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Low back pain and injury in dancers

Low back pain and injury in dancers

Low back pain and injury in dancers

Dance is a popular and physically demanding pursuit, inclusive of all genders and ages across the lifespan, around the world. Dancers are increasingly recognized as both artists and athletes; however, unlike their athlete counterparts, dancers may not have ready access to trusted medical practitioners when injured, especially those familiar with dance-specific terminology, movements, styles, and injury patterns.

May 26, 2023 | Elisa LaBelle, PT, MSPT

Low back pain and injury in dancers

Dance is a popular and physically demanding pursuit, inclusive of all genders and ages across the lifespan, around the world. Dance is both artistic and athletic, requiring a combination of extreme strength, flexibility, and coordination, for the purpose of making intricate movements appear effortless. Dancers are increasingly recognized as both artists and athletes; however, unlike their athlete counterparts, dancers may not have ready access to trusted medical practitioners when injured, especially those familiar with dance-specific terminology, movements, styles, and injury patterns.

The lumbar spine, or low back, is a common site of pain and injury in all athletes, and the second most common site of injury in dancers.1 Repetitive flexion (forward bending), extension (backward bending), and axial loading (compression) through the spine are thought to contribute to increased rates of low back pain and injury in physically demanding sports such as football and dance.1,2 A recent systematic review by Swain et al found indications that approximately 73% of dancers experience at least one episode of low back pain per year; however, back pain only led to time loss or medical attention in 11% of the cases.3 Simply put, dancers appear to be able to maintain high levels of performance despite pain, and low back pain and its impact may be underestimated in this population.2,3

Common causes of low back pain in dancers

Spondylolysis and Spondylolisthesis

Sometimes referred to as “spondies,” these injuries are prevalent in activities that involve repetitive hyperextension of the spine and occur more often in adolescent dancers compared to the general population.2 Spondylolysis is a stress reaction or stress fracture in part of a vertebra called the pars interarticularis, and spondylolisthesis is the forward or backward slippage of one vertebra relative to another. A dancer with a “spondy” may experience dull pain on one or both sides of the low back that worsens with activity and is often provoked by spinal extension and impact.2 Medical imaging is warranted to diagnose and stage injury severity, and frontline treatment is usually conservative, including relative rest and physical therapy.1,2

Facet Sprain / Sacroiliac Joint (SIJ) Sprain

These injuries also occur due to repeated lumbar hyperextension which causes compression of the posterior elements of the spine and pelvis. Symptoms include lower back and buttock pain, muscle tenderness, and occasionally pain that radiates into the thigh.2 Jumping, hyperextension of the back, and abduction of the hip as in développé à la seconde can all exacerbate pain.2 Treatment includes physical therapy with an emphasis on hip and core strengthening, manual techniques, and gradual reinstatement of dance maneuvers that previously aggravated pain.2

Discogenic Back Pain

Accounts for 40% of mechanical back pain and is attributed to repetitive spinal flexion and compression such as occurs in lifting a dance partner overhead.1,2 The dancer with discogenic pain may report dull, diffuse lower back pain that is aggravated by forward or backward bending, rotation, and prolonged sitting. Symptoms may progress to include radiating pain down the leg and neurologic deficits such as muscle weakness and loss of sensation.1,2 Treatment typically includes early return to pain-free activities, core strengthening, and a stepwise return to full dance.1,2

Lumbar Strain

Muscle spasm is a common cause of lower back pain that should be considered a diagnosis of exclusion in adolescent dancers.2 As with most other lower back pain, muscle imbalances and overuse are common contributing factors, and adolescent growth spurts may play a role in the onset of pain.2 The dancer with a lumbar strain might complain of sharp pain located adjacent to the spine, tenderness to touch through affected musculature, and pain and difficulty with movement.2 Treatment includes physical therapy focusing on correcting muscle imbalances around the hip and core and addressing faulty technique.

Prevention

Dancers as artist-athletes have a paradoxical mindset towards pain: tending to accept it as part of their artistic pursuit and deny it out of fear they will be told to stop dancing.4 Specialized knowledge of dance and the ability to work with dancers to minimize their time away from dance are key to managing dancers’ health and recovery from injury2, as well as becoming a provider of choice in the dance community. To reduce risk of low back pain and injury, physical therapists specializing in dance medicine often recommend: 1) safe training loads to minimize overuse and fatigue; 2) cross-training and technique re-training to correct muscle imbalances and reduce repetitive strain; and 3) healthy lifestyle to manage stress and promote adequate rest and recovery. These recommendations not only serve to reduce risk and occurrence of low back pain and injury, but also to enhance performance and longevity in the dancer.


References

  1. Ball J, Harris C, Lee J, Vives M. Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations. Sports Medicine - Open. 2019;5(1):1-10.
  2. Gottschlich LM, Young CC. Spine Injuries in Dancers. Current Sports Medicine Reports (American College of Sports Medicine). 2011;10(1):40-44. Accessed May 23, 2023.
  3. SWAIN CTV, BRADSHAW EJ, EKEGREN CL, WHYTE DG. The Epidemiology of Low Back Pain and Injury in Dance: A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(4):239-252.
  4. Aliberti A, Milidonis MK, Long KL. Performing with Pain: Tools to Guide Rehabilitation and Injury Prevention for Professional Ballet Dancers. Orthopaedic Physical Therapy Practice. 2020;32(4):197-201.

Elisa LaBelle

Elisa LaBelle

Elisa LaBelle, PT, MSPT, is a board-certified clinical specialist in orthopedic physical therapy practicing in New York City, with a specialty in performing arts medicine.

Meet Elisa

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What you need to know about torticollis

What you need to know about torticollis

What you need to know about torticollis

At Performance we care for patients throughout the lifespan, starting as early as infancy. One of the most common diagnoses in babies that can require physical therapy intervention is torticollis.

May 17, 2023 | Maddy Mazoue, PT, DPT, CSCS

What you need to know about torticollis

At Performance we care for patients throughout the lifespan, starting as early as infancy. One of the most common diagnoses in babies that can require physical therapy intervention is torticollis.

What is it?

Torticollis, also referred to as “wry neck” or “twisted neck,” is the term for a condition in which there is tightness in the neck causing one’s head to tilt to one side. This condition is typically associated with babies and some sources say that can affect up to 16% of infants. The most common muscle involved is the sternocleidomastoid (or scm) which causes babies to tilt towards one side and rotate to the opposite.

Torticollis can happen for a variety of reasons, including positioning in the womb, time/position spent in car seats or carriers, breastfeeding preferences, or abnormalities within the neck muscles. Although this is a condition related to the muscles of the neck, torticollis has implications for the overall growth and development of your child. Tightness on one side of the neck can lead to changes in head shape, difficulty with developmental milestones including rolling, sitting, crawling and walking.

Prevention

The best way to prevent the development of torticollis is to encourage your baby to spend time in a variety of positions! One way to do this is to switch the location of toys in the crib or car seat every few days so they are encouraged to look in different directions. Also, make sure to take note of what position you are feeding your baby in. Try to balance the amount of time feeding on each side whether that is breast or bottle feeding. One of the best ways to limit torticollis and associated head shape changes is to encourage your baby to participate in tummy time. The NIH recommends starting with several 2–3 minute sessions throughout the day with newborns and steadily increasing the frequency and duration of sessions until they are reaching at least 1 ½-2 hours per day by the time they are 6 months old. Children’s Healthcare of Atlanta has a great resource on tummy time and positioning techniques.

Signs to look out for

Typically, torticollis develops over the first few weeks of life, so be on the lookout for the signs! Torticollis will typically present as a head tilt to one side and a rotation in the opposite direction. Though that is the most common presentation, you should also look out for:

  • Strong preference for breastfeeding on one side
  • Difficulty rolling to one side/always rolls over one side
  • Trouble turning the head to look in one direction
  • Flat spot on the side of the head
  • Facial asymmetries

Treatment

The good news is, if caught and addressed quickly, babies typically respond very well to physical therapy. PT for this condition includes stretching, education on positioning, strengthening exercises, and promotion of developmental milestones. Your physical therapist will work with you to implement stretching techniques and identify ways to encourage symmetry and age appropriate development at home. If you have any concerns about your baby’s neck or head shape, reach out to your pediatrician or physical therapist so they can get your baby the care they need!

Image credit: ChoosePT.com

Maddy Mazoue

Maddy Mazoue

Maddy Mazoue, PT, DPT, CSCS, is a physical therapist and strength and conditioning specialist who specializes in developing athletes’ return to sport programs.

Meet Maddy

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Get stronger & better: hormonal changes for women in their middle years & beyond

Get stronger & better: hormonal changes for women in their middle years & beyond

Get stronger & better: hormonal changes for women in their middle years & beyond

Many women move through perimenopause and menopause in the dark. While girls get “the talk” for puberty, women could use similar preparation at age 35 to navigate what’s to come.

Apr 28, 2023 | Carolyn Surgent, DPT

Get stronger & better: hormonal changes for women in their middle years & beyond

Get Stronger & Better: hormonal changes for women in their middle years & beyond

Many women move through perimenopause and menopause in the dark. While they will likely hear about hot flashes or possible changes in body composition or sleep, they might not have all the information they need to help prepare for and normalize this important transition. Given the limited education most healthcare providers receive on these topics, it’s no wonder women are underinformed. While girls get “the talk” for puberty, women could use similar preparation at age 35 to navigate what’s to come.

Perimenopause & Menopause Defined

First, remember that while perimenopause & menopause may unfold a little differently for everyone, it’s a normal biological process. Specifically, perimenopause refers to the years leading up to menopause, beginning as early as 35 with changes in menstrual cycle and hormones. Menopause is marked by a full year without a period, but women will experience the effects of tapering hormones for some time to follow. If average life expectancy for women in the United States hovers in the early 80s, you can expect to live 40% of your life in the post-menopausal stage.

Common Symptoms

While the list of symptoms associated with menopause can be overwhelming, there’s plenty to do to feel and perform your best. A partial list includes: hot flashes, changes in body composition or weight gain, vaginal dryness and/or pain, fatigue, joint and/or muscle pain, brain fog, mood changes, irritability or anxiety, sleep disruptions or sleeplessness, and heart palpitations.

What you can do

First and foremost, get educated and find professionals to help optimize your health & performance. In short: hit play, not pause!

  • Stay active – There’s a great deal of research supporting the benefits of staying active through the lifespan. Specifically, activity can help limit risk of cardiovascular disease, support stable blood glucose levels and protect against sarcopenia (muscle loss) and decreased oxygen consumption (VO2max) typically associated with normal aging.
  • Strength Train – Research shows that lean mass declines as fat mass increases in the five years leading up to menopause and five years post menopause. Women may notice the changes in their body composition and weight with alarm and double down on cardio or light resistance training out of concern for “bulking up.” On the contrary, strength training is the best plan for limiting these changes and holding on to muscle essential to feeling good, performing well and living better. Did you know that having more muscle mass is correlated with living longer? Moreover, strength training can provide stimulation for ligaments and other soft tissues that may be impacted by lower levels of estrogen.
  • Keep tabs on stability, mobility & core strengthening – While the need to stay strong through the middle years is incontrovertible, good stability, mobility and a strong core will provide the foundation for any strength training program and overall better function. A stable body can move quickly and accommodate the demands of a changing environment. Having good mobility can insure you can move in ways you want with less risk for injury or imbalance.
  • Improve/maintain pelvic floor function – Hormonal changes and shifting core strength can impact the tone and function of your pelvic floor musculature, increasing risk for incontinence and pain during sex. Discussion of symptoms with a trained provider along with assessment and appropriate treatment can improve function and quality of life.
  • Pay attention to sleep & recovery – Women who are already active may notice some lag in their performance or motivation to exercise consistently at the same intensity through perimenopause and menopause. Simply put, adjusting the types and frequency of key workouts through the week and allowing appropriate recovery becomes more important. Defending your sleep with use of good sleep habits and hygiene may mitigate the effects of hormones on getting quality rest.
  • Defend bone density – Did you know that, according to the National Institute of Health, nearly one in two women over the age of 50 will sustain a bone fracture? And did you know that despite participating in protective weight bearing and higher impact activities, women might still see a decline in bone density for the first five years after menopause? Strength training, weight bearing activities and even plyometrics (as appropriate) should be an important consideration in choosing activities to keep vital in your middle years and beyond.
  • Optimize nutrition & hydration – While many women may turn to calorie restriction or intermittent fasting in an attempt to control weight and body composition changes, these may not work. Ensuring appropriate energy availability to support daily activity, maintain thyroid function and protect overall metabolic health is essential. A licensed nutritionist can help guide the way.
    Review your blood panel with a healthcare provider – Your bloodwork can provide essential information about your health through perimenopause and menopause. Reviewing your lipid profile can provide a window into your cardiovascular health; blood glucose levels can indicate your metabolic health and inflammatory markers can indicate levels of systemic inflammation impacting how you feel and function.
  • Understand common interventions including hormone replacement therapy (HRT) – A great deal of research has been done debunking the findings of the Women’s Health Initiative study in the early 1990s, which overstated the risks of hormone replacement therapy in healthy women. Your healthcare provider can provide more information about the possible benefits of HRT.

Takeaway Message

Getting educated and finding the right support can help you function, perform and feel better in perimenopause, menopause and beyond. From trainers, physical therapists, pelvic floor specialists, performance coaches to nutritionists, the professionals at Performance can help.

Sources

Body composition and cardiometabolic health across the menopause transition (nih.gov)

Figure - PMC (nih.gov)

Changes in body composition and weight during the menopause transition - PubMed (nih.gov)

Muscle mass index as a predictor of longevity in older adults - PubMed (nih.gov

Next Level: Your Guide to Kicking Ass, Feeling Great & Crushing Goals Through Menopause & Beyond by Stacy Sims with Selene Yeager


Carolyn Surgent

Carolyn Surgent,

Carolyn Surgent, PT, DPT, FDN, is a physical therapist and certified dry needling specialist based in Greenwich. She is a mover by nature and loves to explore how the body works and moves.

Meet Carolyn

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Building sustainable habits for young girls: navigating stress

Building sustainable habits for young girls: navigating stress

Building sustainable habits for young girls: navigating stress

Two ways that female adolescents can manage stressors include education about menstruation and being aware of social media usage.

Apr 28, 2023 | Arianna Martignetti, Ed.D.

Building sustainable habits for young girls: navigating stress

The ages of 12 to 18 years old are a critical time for psychological and social development as adolescents develop their identity and sense of self; this can contribute to feeling insecure or confused. For females in particular, associated stressors include body image, social acceptance, and the power of social media. Two ways that female adolescents can manage stressors during this time include education about menstruation and being aware of social media usage.

Females tend to experience their first menstrual cycle (i.e., menarche) during adolescence; your body, hormones, mood, and self-perception change. Learning about the menstruation process, your own cycle, and what is normal versus abnormal can decrease anxiety, increase preparation, and build confidence by having more control over your body. Phone apps are also useful for logging symptoms and patterns to better understand and track your cycle.

As for social media, ask yourself: how often and why do you go on it? Are there specific times that you find yourself using it? How do you feel before versus after using it? To mitigate the harmful effects of social media on your mental health, you can be more purposeful with its use, set a timer to limit your time using it, and unfollow accounts that contribute to a negative headspace.


Arianna Martignetti

Arianna Martignetti

Arianna Martignetti, Ed.D., is a mental performance consultant who works with individual athletes, weekend warriors and teams at all levels. She works with her clients to fine-tune their mental skills or increase their self-awareness to create the change that they want and achieve their goals — and more.

Meet Arianna

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Building sustainable habits for young girls: fueling the body with nutrition

Building sustainable habits for young girls: fueling the body with nutrition

Building sustainable habits for young girls: fueling the body with nutrition

For a teenage female, keeping a healthy mindset, being active and having a healthy eating routine is important as they grow. Nutrition can directly affect a young females health, cognitive performance, mood, and energy levels.

Apr 28, 2023 | Ashley Jerry, MS

Building sustainable habits for young girls: fueling the body with nutrition

For a teenage female, keeping a healthy mindset, being active and having a healthy eating routine is important as they grow. Nutrition can directly affect a young females health, cognitive performance, mood, and energy levels. Hormone health is also a huge factor related to nutrition and the teenage female body.

Your brain, bones and muscles are still growing; therefore, we need to make sure you are fueling your body properly. We want to strive to be athletic, healthy, and happy in our own bodies.

A teenage girl should consume between 2,000 to 2,400 calories depending on their activity levels, according toU.S. Department of Health & Human Services.

Although needs vary, most teens should consume three meals plus a snack or two throughout the day, especially if the teen has increased activity levels with sports. Balanced meals and snacks should include a protein source, carbohydrate source and a high-quality fat source. Carbohydrates are the key to energy, protein is the key to muscle repair and growth, fats are important for nutrient absorption, and fruits and vegetables are vital for vitamin and mineral consumption providing essential nutrients for the teenage body.

  • Examples of protein include chicken, turkey, ground beef, Greek yogurt, fish, eggs, tofu, etc.,
  • Examples of carbohydrates include rice, fruit, beans, potatoes, vegetables, oatmeal, popcorn, etc.
  • Examples of fats include olive oil, avocado, nuts, seeds, etc.

Along with proper intake of calories and nutrients, hydration is also extremely important. Studies show a female teen should intake 80-100oz. of water per day depending on activity levels.

Most importantly, young girls should adopt healthy habits including consuming nutritious foods, staying active, and drinking plenty of water. Having a positive relationship with the mind and body can help keep you happy and healthy in the future. Fuel your mind and body for everyday life, health, mental health, and athletic performance!


Ashley Jerry

Ashley Jerry

Ashley Jerry, MS, is a nutritionist who specializes in a variety of fields, including food sensitivities, medical conditions, and sports nutrition.

Meet Ashley

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Building sustainable habits for young girls: the power of breathwork

Building sustainable habits for young girls: the power of breathwork

Building sustainable habits for young girls: the power of breathwork

As a competitive rower for Brown University, the pressure to perform can be overwhelming; 90% of the job is mental strength. It is important to find ways to cope with that stress, and for me, that involves breathwork.

Apr 28, 2023 | Isabel W., NCAA Rower at Brown University

Photo Credit: Amorphotovideo; @brownwcrew

Building sustainable habits for young girls: the power of breathwork

As a competitive rower for Brown University, the pressure to perform can be overwhelming;  90% of the job is mental strength. It is important to find ways to cope with that stress, and for me, that involves breathwork.

I started rowing in my freshman year of high school during the winter, which meant I was only training on land. Training on ergs (rowing machines) requires incredible lung capacity and control over your breathing, which is difficult considering I am severely asthmatic. Since then, I have been experimenting with different medications to optimize my breathing.

Last year, I added breathwork to the mix, and it has significantly improved not just my breathing, but my mental health, anxiety levels, and even my performance: my numbers started to improve significantly.

While I tried a variety of breathing techniques, I found the Wim Hof method to be the most helpful. This active breathing method doesn’t just increase mental clarity, it’s also a great way to exercise my lungs — which is incredibly important as a rower.

I use Wim Hof’s 11-minute video as a guide:

  • Take 30 rapid breaths
  • On the 30th breath, slowly exhale, 60-90 seconds
  • Take a recovery breath, and hold for 15 seconds

It is important to note that the Wim Hof method is not for everyone, and it takes a lot of trial and error to find the breathwork method that works best for you. Breathwork is also not the equivalent of waving a magic wand and seeing improvement, but it has played a key role in my successes. On top of strength training and a healthy diet, breathwork opened my eyes to many other recovery techniques, especially cold showers. They help open up my lungs and lower cortisol levels, which helps regulate stress levels in not just an athletic setting, but a school or personal setting.

Overall, I have found breathwork extremely valuable and continue to use it to clear my mind, prepare for competitions, and improve myself as both a rower and a teammate.

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The benefits of pre/post-natal fitness

The benefits of pre/post-natal fitness

The benefits of pre/post-natal fitness

Pre-natal fitness under the guidance of a skilled professional is essential in training the body in a safe but challenging way to prepare one’s body for the intensity of labor.

Apr 28, 2023 | Danielle Pasquale, DPT

The benefits of pre/post-natal fitness

We have heard the myth for a long time that you need to decrease your workouts during pregnancy. I’m sure most women have heard, “don’t let your heart rate get higher than 140 while pregnant.” The typical heart rate of a women during labor is between 110-160 beats per minute. But if a woman never trains their body to prepare for the intensity of labor, how will they be able to handle the challenges of it? Pre-natal fitness under the guidance of a skilled professional is essential in training the body in a safe but challenging way to prepare one’s body for the intensity of labor.

There are so many benefits to exercising during the entirety of a pregnancy. It can help ease the symptoms of pregnancy aches and pains like low back, sciatic pain, and sacroiliac joint pain, and will decrease the risk of complications like gestational diabetes and preeclampsia. Exercise will also allow a woman to maintain a healthy weight range and increase the likelihood of an easier delivery. There’s also research to show that exercise during pregnancy has benefits for the baby as well. It shows that there’s a positive effect on a newborn’s motor and coordination development, and the baby gets the same heart benefits as the mother during cardiovascular training.

Exercise during each trimester will vary and will feel different on one’s body as it changes through the pregnancy. In the first trimester, it’s more likely to feel symptoms of nausea and extreme fatigue. Exercise during this time may look more restorative like going for walks, gentle yoga, and focusing on continuing to move. A woman may feel more energy for true exercise during their second trimester. These exercises will look more like the exercise they previously enjoyed prior to the pregnancy. One thing to consider during this phase of exercise, however, is preventing the severity of diastasis recti, or separation of the rectus abdominis muscles before and after pregnancy. Working with a professional to learn ways to prevent this and how to keep your pelvic floor strong during this time is essential.

Staying active and fit during pregnancy will allow a faster recovery after delivery. No matter how fit you were before, post-partum exercise presents with new challenges that women must learn to adapt to. Once cleared by your doctor (typically around 4–6 weeks post-partum), a woman will be able to return to exercise. This will need to be a gradual return to prevent injuries and adapt to the changes a woman’s body has after pregnancy. Learning gentle core activation, pelvic floor exercises and functional parenting activities can assist in a safe return to exercise and prevent injuries. Exercising post-partum helps to improve energy levels, sleep, manage stress more effectively and to lose weight.

Fitness and exercise during and after pregnancy have so many physical and emotional benefits for the mother and the baby. Prioritizing this in a safe and effective way can help to ease the challenges of bringing a baby into this world.


Danielle Pasquale

Danielle Pasquale

Danielle Pasquale, PT, DPT, is a physical therapist who is certified in women's pelvic health, dry needling and pre/post-natal fitness based in Greenwich.

Meet Danielle

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Regenerative medicine at Performance

Regenerative medicine at Performance

Regenerative medicine at Performance

Apr 4, 2023| Jacob Ober, PT, DPT, ATC

Regenerative medicine at Performance

The field of regenerative medicine is ever-changing based on new scientific developments. At Performance Optimal Health, our regenerative medicine team is dedicated to being an extension of the expert care healthcare practitioners provide. Successful patient care is rooted in a team that is dedicated to collaboration to create and consistently update best-in-class physical therapy protocols based on the most advanced evidence and progressions in the field. The best treatment approach includes targeted exercise strategies for the specific area treated and addressing movement and muscle performance deficiencies at adjacent joints. In addition, utilizing advanced technologies such as blood flow-restricted therapy (BFR) also enhances treatment outcomes. Below, we dive into some of the key aspects of regenerative medicine, breaking it down as well as discussing a key modality and treatment outline for one of the most common degenerative diseases.

Visit The Original Article >

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Tips for tapering your spring marathon training

Tips for tapering your spring marathon training

Tips for tapering your spring marathon training

It's the last few weeks of your spring marathon training; whether in the middle of your peak week or your 2-3 week taper, it is important to trust your training up to this point and avoid adding unnecessary stresses to the body. Here are some tips for this crucial period of time.

Apr 3, 2023 | Performance Optimal Health

Tips for tapering your spring marathon training

One of my favorite sayings related to the final three weeks of training leading up to a race is “the hay is in the barn.” This saying refers to the idea that the bulk of the training has already been done, and now it’s time to make sure there is adequate recovery. This process is called the taper. About three weeks before the day of the marathon, the overall volume of training should significantly decrease. There might be a couple of hard workouts 10-21 days out depending on the runner and the intensity of training reached prior, but the key component is that the volume of work decreases. Workouts at this time are geared towards making sure that you still have some stimulus in order to maintain fitness, but don’t put as much stress on your body.

Another piece of the taper that is important is nutrition. Carbohydrate loading starts 3-7 days before the race and is the gradual increase in the percentage of fuel that is coming from carbs. It takes time for the muscle cells to absorb adequate glycogen from the increased carb intake, so just loading up the day before is not enough. Similarly, appropriate hydration for a race is started multiple days before. Both hydration and increased carbs play a role in maximizing the availability of energy while racing. With the combination of dialing in your nutrition/ hydration with decreased volume of training your body should be primed to race your best.

— Brendan Copley, CSCS, ATC. Brendan is a personal trainer who specializes in working with endurance athletes and post-rehab clients.

That's exactly right, Brendan. You’ve spent months ramping up your mileage, perfecting your fueling plan, and preparing your race-day shoes. You’re ready. Whether in the middle of your peak week or your 2-3 week taper, it is important to trust your training up to this point and avoid adding unnecessary stresses to the body. During your taper, it is normal to feel more tired, more hungry, or more aches and pains than earlier in your training. This is because your body is using this time of lower load to heal, ultimately preparing itself for the best racing conditions. Listen to your body: consume adequate calories, sleep more, drink enough water, and say “no” a little more than usual during this time. Resist the urge to run a little farther, or go for a difficult hike with a friend simply because you have more time or energy. Instead, use your extra time to get that massage you’ve been wanting. Resist the urge to suddenly decide to wear a different super shoe, or a different fuel on race day. Instead, pack up your tried and trusted race day shoes and carbohydrates. The hay is in the barn. Trust your training and preparation and allow yourself to have a successful marathon.

— Britt Gunsser, PT, DPT, OCS, CSCS. Britt is a board certified orthopedic clinical specialist, certified Schroth therapist and dry needling specialist. She has completed extensive work on running rehabilitation and is an RRCA Running Coach.

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How Jon Rahm, a Master’s favorite, prepares his body for play

How Jon Rahm, a Master’s favorite, prepares his body for play

How Jon Rahm, a Master’s favorite, prepares his body for play

The current world’s third ranked golfer and popular Master’s favorite Jon Rahm is the pinnacle of golf fitness, and the perfect example of how to best optimize the body-swing connection.

Apr 3, 2023 | Larry Piretra, PT, DPT, CSCS, TPI-M2

How Jon Rahm, a Master’s favorite, prepares his body for play

The current world’s third ranked golfer and popular Master’s favorite Jon Rahm is the pinnacle of golf fitness, and the perfect example of how to best optimize the body-swing connection. Rahm was born with a club foot (a congenital condition in which a baby is born with their foot typically turns inward and downward), which meant he had to have corrective surgery. Because of this, Rahm lacks mobility and stability in his right ankle, which along with limited right hip internal rotation, directly impacts his backswing. Instead of accepting this as a permanent limitation, Rahm was able to work with his team of golf, fitness, and health professionals to modify his swing and build up other aspects of his body for the most efficient swing possible. As you watch him, you will see his patented short backswing, with which he is still able to generate significant power with his bowed wrist and strength throughout his upper and lower body.

Jon Rahm’s current fitness regimen is a balance of mobility, stability, motor control, and sequencing. Rahm credits a lot of his success to his team from Titleist Performance Institute, including his trainer Spencer Tatum, swing coach David Phillips, and health professional Greg Rose. He notes the collaborative communication was vital in everyone adjusting their work depending on everyone’s feedback within their respective field. Rahm ensures his workouts are structured all around compound movements and asymmetries within the exercises specifically, with balance and stability as a specific focus, as these are vital within the golf swing.

Throughout his long 4-day tournaments, Rahm credits his mobility routines and physio-based massage to keep his body in high performance playing shape. He credits much of his in-season success to his offseason programming and putting in the time which directly translates into his in-season performance. Rahm has also worked with nutritional experts to formulate a plan for a proper eating and hydrating schedule for before, during, and after his round. He constantly snacks through his round on trail mix, dried fruit (pineapple, mango, raisins), and pistachios or almonds. This allows him to keep his constant energy without being too lethargic, along with eating a full peanut butter sandwich at the 9-hole turn (the halfway mark).

Jon Rahm’s pre-round routine may look like most individual’s full workout routine. Through a resistive and dynamic warm-up, Rahm ensures his muscles are activated and primed for optimal performance. He focuses on low reps and high intensity-based exercises which include medicine ball toss, kettle bell swings, banded rotations, reactive hip twists, and Turkish getups. This aligns with the current research of resistive warm-ups resulting in longer distance played, compared to isolated or dynamic warmups.

This health and fitness journey is one of the main reasons Jon Rahm is always in the hunt to win, especially in the Master’s Tournament this week. He is the epitome of optimizing your swing based on how your body moves; while there are a million ways to swing the golf club, but based on you and your body, there is one, most efficient way. Along with his team around him, Rahm is constantly improving his body, and in turn, improving his swing.


Larry Piretra

Larry Piretra

Larry Piretra, PT, DPT, CSCS, TPI-M2, is a physical therapist and strength and conditioning specialist who serves as the Manhattan Site Lead and splits his time between the city and Fairfield County. As a Titleist Medical and Fitness Professional, Larry also serves as the Golf Programming Lead for Performance.

Meet Larry

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Performance Optimal Health opens second Naples location

Performance Optimal Health opens second Naples location

Performance Optimal Health opens second Naples location

Mar 3, 2023 | Gulfshore Business Magazine

Performance Optimal Health opens second Naples location

After expanding from Connecticut and New York to North Naples less than six months ago, Performance Optimal Health announced the opening of its second Southwest Florida location. Performance Optimal Health at Athletic Republic, 6425 Naples Blvd., opened earlier this month, offering physical therapy, recovery and wellness services. Based on comprehensive research and the latest technology, Performance clinicians use a team approach that incorporates overall wellness into every aspect of a client’s treatment journey to achieve their goals through coordinated and highly personalized health strategies focused on four pillars of exercise, recovery, nutrition and stress management. Hours of operation are 3 to 8 p.m. by appointment Monday through Thursday.

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Avoiding failure vs approaching achievement

Avoiding failure vs approaching achievement

Avoiding failure vs approaching achievement

Preview our second membership, a 12-week interactive membership, which will focus on mental performance. It will provide you with evidence-based education and tools to work towards increasing your self-awareness, achieving your optimal mindset, and enhancing your athletic performance.

Mar 2, 2023 | Arianna Martignetti, Ed.D.

Avoiding failure vs approaching achievement

Would you say that you are passionate about your sport? Sport performance researchers determined that passionate individuals have an activity that they like (or love), invest their time and energy into it, and then that activity becomes a part of who they are (Vallerand et al., 2008). When this occurs, an athlete can experience a harmonious passion or an obsessive passion. For some, their sport or activity can become a main feature of their identity.

Harmonious passion occurs when an athlete interprets their sport or activity as important or valuable, without contingencies, and freely participates in it. For example, a gymnast enjoys engaging in practice and embraces the challenges without feeling like she needs to do it because of her coaches, parents, or teammates. Athletes with harmonious passion also feel like their sport aligns with other important parts of their life, without their sport feeling it is overbearing. Harmonious passion tends to be associated with more positive experiences and well-being, which can also contribute to better focus and flow within their sport.

In contrast, an athlete may experience more of an obsessive passion in which the athlete feels controlled and participates for particular reasons. For example, the gymnast might think that her self-worth is determined by her participation or affects whether she will be socially accepted. When athletes experience more of an obsessive passion, it might be difficult for them to separate from the thoughts they have about their sport, may not enjoy it as much, or their sports conflicts with other areas of their life. This can affect an athlete’s focus and may contribute to more negative experiences within their sport. Athletes with an obsessive passion may also persist more rigidly; for example, an injured athlete may continue to push themselves, and put themselves at further risk of injury, by participating in their sport when they should be recovering.

Avoiding Failure Versus Approaching Achievement

It is important to note that, in general, passion (whether it is harmonious or obsessive) can be a motivating factor for athletes to deliberately participate in practice, which can contribute to optimal or successful performances; however, is the athlete experiencing higher levels of life satisfaction and enjoyment (such as seen in harmonious passion)? Or having more of a negative/not ideal experience because of it (such as in obsessive passion)? Additionally, athletes with more of an obsessive passion may be more inclined to set goals to avoid failure. For example, a soccer player might set a performance-avoidant goal and tell himself “I don’t want to miss this shot.”

Avoidance can be related to an increase in the fear of failing, heighten our anxiety, and lower our motivation. On the other hand, athletes with more of a harmonious passion tend to be related to more secure levels of self-esteem and set goals that reflect striving toward achievement; these can be in the form of mastery goals, which focus on oneself and personal improvement, gaining knowledge, or developing a skill. A mastery goal might sound like “I want to increase my sprint time by five seconds.” When athletes are mastery and approach oriented, they focus on achieving competence or success and feel as if their goals are more within their control. Our effort, persistence, ability to manage obstacles, and whether we experience pride in our accomplishments can be affected by if we are avoidant or approach oriented.


The Mental Performance Membership is a 12-week interactive membership program that will provide you with evidence-based education and tools to work towards: an increase in your self-awareness, a performance mindset that works to your advantage, and an enhancement to your athletic performance. The membership begins with a 60-minute one-on-one evaluation with a mental performance consultant, followed by a weekly education email series as well as monthly 60-minute consultations. Three-month minimum required.

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Your Longevity Guidebook

Your Longevity Guidebook

Your Longevity Guidebook

If you want to live the longest, healthiest life, there are certain steps that will contribute to overall longevity: proper exercise, diet, and stress management. Here's your guidebook for increasing your longevity and staying healthy as you age.

Mar 2, 2023 | Will Manzi, CEP

Your Longevity Guidebook

If you want to live the longest, healthiest life, there are certain steps that will contribute to overall longevity: proper exercise, diet, and stress management. Here's your guidebook for increasing your longevity and staying healthy as you age.

Advancing in age is accompanied by an accelerating decline of aerobic exercise capacity, best quantified by peak VO2. This decline in aerobic capacity is exacerbated by many comorbidities common to the elderly. However, numerous observational and interventional studies have demonstrated the beneficial effects of exercise training in older adults, both in healthy and diseased individuals.

If you want to live the longest, healthiest life, there are certain steps that will contribute to overall longevity. There are three simple steps to promote longevity, and these three steps are some of the most cost effective, long term, and preventative measures you can take. The three key factors to this outcome are proper exercise, diet, and stress management. If you can take care of your cardiovascular risk factor profile and increase your VO2 max, you can reduce your biological age by 3.23 years, starting as a healthy individual. (Fitzgerald, Kara N et al. “Potential reversal of epigenetic age using a diet and lifestyle intervention: a pilot randomized clinical trial.” Aging vol. 13,7 (2021): 9419-9432. doi:10.18632/aging.202913.) Beginning as an individual with multiple comorbidities, there can potentially be a reduction in 5–10 years. The problem we see in our society is that there is a lack of education and participation into programs that focus on an optimal health approach. We currently have a community in crisis. However, in the Chinese language, the word “crisis” is composed of two characters, the first “danger”, the second… “opportunity!” So, take the opportunity to improve your health today.

VO2 Max

According to the World Health Organization, the average lifespan is 77.8 years, yet the average health span is only 66.6 years. This means the last 10+ years of our lives we are dealing with at least one, but more likely two or more, risk factors. In order to combat this, there needs to be a focus on cardiovascular exercise, more precisely, increasing your maximal oxygen uptake or VO2 max. VO2 max is related to functional capacity and human performance and has been shown to be a strong and independent predictor of all-cause and disease-specific mortality. (Barbara Strasser, Martin Burtscher. Survival of the fittest: VO2 max, a key predictor of longevity?. Front. Biosci. (Landmark Ed) 2018, 23(8), 1505–1516.) VO2 max is most accurately measured in a lab. During a VO2 max test, you wear a special face mask that measures the amount of air you breathe in and breath out while you exercise. You work at progressively harder intervals until you reach your limit. However, there is another accurate representation of VO2 max through an estimated Bruce Protocol Stress test that we can perform at Performance Optimal Health. The test begins with walking and then increases in speed and incline every three minutes until the individual can no longer continue, either due to physical limitations or achievement of 85% maximum heart rate. Originally, the test was made by American cardiologist Robert A. Bruce in 1963 as a non-invasive test to assess patients with suspected heart disease. In more recent years, the test has been used more to help identify a person's aerobic capacity. It is simple: if you want to be in the best shape possible at 85, start increasing your VO2 max now at age 50. In the figure below, you can see how VO2 max decreases over lifespan.

