The View from Sports Center

What Can Arthritis Sufferers Do to Keep What They've Got?

I'm talking about osteoarthritis (OA) - a condition of the joints that leads to a weakening of the cartilage that lines and protects the bones.

If you know you have OA, either your doctor has told you or your own Sherlock Holmes like powers of investigative work on the web have lead you to that conclusion, what you also know is that there's a daily temptation to avoid certain things; do less. You hurt. Or you think you will so you just don't go for a walk or the gym or garden or whatever.

Yet, it's those very things, in some form or variation, that can keep you active and prevent further decline. That's the conclusion from a recent studied published by Northwestern University.

Movement for OA is a sort of homepathic treatment. Homeopathic treatments use just a bit of the very thing that seems to be causing the symptoms. It's based on an axiom called the Law of Similars. So, do a little of the very thing that makes you hurt and you'll hurt less and get stronger.

The challenge is figuring out the little part.

So, I'll pass along some ideas for you.

1. If you hurt when you walk too far, get a timer, put on your walking shoes, start the timer and walk. Stop the timer the moment you feel symptoms. Now, the next time you walk, use 50% of that value. So, let's say you can walk 30 minutes and you knees start to bother you. Walk 15 minute chunks. You'll probably even be able to walk more.
2. Exercise in the water. In August, I flew to Daytona to visit my mother and sitting next to me on the plane was a very talkative, vibrant woman. "Beach Party Betty" is what she called herself. Now, normally, chit-chatting on a plane ride is not fun for me but this woman was fascinating. I asked her a couple of questions of course. "What do you do?" And off she went explaining how she taught water exercise and she was convinced that every "senior" needed to be in the water. She was 69 and acted and moved as if she was 40 or maybe younger. I asked her how often she taught classes. "Everyday except Sunday! Twice a day for an hour each time!" She explained to me that she got into it because of her own hip and knee pain and she found that riding her bike or hiking had become too painful but since she had been doing her water work, she had been able to resume all of her former activities. 
3. Join a Tai Chi class. The slow, controlled movement combined with the mental focus is what I thank works in Tai Chi for folks with OA. I don't mean to discount the eastern philosophy of healing. I just don't understand it well enough to explain it.
4. Start Yoga. Similar to Tai Chi, but perhaps with a bit more risk. Certain poses can be a problem but a good instructor will know that and be able to help you.
5. Get some help to get started. Sometimes, you need professional help to get going. Weaknesses in certain muscles or inflexibility. If you're in Austin, call us. We really understand the issue of OA. Outside of Austin, look for therapists who can talk to you about the interaction of cartilage physiology and exercise. They should know how exercise alters joint health.
6. Talk to a nutritionist about anti-inflammatory diets. Although these diets are not commonly used for OA, they are used for conditions such as Ankylosing Spondylitis and Rheumatoid Arthritis. Here's Andrew Weil's take on such a diet.

If you want to keep moving, keep moving. Find a way. Try one of the steps above and stay active.

 

 

Dunlop, D. D., P. Semanik, et al. "Moving to maintain function in knee osteoarthritis: evidence from the osteoarthritis initiative." Arch Phys Med Rehabil 91(5): 714-21.

Ni, G. X., L. Song, et al. "Tai chi improves physical function in older Chinese women with knee osteoarthritis." J Clin Rheumatol 16(2): 64-7.
   

If the Shoe Fits, Will it Make You Fit?

There are "innovators", "early adopters", "early majority, "late majority" and "laggards" when it comes to trying or buying new things. It's called the "innovation curve".  I'm on the "innovator" to "early adopter" side of the curve. One of those guys that buys new stuff just to try it out; curiosity more than anything (besides, who wants to be known as a "laggard"?

So, a few years ago, I bought a pair of MBT sandals, Chung Shi shoes, and Spira shoes. Oh, and I bought a pair of Kangoos too.

To be fair to the folks I bought them from, no one told me I would become fitter by wearing these shoes (I think they were just happy to see me drop in every couple of weeks).

That's not what Reebok would like you to think though.

They have come out with a shoe that they claim makes you fitter as you walk.

The EasyTone.

Really?

