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New Year, Simple Start

It’s that time of year again.  Everyone is planning on doing the right thing and the gyms are starting to pick up.  Almost everyone you speak to is on the “keto diet” as of the first of the new year.  So many great intentions, so little sustainability.  Here’s a quick reference guide for the new year.

Diet

The word diet is more a statement of what you consistently consume as opposed to the 8 week fix that you’re about to embark on.  Instead of jumping on the bandwagon of the newest fad diet that will inevitably fail, choose the healthy option.  What exactly is the healthy option?  The technical answer is that it depends on a host of information that is impossible to answer in one generic blog post.  But, it is possible to give a generic outline that you can plug and play with. The following is  a simple cheat sheet that you can use that is a heck more sustainable that getting extreme.

For Ladies

To maintain your current bodyweight/body fat consume roughly 1 palm size portion of lean protein, 1 fist portion of veggies, 1 handful of starchy carbs, and 1 thumb of healthy fats/oils.  To drop bodyweight/body fat simply cut out some of the starches.

For the fellas

Double what the ladies consume.

For a more detailed list of healthy foods and complete food composition, check out Precision Nutrition’s website.

Sleep

Whatever you do, get appropriate amounts of sleep.  This isn’t always possible if you have newborns or crappy neighbors, but ultimately you should be able to your sleep pretty regularly.  I’ve made mention of this in the past with an entire article, but the jist of the information is that in order to progress you need your sleep.  There are a number of sleep aids out there.  Melatonin seems to be the simplest choice, but now CBD is jumping into the mix.  If you’ve read my material before and you’re still looking at your phone in bed before trying to sleep, why?  Blue light emission from your phone/tv/tablet/computer can inhibit melatonin production in your body for up to two hours.

Exercise

If you are currently working with a professional, continue to do so.  Who couldn’t benefit from someone else pushing you and tracking your information.  Anything or anyone that promises to get a quick fix is just looking to get your money.  There is no magic pill here.

We can break exercise down into a number of different categories, however, resistance training and some sort of conditioning work are the most effective at achieving your goals.  There are certain populations that need to be careful about what they do and how they do it, but the evidence is pretty clear that exercise seems to positively impact everything.  Doing yard work and house work does not constitute exercise.  Walking does not constitute exercise unless you were unable to walk prior to starting a walking program.  Including upper body pushes and pulls, as well as lower body hip hinging and knee dominant work (squats) are a good starting point.

In conclusion, start to implement these simple tasks into your daily routine and you’ll find that your goals will start to come to fruition.  Seeking out a qualified individual who has experience in not just the exercise aspect of well-being, but in the entire performance envelope will be greatly beneficial.  This way you can have all of this information monitored.  Looking for an exercise physiologist or exercise scientist degree and an appropriate certification is usually a good place to start.

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Patient adherence to home/gym programs following regimen of physical therapy – A first hand clinical perspective

I asked my coworker to write a guest blog post on anything he wanted to write about.  Naturally, he chose to write about home exercise programs for the patient.  This is a great read for anyone from therapist to the rehabilitated.  Check it out, and be sure to look up Ben Sherr as he is a tremendously smart therapist and definitely helps me on a daily basis.

During a course of physical therapy treatment, a patient may be seen up to 2-3 times a week for an extended period of time.  In my short history as a PT, many outpatient orthopedic PT programs will not come to an end with the clearance and official discharge by a PT.  Many people will self discharge, or not return to PT. Those are the cases that I will not be visiting in this blog. However, those who are officially discharged from physical therapy, where do they end up?  Are they compliant with their programs that are set up for them? Are we as PTs working hard enough to ensure that the programs are sufficient for them after they finish their formal PT? The answers to these questions do not seem too clear.  This is just one PT’s self reflection regarding patient’s adherence to their gym/home program following outpatient physical therapy care.

Recently, I have had several patients for whom I have set up gym or home programs to work on their PT exercises following successful completion of PT care.  Whether they will complete their program at home, at the gym, with a trainer, or with a CSCS, they are all discharged with a plan going forward. I work in a clinic where there is a gym next door and there are plenty of terrific, certified personal trainers who are willing to help at a reasonable price.  A goal may be to have them work with the trainer and then become independent and join the gym, once again at a reasonable price. I have found that many patients have a hard time following through with this or start this program and then fall off the wagon. The same speaks to the patients that will “complete their program at home”. Unfortunately, compliance to these home programs is usually slim to none. Some patients may leave physical therapy “pain free” but predictably down the road, they return with the same issues they started with. I put much thought into each individual home program to help my patients be successful. With a lack of adherence to these programs what do I get to show for it?

Most of these patients do very well while in PT, so when they return, are they using PT as a crutch?  That is something that we as PT’s cannot enable, but that is a whole other topic, for another day. Back at the topic at hand.  