V02 Max

Nutrition

In combination with exercise, what is just as important to longevity is a healthy diet. A heart-healthy diet such as a Mediterranean based diet or the DASH diet is recommended in order to reduce risk and decrease inflammation in the body. You want to eat a healthy balance of carbohydrates, healthy fats, and lean protein. The general recommendation for someone doing moderate to vigorous exercise is a 50%, 30%, 20% split respectively. You obviously want to incorporate healthy greens and colorful vegetables, as well as low sugar fruits such as avocados, blueberries, and grapefruit. You can get a majority of your carbohydrate intake through these foods. Lean protein choices such as organic chicken, grass-fed beef, and turkey are exceptional. Healthy fat choices include foods high in omega-3 and omega-6 such as nuts, seeds, avocados, and wild caught salmon.

Stress Management

Lastly, a big component of this longevity equation is the management of stress. First and foremost, there are two different types of stress. Positive stress, or eustress, is beneficial to the body. Negative stress is detrimental to the body, and has been shown to increase cortisol levels, which in turn activates our “fight or flight” response. This reaction has been proven to increase blood pressure and heart rate, muscle tension, and the digestive system slows down. Some symptoms may result in nausea, vomiting, and diarrhea. Positive stressors such as exercise, meditation, and yoga have been proven to have the opposite effect. Exercise has proven to decrease resting heart rate, blood pressure, and cholesterol levels, as well as decrease inflammation of the body. Sleep is probably the biggest component to recovery; per CDC guidelines, children 13-18 should get 8-10 hours per night, while the average adult needs 7-9 hours per night.

All in all, there are three main things to focus on. One: make sure you have at least 150 minutes per week of cardiovascular exercise in your target heart rate. Two: eat a well-balanced diet rich in anti-inflammatory foods and antioxidants, foods such as turmeric and ginger have been proven to decrease the body's inflammation. Finally, having tools to cope with stress can help the body with anti-inflammation, muscle recovery, and increased energy. Some tools include cryotherapy, infrared sauna, exercise, and meditation.

Quick Guide

Target Heart Rate:

  • 220-Age= Maximum Heart Rate
  • Maximum Heart Rate x .60 = 60% Target Heart Rate
  • Maximum Heart Rate x .80 = 80% Target Heart Rate

Healthy Diet Tips:

  • Low fat and low sodium diets help decrease inflammation.
  • Limit salt intake to < 2,000 mg / day.
  • Bake, broil, steam, roast, or poach foods without salt; add vegetables lemons, herbs and spices for flavoring;
  • When you eat out, try to order baked, broiled, steamed, or poached without breading or sauces.
  • Stay away from fast foods.
  • Read food labels.
  • Hydrate, hydrate, hydrate.
  • rack weight weekly or monthly.

Exercise:

Exercise should be coupled with diet to maximize the effects of weight loss and create a healthy lifestyle. The appropriate amount of exercise an individual of your age should be getting is described below under the FITT principle.

Frequency: Greater than or equal to 3-5 days/week of moderate to vigorous exercise.

Intensity: Moderate 40-60% max effort(V0^2R) or Vigorous <60% max effort (VO^2R)

Time: Moderate 30-60 minutes; Vigorous 20-minute maximal bouts before rest

Type: The primary mode of exercise should be cardiovascular in nature, incorporating large muscles being used (bicycling, rowing, and running). The secondary mode is strength training and flexibility/mobility training.

References

1. Woo, M. (2017) Why kids shouldn't specialize in one sport too early, Lifehacker. Lifehacker. Available at: https://lifehacker.com/why-kids-shouldnt-specialize-in-one-sport-too-early-1797954410.

2. Schaeufele, B. (2021) Sport specialization in Young Athletes, The National Sports Medicine Institute. Available at: https://www.nationalsportsmed.com/sports-specialization/.


William Manzi

William Manzi,

William Manzi, CEP, is an exercise physiologist who specializes in the ability to take care of any individual, regardless of any limitations. Having worked with cardiac patients for the past 5 years, Will has developed a speciality in cardiac training and rehabilitation, as well as reading EKGs.

Meet Will

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How Can Nutrition Impact Longevity?

How Can Nutrition Impact Longevity?

How Can Nutrition Impact Longevity?

We are excited to announce that Performance Optimal Health is now offering memberships, the first of which is the Nutrition for Longevity Membership. It is designed to help clients increase their energy, prevent the development of disease, improve quality of life and even prolong their lifespan. Here's a preview.

Feb 27, 2023 | Koren Bradshaw, MS, CDN,CLC

How Can Nutrition Impact Longevity?

Try as we might, we are not able to stop the biological process of aging – even the fittest among us eventually experience the aging process.

What we are able to control, however, are the individual risk factors for the negative effects of aging, and the ability to potentially slow the speed and impact of the aging process.

Fortunately for most, there’s no magic wand required. Through simple, focused changes in diet and lifestyle, we may be able to increase our energy, prevent the development of disease, improve our quality of life and prolong our lifespan.

Though of course aging impacts the entire body, focusing on the health of several key body systems can vastly improve the aging experience by helping to maintain mobility, energy, agility, and cognitive health. Ensuring these areas are healthy will provide for a markedly improved aging experience and more enjoyable later decades.

In the email portion of the Nutrition for Longevity Membership, we will focus on nourishing and supporting the Brain, Bone, Muscle, Skin and Joint, Gut Health, and Immune Systems so that you will feel strong, and more energetic and make strides toward sustained longevity.

How Does Nutrition Make An Impact Here?

Well, much like your mom used to say, you literally are what you eat! The foods we incorporate into our daily diet can and do strongly impact the health and function of these systems so crucial to a healthy aging process. Being sure to intentionally include certain foods provides necessary nutrients and building blocks to support cellular processes, maintain health and even promote growth where ideal, while also protecting against degeneration.

The best way to take your first steps toward longevity is to keep it simple and take a look at your next meal, and the pantry you’re pulling your food from. Quality and content matter when it comes to fueling your health and the first step is making sure what you’re eating is serving you well.

Each week in this series, we’ll delve deeper into a different topic and provide information on how to eat well and incorporate the building blocks you need to maximize your longevity potential!


The Nutrition for Longevity Membership is designed to help clients increase their energy, prevent the development of disease, improve quality of life and even prolong their lifespan. The membership begins with a 60-minute one-on-one evaluation with a nutritionist, followed by a weekly education email series as well as monthly 60-minute consultations.

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The benefits and risks of early sports specialization

The benefits and risks of early sports specialization

The benefits and risks of early sports specialization

Organized youth sports are becoming increasingly competitive and early sports specialization is becoming more popular among young athletes. However, there are many factors to consider when talking about early sport specialization at a young age, as there are both benefits and concerns about early sports specialization.

Feb 22, 2023 | Jacob Ober, PT, DPT, ATC

The benefits and risks of early sports specialization

TOrganized youth sports are becoming increasingly competitive and early sports specialization is becoming more popular among young athletes. Athletes are focusing on one sport at a young age with the hope of increasing their chances of success in the sport, and it’s not uncommon to see youth athletes focusing on one specific sport for a large portion of the year.

There are many factors to consider when talking about early sport specialization at a young age, as there are both benefits and concerns about early sports specialization.

Injury

The biggest concern with early specialization is the greater risk for overuse injuries, especially if your athlete hasn’t gone through puberty, because their muscles and tendons are still developing. Participating in multiple sports allows athletes to develop different neuromuscular patterns and increase their adaptive skills. Moving and falling differently when playing a variety of sports can also be a preventative for injury in your chosen sport.

While early sport specialization can help with skill development in one particular sport, it can also be detrimental in developing overall athleticism. An increased amount of volume of one specific movement while the body is growing can lead to imbalanced development and a higher chance of overuse injury. Athletes that play one sport constantly put their bodies under unique stress specific to that sport. Sports that involve a lot of repetitive tasks, especially unilateral tasks like throwing or swinging, tend to result in muscular and even sometimes skeletal imbalances. "Specializing is not wrong or dangerous. But specializing without adding a good strength and conditioning program is asking for trouble," Andrew Leddy, director of sports performance at Athletic Republic Naples, said. By incorporating that strength and conditioning program, you can address and those imbalances, decreasing stress on the muscles and bones as well as decreasing the risk of future injury.

Repeating the same movements over and over, like pitching a baseball, can put stress on the ligaments, muscles, tendons, and growth plates. According to the data, because kids’ bodies are not the same as adult bodies, those who specialize in a sport have the additional risk of sustaining overuse injuries. For example, in a study of 546 teenage female athletes who played basketball, soccer, or volleyball, there was an increased rate of anterior knee pain in those who had specialized in the individual sports at an early age than those who played a variety of sports. (1)

Burnout

Another issue that can result from early specialization is that it often leads to “burnout.” The pressure for kids to be “committed” to one sport can cause emotional burnout which leads to them quitting the sport. Once they quit, they rarely return. About 70 percent of children drop out of organized sports by age 13. (1) It can be way too much pressure for someone so young.

Young athletes experiencing burnout report:

  • Having less input into training and sport related decisions
  • Practicing with less motivation
  • Motivation becomes extrinsic (pressure from parents or coaches) and based on trying to get a scholarship, not because they derive joy from the sport
  • More stress and less ability to cope with high demands of the sport
  • Overall less enjoyment of the sport
  • Drop in grades or reduced peer interactions

Recommendations

The National Athletic Trainer’s Association’s official statement was in support of the following recommendations relating to the health and well-being of adolescent and young athletes.

1. Delay sport specializing in a single sport for as long as possible: Adolescent and young athletes should strive to participate, or sample, a variety of sports. This recommendation supports general physical fitness, athleticism, and reduces injury risk in athletes.
2. One team at a time: Adolescent and young athletes should participate in one organized sport per season. Many adolescent and young athletes participate or train year-round in a single sport, while competing in other organized sports simultaneously. Total volume of organized sport participation per season is an important risk factor for injury.
3. Less than eight months per year: Adolescent and young athletes should not play a single sport for more than eight months per year.
4. No more hours/week than age in years: Adolescent and young athletes should not participate in organized sport and/or activity more hours per week than their age (i.e., a 12-year-old athlete should not participate in more than 12 hours per week of organized sport).
5. Two days of rest per week: Adolescent and young athletes should have a minimum of two days off per week from organized training and competition. Athletes should not participate in other organized team sports, competitions, and or/training on rest and recovery days.
6. Rest and recovery time from organized sport participation: Adolescent and young athletes should spend time away from organized sport and/or activity at the end of each competitive season. This allows for both physical and mental recovery, promotes health and well-being, and minimizes injury risk and burnout/dropout. (2)

References

1. Woo, M. (2017) Why kids shouldn't specialize in one sport too early, Lifehacker. Lifehacker. Available at: https://lifehacker.com/why-kids-shouldnt-specialize-in-one-sport-too-early-1797954410.

2. Schaeufele, B. (2021) Sport specialization in Young Athletes, The National Sports Medicine Institute. Available at: https://www.nationalsportsmed.com/sports-specialization/.


Jacob Ober

Jacob Ober,

Jacob Ober, PT, DPT, ATC, is a physical therapist, dry needling specialist and certified athletic trainer based in Central Naples who subspecializes in working with athletes.

Meet Jake

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How a 72-hour fast pushes your body into ketosis

How a 72-hour fast pushes your body into ketosis

How a 72-hour fast pushes your body into ketosis

A few months ago, physical therapist Shane Foley chose to complete a 72-hour fast, putting his body into a state of ketosis. Here's what he got out of it.

Feb 22, 2023 | Shane Foley, DPT, OCS, CSCS

How a 72-hour fast pushes your body into ketosis

A 72-hour fast, or fasting for three consecutive days without any food intake, can help your body enter a state of ketosis. Ketosis is a metabolic state in which your body burns stored fat for energy instead of glucose from carbohydrates. Here are some potential benefits of a 72-hour fast that forces your body into ketosis:

Weight loss: When you're in ketosis, your body becomes more efficient at burning fat for energy, which can lead to weight loss. Fasting for 72 hours may also lead to a reduction in overall calorie intake, which can further aid in weight loss.

Improved insulin sensitivity: When you fast, your body's insulin levels decrease, which can help improve insulin sensitivity. This can be particularly beneficial for people with insulin resistance or type 2 diabetes.

Increased mental clarity: Many people report feeling more alert and focused when they're in ketosis. This is thought to be due to the fact that the brain can use ketones (produced during ketosis) as an alternative source of energy.

Reduced inflammation: Some studies suggest that ketosis can help reduce inflammation in the body. This could potentially benefit people with inflammatory conditions such as arthritis or autoimmune diseases.

Improved metabolic health: Ketosis may help improve various markers of metabolic health, such as triglyceride levels, blood pressure, and HDL (good) cholesterol levels. These benefits may also be related to the weight loss that often occurs during ketosis.

However, it is important to note that fasting with zero caloric intake for 72 hours can be challenging and should be done under medical supervision, especially if you have any underlying health conditions. Anecdotally, it was an interesting experience to realize that after the 72 hour mark, I had more energy than before, and that physical activity and exertion helped increase my energy levels, which should help force the synthesis of ketones.

For more on the benefits of fasting, check out our podcast on how fasting can help you lose weight and gain energy:


Shane Foley

Shane Foley

Shane Foley, PT, DPT, OCS, CSCS, is an orthopedic specialist who is certified in strength and conditioning, dry needling, and the Schroth Method. He is the Greenwich Site Lead.

Meet Shane

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What is your biological age?

What is your biological age?

What is your biological age?

How old are you? This is a question you have probably been asked countless times throughout your life. But what many of us don’t think about when we ask this question, is the difference between chronological age and biological age. Let’s dig into what those differences are, and how your lifestyle and habits play a role in shaping your biological age.

Feb 14, 2023 | Robert Mahlman, DPT

What is your biological age?

How old are you? This is a question you have probably been asked countless times throughout your life. But what many of us don’t think about when we ask this question, is the difference between chronological age and biological age. Let’s dig into what those differences are, and how your lifestyle and habits play a role in shaping your biological age.

First, we need to define chronological and biological age. Chronological age refers to the actual amount of time you have been alive, from the moment of birth until now. This is where we get our birthdays from, what we see on our IDs and how many of us think about our lifespan. No matter what we do, our chronological cannot be slowed or sped up. On the other hand, biological age is not based on how much time you have spent on earth, but it is more of an estimation of how much life you have left based on your physiology. Now, what is amazing, is that you can influence this age!

How is biological age calculated?

Biological age is determined in a few ways via genetic assessment. One of which is by the length of your telomeres. A telomere is a structure that acts as an end cap for a DNA molecule, similar to that of a cap on the end of your shoelace to prevent fraying. As we age, telomeres will wear out and shorten because of repeated cell division, stress, and inflammation. When a cell prepares for division, the DNA molecule that looks like the double helix, we all heard about in biology class, unties allowing the genes within to be copied. This does not duplicate the telomere, therefore some of it gets snipped off gradually decreasing its length, but normally their length is long enough that they can withstand this over a person’s lifespan. When the telomere is shortened and eventually disappears, the wear and tear begin to affect your actual DNA (aging the cell) which damages the cells resulting in increased risk for disease and mortality due to the degeneration.

Another way to look at your biological age is DNA methylation, which is a chemical reaction that occurs when a methyl group is added to DNA. This often modifies the function of the genes and affects the expression of that gene — this could involve developing wrinkles or losing bone density. The methylation process can provide insight into a person’s biological age, as research has shown that certain parts of the body age fast than others. If a region is rapidly higher in biological age than in chronological age, that can reveal possibilities of chronic illness — and even cancer risk — of that tissue.

What determines your biological age?

Now that we have discussed the differences between chronological and biological age, let’s dive into the factors that determine your biological age and how can you improve it. By looking at the four pillars of optimal health (exercise, recovery, nutrition, and stress management), you can make gradual changes to your overall biological age based on the proven research.

Exercise

Most people have been told by their doctors over the years to exercise more because that will make them healthier. But many of us do not realize that exercise can affect our biological age, improve longevity and overall quality of life. The American Heart Association recommends 150 minutes (2.5 hours) of moderate intensity aerobic activity or 75 mins of vigorous aerobic activity per week. Now think to yourself, are you consistently getting that each week? Research has shown that individuals who are sedentary have a higher predicted biological age than their chronological age. Conversely, those who more consistently and frequently engage in aerobic exercise have a biological age that is closer to their chronological age. In a study by Garatachea et al, they reviewed how exercise attenuates major hallmarks of aging and is linked to longer telomere length, in addition to decreased negative effects to DNA.

Nutrition

Diet also plays a major role in the aging process. Research has shown that changes in diet done over a consistent period — including lowering caloric intake, eating majority plant-based foods, limiting processed foods and focusing on the Mediterranean diet — aide in decreasing biological age. However, it is always recommended to discuss any significant changes to your diet your healthcare provider to ensure full understanding of dietary needs specific to you.

Recovery

Regarding recovery, sleep is one of the major areas to focus on. The CDC recommends adults ages 18–60 have seven or more hours of sleep each day. Sleep is essential for your body to function properly and for it to recover from the stresses (both mental and physical) of the day. Without adequate sleep it has been shown that there can be an increase in biological age and increased risk of co-morbidities, resulting in decreased longevity. With sleep it is important to understand that the minimum time required is when you are “asleep,” not just in bed. In some cases, one may need to be in bed for up to nine hours to achieve seven or more hours of sleep based on their sleep habits and overall quality. Following health habits such as disconnecting from screens at least 30 mins before bed, avoiding heavy meals two hours before bed, and keeping consistent bedtime and awake time are just a few methods of improving sleep.

Stress Management

Stress of course also plays a role on longevity and biological age as we would expect. Stress is something that we all go through, and we all work daily to manage. This stress can be both physical or mental and can come from various avenues of our lives. Stress has been shown to increase biological age when measured via DNA methylation during the time when is stressed. While it is true that the process returns to baseline once the stressor is removed, a key point is that if this stress is repetitive and consistent overtime which does not allow the body to reset and return to baseline. To help manage stress, meditation, and breathing techniques have been shown to decrease resting heart rate and aide the body in managing stress better over time. In addition, many have found benefits from meeting with mental health or performance coaches to aide in various strategies of managing stress.

Knowing where to start when optimizing your health and longevity is sometimes the most difficult part. Looking at it through the above four pillars and understanding how you stand in each of them will help guide you in the right direction. Some may need to address only one area, and some may need to address all. But they all work together, require balance and constant adjustment to live a healthy lifestyle.

Work Cited

Gao X, Huang N, Guo X, Huang T. Role of sleep quality in the acceleration of biological aging and its potential for preventive interaction on air pollution insults: Findings from the UK Biobank cohort. Aging Cell. 2022;21(5):e13610. doi:10.1111/acel.13610

Garatachea N, Pareja-Galeano H, Sanchis-Gomar F, Santos-Lozano A, Fiuza-Luces C, Morán M, Emanuele E, Joyner MJ, Lucia A. Exercise attenuates the major hallmarks of aging. Rejuvenation Res. 2015 Feb;18(1):57-89. doi: 10.1089/rej.2014.1623. PMID: 25431878; PMCID: PMC4340807.

Han KT, Kim DW, Kim SJ, Kim SJ. Biological age is associated with the active use of nutrition data. Int J Environ Res Public Health. 2018;15(11):2431. Published 2018 Nov 1. doi:10.3390/ijerph15112431

Ho E, Qualls C, Villareal DT. Effect of diet, exercise, or both on biological age and healthy aging in older adults with obesity: Secondary analysis of a randomized controlled trial. J Nutr Health Aging. 2022;26(6):552-557. doi:10.1007/s12603-022-1812-x

Lehallier B, Shokhirev MN, Wyss-Coray T, Johnson AA. Data mining of human plasma proteins generates a multitude of highly predictive aging clocks that reflect different aspects of aging. Aging Cell. 2020;19(11):e13256. doi:10.1111/acel.13256

Poganik JR, Zhang B, Gaht GS, Kerepesi C, Yim SH, et al. Biological age is increased by stress and restored upon recovery. bioRxiv. doi:10.1101/2022.05.04.490686


Robert Mahlman

Robert Mahlman

Robert Mahlman, PT, DPT, OCS, is the Westport Site Lead and a board certified orthopedic clinical specialist and certified Schroth therapist who specializes in the treatment of various orthopedic injuries, along with scoliosis and concussion management.

Meet Robert

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Understanding and preventing cardiovascular disease

Understanding and preventing cardiovascular disease

Understanding and preventing cardiovascular disease

Cardiovascular disease (CVD), also known as heart disease, is the leading cause of death worldwide, according to the Center for Disease Control. CVD includes conditions such as hypertension, stroke, peripheral artery disease, and more. Prevention is an important strategy to reduce death and suffering from CVD, and it relies on managing risk factors and starting preventive medications for those with elevated risk.

Feb 10, 2023 | Will Manzi, CEP

Understanding and preventing cardiovascular disease

As seen in Health & Wellness Magazine.

Cardiovascular disease (CVD), also known as heart disease, is the leading cause of death worldwide, according to the Center for Disease Control. CVD includes conditions such as hypertension, stroke, peripheral artery disease, and more.

Prevention is an important strategy to reduce death and suffering from CVD, and it relies on managing risk factors and starting preventive medications for those with elevated risk.

At the top of the CDC’s list of primary risk factors for all chronic diseases are: smoking, poor nutrition, and sedentary lifestyle.

You may be more likely to develop cardiovascular disease if you have risk factors such as:

• High blood pressure (hypertension).
• High cholesterol (hyperlipidemia).
• Tobacco use (including vaping).
• Type 2 diabetes.
• Family history of heart disease.
• Lack of physical activity.
• Having excess weight or obesity.
• Diet high in sodium, sugar and fat.
• Overuse of alcohol.
• Misuse of prescription or recreational drugs.
• Preeclampsia or toxemia.
• Gestational diabetes.
• Chronic inflammatory or autoimmune conditions.
• Chronic kidney disease.

Living a healthier lifestyle can help prevent heart disease. This includes:

• Eliminating all tobacco use
• Eating a heart-healthy diet
• Following an appropriate exercise program
• Managing your weight
• Eliminating as much stress as possible

What are the signs and symptoms suggestive of cardiovascular, pulmonary, or metabolic disease?

• Pain, discomfort in the chest, neck, jaw, arms or other areas that may result from ischemia
• Shortness of breath at rest or with mild exertion
• Dizziness or syncope
• Orthopnea or paroxysmal nocturnal dyspnea
• Ankle edema
• Palpitations or tachycardia
• Intermittent claudication
• Known heart murmur
• Unusual fatigue or shortness of breath with usual activity

FAQs ABOUT CARDIOVASCULAR DISEASE

Q: Who is most at risk?

A: Individuals with two or more risk factors or individuals who are symptomatic are most at risk. Looking at preventative measures, those who are predisposed to CVD are those with a strong family history of CVD.

Q: How can one prevent heart disease?

A: Preventative measures include a heart healthy diet such as the DASH diet (Dietary Approaches to Stop Hypertension), which is my recommendation which is used nationally by cardiologists through the American Heart Association. A healthy diet, in combination with aerobic, continuous exercise which incorporates large muscle groups, will mitigate your risk factors for CVD. These exercises include dancing, swimming, cycling/spinning, rowing, and running.

Medication can be utilized, but consult with your doctor before taking any drug.

Q: What role do nutrition, stress, and exercise play in CVD?
For modifiable risk factors, some measures can be taken to help reduce a person’s risk of developing CVD:

DIET: DASH stands for Dietary Approaches to Stop Hypertension, and it is designed to help treat or prevent high blood pressure (hypertension).

The DASH diet includes foods that are high in potassium, calcium and magnesium, but limits foods that are high in sodium, saturated fat and added sugars.

Studies have shown that the DASH diet can lower blood pressure in as little as two weeks, and it can lower low-density lipoprotein (LDL or “bad”) cholesterol levels. Hypertension and high LDL cholesterol levels are two major risk factors for heart disease and stroke.

EXERCISE: While not everyone has the same ability to exercise, getting some form of exercise for those who are able has immense heart health benefits. If you have angina or have had a heart attack, you may benefit from cardiac rehabilitation, which is a structured program that incorporates exercise, counseling, and education. Ask your healthcare provider for more information or a referral, if possible.

Stress: Stress is another contributor to CVD, and managing it can improve quality of life. Affordable ways to relieve stress include meditation, breathing exercises, journaling, exercise, time in nature, and connection with others.

At Performance Optimal Health we use comprehensive research and the latest technology to incorporate the four pillars of optimal health (exercise, recovery, nutrition, stress management) into your care. Each pillar plays a significant role in your optimal health journey, and using tools and services from each of the pillars can greatly enhance and expedite your path to success.


William Manzi

Will Manzi

William Manzi, CEP, is an exercise physiologist who specializes in the ability to take care of any individual, regardless of any limitations. Having worked with cardiac patients for the past 5 years, Will has developed a speciality in cardiac training and rehabilitation, as well as reading EKGs.

Meet Will

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What does scoliosis management look like?

What does scoliosis management look like?

Scoliosis is a common diagnosis that we will see in the office and can be managed in various ways, both conservatively and surgically, if necessary. Here's how you can manage it.

Jan 27, 2023 | Robert Mahlman, DPT

What does scoliosis management look like?

Scoliosis is a common diagnosis that we will see in the office and can be managed in various ways, both conservatively and surgically, if necessary. A three-dimensional torsional deformity of the spine and trunk, scoliosis can result in curvatures isolated to the neck, mid back or lower back and even all three. Scoliosis is a progressive disease that affects the alignment of the spine, motion of the trunk and overall symmetry of the human body. About 80% of cases are idiopathic, and most commonly we see it in the younger population, which is known as adolescent idiopathic scoliosis.

Diagnosis

Diagnosis of scoliosis is done through radiographic imaging to examine the anterior-posterior view of the spine in standing and assess a specific angle of the spine called the Cobb Angle. This is the angle formed between a line parallel the uppermost vertebral segment of the curve and the lowest vertebral segment. Clinically, diagnosis of scoliosis is a Cobb Angle greater than 10 degrees. This angle is important to know as it can help with managing treatment and understanding curve progressions over time depending on the age of someone. Diagnosis is in the adolescent population is usually done by the child’s pediatrician and screened by an Adam’s Forward Bend Test, where the child slowly bends forward, and the clinician assesses for curvature of the spinous processes or rib prominence.

Management

While scoliosis is a progressive disease that needs to be managed over a lifetime, it can be done so conservatively. The overall goal of any physician and physical therapist working with someone with scoliosis is decreasing and preventing further spinal deformity, along with a management strategy. Depending on a person’s age, skeletal maturity and Cobb Angle, measurements between 10–25 degrees are recommended scoliosis-specific exercises to manage curvature. Those with curvatures greater than 25 degrees and up to 45 are recommended scoliosis specific exercises and bracing. Those with curvatures greater than 45 degrees are usually recommended surgical intervention, as there is a greater negative effect on the persons skeletal structure and function.

Schroth Method

When it comes to managing scoliosis, there are a couple strategies we will employ that have been shown in the literature to be effective. First is an education of scoliosis which needs to be specific to the person and as stated earlier, their age, skeletal maturity, and Cobb Angle. From there, we determine the best management strategy, be it scoliosis-specific exercises, bracing, or surgery. A form of scoliosis-specific exercise some physical therapists are certified in is the Schroth Method. This method was first developed by Katharina Schroth in Germany during the 1920s. The Schroth Method focuses on the specific three-dimensional scoliotic curve pattern, deviations in the various planes, and breathing techniques. A meta-analysis in 2018 looked at the effects of the Schroth Method on idiopathic scoliosis and noted that it is beneficial for those individuals with Cobb Angle of 10-30 degrees, but less beneficial for those with Cobb Angles greater than 30 degrees. These exercises should be practiced for at least one month to have an effect on core muscle strength and structural deformity.

Pilates

In conjunction with the Schroth Method, we have also found positive results in both the office and in the literature with Pilates. Pilates focuses on core stability, flexibility, posture control, and breathing, similarly to exercises done using the Schroth Method. In the literature, Pilates has been seen to improve symptoms in those with spine related issues and reduce pain/disability in those with chronic lower back pain. In a systematic review which assessed the use of Pilates exercises training and its ability to improve spinal deformity and quality of life, there is evidence that Pilates can assist in reducing Cobb Angle, trunk rotation, decrease pain, and improve overall quality of life. In our review, evidence of Pilates independently managing scoliosis is not yet proven, but in conjunction with other exercises such as Schroth Method and bracing, it improves the results.

Every person with scoliosis is different and should be managed individually, as there are multiple variables that can affect their care. To ensure someone with a scoliotic curve is managed most appropriately, it is recommended they work with someone who specializes in the spine and, if possible, are certified in the Schroth Method. While dosage and recommendations vary, a comprehensive evaluation is necessary to address a person’s scoliotic curve, related musculoskeletal impairments, quality of life, body image, and pain. Ultimately it is also a team approach where communication with the physician, patient, and the parent (if an adolescent). Striving to provide a treatment regimen that matches the persons needs is vital and allows them to succeed.


Robert Mahlman

Robert Mahlman

Robert Mahlman, PT, DPT, OCS, is the Westport Site Lead and a board certified orthopedic clinical specialist and certified Schroth therapist who specializes in the treatment of various orthopedic injuries, along with scoliosis and concussion management.

Meet Robert

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Preventative health is key to avoiding chronic disease

Preventative health is key to avoiding chronic disease

Preventative health is key to avoiding chronic disease

Jan 4, 2023 | Health & Wellness Magazine

Preventative health is key to avoiding chronic disease

As we head into a new year, focusing on preventative health will be your most important tool to stay healthy. While some aspects of our health are predetermined by our genetics, there is a significant amount that we have control over through our lifestyle and daily health decisions. There are also a variety of indicators you can use to determine how healthy you are, or what your risk of chronic disease may be. This month, let’s discuss four key indicators — resistance exercise, inflammatory markers, the importance of Vitamin D, and controlling your stress levels — that will help you start the new year off right.

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How to set a New Year’s Resolution

How to set a New Year’s Resolution

How to set a New Year’s Resolution

The way we create goals can make an impact on whether or not we achieve them. Here's how to set a goal you can actually achieve.

Jan 2, 2023 | Arianna Martignetti, Ed.D.

How to set a New Year’s Resolution

calendar and notebook with smart goals
Should you be setting a New Year’s resolution? Or do you want to set a New Year’s resolution? The way we talk to ourselves can influence the way we feel about our resolutions in the new year, and our behaviors or performances as we work towards them. The beginning of a new year can make us feel excited and motivated to set new goals for ourselves, change a behavior, or try something new. During this time, it is common to set a few goals at once, yet setting too many goals can sometimes become a barrier to reaching them.(1) You may find that focusing on one or two goals begins to affect your behaviors, and naturally affects other areas of your life. These can either become productive changes or negative ones, and not everyone keeps the resolutions they make at the beginning of the year. Below are some ways that our mental performance can help us reach our goals, and how we can hold ourselves accountable throughout the new year.

1. Track your baseline. We will not know whether we are improving, being consistent, remaining stagnant, or decreasing our performance unless we know what our baseline is. After identifying a behavior or goal, track your current level of performance. It may take several days or weeks to track your baseline, which you might perceive as taking time away from your goal, but it is a part of the process as you track where you are starting, so that you know where you are heading.

2. Be objective. Maybe you want to get stronger, be healthier, or perform better. How much stronger do you want to get? Or, where in your body do you want to get stronger? What does it mean to be healthier? What will performing better look like? Many of us may want to get stronger, be healthier, or improve our performance, yet it will look different for everyone. Being more objective and specific can allow us to measure our progress and track our goals.(2)

3. Measure your goals. How do you know if you are getting stronger? How will you know if you are healthier or feeling better? How do you know if your performance improved? Measuring our goals and adding timeframes allows us to evaluate our performance and make adjustments. This also allows us an opportunity to set short-term goals for ourselves along the way. Setting short-term goals can help sustain or increase our motivation and effort as we continue working on our long-term goal(s).(1)

4. Reality check time! Is your goal attainable, or is it too unrealistic? Recognizing the difference between a goal that is an ideal challenge versus one that is too far out of reach can make the difference in our adherence and motivation. In line with this, be willing to adjust. Adjusting our goals does not mean that we are unable to achieve them. This also goes for goals that are too easy to achieve. Setting goals that are too easy may not contribute to us feeling as competent had we achieved a more difficult goal.(3) Our confidence, anxiety, and expectations can contribute to the performances we have and behaviors we engage in as we work toward our goals.

5. Write your goal(s) down. This is a simple, yet imperative, step. In addition to helping us remain on track and evaluate our progress, writing our goals down can serve as a reminder, direct our attention, and influence our focus.(1) In addition, if you are more of a visual learner, then creating a chart can be useful in tracking your goals. One of my favorite visuals is the use of a staircase, with each step including a short-term goal, and enough room to write down whether or not it was achieved.

Setting goals that are for ourselves, rather than for others or for external factors, can contribute to feeling more self-motivated and more in control.(3) Whether you are trying something new, changing a behavior, or maintaining a current one, it can be helpful to recognize why you are doing it; what we tell ourselves can influence our performances and behaviors.

As a mental performance consultant, I work with athletes and individuals on the mental side of their performances to help them reach their goals. For example, some of this can include self-confidence, performance anxiety, arousal regulation, visualization, or self-talk. Working together can involve fine-tuning or identifying the mental skills that you already utilize, or learning and implementing new techniques.

Learn more about mental performance consulting.
References

(1) Weinberg, R. S., & Gould, D. (2019). Foundations of Sport and Exercise Psychology (7th ed.). Champaign, IL: Human Kinetics.

(2) Wilson, K., & Brookfield, D. (2009). Effect of goal setting on motivation and adherence in a six-week exercise program. International Journal of Sport and Exercise Psychology, 6(1), 89-100. doi:10.1080/1612197x.2009.9671894

(3) Ryan, R. M., & Deci, E. L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. New York, NY: Guilford Publications.


Arianna Martignetti

Arianna Martignetti

Arianna Martignetti, Ed.D., is a mental performance consultant who works with individual athletes, weekend warriors and teams at all levels. She works with her clients to fine-tune their mental skills or increase their self-awareness to create the change that they want and achieve their goals — and more.

Meet Arianna

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How to avoid the nutrition resolutions that set us up to fail

How to avoid the nutrition resolutions that set us up to fail

How to avoid the nutrition resolutions that set us up to fail

Jan 2, 2023 | Jacqueline Ballou Erdos, CCSD, CDN

Many nutrition resolutions set us up to fail from the start. So if you’re looking to lose weight this year, consider this.

How to avoid the nutrition resolutions that set us up to fail

It’s that time of year again when many of us make resolutions. We recommit to the gym, resolve to eat clean and strive to lose weight.

The holidays can be a wonderful and festive time of year. But, come January, you might feel drained. You could worry that you overindulged over the holidays, or you may feel a little dreary about the long winter ahead. You may be stressed about the toll the holidays took on your finances, or maybe you didn't have time to travel or see friends and family.

The new year offers us a clean slate, a chance to reset. Resolutions encourage us to better ourselves. They inspire us to do good and they bring hope about the year ahead. In theory, resolutions are a good thing, right?

But, when it comes to nutrition resolutions, it depends. Why? There’s one not-so-little problem about many nutrition resolutions that are made: they set us up to fail from the start.

If you’re resolving to lose weight this year, consider this. (Hear me out).

Diets aren’t sustainable

Diets work, in the short term, but the long-term outlook on diets and weight loss is bleak at best. A meta-analysis of 31 weight loss interventions with follow-ups of two to five years showed that although most people can initially lose 5–10% of their weight in the first six months, the large majority eventually regain all the weight they lost. Between one and two-thirds of people even regain more weight than they initially lost within 2–5 years.

Sticking to a diet isn’t about willpower

Dieting decreases the metabolism and increases hunger. The compensatory mechanisms that occur with dieting make sense from an evolutionary standpoint since our bodies are hardwired for survival. To the body, dieting is viewed similarly as a famine. It defends itself by responding with hormones and signals that decrease metabolism and preserve body fat. This makes us think about food, increases hunger and makes us feel less satisfied when we do eat. In short, dieting causes bingeing through compensatory biologic responses. That is what makes it difficult to stick to a diet — not a lack of willpower.

Body weight is difficult to control

Just like our shoe size, height and eye color, set point theory says that our weight is determined by a complex interaction of genetics and lifestyle. It’s estimated that our weight set point is a range of somewhere between 10–20 pounds, at which point our bodies function optimally.

When we try to lower our set point weight through dieting, the cascade of regulatory mechanisms described above sets in motion to defend our body weight. Set point weight is a weight you tend to maintain when you eat to appetite, in response to hunger and fullness cues. You may have already heard of this under a different name: “intuitive eating.” It may be the weight your body naturally returns to in between diets, or when you do not fixate on weight or food. However, this may not be your target weight, just your natural one.

What to resolve to accomplish instead

This year, instead of making weight loss resolutions that may set you up for failure, how would it feel to start working toward acceptance of your current body? In honoring your body where it’s at now, how can you take best care of it in the new year? Would it be through finding ways to move that you enjoy? Or maybe it’s resolving to take more time for self-care, whatever that looks like for you. Or, it could be finding a way to eat the foods you love and make you feel good.

