjoy Exercise:ology.

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Do you have a copy of my new book, "The Little Book of Sparks"? You can read a sample and order it here.

Question from a Reader: Are Walking Poles Good for Bad Knees?

Greetings,

I have been reading “The View” for a couple years now.
I teach Yoga to adults over the age of 55. We’ve developed a program that works for almost everybody, I volunteer and it’s a beneficial class, as much for socialization as for the benefits of Yoga.

Many people have accumulated knee injuries or arthritis or both. I encourage them to be active outside class and I have a number of people who used to love to walk, but avoid it now because of painful knees. (We do learn about knee anatomy and strengthen the muscles around the knees and hips, and your blog has provided me with much motivation in that area).

I was wondering if you might post any experience you have with walking poles and reducing stress on the knees to allow people to walk when it would otherwise be too painful. Hypothetically, it unloads some weight from the knees (and that’s the best answer I could get from an orthopedic surgeon) — but what is the reality?
Are walking poles a good idea for bad knees?

Best wishes,

W.M.

---

Thanks for your question W.M. And, it sounds like you're helping a lot of people.

The reality is that yes, walking poles reduce the force or unload some of the weight from your knees (and other joints as well)*. And, walking poles increase your step length, stance time, and walking speed. All good things. The only question is whether the walking poles can reduce the force enough for some people.

Walking poles are good for bad knees. They're worth trying.

DK

*WILLSON, JOHN; TORRY, MICHAEL R.; DECKER, MICHAEL J.; KERNOZEK, THOMAS; STEADMAN, J. R. Effects of walking poles on lower extremity gait mechanics. Medicine & Science in Sports & Exercise. 33(1):142-147, January 2001.

Will Knee Pain Cost Rafael Nadal $1 Million?

He failed to win the 2009 French Open, the first time in four years, because of knee pain and knee pain may keep him from defending his Wimbledon title later this month.

It could cost him $1,200,000.

Rafael Nadal is considered as one of the most athletic and fit tennis players in the world. Yet, he his doctors say he has tendonitis in both knees that has plagued him for many, many months.

How does such a fit person end up with tendonitis and why does he still have it?

I doubt Rafael has tendonitis (and that may not be what his doctors actually said but what the media chose to report). Tendonitis is an acute inflammation of the tendon. Considering that Rafael has had knee pain since at least the end of 2008, he more likely has tendonosis. Now, you may think I'm just being picky or hyper about word choice but the two conditions are treated very differently.

Tendonosis does not respond to the usual anti-inflammatory procedures used for tendonitis like ice, non-steroidal anti-inflammatory drugs or other modalities aimed at reducing inflammation. Tendonosis is a focal weakness in the tendon from very small tears that have not fully healed. Why you hurt is still not completely understood but some research suggests that the pain comes from the stress applied to this weakened area as well as certain chemicals that ooze out of the injured tendon into surrounding tissue activating pain receptors.

Tendonosis of the knee usually involves the patellar tendon. This tendon is exceptionally strong so to tear it, even at the microscopic level, you have to use a lot of force. How this happens is most often from a combination of biomechanical abnormalities and high force levels with a large volume of activity and inadequate rest.

Tennis, certainly played at Rafael's level, is a game that creates a lot of force on the knees from sliding, lunging, sprinting, stopping, turning for hours at a time. And Rafael has been very active over the past year. Consider what he has accomplished:

• his fourth French Open title.
• his first Wimbledon title in a match considered the greatest ever.
• an Olympic gold medal.
• a Davis Cup.
• a first Australian Open title.
• several Masters titles.
• a 33-match unbeaten run on clay. 
• became the number one player in the world.
• played 14 matches in three weeks to win clay titles in Monte Carlo, Barcelona and Rome.

And, for at least some of this work, he was already injured. So, he has two ingredients for chronic tendonosis: high force levels with large volume of activity and inadequate rest (in fact, Rafael complained about the tournament calendar being too busy back in May 2009).

As for the other factor, biomechanical abnormlaties, only Rafael, his doctors, trainers, and therapists know anything about that. Typically, the biomechanical abnormalities are usually two things: weakness of the external rotators of the hip and a tendency for the arch of the foot to collapse to the floor. These two events lead to an increase in load on the patellar tendon from a twisting effect on the leg.

So, how does he heal his injured tendon? A treatment that shows a lot of promise for tendonosis is Platelet Rich Plasma injection (and in Austin, here) or PRP. Your blood contains growth factors, chemical agents that encourage tissue to heal. PRP is a process that extracts these growth factors from your blood and then injects them back into the injured tissue at a super concentrated level. But, from the people I've spoken to who have had this procedure done, it's not exactly a smooth ride. It still takes several months for the tissue to heal and in that time, you often experience spikes in your symptoms. So, just about the time you think all is well, your symptoms return sometimes with a little more bite. The end result can be very good though when combined with the appropriate forms of exercise.

