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Get your questions answered by the experts!

Join Dr. AJ Rastogi, MD and Meryl Goldstein, PT, MPT, ART as they talk about back pain and how to avoid surgery.

The place is the Cherry Hill Health and Racquet Club on Tuesday October 9th and 7pm.

Hope to see you there!

It’s not stretching a point to say that most Americans today probably know someone who’s either been on a diet, is on one currently or is planning to start one. The fact is Americans are probably more weight conscious today than they’ve ever been, due in part to the growing emphasis on fitness and to the rising concern about obesity as a health issue.

Aside from the fact that our culture idealizes those who look lean and mean with a flat tummy and six-pack abs, being overweight carries significant medical risks. Diabetes and coronary heart disease are among the more obvious problems, but research has shown that excessive weight can lead to some forms of cancer, sleep apnea, osteoarthritis, gallbladder disease and liver problems. Complications in pregnancy are also on the list.

The desire to lose weight has given rise to an entire industry devoted to making the process appear effortless and relatively fast.  Just watch television for an evening and you’ll be bombarded with commercials touting weight loss programs promising near-miraculous results.

Despite the promises and the hype, anyone who’s been serious about losing weight knows it simply isn’t that easy. It can, however, be done and there are proven methods that can help individuals burn fat and lose weight. Here are six guiding principles that can help one to safely lose pounds, actually improve health and contribute to a sense of well-being.

1. Create a caloric deficit. Simply put, people lose weight by burning up more energy than they consume. Energy, of course, is measured in calories and measuring the number of calories consumed in foods has never been easier. Government regulations require that most packaged foods list their calorie content on the label. In some areas, restaurants must list the calories in each dish they serve. Even smart phones can get into the act with one of the many available apps that will help keep track of the calories taken in at mealtimes and burned during daily activities and/or exercise. The goal, of course, is to burn more calories than are taken in.
2. Start a double-barreled attack on fat. Dieting, by itself, and exercise alone can work, but it may be a while before one sees results. The far better plan is to use a combination of diet and exercise. Eat less, eat smarter, boost activity level and the weight-loss goal is in sight.
3. Eat smart and often. A wise weight-loss diet should be oriented mainly toward lean proteins, fruits and vegetables. Starches and refined carbohydrates should be kept to a minimum. The dieter should drink plenty of fluids (primarily water), and try to eat at least 4-5 small meals per day. This will help the body maintain blood sugar levels and keep burning fat.
4. Add resistance to the workout. A major factor in burning calories is the rate of metabolism. And a major factor in metabolism is lean muscle mass. Build up more lean muscle mass and the result is an increase in metabolism, thus burning more fat. So weight training has to be a part of any effective fat loss program.
5. 

   Exercise with a friend for greater success.

   Jump-start metabolism: Studies have shown that interval training and metabolic resistance training provide the most efficient use of training time. These are examples of high intensity and active rest workouts. Experts agree that we burn more calories during and after exercising with these types of programs.

6. Team up with someone to lose weight: According to a new study published online in the journal Obesity, teammates in a team-based weight loss competition significantly influenced each other’s weight loss, suggesting that shedding pounds can have a ripple effect.  Social networks do play an important part in successful weight loss regimens.

- Contributed by: Joseph Ruhl, PT, Partner, E & A Physical Therapy. Select portions used with permission from Alwyn Cosgrove, August 12, 2008 and Core Performance (www.coreperformance.com)

Are you deconditioned from injury, illness or surgery?

Nobody disputes the value of exercise. As part of a comprehensive weight-loss program, it’s a necessity. As part of a general fitness program, its benefits are many. And for everyone, some form of exercise is essential to help us stave off the effects of aging, to keep us limber and flexible and simply to foster a sense of well-being.

Health experts caution that the basis for setting up any exercise program is simple common sense. Our normal level of activity, our age, general health, weight and other factors should be taken into consideration before starting a regular exercise program. The key is that physical therapy can be utilized to help people become more mobile, more flexible and stronger so they are able to tolerate exercise, thus allowing them to do more. The most common ICD-9 codes we see with patients in these situations are:

719.7     Difficulty walking
719.4     Joint pain
728.87   Muscle weakness
719.5     Joint stiffness
780.99   Decreased functional activity
781.2     Abnormal gait
781.3     Lack of coordination

While most individuals can start a program without professional supervision, some people may want to consult a physical therapist before beginning an exercise routine. Answering these questions can help you decide if the advice of a physical therapist is warranted:

• Do you have anxiety regarding beginning or increasing the intensity of an exercise program because of past injuries?
• Are you apprehensive about how intense your exercise program should be because of unusual aches and pains?
• Is pain a limiting factor for you during day to day activities?
• Do you consider yourself inflexible?
• Do you have difficulty lifting heavy things?
• Are you deconditioned from injury, illness or surgery?

If the answer to any of these questions is yes, it’s probably a good idea to consult with a physical therapist before embarking on a program of exercise. While the right kind of exercise is certainly beneficial, movements that are overly aggressive can cause unnecessary strain and do more harm than good. And nobody wants that.

- Contributed by: Joseph Ruhl, PT, Partner, E & A Physical Therapy

Perform exercises that use body weight for resistance.

There’s no question that people, especially younger folks, are becoming more and more fitness- and body-conscious. The joggers we pass every morning on our way to work are one manifestation of this trend. The growth of fitness centers and gyms is another.

But must people work out at a gym to tone and strengthen their bodies? In the opinion of many, the answer is not necessarily.