Food for thought.


Jacqueline Ballou Erdos

Jacqueline Ballou Erdos

Jacqueline Ballou Erdos, MS, RD, CCSD, CDN is a Registered Dietitian and Board Certified Specialist in Sports Dietetics. She is passionate about helping clients foster a lifelong, healthy relationship with food and their bodies, and works with her clients to create a custom plan that suits their needs.

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Don’t let your golf game deteriorate over the winter

Don’t let your golf game deteriorate over the winter

Don’t let your golf game deteriorate over the winter

Just because the way you train during the winter is changing temporarily doesn’t mean the quality has to suffer. There are ways to make the most of the wintertime, and to do so, having a team around you is just as important as the time you put in yourself.

Dec 14, 2022 | Larry Piretra, PT, DPT, CSCS, TPI-M2

Don’t let your golf game deteriorate over the winter

With the cold weather upon us in the northeast, the golf season shifts from on-course play to off season work within the gym, home, or local simulators. Whether you are looking to lower your handicap, improve your distance, or simply play more golf pain free, it is imperative to put the time and effort in, even if you don't have access to a golf course. Just because the way you train is changing temporarily, doesn’t mean the quality has to suffer. There are ways to make the most of the wintertime, and to do so, having a team around you is just as important as the time you put in yourself. The ideal situation is having both a golf professional and a health or fitness professional to work on all aspects of your game, from swing mechanics to improving your bodies efficiency to move within the swing.

The first important aspect that shouldn’t be ignored is any kind of pain, but particularly low back pain, which is the leading injury amongst golfers, accounting for 25% of all golf injuries. Low back pain may be the source of the pain, but that does not necessarily mean it will be the cause of your pain. The low back is a stable set of joint with the segments above and below (thoracic spine and hip respectively) being mobile joints. Your body requires muscular strength stabilization at stable joints and smooth motion at the mobile joints, and if there is impairment to either of these then dysfunction and pain will ensue. The only way to determine where your dysfunction may be is through a full and comprehensive evaluation, teasing out bits and pieces of impairment you may never knew you had. It is vital to understand the cause of your pain/dysfunction because this changes how your treatment or training plan will be structured.

Most golfers have a goal of gaining yardage on their swings, but do not have a firm plan in place to do so. Approximately every mile per hour gained of ball speed equates to driver carry distance of two yards. Naturally, this means the faster your ball speed, the longer carry distance of your driver. There are a variety of other variables in place that will affect carry distance (club speed, impact, dynamic loft, smash factor, etc.), but ball speed is most often studied. Tour averages for the ball speed on drivers are men at 168 mph and women at 140 mph. Meanwhile for your 10 handicappers, it is 138 mph for men and 119 mph for women. The good news is, an eight-week individualized golf physical fitness program for recreational golfers has previously been shown to improve ball speed by 7.3 mph, which by our calculations, would lead to potentially 14.6 yards of carry distance.

The final piece of the puzzle of improving your golf game is honing in your golf swing itself. This can be done through working with your local golf professional or practicing on a golf simulator, a handy tool during the cold months. Using a TrackMan golf simulator, for example, you can objectively measure whether your swing is improving. TrackMan metrics give you real time feedback on your swing, with approximately 40 metrics, including ball speed, club speed, carry distance, face angle, club path, impact location, and more. You can also play full courses within the TrackMan, thus allowing you to get as close to the course as possible without having to play on the snow.

All of this goes to show that even though you can’t play on the golf course over the winter, there’s no reason not to continue improving your game, addressing deficits, eliminating pain, and optimizing your swing. Putting all those factors together can actually leave you more prepared than ever to get back onto the course. I often recommend to my clients a comprehensive evaluation and Titleist Performance Institute screen, which will examine your body’s mobility and stability, overall power/strength, and assess your swing with metrics from TrackMan’s technology. Finally, by bringing a golf pro and a health and fitness professional onto your team, they can ensure you successfully meet your goals. This collaboration between your golf pro and health/fitness professional is vital to making sure everyone is on the same page and working in sync to make your golf game as efficient as possible.


Larry Piretra

Larry Piretra

Larry Piretra, PT, DPT, CSCS, TPI-M2, is a physical therapist and strength and conditioning specialist who serves as the Manhattan Site Lead and splits his time between the city and Fairfield County. As a Titleist Medical and Fitness Professional, Larry also serves as the Golf Programming Lead for Performance.

Meet Larry

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Optimal Health Assessment: Don’t just treat injuries, prevent them

Optimal Health Assessment: Don’t just treat injuries, prevent them

Optimal Health Assessment: Don’t just treat injuries, prevent them

Dec 6, 2022 | Health & Wellness Magazine

Optimal Health Assessment: Don’t just treat injuries, prevent them

As a society, we are accustomed to regular “check-ups” at the hair salons, dentist, local auto shop. Yet for some reason, it is common practice to only seek orthopedic care when injured. The concept of regular wellness visits to prevent injuries has consistently escaped the musculoskeletal realm and the common practice of most individuals. This concept is somewhat baffling, as it is not only antithetical to our normal “check-up” mentality in other realms, but it also is in direct contrast with the available research on orthopedic injuries. Rather than treating injuries and risking future ones, here's why you should just prevent them instead.

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The impact stress has on diabetes

The impact stress has on diabetes

The impact stress has on diabetes

Stress is a risk factor in developing type II diabetes. Here are some strategies to help minimize its impact that you can incorporate into your daily routine to better manage the stress you have in your own life.

Nov 15, 2022 | Will Murtagh, PT, DPT, CSCS

The impact stress has on diabetes

When you think about how someone should prevent or even help to treat their prediabetes or type II diabetes, you most likely would think of improving the quality of their diet as well as increasing their frequency of exercise, and you would be correct in that thinking. But what many people don’t realize is that stress management plays a large role in both preventing and treating type II diabetes. Recent research shows that depression, chronic stress, and early life adversity are risk factors in developing type II diabetes. Here is the role stress has on the disease, as well as strategies to help minimize its impact that you can incorporate into your daily routine to better manage the stress you have in your own life.

Before we begin, it is important to define what stress is and what the different kinds of stress are so that we can be precise in what we are both speaking about and if what we are attempting to manage or reduce each type. Stress is defined as a physical or mental response to an external cause. The external cause is defined as the “stressor,” which can be anything that causes you to feel like you lack control or is a threat to your overall wellbeing. For example, in recent years, the Covid-19 virus could be viewed as a stressor due to the degree of illness those who were at risk faced if they caught it. Having a big school or work project with an upcoming deadline can also be a stressor, especially if you feel you lack the time to complete it.

There are also different kinds of stress such as distress, which is “bad” stress, and eustress which is seen as “good” stress. Distress is seen as a negative situation, such as feeling overwhelmed, that cause decreases in your mental health and daily function3. On the other hand, eustress is stress that is motivating, positive, and enhances your daily function. A major difference between the two are the thoughts and beliefs of an individual pertaining to their ability to overcome the stressor. With regards to stress management for the prevention of type II diabetes, distress is the stress we would aim to minimize.

When distress becomes chronic, there are biologic responses that occur inside the body due to the body’s natural “fight or flight” response that can have negative impacts on your long term health. Sustained stress leads to a dysregulation of glucose metabolism and hormone function, as well as an increase in chronic low grade inflammation1. With this dysregulation and increase in cortisol into the blood stream, the likelihood of developing type II diabetes rises significantly.

Similarly, chronic stress can impact an individual’s daily behaviors that can also put them at risk for developing type II diabetes. For example, high chronic stress has been shown to decrease the quality of food choices, the frequency of physical activity, and the adherence to medications, all of which can play their own role in mitigating the risk of developing the disease as well as treating it.

Strategies that can help to minimize the risk of developing type II diabetes include techniques to help us cope with and decrease the magnitude of distress in our daily lives. Many of these not only help to decrease stress, but also have other physiological effects that can help you to live a better and healthier life. Such techniques include getting outside and playing with friends or family members, going for walks in nature, starting a meditation or yoga practice, reading a book or short story, or going to the gym to exercise. Methods that can help decrease the magnitude of stress in our lived include breaking down big projects into smaller more manageable tasks, asking for help if you feel you need it, and reframing yourself talk to shift negative thoughts into positive ones.

Stress is a part of our daily lives. Stress can be motivating for us to get things done and accomplish our goals, but it can also lead us to feel anxiety and decrease our quality of life. As you have seen, poorly managed stress can also put our health in jeopardy and put us at risk for diseases like Type II Diabetes. This is why it is important to develop ways to help manage the stress in your own life and seek out help from qualified professionals if you think that you need help.


Will Murtagh

Will Murtagh

Will Murtagh, DPT, CSCS, CISSN, CF-L1, is a physical therapist and strength and conditioning specialist based in Hamden. He specializes in sports and orthopedic physical therapy, with a subspecialty in sports nutrition.ality in cardiac training and rehabilitation, as well as reading EKGs.

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Managing diabetes through nutrition

Managing diabetes through nutrition

Managing diabetes through nutrition

By consuming healthy, whole, unprocessed foods, you can greatly mitigate the risks of developing type II diabetes as well as manage it if you already have it.

Nov 15, 2022 | Will Murtagh, PT, DPT, CSCS

Managing diabetes through nutrition

There are currently more than 37 million adults in the United States who currently have type II diabetes. That equates to about one person out of every 10 who is living with the disease, which is classified as a chronic health condition that affects the capability of your body to turn the food you consume into energy. When we consume food, the digestive system will break down the food that has been eaten into the simplest form of sugar – glucose. Once glucose has been formed, it is then released into the blood stream to be shuttled to parts of the body that require it such as the brain and muscle tissue. However, when someone is classified as having diabetes, the transfer of glucose from the blood stream into these tissues becomes inhibited due to the lack of insulin present (type I) or inability of cells to respond to insulin (type II), the latter of which is not genetic, but developed over time.

So, why does this matter? As we continue to consume food during a meal or snack, blood sugar will begin to rise as glucose is formed and enters the blood stream. If this glucose is unable to be transferred out of the blood stream, negative consequences can occur such as vomiting, excessive hunger and thirst, rapid heartbeat, and vision issues. Long term consequences include heart disease, vision loss, and kidney disease.

Rising blood sugar values is a normal part of the digestive process. However, the above-mentioned negative consequences are a result of the bodies inability to bring blood sugar down to resting levels. Blood glucose levels can fluctuate based on mealtimes, stress, and activity; a normal response after a meal is considered to be at a level of 100-140mg/dl two hours after a meal. If blood sugar remains elevated above 200mg/dl, that would indicate that diabetes is present.

There is currently no cure for diabetes type I or type II. But there are ways you can both prevent further development of the disease as well as optimize your management of it. One of the primary ways to do so also happens to be one of our four pillars of optimal health: nutrition.

By consuming healthy, whole, unprocessed foods, you can greatly mitigate the risks of developing type II diabetes as well as manage it if you already have it. Processed foods are any food item that has been synthesized industrially and typically contain five or more ingredients such as hydrogenated oil, fructose corn syrup and artificial sweeteners, color emulsifiers and preservatives. A recent meta-analysis involving 230,526 adults from several countries over five different studies found that there was a statistically significant increase in the likelihood of developing type II diabetes with a high consumption of processed food. In fact, they found that for every 10% increase in calories coming from processed food, there was a 15% increase in the likelihood of developing the disease.

What does a diet that avoids processed foods and minimizes the risk of developing type II diabetes look like? A great place to start is by choosing non-starchy vegetables, fruits, lean protein, and whole grains5, as well as avoiding sugar sweetened beverages like soft drinks and choosing water or other unsweetened beverages. You can also begin to familiarize yourself with the glycemic index so that you can choose foods that won’t raise blood sugar as rapidly or as high as other foods might.

The glycemic index is a value system assigned to foods based on the effect they have on blood sugar after consuming them. Higher GI foods raise blood sugar rapidly while low GI foods raise it slowly over time. For those looking to prevent or manage type II diabetes you would want to choose foods that are low GI foods to keep blood glucose in an optimal range and steady over the course of the day. For example, choosing lentils (32) which are a low GI food, over french fries (63) that are a high GI food.

Preventing or managing diabetes can be challenging in today’s society. Often it requires a shift in lifestyle to prioritize healthy behaviors such as consistent exercise and eating healthy foods. But, fortunately with the help of professionals, such as nutritionists at Performance Optimal Health, you can get the support you need to avoid things like processed foods in your diet and introduce more whole foods as well as safe and professional exercise programs into your daily and weekly routine!


Will Murtagh

Will Murtagh

Will Murtagh, DPT, CSCS, CISSN, CF-L1, is a physical therapist and strength and conditioning specialist based in Hamden. He specializes in sports and orthopedic physical therapy, with a subspecialty in sports nutrition.ality in cardiac training and rehabilitation, as well as reading EKGs.

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Why sleep matters even more for those with diabetes

Why sleep matters even more for those with diabetes

Why sleep matters even more for those with diabetes

Many Americans have type II diabetes or prediabetes, which impacts all aspects of their health, including sleep. Fluctuations in glucose levels can throw off your entire sleep cycle, resulting in a lack of sleep, or even a higher risk of developing another chronic condition.

Nov 15, 2022 | Natalia Russell, PTA

Why sleep matters even more for those with diabetes

Many Americans have type II diabetes or prediabetes, which impacts all aspects of their health, including sleep. Fluctuations in glucose levels can throw off your entire sleep cycle, resulting in a lack of sleep, or even a higher risk of developing another chronic condition.

What is type II diabetes?

Type II Diabetes is a metabolic disease that results in abnormally high sugar levels, causing insulin resistance. The purpose of insulin is to help lower your blood glucose levels, but when you have type II diabetes, your body can’t produce enough insulin to eliminate the resistance and can potentially stop producing insulin all together. This can cause you to have elevated glucose levels and you might need exogenous insulin to help lower it.

But while 10% of the American population has type II diabetes — 1 in 3 Americans have prediabetes. This is a condition in which sugar levels are higher than normal, but not high enough to be diagnosed as type II diabetes.

How does sleep affect diabetes?

I want you to think back to when you were a kid, and your parents would say those dreadful words, “it’s bedtime.” At that time, you most likely didn’t have any issues with falling asleep, you just didn’t want to! However, if you have diabetes or pre-diabetes, you are more prone to having issues with your ability to sleep, and it’s a deeper issue than not feeling sleepy.

When we sleep, our glucose levels have been found to stay stable during non-REM sleep and increase with REM sleep or when we are awake. If you aren’t achieving a proper amount of sleep, you are likely to have fluctuations in your glucose levels, and as a result you will feel groggy and have an increased need for taking naps throughout the day. This can throw off your sleep cycle all together; when you feel like you aren’t well rested, it can affect your overall health.

Some common issues are obstructive sleep apnea, insomnia, and frequent voiding in the nighttime. These issues may contribute to disturbances throughout the day, such as irritability, getting sleepier in the evening and waking up earlier in the morning, health problems like depression, cardiovascular diseases, high blood pressure, cognitive decline and memory loss which can contribute to an increase in accidents and falls.

How you can improve your sleep habits

We all know life can be crazy and prioritizing sleep may not be at the top of the list, but it should be. With all the demands life brings, we will sometimes get the bare minimum — or even less —hours of sleep.

Sleep is the body’s way of resting, recovering, and resetting for the next day. Unfortunately, there are many distractions that may be getting in the way of you reaching your optimal sleep goal, so here are a few tips to help you feel well rested.

  • Make a routine so your body will know you are starting to wind down.
  • Stay away from blue-light emitting devices such as smartphones, tablets, and laptops at least an hour before bed. These devices have become more prevalent today and promotes cognitive stimulation and can disrupt your sleep cycle.
  • Try incorporating exercise in your day which is beneficial for your overall health and can tire you out to improve sleep.
  • Try having a cup of tea, reading a book, doing a crossword-puzzle, or anything that gives you some relaxation to help train your body that you are getting ready for bed.

To have a good night’s rest, you should get at least 7–8 hours of sleep, especially if you have pre-diabetes or diabetes. Sleep hygiene should be in the same bucket as our other measures of health, like exercise nutrition, recovery, and stress management. It is vital to keeping us healthy and essential for our well-being.

References

Knutson, K. Impact of sleep and sleep loss on glucose homeostasis and appetite regulation. Sleep Med Clin. 2007 Jun; 2(2): 187-197. doi: 10.1016/j.jsmc.2007.03.004

Harris-Hayes, M., Schootman, M. The Role of Physical Therapists in Fighting the Type 2 Diabetes Epidemic. Journal of Orthopedic & Sports Physical Therapy. 2022 Jan; 2(1) 1-16.

Varma, P., Jackson, M. Dreaming of the Good Old Days: Sleep in Older Adults. Journal of Pharmacy Practice and Research (2019) 49, 205–211.

Jniene A., Errguig L. Perception of Sleep Disturbances due to Bedtime Use of Blue Light-Emitting Devices and Its Impact on Habits and Sleep Quality among Young Medical Students. Biomed Research International. 2019: 1-8.


Natalia Russell

Natalia Russell

Natalia Russell, PTA, is a physical therapist assistant based in Hamden. Natalia has a particular interest in working with older populations, knowing helping people with the smallest of things can make a significant difference in their day-to-day lives and ability to move and complete tasks.

Meet Natalia

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Counteracting the effects of perimenopause and menopause

Counteracting the effects of perimenopause and menopause

Counteracting the effects of perimenopause and menopause

Nov 9, 2022 | Health & Wellness Magazine

Counteracting the effects of perimenopause and menopause

Women face many issues as they age in the perimenopausal and menopausal stages of life, such as increased risk of osteoporosis, metabolic diseases, cardiovascular issues, and more. These obstacles create a challenge for women trying to develop a healthy lifestyle or maintain it as they age. Aging can create a whole mix of emotions, from mentally and emotionally, from experiencing feelings of anxiousness and uncertainty to physically feeling due to the hormonal changes. The best way to optimize your health as you age is to work with a collaborative team of professionals that can help guide you through the process. As a Pelvic Health Physical Therapist, it’s my job not only to address acute issues, but to provide tools to help my clients stay healthy in all aspects of their life.

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Prevent and manage prediabetes through exercise

Prevent and manage prediabetes through exercise

Prevent and manage prediabetes through exercise

Approximately 10% of the American population has type II diabetes — and 1 in 3 Americans have prediabetes. Fortunately, diabetes can be prevented and managed by living a healthy lifestyle of proper eating and exercising.

Nov 1, 2022 | Michele Tenney, CPT

Prevent and manage prediabetes through exercise

Approximately 10% of the American population has type II diabetes — and 1 in 3 Americans have prediabetes. These staggering numbers reveal a common issue among the population: lack of sufficient exercise and a poor diet. Fortunately, diabetes can be prevented and managed by living a healthy lifestyle of proper eating and exercising.

Exercise is strongly recommended for people diagnosed with type II diabetes or prediabetes, and for good reason. Exercise helps lower blood sugar levels and ward off symptoms that are affecting people with type II diabetes. Too much rest and lack of movement contributes to higher blood sugar levels, as glucose is not being used up by the body. So, living a sedentary life is not beneficial to anyone, least of all people with prediabetes or type II diabetes. Additionally, exercise reduces stress and encourages weight loss and better cardiovascular fitness.

In addition to those benefits, exercise also helps with mental health and boosts not only our mood, but also our immune system, helping ward off other diseases such as stroke, cancer or heart disease. Exercise also helps aid in a better night’s sleep which also contributes to overall better health as well.

After a diagnosis, it is important to go slow and not jump into strenuous exercise. A quick 30-minute workout is ideal, and if you can get through it without a break; great, but take breaks if you need it. Cleaning and gardening can also count as exercise, but being fully committed to a 30-minute workout every day should be the goal. If you need help with motivation, find a personal trainer to help jumpstart a routine for you. Knowing your weakness and when to ask for help is a strength.

Once you have adopted a good routine and are committed to it, the American College of Sports Medicine recently released new recommendations for more strenuous workouts four to five times per week. However, it is important to discuss these options with your doctor and physical therapist if you are recovering from any injuries, as there are modifications that can be made to your workout routine to prevent further injuries.

The battlefield is in your mind: change the way you think, use self-affirmations, remember how you feel once you’re finished exercising and remember that you are worth every bit of effort you put into yourself. Your body will thank you for it. Repetition becomes a habit and habits become lifestyles, which means there is hope for those who want to prevent and manage prediabetes and type II diabetes. Should you get sidetracked or out of your routine for a period of time, don’t throw in the towel; begin again. Life has detours, and it’s important to learn how to maneuver them.


Michele Tenney

Michele Tenney

Michele Tenney, CPT, is a personal trainer based in Hamden who enjoys working with all populations. As a trainer, Michele takes care to talk about the importance of nutrition in achieving goals.

Meet Michele

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Pilates exercises for healthy joints

Pilates exercises for healthy joints

Pilates exercises for healthy joints

Oct 19, 2022 | Rebecca Deeley

Pilates exercises for healthy joints

In honor of Bone & Joint Health National Action Week, Pilates Instructor Rebecca Deeley shares a few exercises on the Pilates Reformer that strengthen the muscles around the joints without stressing out the joints themselves. These exercises are perfect for those who are recovering after an injury and require low impact methods of gaining strength back.

Watch now >

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The benefits of blood flow restriction therapy

The benefits of blood flow restriction therapy

The benefits of blood flow restriction therapy

Blood flow restriction (BFR) training is a modality that helps accelerate the rehab process, and to reduce risk of future injuries. BFR has been shown to have many local and systemic effects throughout the body, including positive effects on both muscles and bones.

Oct 17, 2022 | Michael Semancik, DPT, TPI-M2

The benefits of blood flow restriction therapy

What is Blood Flow Restriction Training?

Blood flow restriction (BFR) training is a modality that we use at Performance to help accelerate the rehab process, and to reduce risk of future injuries. BFR involves using a medical grade tourniquet, around the arm or the leg, and then performing exercises with the cuff temporarily occluding blood flow to the limb. With BFR, we can do exercises with as little as 20% of your 1 repetition max, while getting the same effects as doing a much higher weight or resistance. This is especially helpful in our patients who are recovering from surgery, allowing us to build strength while still allowing the surgical site to adequately heal. While this may sound intimidating, BFR is well studied in physical therapy research, and the devices we use ensure that it is performed safely.

How does it work?

BFR works by limiting arterial blood flow and stopping venous return to the limb while performing a specific exercise. This then forces the muscles to work in an anaerobic (oxygen deficient) environment, making low load exercises feel extremely difficult.

What are the effects of BFR?

BFR has been shown to have many local and systemic effects throughout the body. At the muscular level, there are improvements in muscle protein synthesis, muscle fiber recruitment, muscular hypertrophy, and muscular endurance. This not only applies to muscles below the level of the cuff, but also above AND on the opposite side of the cuff.

BFR also induces hormonal changes in the body which help with muscular adaptation. Multiple studies have shown an increase in free testosterone and serum growth hormone, both of which help to promote growth of muscle tissue in the body. BFR can also be an effective method for improving bone density in those who may not be able to tolerate higher intensity, weight-bearing exercise.

What conditions do we use BFR for??

BFR can be used for many conditions, most commonly we use it for:

  • Post-surgery (ACL reconstruction, meniscus repair, shoulder labral/SLAP repairs, achilles tendon repairs, etc.
  • BFR allows for effective strengthening exercise without placing too much mechanical stress on repaired tissue
  • Tendinitis (patellar tendinitis, golfer/tennis elbow, achilles tendinitis)
  • Similar to post op, if the tendon is actively inflamed or irritated, BFR can help to perform strengthening exercises without putting more stress on the inflamed tissue
  • Muscle Strains
  • Allows a patient to maintain strength of the affected muscle during the acute phase of a strain Fractures
  • While immobilized, can perform BFR exercises at other joints to maintain strength and promote the release of growth hormone in the body
  • Once you are no longer immobilized, BFR is an effective tool to rebuild strength that was lost
  • Training/Recovery
  • BFR is a great tool for any in-season athlete, or for weekend warriors needing an active recovery day
  • Allows you to maintain strength without putting undue stress on the muscles, joints, and tendons

Michael Semancik

Michael Semancik

Michael Semancik, DPT, TPI-M1, is a physical therapist and certified dry needling specialist who works with young athletes, specifically with rowers, hockey players and football players.

Meet Michael

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How to keep your bones healthy throughout each stage of life

How to keep your bones healthy throughout each stage of life

How to keep your bones healthy throughout each stage of life

To bring awareness to Bone & Joint Health Week, we dive into our own body’s foundation and explore how it changes as we age, as well as how to protect it.

Oct 13, 2022 | Maddy Mazoue, PT, DPT, CSCS

How to keep your bones healthy throughout each stage of life

Unless a bone is broken, it is easy to forget about the fundamental structure supporting our entire body that we cannot see: the skeleton. Yet a skeleton and its bones are integral to our daily life, serving a variety of functions including protecting vital organs, serving as attachment points for muscles, storing minerals, producing bone marrow and more. To bring awareness to Bone & Joint Health Week, we will dive into our own body’s foundation and explore how it changes as we age, as well as how to protect it.

Bones are often thought of as static, unchanging structures, but in reality, bones are constantly changing and developing throughout one’s lifespan. Our 206 bones all have unique shapes and structures, though the general anatomy of bones is fairly consistent. There are two main types of bone, cortical and trabecular. Cortical bone is the hard outer layer that contains the highest calcium concentration, while the trabecular bone is found below the cortex and is made up of a honeycomb-type structure full of bone marrow and fat stores.1 As we age, the size, mineral content, density, and durability of our bones changes considerably.

0-10

Childhood and adolescence are incredibly important periods for bone growth and development. As children grow, their bones accumulate calcium deposits that lay the foundation for bone health long term. Therefore, it is vital for children to get an appropriate amount of calcium and vitamin D in order to promote bone growth as they age. According to the National Institute of Health, products such as milk, cheese, tofu, and yogurt are all excellent examples of foods with high calcium content. Protein is also a key factor, as it improves calcium absorption. In addition to ensuring children have proper nutrition, participation in high impact activities such as jumping, running, and playing sports is also vital to promote healthy bone development.

10-20

As children reach puberty, bone growth surges. Peak growth rates, aka growth spurts, tend to happen around age 11–12 for girls and age 13–14 for boys. Growth spurts start earlier for girls as the onset of menstruation brings a jump in estrogen, which promotes calcium absorption and an increased in bone mineral density.2 As puberty comes to an end, the growth plates close, signaling the completion of this phase of growth and development. This is not, however, the end of the journey for bone development.

120-40

In the years following adolescence, calcium deposition continues at a much higher rate than absorption. The American Academy of Orthopedic Surgeons states that peak bone mineral density occurs between age 25–30 for most individuals. As we get older though, the rate of bone deposition decreases and rate of calcium absorption increases, which means we begin to lose bone density gradually over time. This breakdown rate begins to creep up with age, with a sharp increase for women around menopause. In order to decrease the amount of bone loss, it is crucial to maintain the health of your bones during your earlier years through physical activity such as weightlifting and proper nutrition, including a generous intake of calcium, vitamin D and protein.

45-60

Just as an increase of estrogen improved calcium absorption in adolescence, the drop in estrogen associated with menopause negatively impacts a woman’s calcium stores. As calcium stores deplete, bone mass diminishes, with the average woman losing around 10% of bone mineral density in the first five to six years of menopause.3 As this process progresses, the risk for osteopenia and osteoporosis significantly increases.

>65

Though the effect is not as drastic, men are also at risk for developing osteoporosis. On average, by the age of 65–70, men are losing bone mineral density at the same rate as their female counterparts. As the rate of bone density decreases, the risk of fracture tends to increase. The American Academy of Family Physicians recommends that women over 65 and men over 70 get a bone density test (DEXA scan) as a preventative measure to identify their risk of osteoporosis.

Though a certain amount of lost bone mineral density is normal, there are many modifiable behaviors than can delay or slow down this process that can be implemented at any age. Smoking, alcohol use, and excessive caffeine consumption have all been identified by the NIH as risk factors for increased loss of bone mineral density as one ages. Other important factors to consider are calcium intake and physical activity. As mentioned above, calcium and vitamin D recommendations change throughout the lifespan, but are particularly important during childhood and after age 50 for women and age 70 for men.

Exercise can also have a huge impact on bone health. For those between the ages of 20–50, studies have shown that individuals that participate in moderate to high intensity impact activities have a greater average bone mineral density than those who are less active or who participate in lower impact activities. Though aerobic activities such as biking, swimming, and running are great for maintaining a healthy cardiovascular system and have a number of health benefits, these activities may not put enough load on the skeletal system to promote increased bone deposition. Resistance training has been shown help build muscle, increase bone density, and decrease fall risk. The Mayo Clinic recommends weight-bearing resistance training for those with or at risk for osteoporosis to optimize bone health and decrease risks associated with having decreased bone mineral density. This should, however, be done with close supervision and modification by a medical or fitness professional to ensure exercises are safe and dosed appropriately.

Our bones go through many changes as we progress through our lives, but there are a myriad of ways that we can help promote and support bone health in every stage of life. Lifestyle choices, exercise, and nutrition all have an enormous impact on our skeletal system. Take the extra time to invest in your health and support your bones; your skeleton will thank you!


Maddy Mazoue

Maddy Mazoue

Maddy Mazoue, PT, DPT, CSCS, is a physical therapist and strength and conditioning specialist who specializes in developing athletes’ return to sport programs. She values collaboration and teamwork, and believes that patient care is always better when providers are open and willing to work with each other to best serve the patient.

Meet Maddy

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Optimize your golf performance at any age

Optimize your golf performance at any age

Optimize your golf performance at any age

Oct 12, 2022 | Health & Wellness Magazine

Optimize your golf performance at any age

The best way to optimize golf performance at any age is to optimize total body performance through an integrated team approach. The first step is completing a golf-specific health and fitness screen, which can identify potential impairments or impairments. Once they are identified, a team should be built around the golfer to address not only the impairments, but also to improve general fitness, proper form, hydration, muscle recovery, and mental performance.

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Why you should start treating exercise as medicine

Why you should start treating exercise as medicine

Why you should start treating exercise as medicine

Exercise isn’t just for regular gym goers or athletes; it is a useful tool for people of all ages and abilities to maintain health through every stage of life. Engaging in an appropriate level of regular physical activity can help prevent, treat, or even reverse, chronic diseases as we age.

Sep 16, 2022 | Jamie Stuart

Why you should start treating exercise as medicine

Much like the changing of the seasons, our bodies change and adapt year after year. With September being Healthy Aging Month, it is important to focus on how we can create healthy changes to our bodies over the years. For example, many illnesses often associated with aging are actually the result of sedentary lifestyle and can be avoided by moving and staying physically active (Gonzales et al., 2017). Most people are probably aware that exercise is a great way to stay in shape, build muscle, and burn calories, but the benefits of exercise go well beyond losing weight, running faster, or getting stronger. The American College of Sports Medicine believes that “exercise is medicine” and engaging in an appropriate level of regular physical activity can help prevent, treat, or even reverse, chronic diseases as we age (Swisher, 2010).

Regular exercise is associated with reduced resting heart rate and blood pressure, increased HDL (good) cholesterol and decreased LDL (bad) cholesterol, reduced total body fat, reduced blood platelet adhesiveness and aggregation, improved glucose tolerance (decreased insulin resistance), decreased workload on the heart, and increased bone density (Nystoriac & Bhatnagar, 2018). According to the American Heart Association and the CDC, adults who participate in at least 150 minutes of moderate intensity aerobic exercise (brisk walk or light weight training) or 75 minutes of vigorous exercise (jogging or playing basketball) have a significantly reduced risk of developing type II diabetes, cancers, and cardiovascular diseases.

The idea of exercise serving as medicine does not only apply to adults. Children and adolescents who participate in regular supervised weight training have a reduced risk of developing osteoporosis when they are adults. Young individuals who exercise and participate in sports also have decreased body fat percentage and increased fat free mass (muscle and bone) later in life, compared to those with a sedentary lifestyle. Furthermore, regular aerobic exercise at a young age can reduce risk of developing high blood pressure and cardiovascular disease later in life (Drenowatz & Greier, 2018).

Speaking of cardiovascular disease: it is the leading cause of death worldwide. In the United States, an average of 2,400 people die from cardiovascular disease every day, accounting for 1 out of every 2.8 deaths. Poor health outcomes resulting from cardiovascular disease such as coronary artery disease, chronic ischemia, stroke, and arterial stiffness are on the rise globally, and cardiovascular disease related healthcare costs are expected to increase from 172 billion in 2010 to 276 billion in 2030 in the United States (Pagidipati & Gaziano, 2013; Heidenreich et al., 2011). However, exercise can help reduce mortality from heart disease by increasing the elasticity of arteries which results in greater control over blood pressure. Exercise can also increase blood flow to the heart by increasing the number of branches between blood vessels feeding the heart. These collateral branches can then help supply the heart with oxygen-rich blood in the event of a coronary occlusion which may prevent or lesson the severity of a heart attack (Meier et al., 2013).

To learn more about the direct and indirect effects of exercise on the body, we turn to the field of exercise physiology. Exercise physiologists are medical professionals who prescribe plans that can maximize the benefits of exercise in people struggling with chronic disease. They work with doctors, nurses, and physical therapists to design exercise programs to treat cardiopulmonary diseases such as congestive heart failure and metabolic diseases such as diabetes. Cardiac and pulmonary rehabilitation programs last roughly three months and patients are encouraged to perform moderate intensity aerobic exercise three times per week for one hour under close supervision. In addition, education on health topics such as exercise, recovery, and nutrition are provided, and vitals are continuously monitored to ensure the prescribed exercise is having a positive and significant enough effect. Patients that successfully complete exercise programs designed by exercise physiologists often have significant improvements in their heart and lung function, as well as greater control over blood sugar levels (Bozkurt et al., 2021).

Exercise isn’t just for regular gym goers or athletes; it is a useful tool for people of all ages and abilities to maintain health through every stage of life. Exercise should be seen as a requisite to living and just like regular maintenance of your car, it is necessary to ensure our bodies function properly over time. Staying active and adhering to the recommended exercise guidelines is essential, and some people dealing with complex health issues may need extra guidance and care. Exercise physiologists can prescribe a safe and targeted exercise plan for those suffering from chronic disease or other health issues to ensure they meet the recommended dosage of exercise.


References

Bozkurt, Biykem et al. “Cardiac Rehabilitation for Patients With Heart Failure: JACC Expert Panel.” Journal of the American College of Cardiology vol. 77,11 (2021): 1454-1469. doi:10.1016/j.jacc.2021.01.030

Drenowatz, Clemens, and Klaus Greier. "Resistance training in youth—benefits and characteristics." Journal of Biomedicine 3 (2018): 32-39.

Garber, Carol Ewing et al. “American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.” Medicine and science in sports and exercise vol. 43,7 (2011): 1334-59. doi:10.1249/MSS.0b013e318213fefb

González, Karimé et al. “Physical Inactivity, Sedentary Behavior and Chronic Diseases.” Korean journal of family medicine vol. 38,3 (2017): 111-115. doi:10.4082/kjfm.2017.38.3.111

Heidenreich, Paul A et al. “Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association.” Circulation vol. 123,8 (2011): 933-44. doi:10.1161/CIR.0b013e31820a55f5

Meier, Pascal et al. “The collateral circulation of the heart.” BMC medicine vol. 11 143. 4 Jun. 2013, doi:10.1186/1741-7015-11-143

Nystoriak, Matthew A, and Aruni Bhatnagar. “Cardiovascular Effects and Benefits of Exercise.” Frontiers in cardiovascular medicine vol. 5 135. 28 Sep. 2018, doi:10.3389/fcvm.2018.00135

Pagidipati, Neha J. and Thomas Andrew Gaziano. “Estimating Deaths From Cardiovascular Disease: A Review of Global Methodologies of Mortality Measurement.” Circulation 127 (2013): 749–756.

Swisher, Anne K. “Yes, "Exercise is Medicine"….but It Is So Much More!.” Cardiopulmonary physical therapy journal vol. 21,4 (2010): 4

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The dangers of chronic inflammation and what you can do about it

The dangers of chronic inflammation and what you can do about it

The dangers of chronic inflammation and what you can do about it

Sep 13, 2022 | Health & Wellness Magazine

The dangers of chronic inflammation and what you can do about it

While some levels of acute inflammation aid the body’s natural processes, prolonged, chronic inflammation causes a variety of health issues, including chronic disease and deterioration of body mechanics. It is incredibly important to manage things that can exacerbate inflammation such as a poor diet, sedentary lifestyle, elevated stress hormones, low quality sleep and more to prevent chronic inflammation from occurring.

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New physical therapy concept Performance Optimal Health opens in North Naples

New physical therapy concept Performance Optimal Health opens in North Naples

New physical therapy concept Performance Optimal Health opens in North Naples

Sep 12, 2022 | Gulfshore Business Magazine

New physical therapy concept Performance Optimal Health opens in North Naples

Todd Wilkowski decided to take his professional life and his favorite vacation destination and merge the two of them.