No. Sorry. The science behind this says otherwise. The shoe alone has no additional benefit other than perhaps convincing you to walk more than you would otherwise because you think that doing so will give you legs and a butt to die for.

Researchers at the University of Wisconsin studied three shoes: MBT, EasyTone, and Sketchers' ShapeUps (you know, the ones Joe Montana wears in the ads). They looked at muscle activation among these shoes and regular running shoes and concluded:

"All three toning shoes tested showed no statistically significant increases in either exercise response or muscle activation during the treadmill trials, when compared to the normal athletic shoes tested.  There was simply no evidence to indicate that the toning shoes offer any enhanced fitness benefits over traditional sneakers, despite studies cited by manufacturers seemingly “proving” the toning shoes’ effectiveness."

Ok, so if the shoes don't make you any fitter, why buy them?

Like I said, I buy a lot of stuff just to try it out; see what works, how I can use it, etc. Here's why I bought some of these shoes:

1. I have multiple joint (ankle, knee, spine) degenerative joint disease; couple of Schmorl's Nodes in my thoracic spine. So, reducing impact load for things like jogging makes sense. Thus, the Spiras and Kangoos.
2. The MBT sandals are just about the most comfortable sandal type shoe I've worn. And again, the reduction in impact is nice on the joints so if I know I'm going to be standing around for quite  a while, I'm apt to wear them.
   
3. The Chung Shi shoes force you to walk into the "fall line". They have a ridge across the bottom of the shoe which tends to rock you forward. This will naturally make you walk faster. And, they're also comfortable.
4. Spira shoes also reduce impact load. Their claim to fame was getting banned by the United States Association of Track and Field because the USATF thought the shoe would provide an unfair advantage due to the springs in the shoe.
   
5. The Kangoos reduce the impact of running by about 50%. So, for me, especially after a meniscus tear that hasn't completely healed, reducing impact load makes a of of sense. Yes, they tend to attract a lot of attention. One guy walked up to me and hollered, "Do those things really work?" I wondered what he meant. Work for what? I just said "Yeah" and kept running.

Bottom line, you get fit by stressing your body and for some people buying one or more of these shoes will do that simply because they'll be more active in the shoe than otherwise. But, the shoes alone aren't as magical as their marketing.

A Heart is not a Heart: Do Women Need a Different Heart Rate Max Formula?

Figuring out your maximum heart rate used to be simple: 220-AGE.

That's what I was taught in school. That's what most people, if you ask, will tell you.

Of course it wasn't exactly right either and there's an interesting history behind maximum heart rate.

The year was 1968.

Bill Haskell, an exercise physiologist at the U.S. Public Health Service had been given an assignment by his boss Sam Fox, MD.  Dr. Fox, a cardiologist, was scheduled to talk at a World Health Organization meeting on exercise and heart disease.  Haskell's job was to collect research on maximum heart rate testing. All the experts agreed that exercise was important following a cardiac event or if you had heart disease.

But, at the time, no one knew how hard a person should exercise following a heart attack. Haskell assembled the information and plotted the results on a graph. He and Fox studied the graph and discovered a pattern. By drawing a line through the data points, Haskell found that the maximum heart rate at the intervals of 20 years, 40 years and 60 years, was 220 minus the age. Haskell and Fox presented their finding at scientific meetings in Tel Aviv and Tuxedo Park, New York. In 1971, they published their formula that was to become the gold standard for exercise.

The problem with their discovery was the studies were done only on men all under the age of sixty who did not exercise regularly. Haskell and Fox did not actually perform any research. They compiled data from existing studies. So, their formula was not valid for all people. For a valid study, the results must be true in other places, with other people and at other times. Since Fox and Haskell's work was only on men under the age of sixty, the formula was then only valid for sedentary men under the age of sixty.

Now, new information from Northwestern University in Chicago, suggests that women need their own formula: 206 minus 88 percent of a woman’s age.

The old formula for a woman age 40 was:

220-40 = 180 beats per minute.

The new formula is:

206-(40*.88) = 171 beats per minute.

The researchers followed over 5400 women for 16 years and discovered a link between abnormal heart activity and risk of heart attack. That's also when they discovered the new formula.