If Rafael has tendonosis and he's just now starting his rehab, I think his chances of being 100% at Wimbledon are slim (and he's said that if he's not 100%, he won't play). In his case, tendonosis may come at a very high price.

DK

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Correction

Heidi points out, "You said:  And, if you want to take about ten years off your life, stand tall and walk briskly. Do you mean:  If you want to add to years to your life?"

Good point. I didn't mean that by standing tall and walking briskly you shorten your life. I meant that by standing tall and walking briskly you'll seem ten years younger than  you are.

Thanks Heidi.

DK

Top Speed

I spent a few days last week visiting my mother in Daytona Beach, Fla. The weather wasn't quite nice enough for golf but we managed to get out to the beach in the morning to walk.

And, I mean walk.

My mother can walk and walk and walk. And she's not out for a leisurely, smell the roses sort of walk. No. She's walking near her top speed. For miles.

We ran into a couple of her friends on the beach. My mother wanted me to meet them. Walter, a tan, portly, smiling man in his 70's, with a booming, German accented voice, said, "Yah, well, guud lahck keeping up wit her! Ah wish ah could walk so fahst!"

We walked between 6 and 7 miles each morning. Of course, the fine, clean beach, crashing waves, sea gulls overhead helps. But, still, it's nearly seven miles.

We ran into other people too who all basically said the same thing as Walter. My mother not only walks a lot but she walks fast and with good posture. I would like to say I had something to do with that but it's all her (good job Mom!).

Our walks reminded me of the importance of two things: speed and posture. Decline in walking speed correlates closely with physical problems in later years. And, if you want to take about ten years off your life, stand tall and walk briskly. Standing tall (what some would say is "good" posture) not only makes you seem more youthful but it's better for your spine and even internal organs. And, it makes you feel better about your self. It enhances your mood.

So, here's a reminder to work on your top speed and another one on posture.

DK

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Did you know I have another blog? If you enjoy the science and art of getting and staying fit, you might enjoy Exercise:ology.

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Do you have a copy of my new book, "The Little Book of Sparks"? You can read a sample and order it here.

How to Make Big Changes in Your Life?

Make little changes first.

Write down a list of things you want to change or improve. Maybe it's your diet or your spending habits or your exercise routine. Maybe you want to be a better listener, be more compassionate. And sometimes, you may want to change all of those things. Whatever changes you want to make, write them all down.

Go through the list and find the one thing that's the easiest to change. Once you've chosen it, now write down a list of things you need to do to make the change happen and then, again, pick the easiest one.

Work on that one thing. Make it the center of your day. Focus on it. Apply your time and energy and resources to it and then tackle the next thing.

So, let's assume the thing you want to change is your weight (well, to be more accurate, you want to lose some body fat). A typical list of things to work on to lose body fat might be:

• Eat cleaner and eat enough. (Remove processed foods, excessive fatty foods, sugar, and unhealthy snacks. Reduce or eliminate alcohol. Eat a protein rich breakfast. Hydrate.)
• Exercise.
  • Get a physical exam by your doctor to find out if there's any reason you should not exercise.
  • Pump iron.
  • Walk, jog, play, cycle, swim. Get active.
• Manage stress.
• Create a vision board.
• Identify unhealthy triggers. (e.g. smoking and drinking alcohol tend to go hand in hand.)
• Start a food journal.
• Get enough sleep.

There might be more but, from the list, which one would be the easiest to tackle first? Usually, changing your diet and starting an exercise routine at the same time, which a lot of people do, is tough to keep both things going. What if you chose to visit your doctor first? Check that one off the list. Then, maybe create a vision board or look at your stress levels and how you manage them currently. The vision board is something you can come back to from time to time for inspiration and if you study how you manage stress, you might find that you eat more or drink more or smoke to cope with the stress.

As you check things off your list, you're on your way. When you get to changing your diet, use the same principle of little things first. Maybe just stop eating ice cream at night or potato chips with your lunch or have water instead of Coke.  Just do that for a while then add something else.

You will lose weight just from doing something as little as cutting Coke (or other soft drinks) out of your diet. An average sized soft drink is 155 calories. If you have one per day (and most people drink way more than one), in one week that's 1085 calories. In a month, that total is 4340 calories or 1.2 lbs. of fat. Stop the Coke, drink water, lose fat and you haven't even started to exercise yet!

The tough thing about making a change is how hard it is to execute day to day; to repeat the choices over and over. That's why you'll enjoy more success if you start with small changes first.

A little change can become a big change. Just give your self a chance.

DK

For the latest on MY TRAINING ROUTINES, click here .

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New to the View? Consider subscribing to my RSS feed: Subscribe to this blog's feed. Or sign up to get email updates in the box at the top left hand corner of my blog and then share this blog with your friends.

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Did you know I have another blog? If you enjoy the science and art of getting and staying fit, you might enjoy Exercise:ology.

**

Do you have a copy of my new book, "The Little Book of Sparks"? You can read a sample and order it here.