Performance Optimal Health, founded nearly 20 years ago by Wilkowski in Manhattan, New York, has grown to six locations, with the others clustered in Connecticut. Now, he has a seventh location at 2260 Logan Blvd. N., Ste. 202 in North Naples. It’s at the Logan Landing shopping center, next door to First Watch.

The 1,500-square-foot facility opened with a soft launch Tuesday and will celebrate its grand opening Oct. 13.

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Introducing the Optimal Health Assessment

Introducing the Optimal Health Assessment

Introducing the Optimal Health Assessment

What once was a burgeoning physical therapy practice is now an innovative health care company with a holistic approach to health and wellbeing. We expanded our mission from the original focus on recovery to one of finding balance in all pillars of one’s health: stress, exercise, recovery and nutrition.

Apr 27, 2022 | Todd Wilkowski

Introducing the Optimal Health Assessment

The world has changed a lot in the past two decades, and we at Performance Optimal Health are determined to stay ahead of that change. Our forward-thinking approach is evident in our name, methods, and the services that we provide, and it is only natural that we continue staying ahead of the curve, providing our clients with the care they didn’t even realize was a possibility.

As such, I am pleased to announce that Performance now offers an Optimal Health Assessment, a true evaluation of your health, habits and goals through the lens of the four pillars of optimal health: exercise, recovery, nutrition, and stress management.

A highly credentialed member of our team will take account of your health history, review appropriate health metrics and diagnostic tests, discuss your goals and set forth a personalized strategy to help you achieve them. Whether you want to improve your fitness, optimize sports performance, recover from an injury or increase longevity, this assessment will ensure that all your bases are covered, and all your needs met.

The assessment will cover your quality of movement, sleep, nutritional intake, and stress levels, among other things. We will then devise a program through a coordinated delivery of a combination of the four pillars, tailored to meet your goals.

We will also work with the team you currently have — or build one around you. We have close relationships with physicians, coaches, yoga instructors and more, and plenty of experience working in tandem. But through the years, we have also assembled our own team of experts — physical therapists, personal trainers, Pilates instructors, nutritionists, mental performance consultants, massage therapists, recovery specialists and more — to help you on your journey to optimal health.

Whether you already work with us or have never stepped foot in our doors, the Optimal Health Assessment is the perfect way to determine your goals and set yourself up for success with a team around you to keep you accountable.

To schedule your assessment, call us at 203-557-4000 today.

Todd Signature

Chief Executive Officer
Performance Optimal Health

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Mental strategies to help you transition into your competitive season

Mental strategies to help you transition into your competitive season

Mental strategies to help you transition into your competitive season

If you are heading into your sport this fall, consider your mental performance, which might hurt or help you transition into your competitive season.

Aug 16, 2022 | Arianna Martignetti, Ed.D.

Mental strategies to help you transition into your competitive season

he off-season is an ideal time for training, rest, and recovery. It is also a beneficial time to work on one’s mental skills or learn new mental strategies to become fully prepared for an upcoming season.(1) If you are heading into your sport this fall, consider the following, which might help with your transition into your competitive season.

Where is your attention?

Our attention allows us to bring our awareness to information around us. This affects our interpretations and decision making.(1) During a race, game, or competition, our attention gets bombarded with information constantly, and needs to shift quickly. We can succeed when we focus on the right cues, at the right time, and limit distractions (whether they are internal or external). This might mean maintaining your leg power during a drive while experiencing fatigue. Or it could mean moving your body and positioning your racket to return a serve while hearing your coach yelling on the side of the court.

While these are specific examples, on a broader scale, ask yourself: where is your attention as you enter your season? Some athletes focus on winning; others focus on adapting to a new team or coach, and some might focus on a new skill or position. Some athletes might even be experiencing impactful changes outside of their sport. Regardless of where your focus is, your attention can affect your mental preparation and/or performance. With practice, training your attention can help you become more selective of relevant cues for demands in your sport, help shift or re-focus your attention when necessary, and block out distractions.(2)

How do you prepare?

There are several benefits to having a pre-performance routine or developing preset behaviors. One benefit is that it can help athletes get into their ideal activation state to perform their best.(3) Athletes experience various activation levels; some perform their best with lower activation levels, others when it is very high, and some when it is in the middle. Not all athletes are aware of their ideal activation state, especially if teams prepare as a group (and unintentionally create the same levels in each athlete). There are different ways to identify your ideal activation state. After doing so, some ways that athletes activate their ideal states can include the use of breathing exercises, music, imagery, or mindfulness within their performance routines. Similar to pre-performance routines, routines during a practice or performance can help athletes refocus their attention, manage an error, or handle a setback. Post-performance routines can be used to adjust, reflect on, or improve one’s performance and motivation.(4)

Where is your motivation coming from?

It might be easier to answer this question if you already know what motivates you. If you are unsure of what motivates you, now can be a beneficial time to consider it. Then, ask yourself, where is my motivation coming from? For example, is your motivation coming from within yourself (i.e., autonomously) such as enjoying your sport or wanting to improve? Or is it coming from something outside of yourself, such as your parents wanting you to play, teammates expecting you to perform, or having the chance to play for a travel or college team? Or, right now, maybe you are not experiencing much motivation at all (i.e., amotivation). Researchers have found more autonomous forms of motivation to be associated with lower levels of burnout in athletes.3 Depending on your source(s) of motivation, different types of motivation can affect an athlete’s self-determination.6

How much time do you devote to your physical training?

With the above question in mind, I challenge you to reflect on how many parts of your sport involve your energy, focus, communication, confidence, and attitude (to name a few). How much of your overall training do you devote to them? Although training your mental skills takes practice and does not necessarily provide a “quick fix,” working on your mental game for five to 10 minutes per day can benefit your performance.(1)

Learn more about mental performance consulting.

References

(1) Burton, D., & Raedeke, T.D. (2008). Sport psychology for coaches. Champaign, IL.: Human Kinetics. ISBN-10: 0736039864.

(2) Orlick, T. (2016). In Pursuit of excellence: How to win in sport and life through mental training (5th ed.). Champaign, IL: Human Kinetics.

(3) Williams, J. M., Nideffer, R. M., Wilson, V. E., & Sagal, M-S. (2015). Concentration and strategies for controlling it In Applied sport psychology: Personal growth to peak performance (p. 304-325). Mountain View, CA: Mayfield. McGraw-Hill. ISBN-13:978-0078022708.

(4) Ravizza, K., & Fifer, A. (2015). Increasing awareness for sport performance In Applied sport psychology: Personal growth to peak performance (p. 176-187). Mountain View, CA: Mayfield. McGraw-Hill. ISBN-13:978-0078022708.

(5) Goodger, K., Wolfenden, L., & Lavallee, D. (2007). Symptoms and consequences associated with three dimensions of burnout in junior tennis players. International Journal of Sport Psychology, 38(1), 342-364. doi:10.1123/tsp.11.3.257.

(6) Ryan, R. M., & Deci, E. L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. New York, NY: Guilford Publications.


Arianna Martignetti

Arianna Martignetti

Arianna Martignetti, Ed.D., is a mental performance consultant who works with individual athletes, weekend warriors and teams at all levels. She works with her clients to fine-tune their mental skills or increase their self-awareness to create the change that they want and achieve their goals — and more.

Meet Arianna

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Five tips for injury prevention

Five tips for injury prevention

Five tips for injury prevention

As fall sports pick back up, there is often an uptick in injuries associated with the increase in training load after a slower summer. Here are some helpful tips to help make the increased load feel more workable and prevent injuries from destabilizing your season.

Aug 16, 2022 | Brendan Copley, CSCS, ATC

Five tips for injury prevention

As fall sports pick back up, there is often an uptick in injuries associated with the increase in training load after a slower summer. Here are some helpful tips to help make the increased load feel more workable and prevent injuries from destabilizing your season.

1. Listen to your body

While this is one of the most common recommendations you will hear — especially in the endurance sports realm — it is also one of the most commonly ignored. In the initial stages of getting back into your sport, it can be challenging to understand the difference between the normal discomfort of muscle soreness and injury-related pain.

On one hand, if you pay attention to every little ache and pain, you may not be able to reach the performance goals you desire. On the other hand, if you ignore your discomfort, you could be setting yourself up for injury and time away from your sport. This is where it can be helpful to work with an athletic trainer or physical therapist. As experts in the field, they will help you sort through the signals your body is telling you and brainstorm a plan of action.

2. Monitoring training load

Another place people can get stuck is the idea that because they have taken some time away from their sport, they need to work overtime to get themselves back into shape. So, they perform the most intense workout they could possibly fathom and are so sore that they are unable to walk for the next three days. Instead of pushing yourself, the more helpful (albeit more challenging approach) is to prioritize consistency over a long period of time

Consistency helps make your sport more of a habit; the more it is a habit, the less motivation is needed to perform the activity. The initial stages of training are all about building a base, and the more consistently you can get out there and recover appropriately, the bigger that base will be. One analogy is thinking of training as compound interest: if you can invest little amounts over a long period of time, eventually that interest will compound. On the flip side, if you must keep removing money from the bank, the interest will never add up.

performance vs consistency of training

3. Proper warm up and cool down

Performing an appropriate warm-up can also play a role in warding off soft tissue injury. Warm-ups increase the heart rate, increase blood flow to tight muscles, improve tissue elasticity, and prime the body for activity. The warm-up should consist of:

  • Five minutes of an activity that increases your heart rate. This may consist of using a stationary bike, elliptical, running, jumping jacks, etc.
  • Dynamic warm up which entails stretching targeted muscles through movement, while progressively promoting strength in functional movement patterns
  • Pre-activation: this is a method of activating the hips, core, rotator cuff, and scapular stabilizing muscles depending on the sport and injury history. Pre-activation involves only one or two sets of movement with light to moderate resistance to prime muscles that help prevent the typical compensation patterns.

Performing an appropriate cool down usually includes performing some variation of very low intensity cardio for 5–10 minutes and some light static stretching.

4. Rest and recovery

Having the appropriate amount of sleep and time off are good methods to help make sure that your muscles have had time to restore the amount of energy needed before returning to training. The recommended amount of sleep for athletes is between seven and nine hours. As part of the recovery, it can also be beneficial to incorporate methods that either promote tissue elasticity or venous return. Some examples of these recovery methods are:

  • Normatec
  • Cryotherapy
  • Foam rolling
  • Massage therapy
  • Trigger point release therapy

Nutrition and hydration also play an integral role in injury prevention. Nutrition can affect the recovery of the muscles, as well as the availability of energy while performing an activity. Here are some common nutrition-related concepts to keep in mind for fueling your body for optimal performance and injury prevention:

  • Eat foods that are nutrient dense and have a variety of vitamins, minerals, and antioxidants
  • To decrease inflammation, eat foods that are high in omega-3 fatty acids such as fish, ginger, turmeric, and nuts/seeds
  • Eat foods that are high in protein approximately 30 minutes to an hour after the activity, but don’t disregard carbohydrates! Protein works best when it is eaten in 3:1 carb to protein ratio.
  • Eat the appropriate ratio of fats, carbs, and protein for the type of sport being performed.
  • The USDA recommends for the general public a macronutrient ratio of 45-65% carbs, 20-25% fats, and 10-35%
  • Refer to a sports dietician who can perform a comprehensive evaluation to help determine your specific macronutrient needs
  • In general endurance athletes tend to need a slightly higher percentage (60-65%) of their calories from carbohydrates.
  • To avoid over or under fueling, have the appropriate caloric intake based off your Basal Metabolic Rate (BMR) and intensity of the exercise.

Regarding hydration, even mild dehydration can increase the likelihood of injury while also decreasing your body’s speed, strength, and cognitive function. Here are a few hydration facts to drink up to help feel your best and decrease injuries.

  • It is important to hydrate throughout the day, not just right before activity. Dehydration is cumulative and the hydration status the day before affects the hydration of the day of.
  • Aim to have 8–16 oz of water the hour before exercise, 4 oz per 15 mins of activity during activity, and 16-20 oz for every pound lost during exercise.
  • For particularly hot time periods with intense training, it can be helpful to consistently weigh yourself both before and after the activity to make sure you are making up the fluid weight lost before starting up the next activity.
  • In the heat it is also important to combine water intake with electrolytes drinks that have plenty of (sodium, potassium, magnesium and calcium.)

Unfortunately, both hydration and nutrition recommendations vary depending on the individual’s needs. Therefore, working with a nutritionist or dietician can be invaluable in curtailing recommendations specific to your situation.

The best type of treatment for injuries is a preventative plan. Building healthy habits around activity load, rest/recovery, listening to your body, warm-ups/cool downs, and nutrition/hydration can make a significant difference in your long-term health and well-being. You don’t have to take steps towards change alone. A good healthcare team should be able to work with their patient proactively to help determine a plan, before the injury even happens.


Brendan Copley

Brendan Copley

Brendan Copley, CSCS, ATC, is a personal trainer who specializes in working with endurance athletes and post-rehab clients.

Meet Brendan

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Have low back pain? Here's why you shouldn't wait to address it

Have low back pain? Here’s why you shouldn’t wait to address it

Have low back pain? Here’s why you shouldn’t wait to address it

Everyone seems to experience low back pain at some point in their lives, but often wait to address it. Here's why you should get help sooner rather than later.

Jun 23, 2022 | Payden Houser, DPT, CSCS

Have low back pain? Here's why you shouldn't wait to address it

Let's talk about low back pain, something that everyone seems to experience at some point in their lives. It seems like you could stack the articles, studies, papers, blogs, and textbooks dedicated to low back pain and reach halfway to the moon. Studies show that the prevalence of low back pain worldwide has risen over the last two decades. A global disease burden study from 2010 found that out of 291 conditions, low back pain ranked highest in terms of disability and sixth in terms of overall burden. (1)

Meanwhile, musculoskeletal are the second most common cause of disability worldwide, increasing 45% from 1990 to 2020, and that number is expected to climb. (2) Researchers anticipate that with a rise in sedentary lifestyle, lack of exercise, as well as poor nutrition and sleep health, conditions like low back pain will continue to affect the lives of a large percentage of the global population.

But things are not all doom and gloom. Let’s shed a little light today on what low back pain is, what it isn’t, and how creating a proactive strategy can not only help manage your pain but can help you make sustainable healthy lifestyle changes for the future.

What is low back pain, exactly?

Low back pain is discomfort, tightness, or stiffness in the area below the costal margins of your ribs (the arch formed as your ribs connect to your sternum), and above the lower portion of the gluteal muscles. Pain stemming from the low back can also include leg pain.

The point to make clear is that low back pain is a symptom, not a disease, and can result from several known or unknown sources. Symptoms can be short-lived for only a few weeks or chronic, persisting for several months to years, and can, unfortunately, reoccur if not managed. The good news is that a 2017 JOSPT study showed that although low back pain can be recurrent (ranging from 24%-58% likely to reoccur at 2 years), in most cases, individuals tend to recover quickly. (3)

So what is the cause of low back pain? It can originate from a variety of structures in the body: muscle, tendon, ligament, joint, spinal disc, nerve, and visceral organs. There is also a long list of risk factors associated with contributing to low back pain including prior low back pain, obesity, poor health, manual jobs, and poor work satisfaction, just to name a few. Reading all of the possible contributors to low back pain can be daunting, but rest assured that symptoms can be managed as long as you are willing to make some lifestyle changes and have a plan of action.

Get help without the wait

One of the most significant decisions you can make to address your low back pain is to seek conservative care early. If symptoms are not improving on their own in a few days, then it is best to seek out a provider who understands the anatomy of the spine and how the human body moves.

All 50 states in the U.S. have provisions that allow for what is called "direct access" to see physical therapists; meaning you do not have to see your physician first. Take Connecticut, for example. You are allowed to see a therapist for six visits or 30 days before requiring a prescription from a physician to continue care, which is quite a head start. This provides you with the opportunity to receive guidance from a trained professional quickly, saving you precious time, money, and avoiding unnecessary co-payments and imaging, and surgery.

A physical therapist will perform an initial evaluation seeking to first rule out any potential "red flags" (more serious underlying conditions that require the help of a physician), and then assess your overall status to try and provide you with insight on what could be causing your pain and how to best address the problem.

If you came in with a prescription from your doctor for physical therapy, great! Your therapist can then communicate with your physician on what they believe to be going on and create a solid plan of action.

If you came in via direct access, that's awesome too! Your physical therapist can then help you find an appropriate orthopedist, physiatrist, or other musculoskeletal specialists, to assist in managing your care if imaging or other treatments are necessary. Either way, within a short period of time you will have a robust team of professionals to help you along the way.

Every case of low back pain is different, and they can all be very frustrating in their own way. When your activities and social life become limited, or there is a loss of work and financial hardship, it is easy to feel overwhelmed. It is important to understand that you are not alone in this experience. At some point in life, nearly everyone will experience low back pain. With early action and a good team of healthcare providers around you, your symptoms can be managed effectively and you can be well on your way to returning to the things you love with a renewed sense of confidence and better equipped with the knowledge of how to manage symptoms in the future.

References

1.Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, Williams G, Smith E, Vos T, Barendregt J, Murray C, Burstein R, Buchbinder R. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann 2.Rheum Dis. 2014 Jun;73(6):968-74. doi: 10.1136/annrheumdis-2013-204428. Epub 2014 Mar 24. PMID: 24665116.
Storheim K, Zwart JA. Musculoskeletal disorders and the Global Burden of Disease study. Ann Rheum Dis. 2014 Jun;73(6):949-50. doi: 10.1136/annrheumdis-2014-205327. PMID: 24790065.
3.da Silva T, Mills K, Brown BT, Herbert RD, Maher CG, Hancock MJ. Risk of Recurrence of Low Back Pain: A Systematic Review. J Orthop Sports Phys Ther. 2017 May;47(5):305-313. doi: 10.2519/jospt.2017.7415. Epub 2017 Mar 29. PMID: 28355981.
4.Meucci RD, Fassa AG, Faria NM. Prevalence of chronic low back pain: systematic review. Rev Saude Publica. 2015;49:1. doi: 10.1590/S0034-8910.2015049005874. Epub 2015 Oct. 20. PMID: 26487293; PMCID: PMC4603263.


Payden Houser

Payden Houser

Payden Houser, DPT, CSCS, is a physical therapist and strength and conditioning specialist based in New Canaan who has been practicing since 2015 in the outpatient orthopedic and home health settings.

Meet Payden

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What are the common causes of back pain?

What are the common causes of back pain?

What are the common causes of back pain?

One of the most common and costly conditions that we see in the clinic is low back pain (LBP). We breakdown all the common conditions and share safe exercise tips.

Jun 23, 2022 | Michael Semancik, DPT, TPI M2

What are the common causes of back pain?

One of the most common and costly conditions that we see in the clinic is low back pain (LBP). Whether this is acute or chronic, a large majority of our clients, at one point or another, have experienced low back pain in their lives. The United States is estimated to spend approximately $90 billion annually on the treatment of LBP (this includes MD visits, imaging, surgery, PT, among other treatments), and has also become the number one condition of disability among industrialized nations. So: what should you do if you start to experience low back pain, or have had chronic low back pain?

Basic Anatomy of the Spine

First, let’s explore the basic anatomy of the spine. Your spine is made up of four regions: cervical (seven vertebrae), Thoracic (12 vertebrae), Lumbar (five vertebrae), and Sacral (five fused vertebrae). Each of these regions have slightly different shapes, curves, and structures that allow for different types of movements and protection at each region.

Each vertebra is separated by the intervertebral disc. The disc is made of two main structures, the annulus fibrosus and the nucleus pulposus. The nucleus pulposus is the inner gelatinous portion which will resist compressive forces though the spine, and the annulus fibrosus is the outer ring of the disc, which resists more tensile forces. Together, these two structures help decompress the spine and provide padding between the vertebrae to allow for movement of the spine.

Basic anatomy of spine
Inside spine

Another role of the vertebrae, besides movement, is to protect the spinal cord and corresponding nerve roots from damage. As you can see from this top-down view, the spinal cord is protected within the vertebral foramen. The nerve roots, which will supply the muscles and provide sensation to the extremities, are also protected in the lateral foramen

There are also many muscles that help provide support and stability to the spine. When people think of the “core,” often times we only consider the abdominal musculature (obliques, transverse abdominus, rectus abdominus). While these are important to spine health, the core is a very comprehensive term, and can encompass your abdominals, erector spinae, deep spinal stabilizers, and even your glutes.

There are also many muscles that help provide support and stability to the spine. When people think of the “core,” often times we only consider the abdominal musculature (obliques, transverse abdominus, rectus abdominus). While these are important to spine health, the core is a very comprehensive term, and can encompass your abdominals, erector spinae, deep spinal stabilizers, and even your glutes.

Common Injuries and Conditions

There are many different structures and conditions that can produce pain in the lower back. Here, we have outlined a few of the most common ones, and symptoms associated with them:

Maddy Mazoue

Maddy Mazoue

Maddy Mazoue, PT, DPT, CSCS, is a physical therapist and strength and conditioning specialist who specializes in developing athletes’ return to sport programs.

Meet Maddy

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How a massage can decrease stress

How a massage can decrease stress

How a massage can decrease stress

Massage therapy has been shown to have innumerable benefits, both on body and mind. It has been shown to reduce stress, improve circulation, lower heart rate, and improve immune function, among other positive effects on body systems.

May 17, 2022 | Ashley Moriarty, DPT, OCS

How a massage can decrease stress

Massage therapy has been shown to have innumerable benefits, both on body and mind. It has been shown to reduce stress, improve circulation, lower heart rate, and improve immune function. It can also help relax you after a stressful day or alleviate trigger points due to injury. There are various types of massage, different techniques, and a variety of purposes behind it, but all involve manipulation of muscles and other soft tissue by a licensed massage therapist. But overall, massage can be summed up like this: it can help you to recover and feel better, both physically and emotionally.

Types of massage

While there are many types of massage, I will cover some of the more common ones. The first, Swedish massage, is generally thought of as a relaxation technique, and it uses a gentler level of pressure than others, aimed at releasing tension.

Deep tissue massage uses similar techniques to Swedish massage, including tapping, vibration, sliding and lifting the soft tissue. However, the main difference lies in the amount of pressure used, as deep tissue massages apply more of it.

Finally, trigger point therapy involves finding specific trigger points within the muscle and applying sustained pressure to decrease the tightness and increase blood flow to that area. This can be done in combination with other types of massage.

Massage and its effects on the body

While these methods used various techniques, they all provide numerous shared benefits. One of the more significant benefits is that it can help decrease mental stress via its effects on the nervous and endocrine systems. This is caused by an increased release of dopamine, serotonin, and endorphins, and can help boost mood.

Additionally, massages also help decrease levels of cortisol (the stress hormone) in the body, which can lead to improved sleep, and therefore result in better recovery after exercise and rest.

A massage can also help balance out our sympathetic and parasympathetic nervous systems. It is theorized that a short massage can stimulate our sympathetic system – what determines whether we fight or flight – and make people feel more energized, while a longer massage allows for more time to disengage the sympathetic system and engage the parasympathetic system – rest and digest.

Other body systems are also positively affected by massage, such as the cardiovascular system, lymphatic system, and of course, the musculoskeletal system. Some cardiovascular effects include increased blood flow (which in turn increases oxygen, red blood cells, and nutrients to the area), decreased heart rate, and decreased blood pressure. Lymphatic system benefits included decreased swelling and inflammation, decreased scar tissue, and improved circulation.

Finally, the most obvious effects are those on the musculoskeletal system: decreased physical stress, increased mobility and range of motion, decreased fascial restrictions, decreased trigger points, decreased pain, improved stiffness, improved muscle tone, better post-surgical recovery.

However, while we can name the effects of massage on various body systems, it is important to remember that all of these systems work together, influence each other, and are uniquely linked. The effects of massage are compounded for the ultimate effect: decreased stress, for both the body and mind.


Ashley Moriarty

Ashley Moriarty

Ashley Moriarty, DPT, OCS, ATC, is a board certified orthopedic clinical specialist and certified dry needling specialist based in New Canaan.

Meet Ashley

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Nutrition for the mind and body

Nutrition for the mind and body

Nutrition for the mind and body

The body and mind are connected in more ways than one, especially through the gut. The food we eat directly impacts our hormones, mood, and more. Here's what you need to know about how nutrition can impact not just your gut health, but your mental and emotional state as well.

May 17, 2022 | Koren Bradshaw, MS, CDN, CLC

Nutrition for the mind and body

Ever had butterflies in your stomach or a strong gut feeling? Maybe your digestion gets disrupted, or you have some heartburn when you’re stressed. These are just a few of the outward physical signs we have that our body and mind are truly connected. Today, so many people are searching for “balance” — we’d like to be healthy, feel calm and not stressed, have plenty of time to enjoy families and friends, and accomplish the days’ tasks while fulfilling ourselves with work. This is a tall order that can sometimes lead to more stress!

Physically, our minds and bodies are literally connected — one of our most major nerve bundles, the vagus nerve, runs directly from our brain to our gut (specifically the digestive tract and intestines). The vagus nerves are the main nerves of our parasympathetic nervous system and act as a highway of information between our brain, gut and gut microbiome. It was once thought that information primarily ran from the brain to the gut, but recent research is showing that information more often stems from our gut and brings information to the brain. The food we eat provides information to our bodies about our surroundings, our nutrient status, health, local bacteria, and more.

Often called “the second brain,” the gut is where over 90% of your serotonin is produced as well as about 50% of your dopamine — not in the brain as one might think. Serotonin is sometimes referred to as your “happiness hormone” and has many jobs: it helps to regulate your mood, anxiety, memory, sleep, sexual function, bone health, even blood clotting. Dopamine controls things like concentration, focus, gut motility and feelings of contentment, among others. Additionally — and hugely important these days — the gut is where our immune system largely resides and is where we absorb most of the vitamins and minerals from our food. When the gut lining is disrupted, so too, then, is your production of these neurotransmitters; a chronically disrupted gut can lead to disrupted mood and life and leave you susceptible to illness. It’s easy to see why it’s so important to be mindful of gut health.

Other factors impact both our emotions and our bodies. When we are stressed, our adrenal glands produce cortisol, which is our main stress hormone that acts as a sort of natural alarm in our bodies. Our adrenal glands also produce adrenaline, otherwise known as the “fight or flight” hormone (most of us have experienced this feeling at some point!). Cortisol is a powerful inhibitor of insulin: when cortisol rises — due to stress, illness, or lack of sleep — our body changes how it uses insulin, encouraging our blood levels of glucose to rise and be available for quick energy (to fight that bear it thinks you’re facing down). If and when you don’t use that glucose, what happens to it? You guessed it: it gets stored…as fat, particularly in and around our belly and organs. Cortisol also narrows our blood vessels, causing our blood to pump harder and increasing our blood pressure. Consumption of alcohol has been shown to both increase cortisol levels and disrupt the gut microbiome; it’s best to keep alcoholic beverages to a minimum and find other ways of relieving stress.

How can we best support our mind-body connection? Start with healthy eating!

Being sure to include foods in your diet that support your brain and gut health are an easy place to begin. The brain alone is almost 65% fat! Choose foods that are rich in Omega-3 and other healthy fats, like wild salmon, sardines, organic avocado, cold-pressed olive oil, nuts such as walnuts and Brazil nuts (just two per day will help support your thyroid) and seeds such as chia, pumpkin and flax (grind these fresh to maximize benefits). Fats are also an important part of our cell walls and have the added benefit to helping our skin stay youthful.

Our guts also thrive on fresh vegetables and fruits: the fiber contained in fresh produce acts as a prebiotic, or food for the healthy bacteria that lives in our guts and supports so many of our body’s crucial functions. Whenever possible, include lots of organic, seasonal produce, legumes, unprocessed whole grains; your plate should ideally be at least half-full of veggies at each meal.

Antioxidants are an amazing way to keep inflammation in our bodies low, help fight cancer-causing cells and support brain and gut alike! Berries are especially high in antioxidants (hello blueberries!) and fiber (blackberries), along with vitamin C containing foods like citrus. Look for deeply-colored produce for highest antioxidant levels. And in good news, coffee is actually a very potent antioxidant! Just be sure to keep it to a cup or two per day, as excess caffeine has been shown in some studies to increase cortisol levels.

Most of all, try not to worry too much at first about specific diet plans or what not to eat, and instead focus on what you can include to boost your wellness. Focus on simple, unpackaged foods that are either homemade or have minimal ingredients. And don’t forget to drink plenty of water: aim for at least half of your body weight in ounces of water to support digestion, gut health, alertness, memory and focus.

Finally, small changes in lifestyle can have a huge impact on both body and mind. Adequate sleep helps to clear debris in the mind, lower stress (and cortisol) levels and promote healing and a healthy immune system. Incorporating other stress-reducing techniques such as regular exercise, deep breathing, meditation, yoga or stretching, reading, or even a simple walk after meals can lower stress, help with digestion, and focus and help you on your way to balanced body and mind.


Koren Bradshaw

Koren Bradshaw

Koren Bradshaw, MS, CDN, CLC, is a nutritionist with a functional, whole-body approach. She works with a wide range of concerns, specializing in women's health, new/expecting mothers, autoimmune and thyroid issues, food allergies and sensitivities, celiac disease and anti-aging.

Meet Koren

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How to transition into the outdoor running season

How to transition into the outdoor running season

How to transition into the outdoor running season

With the spring coming up, many are transitioning to outdoor running. Here's what you need to remember for a successful transition.

Mar 17, 2022 | Britt Gunsser, DPT

How to transition into the outdoor running season

Winter running, especially in the Northeast, requires planning, flexibility, and mental grit. Spring races, such as the Boston Marathon and NYC Half Marathon, require 25,000-30,000 participants to train through the winter. As a participant in the latter, I’ve battled it out with winter training the past few months. The temperatures get well below freezing, the roads get icy, and the sunlight gets scarce. All of these variables require runners to have a plan: is it safe to run outside? Is it smart to run outside? Will I accomplish my training goal running outside today? Do I want to run outside?

If the answer to these questions is “yes,” then comes the planning. Visibility, warmth, traction, and water resistance need to be accounted for depending on the conditions of the day. Running in the morning or at night requires a reflective or illuminated vest to be seen by cars. Running in snow and ice requires shoes with better traction, and possibly a decrease in pace. Temperatures below 40 degrees require layering techniques, with increased layers as the temperatures grow colder. Hands and ears, receiving the least circulation, need to be covered. Warmups need to be thorough to truly warm up your body before heading out into cold temperatures. Putting all of that together, the end of my winter runs looked a lot like this (featuring ice on hat, runny nose, double layered gloves, triple layered shirts):

If the answer to these questions is “yes,” then comes the planning. Visibility, warmth, traction,
and water resistance need to be accounted for depending on the conditions of the day. Running
in the morning or at night requires a reflective or illuminated vest to be seen by cars. Running
in snow and ice requires shoes with better traction, and possibly a decrease in pace.
Temperatures below 40 degrees require layering techniques, with increased layers as the
temperatures grow colder. Hands and ears, receiving the least circulation, need to be covered.
Warmups need to be thorough to truly warm up your body before heading out into cold temperatures.
Putting all of that together, the end of my winter runs looked a lot like this (featuring ice on
hat, runny nose, double layered gloves, triple layered shirts)

As hours of sunlight and temperatures start to increase, so does the appeal of outdoor running. It becomes easier to choose the pavement over the treadmill, which can help a runner prepare for race-like conditions. For most, running feels best in the 40s and 50s with low humidity, giving March and April the potential to have great running conditions (aside from the occasional late northeast snowstorm).

Though the weather conditions improve, certain things remain constant no matter the weather: warmups, strength training, proper fueling, and recovery are all necessary. While it is advised to warm up inside during the winter months, your warmup can now be done outdoors when the sun is up and the temperatures are warmer, but it should still be thorough and run-specific. Strength training (advised two days/week during a race training cycle) should still be done on hard workout days, involving leg, core and upper body exercises.

Fueling, which includes pre-, during, and post-workout, remains crucial to recovery between sessions. Fueling is often the most difficult variable for runners to independently plan. I recommend working with a registered dietician with experience with endurance athletes to discuss fueling strategies and decide which is best for you. These strategies should be practiced during the training cycle, and nothing new should be tried on race day. As training cycles ramp up, caloric intake (specifically of carbohydrates) should also increase. Runners are often unknowingly under-fueled because of day-to-day nutrition. A dietician can provide strategies to combat this.

Recovery and rest days are also extremely important. They allow the body to make beneficial adaptations to hard training sessions to truly begin to show improvement. Recovery runs are often assigned in training cycles, and should be kept at a very easy, conversational pace to promote recovery. Full rest days should be exactly as they sound: full of rest. Though rest and recovery days are not as active as workout days, nutrition remains equally as important as the body tries to replenish from the previous workout and prepare for the next one. These are also perfect days to utilize recovery tools available to you. My Hypervolt remains within arm’s reach and I often sit with NormaTec boots on these days to get my legs feeling better and ready for my next workout. I also like to use an infrared sauna, which has been proven to promote recovery from high-level endurance performance training (and feels great during the cold winter months).

As spring approaches, I look forward to shedding the layers in comfortable running conditions, seeing everyone out on the pavement and seeking a personal best in the half marathon!


Britt Gunsser

Britt Gunsser, DPT, OCS, CSCS, is a board certified orthopedic clinical specialist and dry needling specialist. She is a certified RRCA Running Coach who has run multiple marathons and half-marathons.

Meet Britt

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How athlete screens prepare a team for their season

How athlete screens prepare a team for their season

How athlete screens prepare a team for their season

Athlete screens are essential to mitigating the risk of injury and optimizing performance prior to a season. Here's what one coach had to say about the process.

Mar 17, 2022 | Performance Optimal Health

How athlete screens prepare a team for their season

Athlete screens are an incredibly useful tool in helping mitigate the risk of injuries, optimize movement and maximize performance — just ask Ray Marschall, coach for the Greenwich High School Boys’ Tennis and Soccer teams.

Ever since he started coaching 13 years ago, Ray has dealt with athletes starting off their seasons with injuries. Years ago, at the soccer team’s first match, nine of the roster’s players were injured, the majority of whom had quad and hamstring strains. And in tennis, he’s seen too many early-season shoulder injuries.

“There’s little reason for healthy and fit teenagers to have those types of injuries,” Ray said. He started thinking about how to prevent future injuries and decided to develop an off-season training program to help the players be in shape and ready for future seasons.

The following year, only three athletes started the season off with an injury.

Recognizing a need for injury prevention programming

While Ray was able to lower the number of athletes who started off their seasons with injuries on his own, three was still too many. Over the years, he has realized the need for preventative care; teenagers often find it difficult to keep up with the changes their bodies experience as they mature and gain muscle mass and strength.

“From a coaching perspective,” Ray said, “I really don’t want any player to have an avoidable problem at the start of a season.”

So when Ray, who himself has done physical therapy at Performance multiple times, found out that Performance Optimal Health offered athlete screens, he jumped (well, jumped is a bit of exaggeration given that he’d just come off his second hip replacement surgery!) at the chance to help his athletes. “This was a great opportunity for my guys to hear honest, unbiased and professional medical feedback about their physical strengths and limitations and learn how to listen to and take care of their bodies,” he said.

What is an athlete screen?

For twenty years, our team at Performance has worked with youth athletic teams in Connecticut and New York to maximize player performance, optimize competition readiness and minimize injuries through sport-specific training and injury prevention programming.

Athlete screens are an essential part of this effort; we screen teams in our communities right near the end of their off-season to ensure they are prepared for the season ahead. Every athlete’s readiness and physical state is unique, requiring personalized prescription for training and recovery. Our team of specialists perform a set of functional movement screenings on each athlete to evaluate the following key performance areas:

  • Speed and agility
  • Endurance capacity
  • Power output and strength
  • Mobility and range of motion
  • A results report and personalized action plan is provided to coaches, parents, and athletes, detailing areas of risk and areas for optimization.

“The goals are to analyze the requirements of athletes to move and perform within the demands of the sport, and then inspect each deeply. From there, we identify if there is pain or dysfunction that needs to be addressed. Finally, we provide recommendations to help address the issues picked up on the screen,” Shane Foley, DPT, said. Shane is the Greenwich Site Lead who develops athlete screens for the Greenwich community and led the charge with the most recent screen for the Greenwich High School Boys’ Tennis team.

Paving the way forward

Ray was pleased with the results of the screen, to say the least. “The consistency Shane Foley and the other physical therapists provided was terrific. They’re always completely focused on the physiology and what is best for each patient or athlete,” he said.

Now, he hopes that his athletes will be able to take the results and recommendations from the screen and apply them in their play. By looking at the results “in the green,” the athletes will know that they can continue doing what they’ve been doing. But what they will need to pay attention to are the yellow — and especially the red — areas that need improvement.