Muscles get stronger when they have to work against resistance. And, for most people, that can happen at home as well as at a gym, provided the activities are pursued safely and consistently. Wherever and however one decides to exercise, he or she must be patient and not expect results overnight. Individuals who’ve been inactive for a long time may want to consult a physician before beginning.

Here are some of the things individuals can do to gain strength by building muscle mass:

• Work with resistance bands or tubing. Resistance bands or tubing are typically long, thin rubber tubes designed to stretch during the workout. As they stretch, they provide resistance which makes muscles work harder and thus gain strength. Available at sporting goods stores and at many larger chain stores, they’re affordable and are easily portable so users can continue workouts even when traveling. Many are marked with the level of resistance they provide and new users will probably want to begin with lighter resistance and move up to heavier as they progress.
• Perform exercises that use body weight for resistance. These include sit ups, push-ups, pull-ups, dips, pistols, reverse crunches, etc. These exercises are functional and encourage the use primary muscle groups, secondary muscle groups, stabilizing muscles as well as the core. When you’ve done these for a while and they seem to be getting too easy, it’s time to add weights to strengthen their effect. If the aim is to build volume rather than strength, a lot of repetitions (up to 12) should be used; three to five sets with short rest periods between sets.
• TRX suspension trainer makes use of a total body training tool that makes use of the user’s bodyweight to create hundreds of exercises that can benefit any part of the body. The system is very versatile and can be scaled to help the user reach a training goal at any level. (www.trxtraining.com)
• Heavy gardening. While you won’t find gardening in any dictionary listed under “fitness”, the activities it involves, such as digging, shoveling, weeding, etc., require a fairly high level of physical activity and constitute a worthwhile workout. Gardening is also fun for most people and can provide an extra dividend in the form of fragrant flowers or veggies that are great for the diet!
• Yoga. Perhaps the oldest form of exercise, yoga gives a whole new meaning to the word “exercise”. Rather than physical exertion, yoga focuses on body position, mind control, breath control, rhythm and other factors. It offers many variations, each of which is designed to benefit a particular part of the body.

Stretching is important, so be sure to check out the stationary stretch videos on our website. For people in a consistent exercise routine, learn to stretch like the pros with this step-by-step video guide to dynamic stretching. We also have an entire video section on our website devoted to physical therapy exercises for joggers and runners.

- Contributed by: Joseph Ruhl, PT, Partner, E & A Physical Therapy

Regular exercise helps seniors stay independent.

It’s a fact that Americans are living longer. For many, it’s a time to enjoy a more relaxed pace of life. For others it’s one long series of aches and pains. Sometimes, the difference is simply a question of staying active.

Regular exercise can pay big dividends, preventing or delaying diabetes and heart issues, reducing arthritis pain, anxiety and depression. It can even help seniors stay independent.

Exercise for seniors can be divided into four categories:

Endurance activities include walking, swimming and bike riding. They build “staying power” and improve the health of the heart and circulatory system. Experts recommend individuals build up to at least 30 minutes of any activity that causes one to breathe harder. And that doesn’t all have to happen in one stretch—being active for 10 minutes at a time is fine. A good way to gauge level of activity is the ability to talk following exercise. If you can talk without trouble, you’re not working hard enough. If you can’t talk at all, you’re working too hard.

Strengthening exercises build muscle tissue and reduce the muscle loss that often comes with age. On a practical level, having strength means the ability to get up from a sitting position by yourself, lift grandchildren and take fairly long walks. Keeping muscles in shape, especially in legs and hips, can help prevent falls.

Balance exercises also reduce the chances of falling, a common cause of serious health problems in older people. Improving balance can be as simple as standing on one foot as long as possible without holding onto anything for support. Try getting up from a chair without using hands or arms. Another good exercise is walking heel-to-toe, putting the heel of one foot just ahead of the toes of the other foot, with them just touching.

Stretching exercises keep the body limber and flexible, allowing such things as bending over to tie shoes or looking over one’s shoulder when backing a car out of a driveway. Before doing stretching exercises it’s important to warm up the muscles and never to stretch so far that it hurts.

Almost anyone can benefit from physical activity, regardless of age. Even those with health conditions like heart disease or diabetes can exercise and may even benefit from it. For most older adults, brisk walking, swimming, bike riding, gardening, even some weight lifting, are generally safe, provided they’re built up slowly. People over 50 who’ve been mostly inactive should check with their physician before starting a new activity.

- Contributed by: Joseph Ruhl, PT, Partner, E & A Physical Therapy

Stretch for a healthier back.

For most of us, Spring means gardening, spring cleaning, cleaning out the garage, and of course, a push to exercise so we can fit into our swim suit in the summer. All of these activities require bending and lifting which means there is a potential for back pain. Stretching and exercises designed to strengthen lower back and abdominal muscles can prevent the onset of back pain. Try working these simple exercises into your daily routine. Regular low-impact exercises for just 30 minutes a day can increase muscle strength and flexibility for patients with lower back pain. Our physical therapists at any one of our 17 locations can provide a list of low-impact age appropriate exercises. We have provided a series of back exercise videos on our website demonstrating the exercises that are routinely performed under the direction of a physical therapist. Just click here to view the videos.

•    Always stretch before exercise or other strenuous physical activity.

•    Don’t slouch when standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced.

•    At home or work, make sure your work surface is at a comfortable height for you.

•    Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for a long period of time, rest your feet on a low stool or a stack of books.

•    Wear comfortable, low-heeled shoes.

•    Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface.

•    Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed.

•    Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting.

•    Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. A diet with sufficient daily intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.

•    If you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.

Courtesy of the National Institute of Neurological Disorders and Stroke of the National Institutes of Health. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm#191333102