Why do patients have such a hard time following through with their plan of care.  Is it because they feel great and no longer need to do it? Is it because of differing mentalities?  Is life just too busy? There could be many reasons. Well, research does back it up that most patients are not completing their PT home programs after PT, as documented by Rizzo, et al in 2014, stating “patient adherence to physical therapy home exercise programs (HEP) is estimated between 35 and 72%”.  In addition to this statistic, the article also discusses mental models, which is basically how individuals view the world and how they think. Bottom line was that most patients and PT providers have differing mental models, so PT’s have to work extra hard to change their thought process to connect with the patient. Should we be the ones adjusting to them, or should they be adjusting their mentality to match ours? Again, difficult to answer.

I went into PT to help people.  It is as simple as that. I unfortunately have to ask myself am I doing so?  I believe that I am. I can only take a patient so far. If the patient is committed to PT as well, then they will do a great job.  Not only during their official treatment time, but also when they’re on their own. I have come across some tips that may help a patient stay with their routine following PT. First off, finding a purpose.  Why should this patient continue their exercises? Mostly, it will help them avoid re-injury and maintain their improvements. Maybe they are training for something, or maybe they want to better themselves in general.  Any of these are reasonable. Another tip would be connecting to the patient in a more effective manner. The patient may feel more accountable to complete their exercises following completion of PT. From Campbell et al, “initial compliance with PT is high because of loyalty to the therapist.”  It did not state that it drops off as time goes on, but I am sure that it does.  Lastly, education. Educate the patient to the best of your ability as to why they must continue their rehab to avoid decline in their status.  Or put a positive spin on it and educate them on how much improvements they will make by continuing the exercises. Use a goal as an example.  Just a thought. In all honesty, and according to research, somewhere around half of the time it will not work.

Back to the personal cases that I have come in contact with in the outpatient orthopedic setting.  I have had plenty of situations where past patients have followed through on their programs and eventually do not have to continue them.  Mostly this is a post-operative patient who has done great. Those who continue their programs in the long term are most likely athletes who play a sport or in training for an event.  These patients do great with continuation of care. The general public on the other hand, are very challenging. You try your hardest to adjust your mindset to think like the patient. Set them with plan for success.  I have had three gentlemen in the past month who have been set with gym programs, and have not returned once. Is this my fault? I do not believe so. I set them up for great success and put in a lot of effort. The patient themself needs to be accountable at some point, and that starts right after discharge.  

Maybe it is a possibly jaded view on the subject, but it seems that some patients just do not want to help themselves.  In the healthcare system we have today, these people want a quick fix, and some get it, albeit sometimes temporary. Unfortunately, these patients are the ones who are the returning patients.  And what do I do? Treat them with the best care possible. And will they follow their home program when finished? Maybe. Maybe not.

 

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Why is Water so Important?

In this day of information overload and high tech ways of getting better, little emphasis is put on the most important factors for performance.  Even on this site you have the chance to read up on supplements and how they work.  I can’t really stress enough the importance of water.  Go a day without eating, fine.  Go a day without water, things go downhill quickly.

Water is about 60 percent of your bodyweight.  SIXTY PERCENT!  Let’s boil that down further.  Muscle, the thing we try to make more explosive or resilient depending on our game, is 75 percent water.  Blood, that transporter of all things (almost), 83 percent water.  Even if we do everything right–don’t eat refined sugar sources/junk food, exercise, crush your veggies (which have water in them)–you’ll still be lacking significantly without considering your water intake.

Water is a transporter, catalyst to the reactions in our body, a lubricant, help’s with growth, etc.  And just like your car needs an oil change, your body needs water exchange.  We get rid of water via sweat, the bathroom, and from breathing (as vapor).  For each percent loss of water there are repercussions that will impact performance from an athlete point of view, but get into the 5 percent plus range and you’re going to be dealing with some large issues.  Just don’t go there.

With all that said, how do you make sure that you have enough?  Great question.  There are a number of ways that you can guesstimate how much you need, some fancy equations are used to determine this.  To all you non-mathletes out there, a good general guideline is 100-120 fluid ounces of water consumed per day.  The more active you are, the more toward the 120 fluid ounce side of the spectrum you’ll be.

Prior to exercise, drink water.  During exercise, drink water.  After exercise, drink water.  See a pattern here?  Water means water too, not iced tea.  Caffeine has been shown to not have a huge impact on overall hydration throughout the day, however, in the short term it will speed up metabolic processes causing a little dehydration.

Anecdotally, I’ve had plenty of conversations about the importance of water.  The response is usually along the lines of, I don’t like the taste. In which I respond, what taste?  To be fair, water does usually contain some micronutrients which may have an impact on taste.  Who am I to judge? Fine, you don’t like the taste, how in the world will you stay hydrated now???  You can help the process with the foods you eat.  Technically all food has water in it, to some degree.  Fruits and veggies are always a great way to introduce watahh into the system as well as fiber and some micronutrients.

Just try it.  You’ll feel much better.  When you take it away, you’ll notice it.  Have anything to add to the conversation?  Chime in.