The results are also helpful to Ray as a coach, who is eager to use them in his training. “I always ask the guys during tennis matches, ‘What’s working? What’s not? What do you need to change?’ I want them to recognize what’s going well, such as their forehand is solid today, but also recognize what is not working and why, like missing some deep overheads, which might be due to a lack of flexibility or upper body strength, all the while using Performance’s recommendations and exercises as a guide.”

“I really hope that at the end of the season, they will be able to look back and say ‘wow, that screen really helped me,’” Ray said. (He even hopes they’ll admit it to him, but he’s not holding his breath!)

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Improve your heart health with a Mediterranean diet

Improve your heart health with a Mediterranean diet

Improve your heart health with a Mediterranean diet

Mediterranean diets lower risk of cardiovascular disease; here's how to incorporate it into your daily nutrition.

Feb 24, 2022 | Francine Blinten, CNST

Improve your heart health with a Mediterranean diet

Heart disease is the leading cause of death for both men and women in the United States. There are several lifestyle factors that can contribute to cardiovascular and coronary artery disease, one of them being your diet.

Maintaining a healthy body weight with appropriate body composition is key. Even a loss of 5 to 10% of your body weight can have a significant and positive impact on your overall heart health. For instance, a 160 lb. female would have to lose only 8 pounds, and a 220 lb. male would have to lose only 11 pounds, to see clinical improvement.

Abdominal obesity is associated with an insulin resistant state that contributes to heart disease and other modern adult disease. Men should aim for a waist circumference below 40 inches, and women’s waists should be less than 35 inches.

Blood sugar, LDL cholesterol, HDL cholesterol, triglycerides, blood pressure and waist circumference form the dashboard of health. Keeping these measures in range is the basis of metabolic health.

The dietary pattern that best supports heart health is the Mediterranean diet. According to a landmark study conducted in Spain in 2013, among persons at high cardiovascular risk, a Mediterranean diet supplemented with extra-virgin olive oil or nuts significantly reduced the incidence of major cardiovascular events. Importantly, the results were independent of weight loss.

The elements of the Mediterranean diet are plenty of vegetables, fruit, legumes, olive oil, nuts, high quality protein and whole grains.

Here are ways to implement the Mediterranean diet:

Try to decrease saturated fats and trans fats in the diet. Choose monounsaturated and polyunsaturated fats (from olive and grapeseed oils, nuts, seeds, avocados, olives, flaxseed, and fatty fish). High LDL cholesterol levels can place you at risk for developing cardiovascular disease, and the type of LDL circulating in your blood matters. Oxidized LDL is increasingly recognized as a contributor to heart disease, vascular disease, and stroke. You may be able to prevent oxidized LDL by excluding trans fats from your diet, such as pastries, deep-fried foods, and potato chips.

Add more fruits and vegetables to your diet; produce is rich in antioxidants with natural anti-inflammatory properties that may help to reduce the oxidation of LDL.

Aim for 30 grams of fiber from a variety of foods. A diet rich in fiber has health benefits beyond cholesterol control: it helps control blood sugar, promote regularity, prevents gastrointestinal disease and helps in weight management. There are two types of dietary fiber:

  • Soluble fiber: Provides the greatest heart-health benefit because it helps lower total and LDL cholesterol. Good sources of soluble fiber include oats, oat bran, barley, legumes (such as dried beans, lentils and split peas), psyllium, flaxseed, apples, pears and citrus fruits.
  • Insoluble fiber: Insoluble fiber promotes regularity, adds bulk and softness to stools, helps with weight regulation and helps prevent many gastrointestinal disorders. Good sources of insoluble fiber include wheat bran, whole wheat and other whole grain cereals and breads, nuts and vegetables. Foods contain a mix of soluble and insoluble fiber. To receive the greatest health benefit, eat a wide variety of all high-fiber foods.
    Limit refined carbohydrates, sugar and sugar sweetened beverages which can contribute to elevated LDL cholesterol and triglycerides.

When incorporating protein, fill your plate with 2/3 plants and 1/3 protein, and try to include fish at least two times per week, such as this salmon dish. You can have pastured poultry two times per week, and if you eat meat, choose grass-fed cuts and aim for once a week.

People often think eggs are off-limits if they have elevated cholesterol, but that is not entirely true. You can still eat eggs, but I do not recommend fried eggs with bacon and cheese on a roll. Instead, choose eggs with sauteed vegetables.

If you tolerate dairy, have yogurt and small portions of cheese (size of two dice). I encourage having a few vegetarian meals each week, such as this sweet potato & black bean chili.

Sodium is necessary for cellular function, though Americans tend to overconsume it. The most common sources of sodium are deli meats, processed meats such as bacon and hot dogs, cheese, canned soups and fast food. If high blood pressure is an issue, I recommend using less salt and more herbs, spices and citrus to flavor your food.


Francine Blinten

Francine Blinten

Francine Blinten, CCN, CNS, is a firm believer of listening to your body's needs and creating a comprehensive diet that meets those specific goals. She uses lab results, medical history and the client's background to customize an appropriate eating plan.

Meet Francine

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Why you should care about your heart rate variability

Why you should care about your heart rate variability

Why you should care about your heart rate variability

Your heart rate variability can tell you a lot about your health, including stress levels, sleep quality, general readiness and more. Here's how to improve it.

Feb 24, 2022 | Michael Semancik, DPT, TPI-M2

Why you should care about your heart rate variability

You may have heard about a new metric in the health and wellness world: heart rate variability (HRV). Various wearables like the Oura ring, Apple Watch, FitBit and the WHOOP strap measure your HRV, making it more accessible for the average person. But what is HRV exactly, and how can it impact your health?

First, we need to understand resting heart rate (RHR). RHR is the number of heart beats per minute while, as the name suggests, you are in a resting state. The American Heart Association defines normal RHR for an adult is anywhere between 60-100 bpm, but this can be even lower in a trained individual (such as a high level marathon runner whose RHR rests typically in the 40s).

What is HRV?

While RHR measures the number of beats per minute at resting, HRV measures the fluctuation in time between successive heart beats. On an electrocardiogram reading, we will see a number of spikes within each heartbeat. First is PR interval (atrial polarization or activation), followed by the QT interval (ventricular depolarization and repolarization). Within the QT interval is the QRS complex, as seen in the large spike on the picture. The top of this spike is the R wave, and the distance between R waves is known as the R-R interval, which is then used to calculate HRV.

HRV RR Intervals

HRV can be a tough concept to fully understand, so we will break it down with this example:

Let’s say that your RHR is 60, meaning that your heart beats 60 times in 60 seconds. One would likely assume that if this is the case, then your heart is beating every second, or 1000 ms. However, your heart does not beat in a uniform fashion. One heartbeat could be 980 ms after the prior, the next could be 1050 ms after, the next 945 ms after, and so on. This is what heart rate variability looks like.

HRV RR Intervals 2

Sympathetic Nervous System

To understand HRV and what influences it, first we need to dive deeper in the nervous system as a whole. The nervous system is separated into two systems: the somatic (voluntary actions/movements) and autonomic (involuntary) nervous systems. For the purposes of this article, we will look more into the autonomic nervous system. The autonomic nervous system is what controls all the involuntary processes in your body, such as breathing, your heartbeat, digestion, etc. This is then further separated in the sympathetic and parasympathetic nervous systems.

This is the “fight or flight” response in your body; when activated it leads to an overall elevated level of activity and attention. This includes constriction of the blood vessels, dilations of the pupil, increase in blood pressure and heart rate, digestion slows down, etc.

Parasympathetic Nervous System

The parasympathetic nervous system is responsible for the “rest and digest” functions in the body. Conversely, heart rate and blood pressure decrease, digestion starts, etc. Lower parasympathetic activity is associated with multiple cardiac and chronic disorders.

What Influences HRV?

HRV is good measure of physiological readiness in the body. In a healthy, trained individual, there is a “tug of war” between the sympathetic and parasympathetic nervous systems. At times, the sympathetic branches will be more dominant and increase HR temporarily, and other times parasympathetic system will take over and decrease HR. When these are equally balanced, we then see a higher HRV variability, which means that your body is more ready to take on stress at any given point. If one of these systems starts to become more dominant than the other, then we will see less variability in the heart rate.

Here's an example:

If you are experiencing a period of higher stress, either physically (increasing training load and volume), or emotionally/mentally (high stress at home, work etc.), your sympathetic nervous system will be much more active even at rest, and will win this tug of war against the parasympathetic nervous system. Now, your sympathetic nervous system is constantly telling your body to maintain a higher RHR, which results in less variability of your HR.

What do HRV scores mean? What is a good HRV score?

HRV scores are highly individualized to the person, and differ based on age, fitness, or other intrinsic factors. It is more important to look at trends in your HRV over a longer period of time. A low trend can indicate that your body is not fully recovering; this can be due to stress, increased training load/volume, poor sleep, dehydration, etc. A higher trend means that there is better balance in your system, and your body is more “ready to go” at any moment, and can adequately adapt to its environment.

How can you use HRV to modify lifestyle, exercise?

HRV can be a very helpful tool in modifying your exercise routines and daily habits. This is a good tool to show to your physical therapist, trainer, or other professional to help modify your routine or program in order set you up for success.

If you are overtraining and not taking time to recover properly, you may see a downward trend in your HRV. You should:

  • Use this metric as a guide to incorporate more active recovery in your workouts
  • Focus on sleep and relaxation methods
  • However, in some instances, you may want to see a downward trend
    • If you are intentionally going through a high volume or high load training period, you may want to see HRV temporarily decrease during that period

If you are seeing an upward trend in HRV, that means:

  • There is better balance in your system
  • You can start to increase training load, but you should still continue to focus on activities that promote recovery

In order to improve your HRV, you will need to improve the balance between the sympathetic and parasympathetic nervous systems. In many individuals, the sympathetic nervous system is going to be more active compared to the parasympathetic nervous systems. Most of what we deal with is increases in work or home-related stress, poor sleep quality, poor nutrition, or increased training volume.

Strategies to improve input from the parasympathetic nervous system include:

  • Breath work/meditation
    • Relaxation methods that help bring down heart rate
    • Improve parasympathetic input to the body
  • Sleep
    • People who sleep six or less hours per night had lower baseline HRV values than those who slept more than 7 hours
    • Those with low sleep efficiency also had lower baseline HRV scores compared to those with high sleep efficiency
  • Clean eating
    • Foods that increase inflammation in the body will increase sympathetic nervous system activity
  • Hydration
  • Exercise
    • Increasing cardiovascular and muscular fitness will help improve HRV
    • HRV can also help guide exercise choices and help you get the most out of a session
  • Cryotherapy and cold-water immersion
    • Studies to show that whole body cryotherapy has a large influence on parasympathetic reactivation
    • Whole body cryotherapy elicits a high parasympathetic activity due to an acute sympathetic response
    • In one study, researchers found that HRV was likely to increase following one session of whole body or partial body cryotherapy

Michael Semancik

Michael Semancik

Michael Semancik, DPT, TPI-M1, is a physical therapist and certified dry needling specialist who works with young athletes, specifically with rowers, hockey players and football players.

Meet Michael

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Develop your wellness vision and set nutrition goals in the New Year

Develop your wellness vision and set nutrition goals in the New Year

Develop your wellness vision and set nutrition goals in the New Year

Learn how to create a compelling wellness vision that will help you achieve your nutrition goals in the New Year.

Jan 18, 2022 | Jacqueline Ballou Erdos, CCSD, CDN

Develop your wellness vision and set nutrition goals in the New Year

Fruit and nutrition goals for the new year written on a notepad
A wellness vision is a form of visualization, a tool that nutritionists, therapists, business coaches, and mental performance consultants use with clients. Visualization is imagining you at your best, achieving success. As you focus on the desired accomplishment, you imagine, in detail, how you would feel. You might imagine who would be by your side as well as the sights and sounds of the moment. For example, gymnasts may use visualization to rehearse their routines using good form and sticking every landing, while new entrepreneurs might visualize themselves running a thriving business.

A wellness vision is a general statement about what you want in the future for your health and well-being. A wellness vision can relate to physical, mental, emotional, or spiritual health.

Why create a wellness vision? Visualization increases the chances you will reach your health goals, such as eating healthier, transitioning to a vegetarian diet, increasing protein intake, etc. A compelling wellness vision guides short-term goal setting and reminds you why you want to make a change. After hearing of the many positive aspects of creating a wellness vision, you may be wondering how to get started. There are four main components of a wellness vision to consider as you begin:

  • What are your desired outcomes?
  • What motivates you? Why do you want to be your ideal self?
  • What obstacles may get in the way?
  • What strategies can you use to overcome such obstacles?

Ready to start? Here is what you should do:

1. Outline your vision: what is it that you want to accomplish? How will it feel? Think in detail about the what, where, when, and how related to the achievement.

2. Connect your vision to something that motivates you. This might be:

  • Your family: to have more energy to keep up with your grandchildren
  • To be challenged: to sign up for your first 5K road race
  • For better health: to improve your blood sugar or cholesterol levels

3. Brainstorm what obstacles might arise as you set out to achieve the goal. Think realistically here, given the demands of various priorities including work and family commitments. This could involve having to cook for multiple family members who all have different diet requirements, or not having enough time to prepare healthy lunch meals for when you eat at the office.

4. Remind yourself what strengths you have that will help you overcome obstacles. It might be helpful to think of what worked well in the past. Examples include planning your meals in advance, meal prepping or cooking with other family members who share your goals.

5. Think of how friends, family, colleagues, nutritionists, coaches, or others in your life can support you, and ask them for help.

6. Do not be afraid of making mistakes. Your path to achieving your wellness vision will not be perfect, but the important part is to not give up.

7. Set structured SMART (Specific, Measurable, Action-based, Realistic, Time-bound) goals along the way to stay on track, but allow room for flexibility as needed.

8. Review your vision from time to time and adjust to accommodate schedule changes or new priorities. Let’s say you want to include a snack prior to your evening workout to better fuel yourself. If you miss a day here and there, but have generally stuck to your plan, that is still an achievement. You can revise your goal to say on the days you had a larger dinner that already gave you plenty of fuel and protein, you can skip the snack.

9. Celebrate small achievements you make along the way to keep you motivated.

10. Set new goals as you meet your initial goals.

An example of a wellness vision is:

“I want to establish healthy eating habits and regular physical activity habits so I can be a good role model for my children.”

Reflecting on your wellness vision, you can better understand what you value and prioritize. Using your wellness vision, narrow down three things you want to accomplish in the next four months. Set a SMART goal for each.

Setting SMART goals can help you better achieve success in the long term. As you set SMART goals, remember to focus on behaviors you will change rather than outcomes. Additionally, stay positive. In other words, say what you are going to do rather than what you are not going to do to achieve your goal. Make goals powerful: say I will, rather than I will try.

Here is an example of a SMART Goal:

“I will make an appointment with a personal trainer and nutritionist this week to establish a strength training routine I will do once per week and get advice on how to adjust my diet to ensure I’m getting enough protein to supplement my training.”

How are SMART goals connected to your wellness vision? Weekly goals are stepping stones towards your vision. Some weeks, you may need to work more on a goal from the prior week. It may simply take more time to meet some goals compared to others. On other weeks, you may continue to have the same focus, but increase the intensity of the goal (number of minutes and days you walk per week, for example). In addition to setting weekly goals, it is also important to evaluate to what percent you met goals each week. If you meet your goal:

  • 85% of the time or more, it is time to increase the intensity or amount of the goal
  • 65-85% of the time, then stay with that goal for another week
  • 65%, ask yourself if the goal was realistic. Rewrite the goal to make it more realistic for your lifestyle

In addition to writing a wellness vision, some may find it helpful to have a physical reminder of the goal. Making a vision board and placing it in a strategic location in your home can help you remember each day why you want to make a change. You can easily put together a vision board using a poster or corkboard. It is up to you to decide what you put on the board, but choose things that will remind you of how you want to feel when you realize your vision. You might include inspiring quotes, magazine clippings, recipes, meaningful notes from friends, or photos of your family. You can also create a virtual vision board on Pinterest.

Keep in mind that a wellness vision allows you to map out long-term accomplishments, while weekly goals are the small steps towards achieving your overall vision. Stick to your plan, but adjust as needed!


Jacqueline Ballou Erdos

Jacqueline Ballou Erdos

Jacqueline Ballou Erdos, MS, RD, CCSD, CDN is a Registered Dietitian and Board Certified Specialist in Sports Dietetics. She is passionate about helping clients foster a lifelong, healthy relationship with food and their bodies, and works with her clients to create a custom plan that suits their needs.

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Preventing and treating common knee injuries in the winter

Preventing and treating common knee injuries in the winter

Preventing and treating common knee injuries in the winter

Learn about common knee injuries and what we can do before, during, and after to stay active and optimize your health during the winter.

Dec 15, 2021 | Jonathon Mendola, DPT

Preventing and treating common knee injuries in the winter

Much like the shocks in your car help soften your ride down the road, your knees absorb most of the shock during everyday activities and sports alike. Taking a look at winter sports in particular, we can all agree that the knees take quite a beating out on the slopes, the rink or on the court, making it all the more important to take care of them. With the winter sport season in full swing, we sat down with one of our doctors of physical therapy, Jonathon Mendola, to discuss common knee injuries and what we can do before, during, and after to help keep our clients active and optimize their health through the winter season.

What are the most common knee injuries that you see during the winter season?

During the winter, we tend to see an uptick in injury of the anterior cruciate ligament (ACL) suffered while skiing. This type of injury, can range from a partial tear of the ACL only, to a full rupture, sometimes even involving injury to the meniscus and/or the medial collateral ligament (MCL) within the knee. Other common winter sports injuries to the knee include fractured kneecap, or patellar dislocation, common in many winter sports.

What can clients do to help prevent knee injury?

Do we wait until we have engine trouble to change our oil or wait until our tires are flat to get new ones? Of course not! There are plenty of things that people can — and should — do to prevent injuring their knees. For starters, they can take a driver’s seat in injury prevention by meeting with a movement professional such as a physical therapist or qualified personal trainer to go through a movement screening in order to assess their overall functional movement mechanics and thus possible warning signs for potential injury.

What I think many athletes don’t realize is that just because you don’t have pain, doesn’t mean that you are in tip-top-shape. The most common areas for improvement that we see in the physical therapy realm are the hips and core. We often see that those clients who have either poor glute or core strength/endurance are often the ones who come through with injuries to their knees. This lends the question, “why?”

In an ideal world of biomechanics and kinesiology, our bodies are meant to move in a synchronous manor from one segment to the next; a chain if you will, from one link to the next. Here, the time old saying “as strong as the weakest link” rings true. With poor stability in the core or glutes comes poor transitioning of forces and control of load through the knees.

What should someone do if they have knee pain but do not think that they have an acute injury?

Sometimes we experience pain. There is nothing wrong with having some soreness after we go hard on the court are had a day full of moguls on the slopes; you earned that soreness! With that said, it is on you to make sure you give your body the recovery it needs after what you put it through. Recovery comes in many forms; while some may yearn for a good drink in the lodge/paddle hut, there are a few options I recommend to my clients.

Some simple low-tech options include Epsom salt baths, ice packs or sports massages. If you are a bit more adventurous or into tech, you may pair well with vaso-pneumatic compression devices such as Normatec, infrared sauna, or nitrogen-driven cryotherapy. Now while those are good for post activity recovery, it is also important for athletes to take things such as their nutrition, sleep and stress into account as these three factors play a huge role in the body’s capacity and speed of restoration on a global level.

What if a client falls while participating in their sport and thinks they hurt their knee? What should they do?

If a client suffers an acute injury, they should seek medical attention sooner rather than later. Depending on the severity of the injury, athletes can see a number of professionals varying from their primary care physician to a physical therapist directly. What many athletes don’t realize is that in many states, including Connecticut, a client can be seen by a physical therapist without a prescription from the doctor for up to six visits, which means you can get access to physical therapy much more quickly. One of the most exciting parts of my job is being able to be that catalyst to help clients not only get better but also to help them get into the right doctor for their injury — while some injuries can be handled without seeing one, there are often times when the right doctor is crucial to your recovery. At the end of the day, having a good team around you can make all the difference, whether you are working to prevent injuries or treat them.


Jonathon Mendola

Jon Mendola

Jonathon Mendola, DPT, PT, CSCS, is a detail-oriented physical therapist and certified strength and conditioning specialist. He is particularly interested in working with patients post-op.

Meet Jon

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Winter warm-ups anyone can do

Winter warm-ups anyone can do

Winter warm-ups anyone can do

Here are some simple winter warm ups that involve mobility work, dynamic stretches and activation exercises from our personal trainer.

Dec 15, 2021 | Brianna Clifford, CPT, CSCS

Winter warm-ups anyone can do

While warm ups are always essential parts of any workout, they are especially important during the colder months. With colder temperatures dropping, our tendons and joints tighten up, decreasing mobility and increasing soreness. But by stimulating blood flow through dynamic stretches and activating your muscles, you can lower your risk of injury.

Whether you play paddle tennis, hit the slopes on the weekend or simply go to the gym to exercise, make sure you warm up before you start your workout. Don't know where to start? Here are some simple warm ups that involve mobility work, dynamic stretches and activation exercises from personal trainer Brianna Clifford, CPT, CSCS.

Watch now >

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What is vertigo, and how can it be treated?

What is vertigo, and how can it be treated?

What is vertigo, and how can it be treated?

Approximately 40% of adults experience vertigo at least once in their life. There are various causes, all of which have varying levels of treatment.

Nov 1, 2021 | Ken Rubin, DPT

What is vertigo, and how can it be treated?

Approximately 40% of adults experience vertigo at least once in their life, with women being slightly more likely to get it than men. Vertigo is a sensation of spinning that can be associated with dizziness and feeling off balance. Other symptoms associated with vertigo are nystagmus (abnormal jerking eye movements) and nausea/vomiting. Contrary to what you may think, vertigo is not a condition, but a symptom of an underlying problem. Vertigo can be classified as central or peripheral based on the origin of the symptoms. Pathology originating from the cerebellum or brainstem are classified as central, while symptoms arising from the inner ear or the vestibular nerve are classified as peripheral.

Causes

Vertigo is often caused by a problem in the inner ear. The most common causes include Benign Paroxysmal Positional Vertigo (BPPV), Meniere’s Disease or Vestibular Neuritis or Labyrinthitis.

BPPV occurs when very small calcium particles called otoconia or canaliths are dislodged from their normal location (known as the utricle) and collect in the semicircular canals. These inner ear structures are responsible for sending signals to the brain about head position and movement relative to gravity. Malfunctions in this system can result in symptoms of vertigo. These symptoms usually last for a brief period of time and are related to changes in head or body position. While there is no well-known cause for this condition, and it can occur at any age however it is more common in older adults.

Meniere’s disease is thought to result from a buildup of fluid and changing pressure in the ear. This will typically result in episodes of vertigo that last longer than BPPV and are associated with tinnitus (ringing in the ears) and hearing loss.

Vestibular Neuritis or Labyrinthitis is related to an infection, usually viral, that results in inflammation in the inner ear around the nerves that allow the transmission of signals carrying information about head/body position to the brain.

Less common causes of vertigo include head/neck injury, brain tumors/stroke, migraine headaches and side effects of certain medications.

Treatment

Treatment for vertigo depends on what the cause. Oftentimes, vertigo will subside without treatment but vestibular rehabilitation is used in many cases to help strengthen the vestibular system and restore equilibrium.

Canalith repositioning maneuvers are recommended by the American Academy of Neurology to treat vertigo caused by BPPV. If your therapist diagnoses BPPV, he/she may treat you by taking your body through a series of movements that are designed to move the dislodged otoconia/canalith from the semicircular canals back to the utricle where they originated. Symptoms of vertigo occur during this maneuver but subside following. This should significantly reduce symptoms. Exercises that stress the vestibular system will be prescribed by your physical therapist following in order to “re-calibrate” your system.

Currently, there is no known cure for Meniere’s disease. However, you can take medications to treat the symptoms such as meclizine (for motion sickness) and promethazine (anti-nausea). Physical therapy is also recommended in the treatment of Meniere’s disease to improve vestibular function and balance. Alternatively, physicians can perform a number of injections to the middle ear such as dexamethasone (steroid) to reduce inflammation and mitigate symptoms.

If symptoms persist and are debilitating in nature, there are a number of surgical options available that are used as a last resort. One involves endolymphatic sac procedures, which decompress a part of the ear that is responsible for fluid levels. A shunt may also be placed to drain excess fluid that is causing symptoms. Yet another, labyrinthectomy, is a more aggressive procedure that removes the balance and hearing portion of the affected inner ear. Due to the invasive nature of the procedure, this is only performed in cases where the patient already has near or complete hearing loss.

Finally, some doctors may perform a vestibular nerve section, which involves cutting the nerve that sends signals about balance and movement to the brain while preserving hearing function. This requires general anesthesia and overnight hospital stay.

Vestibular Neuritis (or Labyrinthitis) has simpler treatments, including antibiotics, prednisone, and antihistamines as well as medications to treat symptoms such as dizziness and nausea.

Vestibular therapy

Vestibular rehabilitation is a common part of a multimodal treatment for various vestibular conditions including those mentioned above. Exercises prescribed by your physical therapist will be divided into three main categories: habituation, gaze stabilization and balance/postural control.

Habituation involves exercises that provoke symptoms using graded exposure to specific movements or visual stimuli. The goal is to provoke mild symptoms that allow the central nervous system to acclimate the body to the stimulus. An increase in symptoms should be temporary and return to baseline after 15 minutes.

Gaze stabilization is performed with the goal of improving visual acuity during head and eye movements. Common exercises include fixing your gaze on an object while repeatedly moving the object, your head, or both. Head movement can be vertical or horizontal. This can be progressed by changing the environment, body position, speed of movement and duration of exercise.

Balance or postural control exercises may be prescribed to improve steadiness during a variety of tasks in order to promote functional return to activities of daily living, work or leisure. After determining what aspects of balance are impaired, your therapist will provide exercises that are challenging — but safe — so that you are not at risk of falling. These can be progressed by introducing uneven ground, low lighting, narrow base of support, single leg standing, external perturbations, etc.

If you are experiencing vertigo-like symptoms, please contact your physical therapist to determine the appropriateness of treatment. They will be able to assist you in discerning the cause of symptoms, setting up a treatment plan, and referring to another provider if needed.

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How to burn more calories during your walks

How to burn more calories during your walks

How to burn more calories during your walks

Walking is a great way to burn calories, but there are ways to increase that caloric burn.

Nov 1, 2021 | Performance Optimal Health

How to burn more calories during your walks

(CNN)-It’s no secret that walking is good for you. Many of us are trying to get in those recommended 10,000 steps a day that our wearable fitness technology urges us to achieve.

But how many calories are we actually burning, and how can we get the most out of those steps?

There are a lot of different wearables and online calculators to assess how many calories are burned walking. However, they are not entirely accurate, research has shown.

Visit The Original Article >


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What it means to recover from a lack of sleep

What it means to recover from a lack of sleep

What it means to recover from a lack of sleep

Recovering from a lack of sleep takes longer than you'd expect — it can take more than a week to get back to your normal self. Here's why.

Oct 15, 2021 | Performance Optimal Health

What it means to recover from a lack of sleep

(CNN)— Yawning and exhausted from another night of little sleep? Congratulations, you have joined the multitude of people around the globe who suffer from sleep deprivation, a serious problem that can affect your mental and physical health.

Sleep problems constitute a “global epidemic that threatens health and quality of life for up to 45% of the world’s population,” according to World Sleep Day statistics.

But it’s easy to recover from that sleep deficit, right, especially if you’re young? A good night’s sleep or two – and certainly a full week of sleep – and you’re back to your fully functioning self?

Visit The Original Article >

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How an Oura ring prevented me from spreading COVID-19

How an Oura ring prevented me from spreading COVID-19

How an Oura ring prevented me from spreading COVID-19

The Oura ring's data tracking capabilities are powerful tools, and can even help you detect when an illness is coming on. And those tools helped a trainer realize he should get tested for COVID-19, ultimately preventing him from spreading the virus to others.

Oct 14, 2021 | Tim Vallely, CFSC

How an Oura ring prevented me from spreading COVID-19

oura ring

In a time of wearable technologies flooding our society, too much of anything can be detrimental. The constant tracking of daily steps, calories burned and heart rates are a few examples of how some of us may shift from being cognizant to overly reliant on data. I am a firm believer of using data in the correct context, whether that is for daily motivation or conducting an actual experiment. To each your own, as long as you are not becoming a captive to the data and your life is not being affected in a negative way.

As someone who lives an active lifestyle, I have become an advocate of proper sleep and the role it plays in recovery. Throughout my 20’s, I preached and foolishly practiced the mantra, “I’ll sleep when I am dead.” After learning from experts about the benefits of optimizing human hormones and that sleep is actually the most powerful, legal and free performance enhancer on the planet, I realized how wrong I was over the past decade. Being clueless on how I actually slept made me an easy candidate for the Oura ring.

And so I started tracking and analyzing my data, including my sleep. The third week of February — the week of my COVID-19 diagnosis — had promises of being a healthy one, or so I thought.

Monday

Activities consisted of the following: Two online clients along with a strength training session. I had dinner around my normal time of 6 PM and went to bed

How an Oura ring prevented me from spreading COVID-19
How an Oura ring prevented me from spreading COVID-19

Tuesday

Seeing these results, I felt good. I saw a client in person and had a second successful training day of the week. This was the LAST day I felt good before the virus took over in my body. Tuesday night, I woke up at 12:58 A.M. and was up until 3 AM. It was very unusual for me not to sleep through the night. I developed a constant postnasal drip causing me to clear my throat every 5 minutes. This was the first clue that something was wrong.

How an Oura ring prevented me from spreading COVID-19
How an Oura ring prevented me from spreading COVID-19

Wednesday

Big thing that caught my eye here was that my RHR (resting heart rate), which is usually around 43-45 bpm, was elevated to 50 bpm. Resting Heart Rate is the number of times your heart beats per minute when you're at rest, which is a good measure of your recovery. The lower your RHR is, the healthier your heart is, and the more efficiently it pumps blood. An elevated RHR can be a sign that there may be an issue. Your body may be reacting to a night out with drinks, experiencing stress, or fighting off an illness.

Another key factor in recognizing my body was under stress was the results of my Internal Body Temperature. Internal body temperature can rise after eating, drinking alcohol, exercising late or sleeping in a warm environment. With these results and listening to my body, I did not participate in any physical activities on Wednesday, thinking I should take it easy on my body and let it recover.

How an Oura ring prevented me from spreading COVID-19

Thursday

Thursday morning was the first time I felt uneasy after checking my results. After getting nearly eight hours of sleep, I was certain that I should have recovered from the previous two days, especially taking now a second consecutive day off from the gym. My RHR was still higher than usual with a steady increase in body temperature and the same nasal congestion symptoms I was dealing with the previous night. I racked it up to a minor head cold I get every winter.

Eight inches of snow fell in Westchester, NY on Thursday morning and subsided around 2 PM, when I went out to shovel the driveway. I noticed a little fatigue but again categorized that as the never ending shoveling that I have been doing for the last 30 days.

How an Oura ring prevented me from spreading COVID-19
How an Oura ring prevented me from spreading COVID-19

Friday

Although I slept for over eight hours, I felt physically lethargic and ill. For the first time all week, I had constant migraine symptoms. My RHR was elevated to 52 BPM, along with internal body temperature still being elevated. My HRV (Heart Rate Variability) was the last metric that plummeted and caused concern. Heart Rate Variability helps you keep track of your recovery status by comparing your two-week heart rate variability trend to your three-month average. Before going to train an in-home client, I decided to go and receive a COVID-19 test, thinking it was better to be safe than sorry. Within minutes, I tested positive.

By tracking my metrics and analyzing the worrisome data, the Oura Ring assisted me in preventing the spread of the COVID-19 virus. Nine months prior, I would have not only ignored my symptoms and labeled them as the “yearly cold,” but I would have also been blind to the important metrics (heart rate variability, resting heart rate, and internal body temperature) that I was able to track in real time. Without the Oura Ring, I am confident that unbeknownst to me, I would have spread the virus, putting clients, friends and loved ones in harm's way.

How an Oura ring prevented me from spreading COVID-19
How an Oura ring prevented me from spreading COVID-19
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Why do my muscles shake during a workout?

Why do my muscles shake during a workout?

Why do my muscles shake during a workout?

When you start to feel your muscles shake, you may feel like you can't finish your workout, but that doesn't mean you should stop. So what exactly happens when you start to shake?

Oct 14, 2021 | Nicholas DiMeglio, CSCS

Why do my muscles shake during a workout?

I know you’ve felt it before, that feeling when you’re in the last few seconds of a plank, or that last set of a hard workout and you’re trying to squeak out those last few reps. All of a sudden, you feel your muscles start to tremble and shake — and you’re not sure if you can finish what you’ve started. You wonder to yourself, why am I shaking like this and what can I do to keep it from happening?

To fully understand why your body reacts this way when you push outside of your comfort zone, you must think beyond the physical exercise and muscles themselves. The brain remains the commander in chief of the body and will dictate how to best accomplish whatever task is thrown its way.

Activate your muscles

When doing any sort of exercise, the brain first has to send a signal through the nervous system to recruit the muscle fibers needed to complete the activity. You may have heard of “muscle activation” as part of a warmup before doing heavier or more intense training. If your plan is to do squats in your workout, you will likely do lower-level exercises, such as glute bridges or hamstring curls, to start the process of recruiting muscle motor units.

Think of muscle recruitment like your favorite restaurant. How do they provide staff for the restaurant? Does the manager schedule the staff on a Tuesday morning? Or do they schedule the majority of their staff on Friday and Saturday evening? My guess is the latter. They need to have enough staff on hand during peak hours and fewer staff on hand during the slower parts of the day and week.

All hands on deck!

This is the same way that muscle fibers get recruited: on an “as needed” basis. The more strenuous the activity, the more motor units are needed to complete the task. As the exercise becomes more fatiguing towards the end of the workout, more muscle fibers have to step in to take the place of the other depleted motor units. This is where the shaking and trembling comes into play.

So, you’re in the middle of your plank and so far, so good. You feel comfortable and capable of holding the position because you have yet to tap into those reserved muscle fibers. Only half the staff are working since it’s a Tuesday morning and the restaurant isn’t packed. And that’s when suddenly things ramp up. You’re starting to fatigue; the lunchtime rush is starting to make their way through the door. So, you call on more staff, more muscle fibers start to get recruited and give the other fibers a break so they can recover. Your body shakes because your muscles are constantly alternating between states of contraction and relaxation to give you the best chance of finishing that minute long plank or last set of bicep curls.

How do you prevent these muscle shakes from happening? You keep pushing yourself outside of your comfort zone and embrace the shaking because that’s the moment where you get stronger. Training never gets easier, and it’s not meant to. Training is meant to constantly challenge you to be better than you were yesterday, so if that 60 second plank starts to seem less daunting, keep pushing past that until you find yourself outside your comfort zone once again.


Nicholas DiMeglio

Nicholas DiMeglio

Nicholas DiMeglio, CSCS, is a personal trainer at our Greenwich and New Canaan locations. He has a passion for sports, which led him to become a trainer, and he now seeks to quarterback his clients' care in order to help them succeed.

Meet Nick

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Why is there an increase in work-from-home injuries?

Why is there an increase in work-from-home injuries?

Why is there an increase in work-from-home injuries?

Though many Americans are working from home, there has been a seemingly counterintuitive increase in work-related injuries. The reason may lie in your commute — or lack thereof.

Oct 1, 2021 | Kiera Klaum, DPT

Why is there an increase in work-from-home injuries?

With recent events, working from home has become a new normal for many Americans. With this change, varying data has come to light amongst this massive lifestyle change. One would posit that working from home should result in no work-related injuries, right? Recent studies have hypothesized no, not really. Instead, we’ve seen a rise of injured in people working from home — but what is the culprit? What mistakes are we making?

Part of it may lead back to where we choose to sit. A recent survey taken by NuLab amongst 856 participants working from home during the COVID-19 pandemic found that about 40% are not performing their work duties from a desk, with almost 30% of them reporting working from their bedroom.

There is also a common thread between the common injuries being reported to me in the clinic from the working-from-home population, one of which being back and neck pain with onsets that become worse at the end of the day. Having the ideal ergonomic set up in your workspace at a desk is still only a part of the equation. (For more, check out our article on how to achieve proper workspace ergonomics.)

With fewer employees coming into the office and total step counts on your daily travels decreasing as you only move from one room of your home to another, the answer may be as simple as it seems: the culprit may be your commute — or lack thereof.

But what does your commute have to do with this? More than you may think. With decreased commute times comes decreased activity for all those working from home. Current medical research supports that decreased activity results in deconditioning of our bodies, which results in strength and endurance losses. Prolonged immobility within the first week is proven to result in a significant decrease in muscle mass, bone density and higher rates of reported pain.