Some women who used the old formula (based on men under the age of 60) found that they could not sustain the heart rate, got frustrated, or exhausted during the exercise. The new formula should correct that making exercise more productive and useful.

But, you may not want to wear a heart rate monitor or stop and take your pulse while jogging or running or cycling. If so, you can read about a different method by clicking here.

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Gulati, M., L. J. Shaw, et al. "Heart rate response to exercise stress testing in asymptomatic women: the st. James women take heart project." Circulation 122(2): 130-7.

Follow my recovery from a meniscus tear here. 

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What Do I Do for Hip Pain?

I am 61 years old and am most happy when I am hiking, biking, dancing or kayaking.  Degenerative joint disease in my right hip (which an x-ray showed at my last check-up) does not fit into that lifestyle. I have recently been in enough pain to the point that simple walking and even garden work causes pain. I do not want medication.  I want to cure this.

I am going to do your “tailgator” program for my hip.  What other exercises should I do? I have been helped by a physical therapist who gave me exercises to strengthen the muscles in the area…what else should I do? 

I figure that the only aerobic exercise that would be low impact would be swimming, but what about weight bearing exercise for osteopenia?

I am motivated to do anything to fix my problem.

Thanks!

Deborah

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First, thanks for reading Deborah. And, for sending in a question that a lot of people may also have.

To overcome the effects of osteoarthritis, you have to assemble a game plan that includes several things. And the game plan is modified some according to your unique set of problems so this a general strategy to get you started.

• Anti-inflammatory diet. Here's a really good overview of the anti-inflammatory food pyramid. What we eat or drink can greatly influence how our body reacts to physical and emotional stress and can even create inflammation from the nutrients. An anti-inflammatory diet helps you reduce the pro-inflammatory markers produced by these stresses.
• Adequate flexibility of the lumbar spine, hip, and ankle. When joints are sensitive to load, as in OA, inflexibility above and below the joint, can increase force transmitted through the painful joint. Your physical therapist should be able to tell you whether you have enough flexibility and how to improve it. I perform a series of biomechanical tests to help identify movement faults due to weakness or inflexibility but that process is way too detailed to go into in a blog.
• Excellent core muscle endurance. You can test your core endurance with the side plank test. You should be able to hold the position for 20 seconds on each side (see image). If you fail this test,  you have to work on developing the core. You're after endurance not strength. Read anything by Stuart McGill for ideas.
• Low load, high volume motion. I prefer the Total Gym for this. There are other devices that are similar (Body Rail, Vigor), but I haven't used them. You have to find a level of force that is very comfortable to your hip. Usually that will be around the 3rd or 4th rung on the Total Gym. You squat until your knee approaches 90 degrees. It's not a sprint. Slow, comfortable pace. Lots of repetitions. I usually start with 10 minutes, take a break, work on other things, then come back and do another 10 minutes gradually working up to 30 total minutes per day.
• High volume motion with almost no load. Hip swingers is what I use most of the time.
• Muscle strengthening. You know about this, but you have to be careful. The loads produced by the muscle contractions can overload the joint. The muscles to concentrate on are the hip rotators and abductors. 
• Cardiorespiratory exercise. What you do for this depends on how much force your joint can withstand. I will use swimming, ellipticals, walking or exercising in water. In the clinic, we have an anti-gravity treadmill so we can help people walk or even jog without overloading the joint. I shoot for 30 minutes with a 12-13 Rating of Perceived Exertion.
• Supplements. Here's an article I wrote about this. Try to avoid taking NSAIDs as much as you can. Sometimes you have to but I've had clients who turn to NSAIDs at the first sign of pain. Give your body a chance to fight through it. NSAIDs have been shown to weaken the joint cartilage with prolonged use.
• Get real. This is the hard part. You have to accept how much your body can do without injuring your self over and over. While you're working on rebuilding your joint capacity, you'll likely have to let go of doing certain things, and most of these are things you really love to do, until your joint is strong enough to withstand the loads of those activities. If you don't do this, you not only continue to hurt, you'll advance the disease process and simply lose more and more things from your life over time. There's a phrase from Buddhism that I like a lot - "The Middle Way". It means finding the path between too much and too little. Avoid the extremes. 
• Meditate. Meditation calms the sympathetic nervous system - the fight or flight part of your body. It helps you clear your mind of the past and future and just focus on now. I especially like Dale Goldstein's "Awareness Meditation" audio guide.
• Journal. Gratitude for what you have, for what you can do. There are always people worse off the you.