Yet many situations arise with low levels of reported pain, not enough for someone to feel a need to for medical attention. Often, individuals avoid addressing the issue until the pain interferes severely with their daily functioning. For example, a person new to working from home may not have the appropriate desk chair and starts to feel pain in their lower back but ignores it while the pain is manageable or not always noticeable. Once the situation lasts for long enough, the pain increases and the person has no other choice but to seek medical attention, even if they manage to get a better chair.

Successfully managing pain early is proven to be a key component in recovery and decreased risks of developing chronic conditions associated with it. Being active, getting up and moving can do the body a world of good. Resistance exercise especially is proven to lead to greater muscle mass increases and increased quality of life. Standing up from your home set up and doing hourly walks are all examples of ways to better incorporate more movement into your daily life until normalcy is attained in your working environment.

And what does physical therapy have to do with all of this? Finding the root of the problem quickly and effectively can significantly decrease your risk of further issues. Don’t wait until it’s too late.


Kiera Klaum

Kiera Klaum

Kiera Klaum, DPT, is based out of the Darien office. She focuses on orthopedic physical therapy, has experience with post-operative and post-COVID care and has worked with people of all ages and backgrounds, including athletes.

Meet Kiera

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An injury that impacted more than just her shoulder: a client’s journey

An injury that impacted more than just her shoulder: a client’s journey

An injury that impacted more than just her shoulder: a client’s journey

When Lauren C. started to suffer from a frozen shoulder, it changed everything. Since the start of the pandemic, Lauren has been working with Jon Mendola in Darien to regain not just mobility in her shoulder, but to regain as much of her previous life and hobbies as she can.

Oct 1, 2021 | Jonathon Mendola, DPT

An injury that impacted more than just her shoulder: a client’s journey

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Finding the motivation to follow through with your home exercise program

Finding the motivation to follow through with your home exercise program

Finding the motivation to follow through with your home exercise program

It can be difficult to do your homework. Here's how to find the motivation to follow through with your physical therapy home exercise programs and make the most of your recovery.

Oct 1, 2021 | Danielle Pasquale, DPTDanielle Pasquale

Finding the motivation to follow through with your home exercise program

You’ve probably heard of physical therapy homework, or home exercise programs, before. A home exercise program is a personalized exercise program tailored to an individual, to be performed outside of the physical therapy clinic as a way to maintain progress during time away from the clinic. These programs are carefully designed to maximize recovery programs and allow you to continue to work outside of the clinic.

The challenge is that a home exercise program can be easily forgotten throughout the course of care and you may not be making strides towards recovery as expected, due to not being in the clinic. As physical therapists, it is our job to make sure you’re adhering to the program and performing it outside of PT sessions. So, the question is, how do we motivate you to perform your exercise program, and what steps can you take to make sure you stick to it?

Step one is to collaboratively create a plan and schedule. When faced with an injury, creating a routine is very important in the recovery process. At first, the plan may look like rest, ice and elevation. But then, the plan will need to evolve into something more challenging in order for you to return to where you were before the injury. Just like at the beginning of the process, it’s important to make the home exercise program an integral part of your routine.

Taking a look at your schedule with your PT and deciding what time of the day will be best to complete it is a good place to start. For example, if you prefer exercising in the morning, set aside 15 minutes before you get ready to do your program, rather than leaving it to the end of the day when you are tired.

Another important part of having an effective home program and sticking to it is making sure it fits in line with your goals. Informing your physical therapist about what is most important to you and what you want to get back to will help them design the best program for you.

For instance, if your goal is to return to golfing, the home exercise program should be designed to involve specific exercises that will strengthen or stretch the muscles needed to improve your golf swing. Sitting down and talking with your PT about how each of the exercises are directly related to helping you meet your goals will allow you to understand the “why” and motivate you to take the time to do it.

We don’t want these programs to feel like a job; we want you to try and have fun with it! If you’re getting bored of your same routine, switch it up. Instead of waking up and doing your home exercises right away, plan a different time in the day to do them or try going to a new place to do them. For people who enjoy nature, bring a yoga mat and do the exercises outside or at a park on a nice day. If getting a gym membership has been something on your radar, go get one and start your workout with your home program.

You can also take this as a time to decompress and manage your stress in life. Put on your favorite music, podcast, tv show or even meditation audio and make the time you do your exercises a peaceful time. There are so many ways to make it an enjoyable time, so find what you like to do and incorporate your exercises into that!

Finding the motivation to perform a home exercise program can be challenging. Understanding why you’re doing each activity and how it can benefit you will help to create the drive needed to reach your goals. Work with your therapist to develop a plan and program to help keep you on track and allow for long term outcomes. Have fun with it and find ways to make it something you enjoy!


Danielle Pasquale

Danielle Pasquale

Danielle Pasquale, DPT, is a physical therapist based in Greenwich. She strives to create a collaborative environment with each patient, ensuring they feel equally involved in their care.

Meet Danielle

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The four best running belts

The four best running belts

The four best running belts

With Autumn in reach, it's time to stop using treadmills and take advantage of the cooler weather and take your runs outside. Here are the four best belts to make sure you can still have your essentials on your runs.

Sept 15, 2021 | Performance Optimal Health

The four best running belts

A running belt lets you bring your phone, keys, and even water on a run while keeping your hands—and pockets—free. A good one does its job with zero bouncing or discomfort. We tested 37 belts and bands to find those you’re likely to notice the least while logging miles. We recommend the SPIbelt Large Pocket for daily runs. If you want an everyday belt with more pockets, we like the Nathan Adjustable-Fit Zipster. The waistband-style Naked Running Band is our pick for runners who need added capacity, and if you want a belt with two water bottles, we think the Nathan TrailMix Plus is the best.

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Want to stop procrastinating your bedtime? Here's how

Want to stop procrastinating your bedtime? Here’s how

Want to stop procrastinating your bedtime? Here’s how

Ever delay going to sleep? It's not uncommon to find that the only "me time" you can get is at night, but it may do more harm than you think.

Sept 15, 2021 | Performance Optimal Health

Want to stop procrastinating your bedtime? Here's how

Celeste Perez could have been asleep. But at 2 a.m., she was puttering around in her bedroom-turned-beauty salon: First, she rolled a microneedling device around her face to improve her skin tone, and then she shaped her eyebrows with a laminating treatment. At 3 a.m., Perez, 34, embarked on a Wikipedia treasure hunt, spinning down a rabbit hole of things that she urgently had to know more about: the definition of multipotentiality, Mariah Carey’s discography and Cleopatra’s beauty remedies.

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Could the pandemic be hurting your pelvic floor?

Could the pandemic be hurting your pelvic floor?

Could the pandemic be hurting your pelvic floor?

With people sitting at their desks more often and feeling more stress during the pandemic, there's been an increase in pelvic floor issues. Here's why — and some tips to help.

Sept 1, 2021 | Performance Optimal Health

Could the pandemic be hurting your pelvic floor?

The coronavirus pandemic has been blamed for a rise in mental health conditions, weight gain, broken toes, skin picking and dental issues. But, according to physical therapists and urologists, it also may be responsible for problems in an often-overlooked part of our bodies: the pelvic floor.

Located at the base of the pelvis, the pelvic floor consists of a group of muscles that provide support for internal organs, including the bladder, rectum, uterus and prostate. The muscles are also involved in posture, urination, bowel movements and sex.

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Time to meal prep: vegetarian breakfast burritos

Time to meal prep: vegetarian breakfast burritos

Time to meal prep: vegetarian breakfast burritos

This is the perfect breakfast burrito recipe for people on-the-go, large families and vegetarians. Delicious and packed with protein and healthy fats!

Sep 1, 2021 | Jacqueline Ballou Erdos, CCSD, CDN

Time to meal prep: vegetarian breakfast burritos

As a registered dietician specializing in sports nutrition and pediatrics at Performance Optimal Health, I love to share quick and nutrient-dense meals for people on-the-go. I recommend this recipe frequently because it’s delicious and it contains all the elements of a balanced, satisfying breakfast: some carbs, fat and protein. They can be made ahead and frozen, so it makes for a fast, easy breakfast with a little bit of prep time. Perfect for after a workout, before school or during a busy workday! This recipe is originally from “Run Fast Eat Slow” by Shalane Flanagan and Elyse Kopecky.

Makes 6 servings.

Ingredients

  • 1 tablespoon olive oil
  • 1 bag (6 oz) baby spinach (about 4 packed cups)
  • 10 eggs, beaten
  • ½ teaspoon fine sea salt
  • ¼ teaspoon ground black pepper
  • 6 burrito-size whole grain tortillas (about 10 inches)
  • 1 ½ cups grated Gruyere or other favorite cheese
  • 1 ½ cups black beans or 1 can (15 oz) chili beans

Recipe

1.Heat the oil in a large nonstick skillet over medium heat. Add the spinach and cook until just wilted. Add the eggs, salt and pepper and cook, stirring continuously, until scrambled. Remove from the heat.
2.Place each tortilla on a 12 x 12-inch sheet of aluminum foil and sprinkle with ¼ cup of cheese. Divide the egg-spinach mixture among the 6 tortillas, placing in a strip down the center of the wrap. Top each with ¼ cup of the beans.
3.Roll up each tortilla like a burrito by folding in the tops and bottoms, and wrap tightly in the foil. Place together in a gallon-size freezer bag and freeze for up to 2 months.
4.To reheat, unwrap from the foil, place on a microwaveable plate, and microwave on high for 2 to 3 minutes, rotating after 1 minute, until warm in the center.


Jacqueline Ballou Erdos

Jacqueline Ballou Erdos

Jacqueline Ballou Erdos, MS, RD, CCSD, CDN is a Registered Dietitian and Board Certified Specialist in Sports Dietetics. She is passionate about helping clients foster a lifelong, healthy relationship with food and their bodies, and works with her clients to create a custom plan that suits their needs.

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The myth of “no pain, no gain”

The myth of “no pain, no gain”

No pain, no gain, right? Wrong. While you may think soreness after a workout means it was effective, the pain may not be necessary for gains.

Sep 1, 2021 | Christopher Nolan, CSCS

I am sure many of us have all heard the phrase, “no pain, no gain” at some point in our lives. Whether it be from a coach, trainer or anybody attempting to motivate us during a workout or convince us to work through soreness during a subsequent bout of exercise. This leads to the notion that if we are not very sore following an intense workout, then we simply didn’t work hard enough. The idea is that the soreness you are feeling post exercise is ideal and a great indicator of gains to come in the form of muscle growth (hypertrophy) and will lead to an increase in overall performance.

But what if I were to tell you that this in indeed simply a myth? Pushing through muscular fatigue and pain in order to achieve optimal gains not only has no evidence to support it, but could potentially show an adverse effect on your athletic performance. This does not only pertain to the athletes out there, but also to the general exercise practitioners. First, let’s tackle what exactly muscle soreness post-exercise and hypertrophy are, and if there actually is any direct correlation between the two.

Delayed onset muscle soreness

A common occurrence following bouts of new or vigorous physical activity is delayed onset muscle soreness (DOMS). DOMS is routinely recognized by individuals who regularly perform resistance training as one of the best indicators of an effective training session. Some view DOMS as a necessary precursor for muscle remodeling and growth. Soreness can become evident six to eight hours following a training session and peak approximately 48 hours post-exercise, but can be highly variable depending on factors such as exercise intensity, training status and genetics.

Hypertrophy is the growth of skeletal muscle in response to repeated bouts of resistance exercise. This will be characterized by an increase in the cross-sectional area of individual muscle fibers as well as the volume of the entire muscle. Force production (strength) is a function of the cross-sectional area of muscles, so the result of increased hypertrophy will include an increase in overall strength.

Can you train without pain?

The series of events which leads to muscle remodeling and growth following exercise is thought to be initiated by muscle damage. In a study of subjects performing an eight-week lower extremity eccentric resistance exercise program, Flann et al. aimed to investigate if muscle hypertrophy and strength gains were possible without the evidence of symptoms of damage.

They tested two groups of participants (14 healthy college students, eight males and six females, of equalized age, sex, height, body mass, and quadriceps strength) who were separated into pre-trained and naive participants. The pre-trained group was initially introduced to a three-week ramp-up program to prep their body for the same subsequent eight-week resistance program that both groups would follow together.

Their results showed that both groups demonstrated significantly differing levels of muscle damage, with the pre-trained group having no demonstrable muscle damage throughout the eight weeks, whereas the naive group showed muscle damage well above normal levels and much greater levels of perceived muscle soreness. Even with the naive group presenting with more measurable muscle damage and perceived DOMS, both groups show equal gains in quadriceps muscle strength and size. Concluding that muscle damage and elevated levels of perceived soreness are not required for gains in strength and hypertrophy, therefore disproving the notion of “no pain, no gain.”

More pain, more loss?

According to Schoenfeld and Contreras of the Strength and Conditioning Journal, “high levels of soreness should be regarded as detrimental because it is a sign that the lifter has exceeded the capacity for the muscle to efficiently repair itself. Moreover, excessive soreness can impede the ability to train optimally and decrease motivation to train. Thus, the applicability of DOMS in assessing workout quality is inherently limited, and it therefore should not be used as a definitive gauge of results.”

Increased levels of soreness shouldn’t always be the desired result of bouts of exercise nor should it be used as a gauge of the effectiveness of a workout. However, DOMS is not necessarily a bad result and is very common amongst those participating in resistance training or long bouts of aerobic exercise. Increases in hypertrophy and force production can be achieved without the onset of DOMS or elevated levels of muscle damage. Don’t immediately think you didn’t work hard enough if you don’t end up sore following exercise sessions. Gains can be made without pain.

References:

Schoenfeld, Brad J. MSc, CSCS, CSPS1; Contreras, Bret MA, CSCS2 Is Postexercise Muscle Soreness a Valid Indicator of Muscular Adaptations?, Strength and Conditioning Journal: October 2013 - Volume 35 - Issue 5 - p 16-21.

Kyle L. Flann, Paul C. LaStayo, Donald A. McClain, Mark Hazel, Stan L. Lindstedt; Muscle damage and muscle remodeling: no pain, no gain?. J Exp Biol 15 February 2011; 214 (4): 674–679.


Christopher Nolan

Christopher Nolan

Christopher Nolan, CSCS, is a personal trainer and certified strength and conditioning specialist based in Westport. He is passionate about exercise science and sport-specific training, and is working toward a certification as a Functional Strength Coach.

Meet Chris

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Tips on avoiding joint pain during exercise

Tips on avoiding joint pain during exercise

Tips on avoiding joint pain during exercise

Experiencing joint pain during exercise is not inevitable. Here are some tips on how to keep your joints moving, loose, fluid and pain-free.

Aug 15, 2021 | Carter Bushway, CPT, CSCS

Tips on avoiding joint pain during exercise

The joints in your body are made up of muscle, cartilage and ligaments that connect your bones together and allow for all the movement your body needs to perform throughout the day. On an average day, these movements go on without a hitch. However, there are days where you can feel every move you make, and those joints feel like they need a whole quart of oil to function properly. Let’s take a quick dive into how and why those days happen, and what you can do to help prevent and manage those symptoms.

Joint pain can be a result of a few primary causes:

1.Arthritis – Swelling, pain, decreased range of motion and stiffness in the joints are the most common symptoms associated with arthritis. There are over 100 different types of arthritis and over 22.7 million people in the United States are affected by one of them (via the International Association for the Study of Pain, 2016).
2.Injury – Whether it is muscular, skeletal or ligamentous, any damage of the tissues surrounding the joint can cause pain.
3.Being overweight – Having extra weight for your body to carry around can result in an increased amount of strain and stress on the body and a significant amount of pain.

These primary causes can affect a lot of us via genetic predisposition, in which we have little to no control over. However, what we can control is how we manage this joint pain and protect ourselves from making it worse or getting the symptoms altogether. Often, we look towards the complete stoppage of activity to alleviate pain, but in recent years studies have shown that exercise can provide a great benefit to those experiencing joint pain by keeping the joints moving, loose and fluid.

Before you get started with any sort of planned exercise, make sure that you warm up properly. A 5–10-minute warm up routine will be crucial to not only your performance during the workout, but also your joint’s ability to perform all the movements you have ahead of you. This warmup should consist of lighter exercises that are a mini version of what you’ll be doing in the main part of your workout. For example, if you’re doing a strength routine for the day and have weighted squats planned, add in some bodyweight squats and a wall sit to help get those quads firing and put your hip, knee, and ankle joints in the right position. Sprinkle in 5 minutes of light conditioning to get your heart rate up (stationary bike is a great option to keep impact on the joints low) and you and your joints will be prepared for your workout!

Exercise selection is tricky for anyone, especially when given restrictions and having to think of workarounds for your joint pain. A lot of the time we tend to eliminate the more traditional exercises such as squats, hip hinging and planks and try to seek out the perfect exercise that gives us what we want without any sort of pain. But most traditional exercises can be modified to fit those needs and still protect those joints. Putting a wedge under your heels to help with ankle mobility during squats can help you put more emphasis on driving through your heels, which will result in less pressure on your knees. A half foam roller under your hands can help make your wrists more comfortable during push ups or plank variations. If you need help with modifying the exercises you want to do, consult a personal trainer or physical therapist for your exercise selection.

What is just as important as before and during exercise is what you do after, and this is where a few major steps can be taken to help improve your joint health. Don’t take your cooldown from your workout for granted, and always stretch to end the workout. It is a great way to steadily decrease your heart rate and decrease tension in your muscles post-workout, which will in turn increase overall joint range of motion. During that stretching, try to incorporate foam rolling into your cooldown routine. Foam rolling targets not only muscles, but fascia, which is the connective tissue that surrounds muscles and joints to keep them in place. Tightness of fascia in certain areas can results in restrictions and pain within the associated joints.

While all these adjustments you can make during your workouts will help with your joint pain, making that extra effort and taking care of your body between exercise sessions is just as important. Many times, we tend to isolate our activities and forget that everything we do effects everything we do. Improving on our recovery, nutrition and sleep will provide just as many positive benefits to our joint health as reshaping the way we exercise. Using a hot pack or sauna in between workouts will increase blood flow and loosen up tight muscles. Following an anti-inflammatory diet can improve your body’s healing response and reduce that chronic joint inflammation and pain. Getting those eight hours of sleep will allow your body to physiologically recover from that workout and be ready for the next day ahead. All these little things outside of the exercise can help improve our body’s response to the exercise and decrease the overall pain and discomfort many of us experience.

Joint pain can be inhibiting and frustrating for anyone who experiences it. We feel like we can’t do things that we used to be able to do, and that we must flip our lives upside down to meet the new expectations of our body. But there are some things that we can do to help maintain control, and keep doing the things we love to do, for as long as we love to do them. If you’re looking to do just that, start a conversation with your friendly neighborhood health professional, and we’ll get you on the right track!


Carter Bushway

Carter Bushway

Carter Bushway, CPT, CSCS, has a passion for sport-specific training, plyometrics and explosive movements, and is studying to become a Certified Strength and Conditioning Specialist.

Meet Carter

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How to overcome overtraining syndrome

How to overcome overtraining syndrome

How to overcome overtraining syndrome

Overtraining your body can lead to a variety of side effects as well as poor performance. Your body can only take so much without receiving any rest or recovery days. But you can come back from overtraining — with adequate recovery time.

Aug 15, 2021 | Brianna Clifford, CPT, CSCS

How to overcome overtraining syndrome

Intensity. Toughness. Unrelenting work ethic. When we think of these descriptions, we probably envision an uber successful professional athlete, a marathon runner, or even a bodybuilder. Generally speaking, these are positive terms that are associated with success. But what happens when these terms are taken to the extreme… when the intensity and frequency of training pushes the athlete past the point of recovery?

Effective training operates on somewhat of a bell curve. There needs to be enough stress (the aforementioned intensity and effort) on a body to create an adaptation or improve performance. However, constant overload doesn’t mean constant improvement. The body can only tolerate increased training when there is an adequate rest and recovery period. If the amount of stress continues to increase over a prolonged period, and the recovery is not adequate enough to keep up, performance results may diminish. If adaptations and progress begin to decrease, while training excessively the athlete may be experiencing overtraining syndrome.

Symptoms of overtraining can include chronic fatigue, mood swings, plateau in performance and trouble with sleeping. If left unaddressed, overtraining can even produce injuries such as stress fractures, sprains and strains or joint pain. Mental symptoms of overtraining include lack of concentration, lack of enjoyment in exercise or sport and decrease in confidence.

There can be a myriad of signs of overtraining depending on the individual athlete, but it remains true for all athletes that it is important to approach training from all angles. It’s not just the relentless physical effort that gets an athlete to achieve a goal, but the assessment of total physical and mental well-being that will ultimately progress them further. This is what separates the greatest of athletes from the rest.

So, how do we combat overtraining syndrome? The biggest factor is rest. Athletes may see improved performance by simply decreasing training volume. Training volume might be decreased by 50-60 percent, and in some cases the athlete may be asked to stop altogether for a brief period.

Aiming for seven to nine hours of sleep can also help with recovery. Turning down the thermostat, spending the last 30 minutes before bed phone-free, and making your sleep space as dark as possible are just a few ways to improve sleep quality.

Making sure you are eating enough to fuel intense workouts is an underrated tool in assisting with recovery. Working with a nutritionist can be a helpful step in making sure your macronutrient count is appropriate for the training goals.

Another approach is taking care of your mental health; perhaps monitoring time spent on social media, or maybe taking up meditation can also aide in recovery by helping you focus and relax.

Once you’ve recalibrated and when the time is right, you can gradually increase training back up, building in rest days and recovery periods. Finally, understand that overtraining is not strictly for professional athletes. If you find yourself unable to recover from extreme workouts, or start experiencing burnout, you may consider that overtraining is to blame. Working with your coach and finding a balance of proper stimulus, and adequate recovery will go a long way in achieving your fitness goals.

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Yes, you can treat tennis elbow without surgery

Yes, you can treat tennis elbow without surgery

Yes, you can treat tennis elbow without surgery

Surgery is not always the first solution to treating tennis elbow. There are numerous established treatments you can try instead, including physical therapy, dry needling and local cryotherapy.

Aug 1, 2021 | Ken Rubin, DPT

Yes, you can treat tennis elbow without surgery

"Tennis elbow,” or lateral epicondylitis, is a common condition that presents with pain and tenderness around the lateral elbow at the site of the common wrist extensor tendon. This condition is frequently associated with a backhand motion in tennis and forced wrist extension, hence its name. It is also common in people who perform repetitive gripping activities, such as manual laborers. In the first three months of symptom onset, the condition is associated with an acute inflammatory process taking place at the insertion of the common wrist extensor tendon as it attaches to the humerus. The extensor carpi radialis brevis is the most commonly implicated muscle. The pathology appears to be consistent with degeneration of the long extensor tendons near the insertion to the humerus when symptoms last greater than three months. Up to 20% of cases persist after one year.

Tennis elbow affects between 1-3% of the general population, 7.4% of industrial workers, and 40-50% of tennis players. People between ages 35-50 years old are at highest risk.

However, it is important to speak with your physical therapist or physician to rule out other possible causes of lateral elbow pain. One common differential diagnosis is radial tunnel syndrome. This is a condition where the posterior interosseous nerve is being compressed as it travels under the supinator muscle which will also present with lateral elbow pain.

The good news is that there are numerous established treatments for tennis elbow. Symptoms can often be managed conservatively with physical therapy, but in some cases medical intervention is indicated. These interventions include, but are not limited to, the use of non-steroidal anti-inflammatory drugs, corticosteroid injections, protein-rich plasma injections, or in rare cases, surgery. This article will focus on physical therapy interventions. Your therapist will be able to refer you to another medical provider if you are not appropriate for therapy.

There is strong evidence for the use of strengthening exercises in the treatment of tennis elbow. Specifically, eccentric strengthening of the wrist extensor tendons. Eccentric strengthening refers to loading a muscle with resistance while it is lengthening. Conversely, concentric strengthening refers to loading a muscle while it is shortening. In a study where subjects had symptoms for greater than three months, the group that was prescribed eccentric strengthening demonstrated a faster regression of pain and a greater increase in muscle strength when compared to a group that was prescribed concentric strengthening. These results were persistent through the 12-month follow up period. Your physical therapist can help guide you in how to correctly perform these exercises, how much volume to complete and the appropriate resistance to use.

Exercises prescribed by your therapist will not be limited to your elbow. Research supports the use of scapular and rotator cuff strengthening in the treatment of tennis elbow. Training the lower and middle trapezius muscles can assist with scapular stabilization that will reduce stress on the elbow when participating in gripping activities and racquet sports.

Various manual therapy techniques are supported in the literature as part of a comprehensive treatment for Tennis Elbow. These include deep friction massage (DFM) and dry needling (DN). DFM is a technique intended to increase blood flow to a tendon in order to facilitate healing by increasing the supply of oxygen transported to the tissue. The goal of DFM is to prevent abnormal fibrous adhesions and abnormal scarring. This has been shown to decrease pain and improve grip strength in patients with tennis elbow.

Dry needling is a procedure in which a physical therapist penetrates the skin with a thin monofilament needle to treat underlying myofascial trigger points to manage neuromusculoskeletal pain and movement impairments. Trigger points refer to tight bands of muscle that disrupt function, restrict range of motion, cause local tenderness or refer pain. When comparing patients who received dry needling in addition to standard physical therapy in the treatment of tennis elbow to patients without DN, the DN group demonstrates an increased rate of pain reduction. DN has also been shown to be comparable to corticosteroid injections for patients with tennis elbow and actually may be superior in terms of perceived benefit from the patient. Both treatments were shown to be effective; however, there was a significantly higher rate of adverse reactions to those treated with corticosteroid injections compared to DN.

Various modalities may be beneficial in treating tennis elbow in addition to exercise and manual therapies. Local cryotherapy has been demonstrated to reduce the intake of analgesics and improve physical activity levels on those being treated for tennis elbow. This is due to reduction in inflammation in the target tissue, amongst other physiologic effects.

In conclusion, tennis elbow is a common condition trademarked by lateral elbow pain that is oftentimes associated with repetitive gripping activities and racquet sports. It is important to see a physical therapist once symptoms present to prevent tendon degeneration, development of chronic symptoms and to establish a comprehensive program to address the underlying impairments. Your physical therapist will establish a patient-centered treatment plan consisting of progressive exercise, manual therapies and modalities to reduce pain and restore full function.

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Recovery: the forgotten element of a successful training regimen

Recovery: the forgotten element of a successful training regimen

Recovery: the forgotten element of a successful training regimen

People often overlook recovery and how it compliments — and accelerates — performance in whatever activity you partake in. Here are some ways that different recovery modalities can help facilitate a robust recovery program to match the intensity of your fitness program.

Aug 1, 2021 | Jordan James, CSFC

Recovery: the forgotten element of a successful training regimen

Over the past 25-30 years in the fitness industry, we have heard everything. From exercising at a moderate intensity for 150 minutes to how blood flow restriction can accelerate your rehab protocol, we are constantly fed with new information on how to tweak and improve our workouts. Yet many still face the same results and give up on their goals.

What people often fail to mention is the recovery aspect and how it compliments — and accelerates — performance in whatever activity you partake in. Here are some ways that different recovery modalities can help facilitate a robust recovery program to match the intensity of your fitness program and help you achieve your goals. Here are some different ways to implement recovery into your life:

Hydration: as sweat evaporates from your skin during exercise, it removes heat from the body, but you also lose body fluid. So, you need to drink fluid during exercise to replace the fluids you lose when you sweat. That way, you'll reduce the risk of heat stress, retain normal body function and maintain performance levels. Water plays a significant role in the process of recovery, from helping digest vital nutrients to repairing muscles damaged during exercise. Remember that our muscles are actually 75% water! It is recommended to have at least eight ounces of water within 30 minutes of exercise.

Normatec: An underrated form of recovery comes in the form of compression therapy. By using Normatec compression sleeves, you can accelerate recovery after exercise, allowing you to get back onto your feet more quickly. They can be used daily for 20-30 minutes, and come in the form of leg, arm and hip sleeved. Here are some of the researched backed evidence benefits when active individuals incorporate Normatec sleeves: reducing swelling and inflammation, speeding up muscle recovery, preventing delayed-onset muscle soreness, relieving muscle pain, improving athletic performance, and increasing flexibility and range of motion.

If you prefer more old-school methods of recovery, think about incorporating massages into your regimens. Massages that focus on techniques such as deep tissue can sooth your muscles, increase flexibility, reduce stress and reduce risk of future injuries. Another important component is reducing lactic acid buildup. During exercise, especially strenuous anaerobic exercise, the lactic acid levels can rise, causing fatigue, decreased blood flow to the area and elevated levels of soreness. A sports massage promotes recovery to these affected areas by flushing the lactic acid build up and circulating re-oxygenated blood.

It is also important to tailor your recovery approach to the type of workout you want to complete. For example, cardio-focused training, such as sprinting or long-distance running should be followed by Normatec compression therapy and cryotherapy to help eliminate toxins and decrease inflammation throughout the body. Stretching is also key here, both before and after a workout.

If you are focusing on strength training, it is essential to alternate high and low intensity and volume days to allow your body enough time to recover. An example of this could involve doing a heavy workout on Monday, following it up with a lighter workout with a focus on mobility and recovery on Tuesday.

If you want to take the next step in planning out your recovery, we recommend using a smartwatch, Oura ring of Whoop strap to track your body’s feedback. From examining your heart rate to tracking how your workouts affect your sleep, wearable technology can give you detailed insights into how your body performs and reacts to the stress of a workout. If you don’t have any of these devices, simply listening to your body and responding appropriately will make a difference. If you notice you are more tired after HIIT days, it may be helpful to schedule your rest day the day after you complete a HIIT workout.

At the end of the day, while there are some things everyone should do to recovery (hydrate, sleep, take a day off), ideal recovery programs vary from person to person. Trying out various methods and combinations can help you maximize your recovery — and your training. Don’t know where to start? A trainer or recovery specialist can help!

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Why good sleep is key for the USA Olympic team

Why good sleep is key for the USA Olympic team

Why good sleep is key for the USA Olympic team

Sleep affects performance, & when the athlete is traveling the globe, it is hard to come by. See how the USA team overcomes those challenges.

Jul 28, 2021 | Performance Optimal Health

Why good sleep is key for the USA Olympic team

Olympic athletes are famously meticulous. Their workouts are carefully structured, their diets carefully balanced – every move designed to maximize athletic potential, with nothing left to chance.

And sleeping is no different.

Visit The Original Article >

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Can a low-carb diet improve your heart health?

7 nutrition and training strategies Olympic athletes use

7 nutrition and training strategies Olympic athletes use

We can all learn from Olympic athletes' nutrition habits. From staying consistent to avoid fad diets, their advice comes from experience

Jul 15, 2021 | Performance Optimal Health

Can a low-carb diet improve your heart health?

It's no secret that becoming an Olympic athlete isn't easy. Seemingly superhuman genetics? That's status quo. An Olympianalso has to treat training like a full-time job—because it is, in fact, a full-time job at their level. And while their training and motivation to come out on top and bring a gold medal home may be a notch (or quite a few notches) above your level, the core strategies they follow aren't complicated.

Visit The Original Article >

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The training regimen that qualified Allyson Felix for the Olympics

The training regimen that qualified Allyson Felix for the Olympics

The training regimen that qualified Allyson Felix for the Olympics

To be the best of the best, you need to perform at peak performance, & Allyson Felix is well aware. Take a look at her intense training regimen.

Jul 15, 2021 | Performance Optimal Health

The training regimen that qualified Allyson Felix for the Olympics

The grueling training regimen in the pursuit of qualifying for Olympic Games is not meant to be done at a sustainable pace. It’s a carefully calibrated push to prepare to perform at peak levels.

But when the 2020 Tokyo Olympics were postponed until 2021 this past March due to the ongoing Covid-19 pandemic, four-time Olympian and sprinter Allyson Felix was at the height of her training. What exactly does that entail? How about three hours of endurance training on the track followed by two more lifting in the gym?

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What happens when an Olympic athlete overtrains

What happens when an Olympic athlete overtrains

What happens when an Olympic athlete overtrains

Pushing yourself too hard is no joke. When Olympic athlete Simone Manuel didn't get enough rest & recovery, overtraining syndrome hit her — hard.

Jul 15, 2021 | Performance Optimal Health

What happens when an Olympic athlete overtrains

OMAHA, Neb. — In an afternoon practice session last month in Palo Alto, the Stanford women’s swim team pounded through a vigorous freestyle set. Working with resistance equipment and then performing a grueling series of short-rest sprints, Greg Meehan’s team was pushing itself hard.

In an adjacent pool, Olympic gold medalist Simone Manuel was doing a much more gentle workout, and it ended early. This was a time of intense final preparation for U.S. Olympic trials, and Manuel wasn’t up for it. Something clearly wasn’t right, but the American record-holder, reigning world champion and Olympic gold medalist in the 100-meter freestyle wasn’t ready to discuss it at the time.

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How to enhance recovery through nutrition

How to enhance recovery through nutrition

How to enhance recovery through nutrition

At Performance, we take recovery days (and recovery itself) very seriously. But there’s an aspect of recovering after a workout that is often left out of the conversation: your meals.

Jul 1, 2021| Jacqueline Ballou Erdos, CCSD, CDN

How to enhance recovery through nutrition

At Performance, we take recovery days (and recovery itself) very seriously. But there’s an aspect of recovering after a workout that is often left out of the conversation: your meals. Well-designed recovery meals and snacks enhance training, reduce muscle soreness, improve performance in the next workout, and support the immune system.

It is especially important for athletes who are completing high volume or intensity training sessions, heavy lifting, working toward or participating in a competition, working out two to three times a day.

Recovery nutrition encompasses fluid, macro, and micronutrient replacement following a training session. A sound recovery nutrition protocol will allow athletes to optimize training adaptations and perform at their body's full potential in the next training bout, the next training block and year after year.

Recovery extends beyond the short-term recovery window immediately following training. An athlete's consistent day to day habits allow for nutrition to support improvements in performance. You can use the four Rs of recovery as guidance in approaching your recovery nutrition.

The Four Rs of Recovery

1.Replenish muscle glycogen (carbohydrate stored in muscle) following a training session. Aim for an intake of 30-60 grams of carbohydrates, or ~ 0.5 grams per pound of body weight.
2.Repair and regenerate skeletal muscle with high quality protein sources and key amino acids (e.g. leucine). Aim for a 15-30g intake of protein.
3.Reinforce muscle cells, immune function and central nervous system function with colorful and antioxidant rich foods (e.g. fruits, veggies, whole grains, fish, nuts, olive oil).
4.Rehydrate with fluid and electrolytes according to individual sweat lost during training. (Fluid Loss Calculator)

General recovery nutrition tips:

  • If working out twice per day, eat an initial recovery meal or snack, then follow-up with another within two hours
  • Include antioxidant-rich fruits and vegetables at meals and snacks
  • Eat regular meals and snacks every three to five hours, including a balance of carbs, protein, and healthy fats
  • Weigh yourself before and after workouts to estimate sweat losses and drink ~20–24 ounces fluid per pound lost
  • Include salty foods after workouts longer than two hours

Consuming nutrients within 30–60 minutes of training or competition can enhance nutrient delivery to muscles while heart rate and blood pressure are increased. It can also result in faster glycogen replenishment and initiation of tissue repair as well as support the body's metabolic switch from muscle breakdown to muscle building, all of which are key to recovering after a workout and making progress.

But while the body may be most responsive to nutrients in the hour or two after exercise, continuing to deliver the right nutrients for the next 24–48 hours fully enhances the training response as well and prepares you appropriately for upcoming training sessions. You should continue to repeat the ingestion of all these nutrients in well-balanced meals and snacks every few hours in order to achieve your total daily nutrient needs.

Recovery nutrition after light exercise

It is also important to note that your recovery nutrition is highly personalized. It should also depend on the type of training session, training volume and intensity, timing of your next session, body weight and your goals. If you are training for a competition, your nutrition intake will look different from when you are simply working out to stay fit and healthy, for example.

If someone is working out lightly, or even once a day and not completing intense workouts (e.g. skills/drills, yoga, stretching, recovery day, weight loss phase) the next meal or snack is sufficient to meet recovery needs.

As you work out more often or at higher intensities, it becomes more important to prioritize timing and the details of recovery nutrition post-workout.


RECOVERY SNACK IDEAS
Choose a food from protein column + food from carb column based on training session!

Protein: 15-20g

3/4 cup cottage cheese
2 string or slices of cheese
1 cube firm tofu
2-3 cooked eggs
2-3 oz. deli meat
1 1/2 oz. jerky
2-3 oz. fish, chicken, beef, pork
1/2 cup nuts or seeds*
4 tbsp. nut butter**
1/2-3/4 c. edamame
1 c. beans*
2 c. milk (cows, soy)*
1/2-3/4 cup plain Greek yogurt*

Protein: 20-25g

1 1/2 cup cottage cheese
1 1/4 cube firm tofu
3-4 cooked eggs
3-4 oz. deli meat
2-2 1/2 oz. jerky
3/4-1 cup nuts or seeds*
1 c. edamame
1-1 1/2 cup beans or lentils*
1 serving protein powder
2/3 c. roasted edamame
1 1/2 cup Greek yogurt*
3-4 oz. fish, chicken, beef,
pork

Carbohydrates: 15-30g

1 piece or cup fresh fruit
1/4-1/2 cup dried fruit
1 c. fruit juice
1 c. chocolate milk
1/2 cup oatmeal
1-2 slices sandwich bread
1 English muffin
1 granola or cereal bar
1 x 8" tortilla or wrap
1/2-3/4 cup rice or farro
1/2-1 cup quinoa, beans, lentils*
3/4 cup cooked pasta
1/2 cup applesauce

Carbohydrates: 45-60g

2-3 pieces or cups fresh fruit
3/4-1 cup dried fruit
2 c. fruit juice
2 c. chocolate milk*
1-1 1/2 cup oatmeal
1 bagel
2 English muffins
2 x 8" tortillas or wraps
1-1 1/2 cup rice or farro
1 1/2-2 cup quinoa, beans,
lentils*
1 1/2 cup cooked pasta

*Protein source contains as least 15g of carbs, carb source contains at least 10g protein
**High calorie protein source due to high fat content


Jacqueline Ballou Erdos

Jacqueline Ballou Erdos

Jacqueline Ballou Erdos, MS, RD, CCSD, CDN is a Registered Dietitian and Board Certified Specialist in Sports Dietetics. She is passionate about helping clients foster a lifelong, healthy relationship with food and their bodies, and works with her clients to create a custom plan that suits their needs.

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On your period? Here’s how you can maximize your training

On your period? Here’s how you can maximize your training

On your period? Here’s how you can maximize your training

Depending on which phase of your menstrual cycle you're in, you should approach your training — or recovery — differently.

Jun 15, 2021 | Jessica Klecki, DPT

On your period? Here’s how you can maximize your training

So, you started your period; great! Cue the tampon hiding in the sleeve trick, the constant paranoia of leakage and finding every excuse in the book to eat that extra piece of chocolate. It’s been happening monthly like clockwork (maybe) since puberty, but do you actually know what happens in your body during this phase of your cycle? That’s right, PHASE. Your cycle is more than menstruation itself (the bleeding part).

The average menstrual cycle spans anywhere from 21–35 days and consists of two phases. The first is the follicular phase, which begins the first day of your period and ends at ovulation. The second is the luteal phase, which begins at ovulation and ends on the first day of your period. Ovulation occurs around 12¬–14 days after menses (your period) begins. The length of these two phases can vary based on the length of your entire cycle and when ovulation occurs.

Many women find it helpful to track their cycles with a tracking app (Clue, Flo, Ovia) — and some smart watches even come with a built-in feature now! It’s important to note that usage of oral contraceptives or IUDs can alter your natural cycle length and its characteristics because they alter the hormone levels in your body.

Your cycle is dependent on these hormones. Estrogen and progesterone are both sex hormones responsible for the development and regulation of the female reproductive system. You can see how the levels shift in the images below:

On your period? Here’s how you can maximize your training

During the follicular phase there is a gradual rise in estrogen until ovulation. At ovulation, there is a steep drop in estrogen levels. Throughout the follicular phase progesterone levels stay relatively low.
Then, in the luteal phase, a sharp rise in progesterone occurs as estrogen levels stay low. If an egg is not fertilized and implanted, progesterone levels dip and shed the uterine lining, resulting in your period. If an egg is implanted, your progesterone levels continue to rise, pausing your cycle and preparing you for pregnancy, causing you to miss your period.

Higher levels of estrogen (follicular phase) prepare the body for ovulation and can have many effects on the body, including: increased glucose (sugar in the bloodstream for immediate use) usage, increased pain tolerance, increased tolerance to intense exercise, improved endurance and increased joint laxity (more mobility in joints). This means when estrogen levels reach their peak in our bodies we have more energy, recover quicker and can tolerate more before experiencing fatigue.

On the other hand, higher levels of progesterone (luteal) prepare the female body for when an egg is fertilized and implanted. These effects can include: increased fat storage, heart rate, breathing rate, glycogen (stored glucose for energy later) storage and joint laxity, as well as slowed muscle growth. Unlike peak estrogen effects, our bodies store more energy and tolerate less when progesterone peaks.

Since these hormones are affecting our performance, how can we use this information to our advantage?

The follicular phase (including your period week) is the time to train hard! Think higher intensity exercise including heavy/high intensity strength training and higher volumes for cardiovascular-based exercise (HIIT workouts, running, rowing, swimming, etc). Now is the time to reach for your personal best and really push yourself. We often avoid exercise during period week, but a little movement could be just what you need. You have enough energy stored from the luteal phase to fuel your workouts, and you may notice you are able to perform better than you thought!

The luteal phase is the time to rest and recover. If you feel like you’re dragging and are tired, listen to your body! Focus on lighter resistance exercises and low-effort cardio (LISS). This is the perfect time to take out your yoga mat or head outside for a walk.

While these are just a few tips to guide you, remember that Olympic gold metals, the U.S. Open, and NCAA championships have been won by women in all phases of their cycles.


Jessica Klecki

Jessica Klecki

Jessica Klecki, DPT, is a pelvic health specialist whose unique approach involves creating comprehensive treatment plans that incorporate various exercises, breathing techniques and stretching methods.

Meet Jessica

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Recovery spotlight: massage

Recovery spotlight: massage

Recovery spotlight: massage

While there are various methods of recovery, few have been around as long as massage. Here's the quick rundown on everything you need to know about the wonders of massage.

Anne Triano, LMT

Jun 15, 2021 | Anne Triano, LMT

Recovery spotlight: massage

“Massage.” The word itself sounds peaceful and calming. It’s derived from many ancient languages and cultures: from the French “massage,” meaning “friction of kneading” to the Arabic “massa,” meaning “to touch, feel or handle” to Latin’s “massa,” meaning “mass, dough.”
While those are simple definitions, the word today is actually easier to describe than to define. Massage is “the manipulation of the soft tissues (muscles, tendons, ligaments, fascia and skin) and joints of the body to gain a therapeutic response, aiding in the healing process, and promote relaxation and well-being.”

The practice of massage has been around for thousands of years. The power of touch can be so comforting, assuring and healing, something of high importance, especially in these current times. It is not fully known why massage has so many benefits, but the nervous system sheds some light on it. Our nervous system consists of two parts: the “fight or flight” stress response – our sympathetic nervous system; and the “rest and digest” parasympathetic nervous system, which brings balance to the sympathetic nervous system.

Massages bring balance to the nervous system

A massage can release endorphins by stimulating the autonomic nervous system. As the sensory receptors in our skin and muscles send messages through our nervous system, our brain will use that stimulation as a directive to find balance. As a result, massages decrease pain and stress as well as provide an increase in relaxation and calmness. For example, an athlete may experience sore muscles, and a massage can loosen up those muscles, balancing out the pain.

Many of us have life stressors, injuries, tight, tense muscles and general pain. Along with other modalities to assist these issues, massage can be an immensely helpful addition to relieve many physical and mental difficulties. Not only can massage help with physical issues, but there’s also proof that massage can help with anxiety and depression. Our lives are busy and can be complicated. Getting a massage can loosen tense, tight muscles after just 30 minutes on the massage table. Relief to specific areas are noticed and felt by the massage therapist during the session, allowing them to constantly react to the person’s body cues. Right after the massage, people will notice that they have less tightness, tension, and less pain. This relaxation, rest and recovery are signs of your parasympathetic nervous system doing its job.

Types of massages

You may think a massage is just a massage, right? Not so much. There are various types of massages that are used for different purposes. Each massage is tailored to the person’s needs, and it can be used to solve a variety of problems. A wellness massage can help you relax after a long day, relieving tension in your muscles. A medical massage can aid in recovery from injuries, surgeries or procedures. Similarly, a sports-focused massage, tailored for athletes, usually features a rigorous approach pre-events through increased movement throughout the session and applying deeper pressure, followed with a less rigorous approach post-events. However, each of these three types of massage have the same overarching goal: to help you recover.

Now that you know what the general massage categories are, let’s break them down further.

Wellness Massage

This type of massage is meant to aid in relaxation, reduce tense, sore muscles and to help calm the mind. There is usually a range of styles of massage focusing on the hand pressure, varying from light to deep. Many techniques are used to allow for the sense of relaxation and calm.

Medical Massage

When a client has a specific medical situation – post-surgery, post-injury or possibly experiencing general chronic pain or soreness, a medical massage can manage pain and discomfort. For example, a massage therapist can release the ropy bands in the shoulders or the areas around the surgical or injured site to help keep inflammation and soreness to a minimum. Hip replacements, rotator cuff surgeries and knee replacements are all common reasons to receive a medical massage.

Sports Massage

Whether you’re a young athlete, seasoned runner or a weekend warrior, any athlete can benefit from a massage to loosen chronically tight muscles or give the athlete pre-event energy by invigorating the muscles or release built-up tension in your muscles by applying deeper pressure. The goal is to give the sports-minded more energy for their sport or activity as well as help with relaxing their well-used muscles after any event.

The key takeaway? Massages have been used for centuries to relieve stress and aid in recovery. The benefits that massages provide for our nervous system can be used for many situations and reasons, making them a great tool for recovery.


Anne Triano

Anne Triano

Anne Triano, LMT, is a seasoned massage therapist who specializes in various massage techniques such as trigger point therapy, sports and deep tissue, Swedish and relaxation.

Meet Anne

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Craving plant-based protein? Try this warm lentil salad!

Craving plant-based protein? Try this warm lentil salad!

Craving plant-based protein? Try this warm lentil salad!

Looking for new plant-based recipe? Look no further! This warm lentil salad is a perfect blend of healthy fats, protein, plenty of nutrients and delicious taste.

Jun 1, 2021 | Francine Blinten, CNS

Looking for new plant-based recipe? Look no further! This warm lentil salad is a perfect blend of healthy fats, protein, plenty of nutrients and delicious taste.

Lentils, which make up the base of this dish, are an excellent source of calcium, zinc, potassium, magnesium and folic acid. They neutralize acids produced in muscles, support immunity and wound healing.

But the sunflower seeds are the stars of the show; they contain Vitamins A, B, D, E and K, calcium, iron, potassium, zinc, magnesium, omega 3 and 6 essential fats. These little seeds pack a punch: they are better sources of nutrients than most meat, eggs and cheese!

Serves four.

Ingredients

  • 2/3 cup uncooked green lentils, rinsed, no need to soak
  • ½ cup chopped onions
  • 1 tablespoon fresh lemon juice or vinegar
  • 2 tablespoon + 1 teaspoon olive oil
  • 2 cups water
  • 1 carrot, grated
  • ¼ cup pitted olives
  • ½ cup crumbled feta cheese
  • ¼ cup sunflower seeds
  • Salt and pepper to taste
  • 2 cups salad greens

Recipe

1.Simmer lentils and bay leaf in water for about 25 minutes or until tender. Drain and discard the bay leaf.
2.Sauté onions in one teaspoon olive oil in skillet over medium heat until softened, about 10 minutes.
3.In a large bowl, gently toss lentils with onions, grated carrots, olives, feta cheese and sunflower seeds. Add lemon juice and olive oil and toss.
4.Serve over fresh salad greens.


Francine Blinten

Francine Blinten

Francine Blinten, CCN, CNS, is a firm believer of listening to your body's needs and creating a comprehensive diet that meets those specific goals. She uses lab results, medical history and the client's background to customize an appropriate eating plan.

Meet Francine

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Progress does not stop with age: how to train for life

Progress does not stop with age: how to train for life

Progress does not stop with age: how to train for life

Age-related declines in physical fitness and health are not a sure thing — here's how you can subvert expectations and stay fit as you grow older.

Jun 1, 2021Mathew Welch, ATC, CSCS

May 26, 2023 | Elisa LaBelle, PT, MSPT

Progress does not stop with age: how to train for life

“Oh yeah? Well, just wait until you’re my age…”

“That routine won’t work for someone in their 50s.”

“This is what happens! As you get older, things start to break down.”

  • How many times have you been told this from a friend, colleague or worse, a fitness or healthcare professional? Here are some cold, hard stats that matter:
  • Strength and muscle mass can begin to decline as early as age 30 — between 3–8% per decade. At age 50, these losses may exceed 40% and 15% (respectively) every decade after (1,2,3).
  • Adults can lose power 1.7x faster than their strength as they age (4).
  • Individuals with below-average grip strength in one study were 50% more likely to die earlier than their stronger counterparts. Researchers concluded, “muscle weakness is a serious public health concern.” (5)

What if I told you that these age-related declines in physical fitness and health are not such a sure thing as we have all been led to believe? A recent meta-analysis of 47 studies of individuals 50 and over showed after 18 weeks of strength training, the average increases in upper and lower body strength were 49% and 62%, respectively (6). Another meta-analysis observed older adults who performed full-body strength training and found that it is possible to achieve an up to 13.5% increase in lean muscle mass (7). In terms of power development, one study showed that older adults can improve their maximal muscle power by 51% after 12 weeks of explosive and ballistic resistance training (8).

This is evidence that you can still crush your fitness goals well into your 30s, 40s, 50s and beyond while mitigating pain or injury. In this article, I will debunk the myths associated with exercise and aging. I will also give you a fitness and recovery blueprint that will help you set clear training goals, train intelligently and optimize your recovery so you can build resiliency to train for a lifetime.

You’ve been lied to

Using health-related buzz words (HIIT training, circuit training, low carb, keto, vegan) or recommendations is common in popular men’s health-related articles and magazines. And they have large audiences who are prone to listening to what they say. The most popular magazines, Men’s Health and Men’s Fitness, reach an estimated 71 million readers worldwide!

However, you should be cognizant when implementing recommendations provided in these magazines and those alike. According to a study published last year, out of 160 recommendations made across several volumes by these two popular men’s health-related journals, only 38 (23.6%) were supported by available medical literature findings (9). This literature was extensively reviewed by a panel of health experts across multiple disciplines.

While I have nothing against these two magazines and acknowledge that they have incredible reach, I recommend you speak with a fitness or healthcare provider before implementing any medical interventions obtained from a magazine. At Performance Optimal Health, we pride ourselves on being teachers and scholars. That involves educating ourselves on current research and practicing what we preach so that we can be a credible resource to help you maximize your health and fitness!

The remainder of this article will serve as a blueprint for you to navigate the wild west of health and fitness in search of answers to help set you on the path of accomplishing your health and fitness goals.

Goal Setting

First stop — it’s time to set clear training goals. This means digging deeper than “tone-up” or “get back into shape.” The biggest issue with goals like this is that they aren’t specific or measurable. As a result, you have no way of knowing whether your training is really working because there was no clear goal or process from the start. A better way to set training goals for yourself requires two steps. First, use the SMART method and then describe the skills or behaviors you will need to adopt that will help you accomplish this goal.

S – Specific
M – Measurable
A – Aggressive but Attainable
R – Realistic
T – Time-orientet

When you apply this method to the vague goal of “losing weight” it turns into:

“I will lose 10-pounds a month from today. I will do this by exercising 4–5 days per week and planning my meals at the beginning of the week. I will get 7–8 hours of quality sleep by adhering to a sleep schedule and use the heat sauna once every week on my off day for recovery.”

While this goal is clearly defined, we all know that life happens. It’s one thing to write down or verbalize your goal and how you will go about it, it is another to actually follow through There will be times when you are stressed, confused, frustrated and even exhausted.

Accomplishing your goal will require a balance of self-knowledge, task knowledge and grit. You must be honest with how much you are willing to give. You must be honest with how much you actually know about what it is you’re trying to do. If you don’t, consult a professional! Lastly, you must realize that failures are merely results. Understand that accountability, consistency, effort and the ability to learn from failures is the key to accomplishing any long-term goal.

Training principles

When it comes to training, progression and overload are the name of the game. More reps, more sets, more weight, more difficult exercise variations, completing a workout in a shorter period of time (training density) are all forms of these principles. However, training is not linear. If this were the case, we would all be squatting and bench-pressing thousands of pounds by now from cumulative increases over the years. Intelligent training involves manipulating specific training variables (volume, intensity) based on training goals, experience and most importantly, your ability to recover.

Furthermore, diminished returns are inevitable when you have been training for several years. You will no longer reap the same benefits (muscle growth and strength) with the same methods you once used. If you’ve been doing the same fitness routine for the past 6 months, it’s unlikely you’re getting the desired results. Therefore, subtle variations in training methods and exercises over time are critical in keeping your body strong and resilient.

Given all this, however, more training does not always equal more results. You can only train as hard as you can recover! Training itself is a catabolic process (breaking down muscle fibers) while recovery is anabolic (improved tissue strength and resiliency). However, most people have no plan for the 23 hours they spend outside of the gym. Taking this into account, creating the right balance between exercise and recovery is a critical piece of how we approach our client’s programming at Performance.

Training program

A typical training program at Performance Optimal Health follows the R7 method created by Mike Robertson. This involves dedicating a specific amount of time to multiple fitness qualities: flexibility/mobility, dynamic movement, Corrective exercise, power, strength, conditioning and recovery. The amount of time dedicated to each component of the program depends on the client’s goals and current fitness level.

Even when considering injuries, we find a way to maximize each client’s 60-minute session incorporating all of these components. As you age, you don’t have to stop doing certain exercises, methods or trade strength training for pure cardio. In fact, the research tells us we should be doing everything we can to stay fit for life by balancing the qualities previously mentioned. Here are some examples of one of our awesome clients, Paul Steed putting this on display:

Remember, progress does not stop with age. There will always be room for improvement, but no room for excuses.

Refrences

1. Volpi, Elena et al. “Muscle tissue changes with aging.” Current opinion in clinical nutrition and metabolic carevol. 7,4 (2004): 405-10. doi:10.1097/01.mco.0000134362.76653.b2
2. Mitchell, W Kyle et al. “Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review.” Frontiers in physiologyvol. 3 260. 11 Jul. 2012, doi:10.3389/fphys.2012.00260
3. Keller, Karsten, and Martin Engelhardt. “Strength and muscle mass loss with aging process. Age and strength loss.” Muscles, ligaments and tendons journalvol. 3,4 346-50. 24 Feb. 2014
4. Skelton, Dawn A., et al. “Strength, Power and Related Functional Ability of Healthy People Aged 65–89 Years.” Age and Ageing, vol. 23, no. 5, 23 Sept. 1994, pp. 371–377., doi:10.1093/ageing/23.5.371.
5. Duchowny, Kate. “Do Nationally Representative Cutpoints for Clinical Muscle Weakness Predict Mortality? Results From 9 Years of Follow-up in the Health and Retirement Study.” The journals of gerontology. Series A, Biological sciences and medical sciencesvol. 74,7 (2019): 1070-1075. doi:10.1093/gerona/gly169
6. Peterson, Mark D et al. “Resistance exercise for muscular strength in older adults: a meta-analysis.” Ageing research reviewsvol. 9,3 (2010): 226-37. doi:10.1016/j.arr.2010.03.004
7. Fragala, Maren S., et al. “Resistance Training for Older Adults.” Journal of Strength and Conditioning Research, vol. 33, no. 8, 2019, pp. 2019–2052., doi:10.1519/jsc.0000000000003230.
8. Caserotti, P., et al. “Explosive Heavy-Resistance Training in Old and Very Old Adults: Changes in Rapid Muscle Force, Strength and Power.” Scandinavian Journal of Medicine & Science in Sports, vol. 18, no. 6, 2008, pp. 773–782., doi:10.1111/j.1600-0838.2007.00732.x.
9. Jalloh MA, Barnett MJ, Ip EJ. Men’s Health-Related Magazines: A Retrospective Study of What They Recommend and the Evidence Addressing Their Recommendations. American Journal of Men's Health, 14(3): 2020, doi:1557988320936900.

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The myth of the pre-performance “hype-up”

The myth of the pre-performance “hype-up”

The myth of the pre-performance “hype-up”

While some people think getting "hyped" before a performance is beneficial, it may actually have adverse effects and hinder performance.

Jun 1, 2021 | Riley Fitzgerald, Ed.M.

The myth of the pre-performance “hype-up”

For athletes, exercisers and performers of other varieties, the development of routines plays a critical role in optimal pre-performance preparation. Developed and executed properly, routines provide performers with a consistent approach for eliciting and leveraging the physical and mental states that set the stage for optimal performance.

We often think of pre-performance preparation as a light switch of sorts: either the switch is flipped and you’re ready to go, or it remains “off” and you aren’t. Further, we’re frequently taught that “ready to go” is synonymous with being hyped-up and ready to run through a wall (figuratively speaking, of course).

Hype can be detrimental

Though well intended, this conceptualization of pre-performance preparation is misguided and often does more harm than good. The truth is that optimal preparation is highly variable and individual in nature, requiring a more nuanced approach. While it’s true that some individuals perform well when hyper-activated physiologically and mentally, the reality for many is that this over-arousal elicits a detrimental stress response and negatively impacts performance as a result.

Physiological arousal is vital to performing well, as it allows us to harness resources from the body that are necessary for any type of vigorous activity. But at a certain point, activation of the body can turn into a stress response that becomes hindering rather than energizing. Hyperventilation, fast heart rate and heightened muscle tension are a few examples of the physiological consequences of over-arousal which, subsequently, are correlated with outcomes such as fatigue (1) and increased likelihood of injury (2).

Let’s also consider the psychological side of pre-performance activation and preparation. How we feel physically can influence our mood, where our attention is placed, as well as our thoughts and self-talk (3)†. While the emotions and cognitions that prime optimal performance vary from person-to-person (4), a general feeling of excitement is often described as a beneficial psychological state that is elicited by getting “hyped up.” Yet, when over-activated physically, feelings of excitement can quickly turn into cognitive stress, worry and doubt, among other less desirable mood states.

Identifying your sweet spot

Rather than viewing preparation and activation as the flip of a switch, it can be helpful to imagine the process as being more of a dial. Being “in the zone” looks and feels different for every athlete and performer. Take a look at the dial to the right. If a 1 means that you are so relaxed that you are on the verge of sleep, and a 10 is so riled up that your heart feels like it might jump out of your chest, what’s your optimal number before a game, match, lift or performance?

The myth of the pre-performance “hype-up”

Exploring the questions below can help us identify our sweet spot and begin to explore what it looks like, why it helps us and what we can do to get ourselves in that spot before we perform. If you’re having trouble, think back to a past performance where you performed well.

“When I feel prepared and ready to play, I am…”

  • Physically feeling?
  • Thinking about?
  • Saying to myself?

Take Control

With an understanding of what being in the zone looks like, we can start to assess our pre-performance routines. Maximizing routines requires an honest reflection of how we utilize our time before competition/performance. Here are a few things to consider:

"What am I doing before performing? Is this process consistent, or does it vary from performance to performance?"

Are the actions involved in my routine intentional? If so, what purpose do they serve?

  • When I’m above my sweet spot:
  • When I’m below my sweet spot:
  • What can I add to my routine that will help me reach my sweet spot number?

  • When I’m above my sweet spot:
  • When I’m below my sweet spot:

The dial can be a valuable tool for identifying and embracing our individual needs and preferences. This approach also highlights the fact that preparation isn’t always a matter of getting hyped up. Of equal importance is the ability to recognize when we are over activated and need to “dial down.” We can’t always hit our exact sweet spot prior to performing, but we can set ourselves up for success by intentionally nudging the needle in the right direction.

While some people can identify their sweet spot on their own, some may need additional guidance. One-on-one mental performance coaching is a great opportunity to learn more about stress regulation and to develop personalized, tailored pre-performance routines that can be replicated time and again to enhance your success.

†The mind-body relationship goes both ways. Over-activation of the body, as discussed previously, can influence our mental state. Our perceptions of the demands in front of us – the task at hand and whether we feel competent, our opponent, and so on – can likewise shape our physiological activation.

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How much does Russell Wilson spend on recovery?

How much does Russell Wilson spend on recovery?

How much does Russell Wilson spend on recovery?

Seattle Seahawks quarterback Russell Wilson takes his recovery seriously, spending about 1 million per year to keep his body healthy.

Jun 30, 2023 | Performance Optimal Health

How much does Russell Wilson spend on recovery?

Since being drafted in 2012, Seahawks quarterback Russell Wilson has never missed a start. When Wilson takes the field against the 49ers on Sunday, it will mark his 133rd consecutive regular season start, which is the second-longest active streak in the NFL.

The key to keeping the streak alive is two-fold: You have to play well so you don't get benched and you have to stay healthy. Based on the way Wilson describes it, that first thing might actually be easier than the second thing, because it appears the 31-year-old spends nearly all of his free time trying to help his body recover and trying to stay healthy.

Visit The Original Article >

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What in the world is pelvic physical therapy, and why have I never heard of it?

What in the world is pelvic physical therapy, and why have I never heard of it?

What in the world is pelvic physical therapy, and why have I never heard of it?

Even though it has been around for centuries, pelvic physical therapy is a largely unknown to the average person, preventing people from addressing common issues that are treatable.

May 1, 2021 | Jessica Klecki, DPT

What in the world is pelvic physical therapy, and why have I never heard of it?

I remember sitting in my penultimate semester of physical therapy school thinking (probably out loud if you know me), “wait, wait, wait, we can do what? Where? Why would anyone want to do that?”

Like many physical therapists, I started school with the goal of working with high-level athletes and the dream of working for a professional team. Oh, how dreams can change.

You’re probably wondering what possibly could have shocked me that far along into our physical therapy coursework. The moment in class I was referring to was, of course, the (very) short blurb that was the “intro to pelvic health” presentation that included a vague explanation of an internal coccyx (tailbone) mobilization technique.

This information rocked my world! It changed how I thought about my own body and it changed how I looked at physical therapy as a profession. That day, I realized we are so much more than just the rehabilitation of sports injuries, and I needed to know more.

So, what exactly is the pelvic floor?

Take a moment to consider your abdominal area as a soda can with the respiratory diaphragm as the top, your “core” muscles as the front and sides, and your back muscles as the back of the can. The can is still missing a very important component: the bottom!

Your pelvic floor supports the bottom of the can by providing a hammock, or bowl-like support, at the bottom of the pelvis. It has five very important functions:

1.Supports the internal organs
2.Sphincteric control of urethra and anus (urine and stool)
3.Sexual
4.Stabilization/core activation (completes the soda can!)
5.“Sump pump” for circulation/lymphatic system

Origins of pelvic physical therapy

Now, since no one knows about pelvic physical therapy that must mean it's new, right? Nope!

Some of the techniques used by pelvic physical therapists have been described in the ancient texts of Chinese Taoism 6,000 years ago. Hippocrates and Galen of Ancient Greece and Rome also taught pelvic floor exercises. However, these techniques were long forgotten during the dark ages until modern medicine received its first dose of pelvic floor-specific exercises.

Margaret Morris stepped up to the plate when she connected the importance of pelvic health to the overall health and well-being of her dancers. She published a paper in 1936 that introduced British society to pelvic floor physical therapy. Unfortunately, she is often overlooked in history. Many erroneously think the world was introduced to pelvic floor exercises by Dr. Arnold Kegel in the 1940s. While Dr. Kegel helped spread knowledge of pelvic health and his “Kegel” exercises, his techniques had been used around the world for centuries.

What does pelvic physical therapy look like today?

Today, pelvic floor physical therapy is so much more than just “Kegel” exercises. As pelvic floor/pelvic health therapists, we are musculoskeletal experts that specialize in the area associated with and within the bony pelvis. This includes the innominate (ilium, ischium, pubis), sacrum, sacroiliac joints, and coccyx. The pelvis houses the pelvic floor which is a region (not just one muscle!). We seek to see and treat the body as a whole and treat our clients as a WHOLE person. We are interested in how the gastrointestinal tract, reproductive, orthopedic, urologic, neurologic, and dermatological systems function together and how that affects your overall function and health.

The muscles of the pelvic floor are skeletal muscles. They behave just like other muscles in the body: they can be too short/tight or too long, or they can be weak and ineffective at their “jobs,” or they can even lack coordination. And did you know that eight out of 10 patients who are performing “Kegels” on their own are doing them incorrectly? Often this is due to poor proprioception (awareness of the position/movement of the body and its parts). It is hard to master the coordination of these muscles when you can’t see them working!

It's not just you — and you can get help.

Unfortunately, many of these pelvic health issues go untreated and undiagnosed because of one simple fact. It’s a little weird to talk about, but it shouldn’t be!

New moms in France are referred to a pelvic physical therapist immediately after birth and are insured for a minimum of 10 visits, which is obviously not the case in the United States. But it’s not just recent moms who are in need — there are many reasons to see a pelvic physical therapist. Common diagnoses treated by pelvic therapists include (but certainly are not limited to):

  • Incontinence (urinary and fecal)
  • Prolapse
  • Constipation
  • Vulvodynia and Vaginismus
  • Dyspareunia (pain with intercourse)
  • Coccyx pain
  • Diastasis Recti
  • Interstitial Cystitis
  • Polycystic ovary syndrome
  • Endometriosis
  • Chronic pelvic pain

Although talking about issues in the pelvic region can seem a little strange, and maybe even a little taboo at first, it is important to see how important this little area is to overall health and quality of life.


Jessica Klecki

Jessica Klecki

Jessica Klecki, DPT, is a pelvic health specialist whose unique approach involves creating comprehensive treatment plans that incorporate various exercises, breathing techniques and stretching methods.

Meet Jessica

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The importance of getting evaluated following a concussion

The importance of getting evaluated following a concussion

The importance of getting evaluated following a concussion

Concussions have not always been treated as seriously as they should have, but with new reports coming to light, people are starting to realize it is essential to start managing and treating concussions at a young age, especially for young athletes. Here's why.

May 15, 2021 | Robert Mahlman, DPT

The importance of getting evaluated following a concussion

Concussions have not always been treated as seriously as they should have. But with reports coming to light about the NFL hiding the full extent of the dangers of concussions, the public has come to realize it’s not something that should be ignored. It is essential to start managing and treating concussions at a young age, especially for young athletes, before the issue progresses.

What is a concussion?

A concussion, as per the Centers for Disease Control and Prevention, can be defined as a mild traumatic brain injury resulting from a blow or quick jar to the head which results in the brain rapidly moving back and forth. This back and forth motion results in a chemical cascade within the cells of the brain, which can result in rapid short-lived impairment of neurologic function. Symptoms can include dizziness, amnesia or loss of consciousness, headaches, fogginess, sensitivity to sound and light, difficulty with balance and various other neurological impairments; all these symptoms can develop in a matter of minutes or hours post-concussion.

The CDC estimates that 1.6 to 3.8 million concussions occur annually. Now, this is not meant to scare you from having your children play sports: a total of 60 million children and adolescents participate in sports annually and a total of 400,000 experience concussions. The actually scary statistic is that it is estimated that more than 500,000 children and adolescents that experience sports-related concussions are not treated in a health care setting. (Gaw and Zonfrillo 2016, Zogg et al 2018).

Diagnosis of concussion

To make some sense of all of this, let’s discuss how concussions are diagnosed and why it is important to perform a diagnosis in the first place. The first line of diagnosis in the on-field assessment, which is usually performed by a trained physician or athletic trainer. These clinicians will commonly use the Sport Concussion Assessment Tool, known as the SCAT 5, for on field/sideline assessments of athletes.

The SCAT 5 assessment has various components, with the most important being emergency assessment and stabilization of the athlete in serious situations. It also contains a cognitive assessment that examines the athlete's orientation and concentration. Based on an athlete's overall responses and symptoms, along with a balance assessment, the medical provider can properly triage the patient to the emergency department, hold them from the game or allow them to return to play.

Though the assessment itself is straightforward, the diagnosis may not be. In concussion literature, there is a strong emphasis on the recognition and diagnosis of concussions as soon as possible in order to promote healthy outcomes. After an athlete sustains a concussion, they should have a follow up evaluation by their primary care doctor who is familiar with concussion management and/or a concussion specialist. As medical providers know, no one truly presents the same symptoms, and this is especially evident with concussions.

Dr. Audrey Paul, MD, Ph.D., FACEP, FAAP, of Advanced Concussion Solutions works closely with our physical therapists. “Unfortunately, there is no single test that diagnoses a concussion. Concussion diagnosis involves a multifocal evaluation of several systems including the vision, balance, cognitive function and exercise tolerance,” Dr. Paul said. A proper initial evaluation also takes time, at least 30 minutes. There are also new tools becoming available that assist with concussion diagnosis and prognosis, including quantitative EEG, according to Dr. Paul which can make the diagnosis process more consistent. The in-office evaluation that will be performed by a physician and eventually a physical therapist will include a thorough patient history to discuss prior concussions, past medical history and background on the current concussion sustained.

Various factors have been shown to increase recovery time, including female gender, history of any anxiety or depression, dizziness, higher baseline symptom scores and history of migraines (Kutcher and Eckner 2010, Hou et al 2012). A concussion can present with a wide array of symptoms and impairments, so a thorough physical exam is necessary. This will include, but is not limited to, an examination of a patient's cognition, vestibular/ocular motor function, cervical spine, balance and blood pressure. Based on this information, a team-based approach can be taken to manage a patient following a concussive event.

A major change in the way concussions are managed is a transition to focusing on recovery and being active throughout the recovery period. A study by Schneider et al. 2014 noted that randomized athletes with sport-related concussions into three groups; standard rehabilitation (non-treatment), cervical spine rehabilitation and vestibular rehabilitation. In eight weeks, 73% of the treatment group recovered, while only 7% of the control (non-treatment) group recovered. Following a concussion, people can experience a major exercise intolerance which fortunately can be addressed with a targeted and patient-specific active recovery.

Concussion Treatment

Treatment for concussions initially revolved around rest and time to heal known as cocoon therapy. What we have learned over the last five years is that targeted active recovery is a better recovery method. A study by Thomas et al in 2015 took concussed students and randomized them into two groups: one to two days of rest or five days of strict rest. It was found that those in the first group recovered more rapidly than the strict five-day rest group. However, there have also been several animal-based studies that have looked at the use of exercise and activity too early in the recovery process, which had a negative effect on the body. What this tells us is that it all comes down to a balance, and recovery truly is patient specific.

Balance deficits and dizziness are found in up to 67% of patients with concussions. Athletes with vestibular based symptoms such as these are likely to have longer recovery times, sometimes up to six to seven times more likely to have a prolonged recovery. Alsalaheen et all 2010 found that athletes with vestibular symptoms that underwent physical therapy were significantly more likely to recover faster and return to sports sooner than those who did not.

Visual impairments, which include blurry vision, double vision, light sensitivity and abnormalities in eye movements, are found in 42% to 50% of patients following a concussion. About 92% of athletes with concussions also experience headaches. With a strong relationship to the cervical spine, physical therapy has been proven to be very helpful for the management of headaches in the concussed population. Lastly, the implementation of aerobic exercise when appropriate has significantly improved recovery time in adolescent athletes and decrease prolonged symptoms post-concussion.

As the athlete nears full symptom alleviation, they should be put through a combined battery of physical and mental tests that will promote a safe to return to sport. These can include vigorous treadmill and bike interval testing with the heart rate being monitored, sport-related agility and coordination drills and lastly mental/reactionary tasks layered in for specific cases. “Return to sport testing is essential for safe return to athletics to prevent a second concussion or an orthopedic injury. Current literature has shown that the best way to assess recovery is through heart monitoring and exercise tolerance,” Dr Paul explained.

Concussions are a major player in many adolescent athletes' lives. The medical profession has made great strides over the years to improve its diagnosis, examination and treatment of patients with concussions. Most importantly, we have learned that a timely and effective diagnosis and examination can decrease prolonged recovery and limit long term effects of concussions. And most importantly a patient centered active recovery leads to an earlier and safer return to play for athletes.

References

Alsalaheen BA, Mucha A, Morris LO, et al. Vestibular rehabilitation for dizziness and balance disorders after concussion. J Neurol Phys Ther. 2010;34(2):87-93.
Gaw CG, Zonfrillo MR. Emergency department visits for head trauma in the United States. BMC Emerg Med. 2016;16(5).
Hou RH, Moss-Morris R, Peveler R, et al. When a minor head injury results in enduring symptoms: a prospective investigation of risk factors for post-concussional syndrome after mild traumatic brain injury. J Neural Neurosurg Psychiatry. 2012;83:217-227.
Kutcher JS, Eckner JT. At risk populations in sport related concussions. Curr Sports Med Rep. 2010;9(1):16-20.
Schneider KJ, Meeuwisse WH, Nettel-Aguirre A, et al. Cervicovestibular rehabilitation in sports-related concussion: a randomized control trial. B J Sports Med. 2014;48:1294-1298.
Thomas DG, Apps JN, Hoffmann RG, McCrea M, Hammeke T. Benefits of strict rest after acute concussion: a randomized controlled trial. Pediatrics. 2015;135(2):213-223.
Zogg JK, Haring SR, Xu L, et al. The epidemiology of pediatric head injury treated outside of hospital emergency departments. Epidemiology. 2018;29(2):269-279.