If you start working this list, you should start feeling better. The thing to remember is that your body is amazingly adaptable. Just give it a chance and you can really improve a lot of things in your life. Just because you have changes on x-ray doesn't mean you're doomed to a life of sitting on the sidelines watching everyone else enjoy themselves. But, you must be patient, persistent and disciplined.

I hope this helps you.

Follow my recovery from a rotator cuff tear here. I post new stuff every day or two generally.

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

Sirens of Temptation

"It's just SO nice out! I just HAVE to go for a run!"

"My yard was so sad and it was so beautiful outside! I just HAD to work on it!"

The Sirens of Temptation. Injury be damned. I'm not dead yet. And all the other things we say to ourselves to give us permission to do stuff which is actually harmful.

Uh-huh.

I get it. 

In fact, read about my night of bowling with a rotator cuff injury to learn just how much I get it.

What is Strength?

What does it mean to be strong?

Is it the amount of weight you can lift? Bench press? Biceps curl?

Or, how fast you can lift it? An Olympic clean and jerk for example?

Or is it how well you can control the weight you lift at the speed you lift it?

The formal definition of strength is the maximum amount of force a muscle or group of muscles can produce under specific circumstances.

Strength is condition specific.

So, in light of that, check out this video for a stunning display of strength in action.

Wow.

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For the latest on my shoulder recovery, click here.

Post-Prolo: Day 1

You can find my journal of post-prolo recovery and my shoulder rehab here. From the main page of the blog, look on the left hand side below READERSHIP and you'll see a link to "Shoulder Recovery and Rehab". It'll be one page so all of the entries will be together. When I add something, I'll post a link to it.

Onward....

The Mistakes Marathoners and Half-Marathoners Make

Running season is gearing up. For those of you into the long runs, here's a good article on the common training mistakes runners make for a marathon or half-marathon.

What You and Olympic Athletes Give Up to Win

How do you ski down a steep, icy mountain at speeds faster than what you can drive on most highways knowing that at any moment the slightest extra weight shift could send you tumbling like a rag doll and even kill you?

And then, if you do happen to crash at 70 mph or more and break something, slash something, crush something, how do you get back on those skis and do it all over again a year or two later?

Downhill racers are different. Maybe it's genetic. Maybe there is something different in their brains like an atrophied amygdala, where fear resides.

Or maybe not.

Maybe they're just really committed. Dedicated. Focused. Maybe they've trained themselves to go after what they want and they've made the mental and emotional adjustments to do what it takes to get it. They know they can't have everything. If they want Olympic Gold, there's a price. Freedom.

These athletes train hard; hours per day. They have seriously regimented lives. Diet. Sleep. Travel. Practice. Train. They have coaches and trainers and sports psychologists. They learn how to use visualization techniques to practice even while they're off the course . They deny themselves things everyday hoping that one day the work will payoff in Gold. And if they crash, get hurt, they start over.

Olympic athletes exchange freedom for victory.

And so do you and I.

To overcome any injury or surgery, you have to give up things. Sometimes it's a hobby or sport or routine that keeps re-injuring you or sometimes it's 15 minutes of sleep so you can get up in the morning and exercise. Sometimes the thing you have to give up is being angry at your injury, pain, or situation and sometimes it's thinking you know (and you can put me in this group).

You always have to give something up though.

And, that's the really hard part.

But then, if it's easy, the Gold isn't worth much, is it?

Barefoot Running

Several questions recently about barefoot running so here's an interesting article on the subtle shift in load by changing from a heel strike to mid-foot running style and here's a site that digs into the differences between a conventional running style and barefoot.

And yes, I dig my Vibram Five Fingers. But, you have to work your way up to a sustained amount of running since your calf, Achilles tendon, and buttock muscles are not used to doing so much work. Or at least mine weren't :-)

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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 right hand corner of my blog and then share this blog with your friends.

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