Robert Mahlman

Robert Mahlman

Robert Mahlman DPT, PT, OCS, is the Physical Therapy lead at Performance and a certified Schroth therapist who specializes in the treatment of various orthopedic injuries, along with scoliosis and concussion management.

Meet Robert

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Recipe: Halibut Milanese for two

Recipe: Halibut Milanese for two

Recipe: Halibut Milanese for two

Get plenty of nutrients, indulge your pescatarian side and enjoy the fresh taste of this delicious halibut recipe.

May 15, 2021 | Francine Blinten, CNS

Recipe: Halibut Milanese for two

This recipe is one that I highly recommend to my clients. It is nutrient-dense, and contains omega-3 fats and high-quality protein. Arugula, endive and tomatoes round out the meal with a nice mix of vitamins and minerals, and it tastes great!

Ingredients

Halibut

  • 2 tablespoons olive oil
  • 12 ounces Fresh North Atlantic Halibut, no skin
  • 1 egg yolk, slightly beaten
  • ¼ cup Italian breadcrumbs
  • ¼ cup parmesan cheese, grated
  • A pinch of salt
  • A pinch of black pepper

Salad

1 large beefsteak tomato sliced
2 cups baby arugula
1/2 cup endive, sliced thin
1 tablespoon white balsamic vinegar
2 tablespoons olive oil
A pinch of salt
A pinch of black pepper
¼ cup shredded parmesan cheese
Lemon wedges, optional

Recipe

1.Preheat a non-stick skillet while you combine breadcrumbs and parmesan cheese in a bowl.
2.Season both sides of the halibut with salt & pepper.
3.Brush the top half with the beaten egg yolk. Lay the top half in the bread crumb and cheese mixture and press down.
4.Add the olive oil to your heated pan and place the top half of the halibut into the pan.
5.Sear for 20 seconds. You will see the breading on the outer edge of the halibut start to brown.
6.Flip the fish, turn the heat down to medium and allow it to cook 5–7 minutes.
7.Fan the slices of tomato on two plates.
8.Combine arugula, endive, vinegar, olive oil, salt & pepper. Lightly toss, and place in the middle of your tomato slices. Top with shredded parmesan cheese.
9.Divide the fish and place a piece on top of each salad. Lemon wedges optional.


Francine Blinten

Francine Blinten

Francine Blinten, CCN, CNS, is a firm believer of listening to your body's needs and creating a comprehensive diet that meets those specific goals. She uses lab results, medical history and the client's background to customize an appropriate eating plan.

Meet Francine

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Finding her way in the world of physical therapy

Finding her way in the world of physical therapy

Finding her way in the world of physical therapy

May 1, 2021 | Ashley Moriarty, DPT, OCS

Finding her way in the world of physical therapy

I wish I had a positive story of why I became a physical therapist – an injury I overcame, a family member who inspired me, a teacher who really pushed me, but my story is a little more negative (but it turned positive in the end!). I did in fact have physical therapy as a kid, but was it knee pain or shoulder pain, I can’t remember? It was boring and my physical therapist never talked to me. It didn’t really help, I stopped going, and I moved on with my life. Overall, a negative experience.

Exploring the world of physical therapy

Fast forward a few years to high school, college visits and thinking about the future. Physical therapy was always stuck in the back of my mind, but in a way that made me think, “physical therapy has got to be better than what I experienced.” I knew I wanted to work with motivated people and be constantly learning, with every day looking different than the last.

I started looking more into what physical therapy could be and jumped into a six-year program at Boston University. After many classes and clinical rotations and a first job, I kept thinking, “there’s got to be more than this.” Which is how I found myself at Performance, where it’s more than just physical therapy.

I’m lucky that I found a place where the team mentality is that physical therapy is just one aspect of care, one piece of the puzzle. Of course, sometimes physical therapy is the big puzzle piece, but sometimes it’s smaller one or just the first one. Sometimes it’s not even something that you’re missing. Either way, it’s a team approach to care, and everyone works together to connect with our clients and each other.

Never does a day go by that is filled with silence; I aim to make physical therapy a pleasant, welcoming endeavor where my client also sees me as a friend, helping them on their journey. Every day, I work hard so that I do not recreate my own experiences with physical therapy for others. I want to be the glue in their health puzzle, not just a part that may get lost.

Putting together the puzzle of health

And in helping my patients and clients put their health puzzle together, I’ve tweaked how I look at my own. It’s easy to say that optimal health is finding a balance between the four pillars (exercise, nutrition, recovery and stress management). It’s also easy to say that it looks different for everyone based on their individual goals and lives.

What’s harder to understand is that even for myself, the achievement of optimal health looks different day to day, year to year. Life is constantly changing and I am constantly adapting, so my journey toward optimal health should also be flexible. What I need today is not what I need tomorrow, and it may look completely different than what I needed six months ago and what I will need a year from now. I’ve learned rest days are good for you, and what you feed your soul is just as important as what you feed your body. Trying a new recipe, walking my puppy, catching up on The Bachelor, or getting a new personal record in a Peloton ride are all aspects of my optimal health.

My takeaway: find what’s important to you and for you, and get started today.


Ashley Moriarty

Ashley Moriarty

Ashley Moriarty, DPT, ATC, is a physical therapist and certified dry needling specialist based in New Canaan. Before joining Performance, she worked in Boston with both high school and collegiate athletes.

Meet Ashley

10 ways moms can support their daughters’ healthy relationship with food

10 ways moms can support their daughters’ healthy relationship with food

Top 10 tips on how moms can support their daughters (and sons) in having a strong, healthy relationship with food and their bodies.

May 1, 2021 | Jacqueline Ballou Erdos, CCSD, CDN

10 ways moms can support their daughters’ healthy relationship with food

A lot of times, the idea of achieving wellness is oversimplified, and boiled down into diet hacks and buzzwords that promise fast results. You know the ones I’m thinking about: keto, plant-based, intermittent fasting, gluten-free, clean eating, all-natural, organic. But in reality, health is complex and multifaceted, influenced by genetics, diet, activity level, sleep, stress, socioeconomic status, gender, education, access to healthcare, social support networks and the environment in which we live.

And what does this have to do with moms supporting moms and daughters? Having a daughter myself, I know how much she picks up on from what I say (for better or worse!) One of my mom friends and I were joking about how sometimes looking at our oldest kids interact with their younger siblings is like looking in the mirror.

Our daughters learn from us every day: they watch how we eat, take note of which foods we don’t eat. They hear the way we describe different foods, how we treat and talk about our bodies, and they feel the emotions that we feel in relation to eating, physical activity and our bodies.

Without trying to oversimplify this too much, these are my top 10 tips on how moms can support their daughters (and sons) in having a strong, healthy relationship with food and their bodies.

1. Focus on healthy habits like eating well and regular physical activity instead of tracking weight on a scale.

2. Drop the weight talk. Research shows parental weight talk (about their own dieting or weight) and commenting on their child’s weight is associated with an increased risk for the child of being overweight or having an eating disorder.

3. Eat as a family as much as possible. Eating family meals more throughout the week is associated with eating more fruits and vegetables, calcium-rich foods and fiber. Family meals offer a time for parents to role model healthy eating behaviors, and helps parents be more aware of their child’s eating habits.

4. Keep mealtimes pleasant. Avoid unproductive talk about food such as commenting on what your child is or isn’t eating or telling children not to take seconds.

5. Make eating well and being active a family affair. It’s good for everyone to eat well and include daily movement that’s enjoyable. Make healthy meals for the whole family including a balance of each of the food groups at each meal:

  • Protein-rich foods (chicken, fish, beef)
  • Whole grains or starchy vegetables (brown rice, whole wheat bread, whole wheat pasta or potatoes)
  • Vegetables and/or fruits
  • Fats (olive oil or butter, for example)
  • Water or milk

6. Serve meals family style and allow your child to eat until he or she is satisfied.

7. Ensure your child gets enough sleep – children and teens have different needs depending upon their age:

  • 3–5 years: 10–13 hours (including naps)
  • 6–12 years: 9–12 hours
  • 13–18 years: 8–10 hours

8. Have a plan for sweets, treats and sugary drinks. Don’t avoid sweets altogether, as when children are given the chance to eat them (at parties, friends’ houses), they are more likely to overeat them. Instead, limit the number of sweets and treats brought into the house, and aim for a balance of healthy foods 90% of the time and sweets and treats 10% of the time.

9. Don’t label foods as good and bad. It makes us feel bad when we eat “bad” foods. One alternative is calling sweets and treats “fun foods.”

10. Offer regularly scheduled meals and snacks every 3-4 hours for children and every 4-5 hours for teens. And limit meal skipping – skipping breakfast tends to lead to grazing throughout the afternoon and evening. Eat meals at the table, without distractions like TV or cell phones. Close the kitchen between meals and snacks. Routine, predictable meals and snacks help with appetite regulation and promotes healthy habits.

It starts with us, moms. You got this.


Jacqueline Ballou Erdos

Jacqueline Ballou Erdos

Jacqueline Ballou Erdos, MS, RD, CCSD, CDN is a Registered Dietitian and Board Certified Specialist in Sports Dietetics. She is passionate about helping clients foster a lifelong, healthy relationship with food and their bodies, and works with her clients to create a custom plan that suits their needs.

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How do I prepare for my COVID vaccine?

How do I prepare for my COVID vaccine?

How do I prepare for my COVID vaccine?

You may be wondering how you should best prepare for the vaccine to maximize its effects. Here's what you need to know.

Apr 14, 2021 | Performance Optimal Health

How do I prepare for my COVID vaccine?

As of this week, over 75 million people in the United States have been fully vaccinated, paving the way for a return to normalcy. With about 3.4 million going into arms each day, experts predict the country will achieve herd immunity by the fall.

You may already know friends, family, or even some of our team members who have already received their vaccines. You may even be counting down the days until you can get it, too. This may lead you to wonder how you should best prepare for the vaccine to maximize its effects.

What side effects may I experience?

The first thing you should be aware of is the likelihood of feeling side effects within 24 hours of receiving your dose. These often include pain and discomfort in the arm you received the shot, fatigue, fever, muscle pain, chills and nausea. However, some people may experience rare allergic reactions, which is why most vaccination locations ask people to sit and wait in a waiting room for at least 15 minutes after receiving your shot.

Effects also tend to intensify after receiving the second shot, so we recommend you schedule your second shot (if applicable) appropriately. Try to take it on a Friday or Saturday, or take a day of from work the day after. This will allow you to adequately rest and recover from any symptoms you may have.

Experiencing any of the common side effects is no reason to worry — it is just a sign that your body is working to build protection against the coronavirus. On the flip side, if you don’t experience any side effects, that does not mean the vaccine did not work: you will still be protected.

To alleviate any discomfort you feel in your arm, the Center for Disease Control recommends applying a clean, wet washcloth on the area and to move your arm around. The CDC also recommends drinking plenty of water and dressing lightly to combat fever. If any of the side effects persist after a few days, you should contact your healthcare provider.

Decreasing the severity or likelihood of side effects?

Now, in order to decrease the severity or likelihood of side effects, you should avoid drinking alcohol the night before and get a good night’s sleep to keep your body alert and well-rested the next day. You should also avoid taking anti-inflammatory medications leading up to the vaccine, such as aspirin, ibuprofen or other types of pain relievers. These medications may interfere with your immune response, weakening its reaction to the vaccine.

Other medications to look out for are steroids; if you take steroids for chronic conditions, that should not pose an issue. But if you are taking steroid injections, you should discuss taking the vaccine with your health provider first. Additionally, if you are also in the process of taking another vaccine, you should leave a 14-day buffer period in between taking the different vaccines. This will let your body mount an adequate response to both triggers.

However, most other medications are safe and will not interact with the vaccine, such as those for blood pressure, diabetes, asthma and other common conditions.

Next steps

Both the Moderna and Pfizer mRNA vaccines are about 95% effective at preventing COVID-19 two weeks after the second dose. However, this does not mean that all precautions should go out the window. The CDC still recommends against participating in medium or large gatherings, both inside or outside, as well as interacting with non-vaccinated people indoors without masks.

Yet the CDC also lessened other restrictions for those who are vaccinated: they are allowed to be indoors with other vaccinated people, for one. They can also visit other unvaccinated households whose occupants are not at risk of serious disease. Traveling domestically without a pre- or post-travel test is also an option, as well as not having to quarantine upon arrival. For a full overview of the CDC’s recommendations for people fully vaccinated, you can find out more on their website.

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Managing stress through yoga

Managing stress through yoga

Managing stress through yoga

Though stress can wreak havoc on your life, practicing yoga and improving your breath work can help manage it.

Apr 14, 2021 | Jerre Skeats

Managing stress through yoga

By Jerre Skeats

Stress is a fact of life. It’s never going to go away, not fully. We are inclined as humans to look for and create problems and stress. The bad news is that stress can be a killer. “Stress causes deterioration in everything from your gums to your heart and can make you more susceptible to illnesses ranging from the common cold to cancer,” according to the Association for Psychological Science's magazine Observer.

But the good news is that stress can be managed and regulated. Building a toolbox to manage stress in your life is one of the healthiest things you can do. Regular exercise, eating well and having strong social connections, for example, are great tools. But the biggest tool you can have to manage stress lies in yoga.

Why? Our nervous system has evolved through the fight or flight scenario. The nervous system is hard wired to respond to everything around you in some fashion. The trick is to manage that response so that the nervous system doesn’t shoot you full of cortisol, raise your blood pressure and heartbeat. This is the fight scenario, which triggers the sympathetic system. (The sympathetic system regulates the body’s response to stressful situations, while the parasympathetic system is responsible for the body’s actions while at rest, such as digestion or relaxation.) It’s not easy, but over time, yoga teaches you how to recognize those stress triggers and how to respond differently.

Yoga calms the nervous system, which means it activates your parasympathetic nervous system. The key to controlling the nervous system is controlling your breathing. The respiratory system is the only system in the body that we can control both consciously and subconsciously.

When we control the breath, we control the body. For example, empty your breath now: inhale through the noise and fill up, sigh it out the mouth. Do that three times and notice how you changed. That breath work immediately told your vagus nerve (a super important communication channel in your body) to chill.

When we practice yoga, we control the breath for the entire session and link body movements to the breath. Sometimes these movements are gentle and restorative, while other times they are more vigorous. Yoga is breath first, movement second. Without the breath, there is no yoga.

For over 2000 years, humans have practiced yoga. For sure, yoga is important for injury prevention and enhanced athletic performance, but that really didn’t matter so much until the modern world. Yoga has lasted this long for the mental space and health it teaches the student.

Through controlled breathing, you quiet the nervous system and the brain. This quieter mind allows you to recognize more clearly those triggers in your life that create stress. Then, yoga teaches you to accept the stress as fact and let it exist, without triggering a fight response. It sort of helps you “park” stress in a place where you can deal with it the way you choose to deal with it, rather than letting the stress manage you.

It’s not easy; it takes effort. But managing stress is the most important thing you can do for your health. Do yoga. Breathe well.

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Finding the right balance

Finding the right balance

Finding the right balance

Carolyn Surgent is a mover by nature, so it’s no surprise she became a physical therapist. What could be better than helping people get back to moving the way that matters most to them?

Mar 15, 2021 | Carolyn Surgent, DPT

Finding the right balance

I’ve always been a mover, so it’s no surprise I ended up a physical therapist. What could be better than helping people get back to moving the way that matters most to them? But as I approach twenty years in physical therapy, I am all the more aware that there’s so much more that makes coming to work such a pleasure. It means never having the same day twice. I am continually learning, meeting new people, teaching and partnering in others’ journeys to optimal health, helping them find the right balance.

A lifetime of movement

Most of my happiest memories as a kid involve movement: dance class, monkey bars, riding my bike to the beach, splashing in the waves, running for home base in tag. Through my school years and beyond, physical goals have been a constant. From years as a dancer, I learned about discipline, technique and the importance of having a strong core. From years on a mat, yoga has taught me the importance of practice and a deep understanding of structure, function and alignment. From competitive triathlon seasons, I found a deep appreciation for endurance and the importance of preparation. And what a surprise when I found out I was pregnant just days after my securing a personal best in a local triathlon!
Some physical goals have just been for fun, like the year of learning to do a decent push up, or the months spent mastering a handstand. I even tried a season as an adult beginner at Row America here in Greenwich.

The lessons I’ve learned from movement run through the many years spent in school and professional training, meeting my husband on a NYC subway, and starting our family here in Greenwich fifteen years ago. I love how full these years have been with work, community commitments, family and friends, and always, movement.

Finding balance in life — physically & mentally

When the days are filled with things and people that matter, the notion of balance looms large. Inevitably, you can’t make everything a priority and stay sane – even when you have the best intentions. Balance becomes a fluid thing, not a goal. I see it more like posture: no point striving for some ideal. It’s probably best to just increase the time you’re spending in a good position.

In fact, you can look at optimal health in the same way. You can see it is a process — one of making choices, doing what feels right and works for you. For me, that’s trying my best on any given day to learn something new. I strive to stay curious and surround myself with people and things that fill my tank: getting outside, spending time with family and friends, moving. My middle years so far have been about learning to do a better job of taking care of myself, getting better rest and time being still.

My family grew up with a saying my grandfather loved: “Good, better, best. Never let it rest.” Through my 20’s, 30’s and 40’s, I pressed through almost everything by working harder. As I start my 50’s, I’d like that mantra to evolve. Maybe “good, better, best. Remember to get some rest” is a better version!

Keys to success?

  • Trust the process
  • Keep practicing
  • Enjoy the journey!

Carolyn Surgent

Carolyn Surgent

Carolyn Surgent, DPT, is a mover by nature and loves to explore how the body works and moves. She holds a deep curiosity on helping people and enjoys educating others on the importance of taking care of your mental and physical wellbeing..

Carolyn

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Through motherhood, she found a second career

Through motherhood, she found a second career

Through motherhood, she found a second career

Francine Blinten started her career in the corporate world, but through motherhood, she discovered her passion: nutrition.

Mar 15, 2021 | Francine Blinten, CNS

Through motherhood, she found a second career

I started my career in the corporate world, but after twelve years, I left my job to be a full-time mom. It was during this time that I saw how food could shape my children’s health and development, and decided it would be the focus of my career going forward.

A childhood full of inspiration

I took inspiration from my own childhood, remembering how my own mother fed my family healthy, delicious meals. She was ahead of her time: she read Prevention Magazine and even put Vitamin C in our Christmas stockings. This was during the 60’s and 70’s, when my friends were eating Hostess cupcakes and drinking soda after school. But at my house, it was minestrone soup and tea.

My mom inspired me to give my children the best start in life I could by feeding them freshly prepared food including fish, vegetables, fruit, and whole grains. When we had play dates, other moms would comment on my daughters’ sophisticated taste in food. They would ask how they could get their children to eat zucchini and fish instead of chicken nuggets and fries. This was a defining moment in my life, and I started looking into a possible career as a nutritionist.

Embarking on a new journey

I never studied science at the undergraduate level and all the master’s programs in nutrition were science degrees. I was initially intimidated by the curricula but decided to give it a try. I found myself on a journey to “inner space” and became fascinated with cells, tissues, and organs. I was in my late thirties and discovering biochemical pathways, anatomy, physiology and biostatistics for the first time. I could not get enough.

Someone once told me, “find the thing that makes you lose track of time because that could be your life’s work.” For me, it was learning about the human body and all its wonders. Through motherhood, I stumbled upon my passion.

As I was completing my coursework and beginning my master’s thesis, I met a brilliant medical oncologist, Dr. Barry Boyd. He offered me an opportunity to work in his office and rounded out my education by showing me how to implement my academic knowledge in a clinical setting. I worked with real patients, people who were facing serious illnesses and treatment with metabolic side effects.

Disease is a serious and unfortunate issue, and I am thankful I can be on the side of healing and improving quality of life. When the word “disease” is hyphenated, we get dis-ease. Optimal health is the opposite of dis-ease: it means ease of movement, ease of living, and balance in biological systems.

What lies in my future

I continue this work today and have broadened my work with other patient populations. I have seen the role that diet and lifestyle modifications can play in health. It is a rewarding profession, and I am grateful for this second career. Sometimes, I wonder what my encore will be, but for now, I see no reason to leave the world of nutrition.


Elisa LaBelle

Francine Blinten

Francine Blinten, CCN, CNS, is a firm believer of listening to your body's needs and creating a comprehensive diet that meets those specific goals. She uses lab results, medical history and the client's background to customize an appropriate eating plan.

Meet Francine

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Researcher, educator, mentor: the lasting legacy of Dr. Doris Calloway

Researcher, educator, mentor: the lasting legacy of Dr. Doris Calloway

Researcher, educator, mentor: the lasting legacy of Dr. Doris Calloway

Dr. Doris Calloway was a pioneer in food science, producing key research on reproductive nutrition, food preservation, malnutrition and dietary standards. She was a researcher, educator and mentor, and left a lasting legacy on the world of nutrition and public health.

Mar 1, 2021 | Performance Optimal Health

Researcher, educator, mentor: the lasting legacy of Dr. Doris Calloway

Visit The Original Article >

A force to be reckoned with

A force to be reckoned with

Trish Kirsch discusses how Performance helped her daughter, Saylor, recover after an injury; Though doctors were unable to help at first, they were finally able to discover the source of her Saylor's injuries and put her on the path to recovery. It was not an easy path, but Saylor defied odds and returned stronger than ever to the sport of diving.

Mar 1, 2021 | Performance Optimal Health

A force to be reckoned with

We interviewed Trish Kirsch and discussed how Performance helped her daughter, Saylor, recover after an injury; Though doctors were unable to help at first, they were finally able to discover the source of her Saylor's injuries and put her on the path to recovery. It was not an easy path, but Saylor defied odds and returned stronger than ever to the sport of diving.

What brought you to Performance?

My daughter Saylor has had a passion for diving since she was seven. She’s been a force to reckon with, competing nationally and diving for the Greenwich Marlins and the Junior Olympic Team, but she started to experience knee problems around the age of 14. It even came to the point where Saylor could not go out shopping at the mall with her friends, she was in so much pain.

We looked for answers every day; we saw countless doctors and physical therapists, but Saylor was not getting better. Finally, Dr. Bryan Kelly at the Hospital for Special Hip Surgery realized that Saylor’s knee problem originated from her hips, and that she had labral tears on each side. Dr. Kelly sent her to Performance’s Shane Foley to prove this theory, which he did. In 2018, Saylor had two consecutive hip surgeries that finally set her on the road to recovery.

How did Performance get Saylor back on her feet?

Shane set up both Saylor and her coach with a plan to recover. He even came to the Greenwich YMCA in the spring of 2019 to watch her dive for the first time in a year. Shane sat on the deck, observing how diving impacted Saylor’s body, and developed a physical therapy plan suited to her needs. Not only does he know so much about the human body, he knew just how much to push it — and when it needed to rest.

Why is Performance different?

The constant communication. Shane was always speaking with Dr. Kelly, both before and after Saylor's surgeries. We could not find a practice that had this level of a connection with a doctor — and we looked everywhere, even in the city. Shane and Dr. Kelly provided ongoing conversations and constant care, allowing Saylor to recover with enormous support. When Saylor was diving again, Shane was there for her, checking in during meets to make sure she wasn’t pushing herself. Shane was our lifeline.

Where is Saylor now?

We had no idea Saylor could come back from her surgeries, but she proved everyone wrong with Performance’s help. She was back to competing at the AU Nationals in California just last year and was recruited to dive at several colleges in the fall! Ultimately, Saylor chose Fordham University and its’ Swimming and Diving team, but she showed it was possible to come back from multiple surgeries better than ever, and we are so proud of her and her amazing accomplishments.

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A laundry list of injuries uncovered a passion for athletic training

A laundry list of injuries uncovered a passion for athletic training

A laundry list of injuries uncovered a passion for athletic training

As a young athlete, Megan Kudrick sustained many injuries. But instead of slowing her down, they helped her find her passion: athletic training.

Mar 1, 2021| Megan Kudrick, ATC

A laundry list of injuries uncovered a passion for athletic training

Ankles, hips, knees, the brain. All places of past injury and all things that shaped me into the person I am today and helped me get to where I am today. Aside from turning into a laundry list of injuries, this guided my career path in more ways than one.

My introduction to the world of athletic training

In high school, I sprained and broke my ankle two times; this made me become close with my athletic trainer, so much so that I decided I wanted to go to school for athletic training. During my senior year of high school, I even decided to intern with my mentor as a way of accumulating class credits. I went on to college and fell in love with the world of athletic training, continuing my athletic career as a triathlete and collegiate rugby player. I also came to realize that helping athletes after an injury wasn’t enough: I wanted to be able to help even more.

I was at my internship at a high school doing rehab for two soccer athletes during pre-season, in charge of creating their return to play strengthening program. As I did that, I noticed that these athletes were sorer than they had been all pre-season from doing basic, bodyweight exercises. This was when I realized that they were weak and deconditioned; no wonder they got hurt. It was then that I decided I wanted to be on the other side of injury, on the side of prevention. I want to train people, help them become more resilient and better athletes. Now, I am applying to grad school to pursue exercise science with a concentration in strength and conditioning.

Putting myself in my athletes' shoes

Not only have my past injuries led me to this career path, they mentally shaped me to be tough, resilient and understanding. I was able to connect with my athletes in all facets of training: from the tough games to the losses and controversies, the injuries to the wins, etc. I had lived it in some ways, and being a collegiate strength and conditioning coach, I grew and experienced it with my athletes. My goal is to always help others get better and improve themselves and to give them confidence in themselves and their athletic abilities. What better way to do so than bandaging and rehabbing them after injury, and getting them better, faster, and stronger?

A career path that led to personal growth

My career path has also helped me grow as a person. I used to be extremely shy in front of crowds; I became uncomfortable and was unable to speak publicly. I gained my voice through coaching and athletic training. It was a voice that talked to parents and helped shape young adults going through some of the most transformative years of their adult lives. It became the voice of reason when things weren’t going right during a training season, or when I had to solve issues between teammates and coaches.

Athletic training truly shaped me into the person I am today, and not just by providing me with experience. I took that experience, reflected upon it, and found value in it to add to my professional career. I have been wrong plenty of times or have not always have the right answer or didn’t know what my next move was. But ultimately, I ditched any type of ego, learned from my mentors and colleagues and grew as a trainer and person. This meant going to other athletic trainers to collaborate on a return to play program for a baseball, acrobatics or tumbling athlete. It meant reaching out to fellow coaches who have mastered their craft to get their opinions and wisdom and starting conversations and using my voice to help others. And that is where true growth and learning comes from.

The key to success? Collaboration

This is one of the biggest reasons that I am part of Performance Optimal Health; it truly is an optimal program. We huddle, we collaborate and bounce ideas and knowledge off of each other. My experiences have made this collaboration all the more important to me. During my senior year of college, I got a severe concussion where I was unable to finish a sentence. I couldn’t go to class, write or even function as a college student. If it wasn’t for my athletic trainer’s constant communication with my doctor, professors and coach, I would be in much worse shape than I am today. They all worked together to help me recover and took a whole-body approach to it, as well. My physical therapist did not just work on my hip, they focused on the whole body. Better yet, they communicated back with my doctor so we were all on the same page, and I got the best care possible.

Throughout this, I learned that the body does not operate separately: the muscular system doesn’t operate without the nervous system and the nervous system does not operate without the brain. Learning all of this at a young age allowed me to bring that knowledge with me later in life. I took it to my athletes, my teammates, and now my work at Performance. We are all constantly bettering ourselves, and I never want that to end.

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Nutrition: A key component of your personal peak performance

Nutrition: A key component of your personal peak performance

Nutrition: A key component of your personal peak performance

The food you eat impacts a variety of body functions, changes your moods and affects performance. Eating better will help you feel and move better.

Apr 1, 2021 | Jaclyn Weiner, M.Ed

Nutrition: A key component of your personal peak performance

Our bodies are complex machines; if one thing goes wrong, it affects the rest of the system. Some issues are easily fixed — feeling tired? Maybe you need more sleep. Experiencing knee pain? You may need physical therapy. However, there are many other issues or challenges your body faces that are not simple to address. Notably, nutrition can impact a variety of body functions, change your moods and affect performance. A poor diet can lead to unhealthy weight loss or gain, decrease energy, cause brain fog and more. A healthy diet, on the other hand, can improve athletic performance, increase energy and enhance productivity. Eating better will help you feel and move better, and can solve issues you may have previously struggled to address.

An athlete's journey

Take my friend Lindsay, for example. She considered herself a healthy, well-rounded individual and was a star athlete in many town sports leagues in her early years. As a typical adolescent, she believed she had a healthy relationship with food and nutrition. However, the truth was that she never truly understood the connection of athletic performance with proper nutritional intake.

Lindsay thought her overall health and BMI (body mass index) was within a healthy range. Therefore, she believed she had a positive relationship with food. But in high school, Lindsay's overall self-image started to change. At this time, she became obsessed with her body image and stopped eating: she was trying to fit in the perfect teenager's ideal. Soon enough, Lindsay started exhibiting a fast drop-off in her top-tier positions — from the soccer fields to the tennis courts.

The effects of not fueling her body properly

Subsequently, Lindsay, a member of a junior varsity tennis team, was running on zero fuel. She was consuming under one thousand calories a day and was showing signs of being nutritionally depleted. Lindsay’s BMI started to borderline underweight and her overall health and natural athletic traits began to fade. She had a difficult time running both short and long-distances without getting out of breath. Because Lindsay lost her stamina and inner core strength, matches that would generally be wins turned into constant losses. Without taking care of her body, how could she expect to ace the game?

The food we eat turns into glucose, which provides energy for our brain and body to stay active and aware. When a person does not consume enough food, they begin to lack energy and focus. But the solution is not to eat just anything — not all food is processed efficiently. If you lead a diet that subsists off fast food or sugar and carbohydrates, your body will have a difficult time processing that food. Not only will you feel too full, bloated or slow, but this kind of food can also give you a quick “high” of energy that leads to a crash. Instead, a balanced diet that incorporates protein, healthy fats, minimally processed carbohydrates and fruit is the way to go. Additionally, snacking throughout the day, rather than binging when you feel the most hungry, will allow you to sustain a steady level of energy throughout the day.

Getting back on her feet

With much introspection and family guidance, Lindsay finally understood and appreciated the relationship between health, nutrition and athletic performance. She began to finally accept that her body was her engine. In order to perform at the highest level, she had to consume the proper amount and quality of fuel — food. Good fuel is an integral component to success, from the high school athlete to the everyday weekend warrior or professional athlete. Adequate food intake is a building block for overall health in our daily lives and on playing fields.

Lindsay stopped calorie counting, focused on proper nutrition and started to think of ways to challenge herself to become healthier every day. Nutritional well-being became her new way of life. Lindsay researched the topic and learned that a well-balanced diet was key to an overall healthy lifestyle. She started to eat well again, and her stamina started to come back. Challenging herself, she was once again able to run more vigorously than ever. Lindsay went on to play varsity tennis with a winning record and led her soccer team to the league championship.

Today, Lindsay is a young professional mother who runs every day and enjoys many sports. She lives a balanced nutritional lifestyle and even became an excellent cook, dedicated to incorporating organic produce and other nutritionally sound foods in her recipes. She wants to provide for both herself and her kids’, ensuring they have the fuel they need to grow and stay healthy.

A holistic approach to health turns into success

Nowadays, many of the most successful professional athletes attribute their success to having a team of varied multidisciplinary professionals. The support staff, ranging from cooks to psychologists to athletic and physical therapy trainers, work together to provide a holistic approach to health. There is a clear understanding that your body, mind, and soul work together for peak performance. Tom Brady, the football quarterback, is the perfect example of following a strict nutritional lifestyle. His dietary regimen allows the 43-year-old to perform like a 25-year-old and win yet another Super Bowl. Tom recognizes that his food intake, which is interestingly mostly plant-based, is a crucial component to his longevity and illustrious sports career.

I hope to see more articles, documentaries, and books written on professional sports figures who live a healthy and balanced lifestyle. Not everyone realizes the connection between nutrition and improving performance. That’s why education is so important. Whether you learn from your friends, family, trainer, therapist or nutritionist, learning more about the food you eat is integral to leading a healthy life.

I personally hope to influence the people around me to live healthier, more sustainable lives through proper nutrition and exercise. Although Lindsay doesn't play competitive sports, she continues to educate herself in all aspects of a healthy balanced lifestyle. Personally, I cannot wait for my daily morning run, absorbing nature's beauty and listening to my music. I am also looking forward to my homemade kale shake — while a small aspect of my daily regimen, it still makes a difference. Each aspect and component of one’s daily regimen, big or small, helps improve peak personal performance.

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The importance of a good night’s sleep

The importance of a good night’s sleep

No matter how much we take care of our bodies while we are awake, sleeping poorly can erase many of those gains. In order to be successful, happy and healthy, we must pay attention to the quality of the sleep we are getting.

November 15, 2020 | Ashley Moriarty, DPT, OCS

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No matter how much we take care of our bodies while we are awake, sleeping poorly can erase many of those gains. We must pay attention to the quality of the sleep we get to be successful, happy and healthy.

Defining Sleep

Sleep is a naturally occurring, easily reversible state that is marked by the absence of wakefulness and a loss of consciousness. It is typically associated with certain body postures (such as lying down with your eyes closed) and marked by changes in brain activity. It is considered essential for the recovery of the body’s physical and mental functions.

In terms of evolution, sleep would be considered a weakness. If the goal is survival, sleeping, with its accompanied loss of consciousness and incognizance of surroundings, would leave you vulnerable to predators. So why then, do we spend so much time sleeping? In order to determine its importance, most researchers assess what happens when someone is deprived of sleep. Studies have shown that as little as 24 hours of sleep deprivation can lead to hallucinations and psychosis. Lack of sleep is also is correlated with higher incidences of heart disease, diabetes, cancer and other illnesses. Sleep is good for overall health both physically and mentally, but it is primarily a restorative process for the brain.

On average, your brain uses only half the usual amount of glucose (energy) during sleep, allowing your energy reserves to be restored. It drives out toxins, clearing out waste products that are created during the day. Most importantly, however, sleep helps with neuroplasticity, or your brain’s ability to learn new skills, create new memories and evolve.

Sleep Requirements

Adults require eight hours of sleep. One could function on less, but that would create a sleep deficit, causing physical and mental harm. Overall, Americans get 6.8 hours of sleep per night on average, a number trending down each year. Work schedules are busier, modern society encourages us to stay up later and wake up earlier and there is more pressure for daily productivity.

School-age children and teens require 10–12 hours of sleep. As a result, some school districts opt for later start times to allow kids to get a full night’s sleep. Preschool-age kids need 10–13 hours, and toddlers need even more than that, somewhere around 11–14 hours.

Breaking Down Sleep Cycles

Sleep can be broken down into REM and non-REM states, with non-REM being further broken down into three phases.

  • Non-REM phase one begins when you start moving from being awake to asleep. The pattern of your brainwaves change, your muscles begin to relax — although you may experience muscle twitching — and heart rate and breathing begin to slow.
  • Non-REM phase two follows as a period of light sleep, like phase one. Brain wave activity slows with occasional bursts, body temperature drops and heart rate and breathing continue to slow.
  • Phase three, often considered the most important phase, is deep sleep. Heart rate and breathing are at their slowest and your brain is restoring energy. It is during this phase that memories are created and hormones are release to aide in tissue healing and growth. This phase tends to be longer during the earlier hours of sleep, but shorter as you get closer to waking up.
  • REM stands for rapid eye movement and is a phase marked by side to side eye movements, higher brainwave activity and dreaming. Your arms and legs are slightly paralyzed during this phase as a protective mechanism to prevent flailing as you dream. You reach your first REM phase about 90 minutes into sleep and cycle through all stages throughout the night.

A person can go through all sleep cycles three to four times a night, although this fluctuates from people to person. Improving sleep hygiene can lead to a more predictable and consistent sleep pattern. Ideally, adults should spend 20–25% of total sleep time in REM sleep and phase 3 non-REM should be around 13–23%. On the other hand, toddlers should spend half of total sleep in REM sleep and the other half in phase three non-REM sleep. Because both cognitive and motor memories are created in deep sleep, toddlers need a high amount of it. Since they are leaning and developing at such a rapid rate, it only makes sense that toddlers benefit from the sleep phase that aides in neuroplasticity.

Impact of Sleep on the Body's Recovery

Sleep can also affect immune function: generally speaking, good sleep acts positively on the immune system, and bad sleep acts negatively. Cortisol, the stress hormone, decreases at night, while human growth hormone and prolactin, both released naturally, increase at night to promote tissue healing. T cells, the body’s fighter cells, and their helper cells both function better with higher quality sleep. Poor quality sleep can lead to impaired cognitive function and impaired memory, and can have long term consequences. This includes an increased risk of cardiovascular disease, hypertension, coronary artery disease and diabetes. A good night’s sleep is necessary to allow your body to recover properly.

How to Get a Good Night's Sleep

You can take a guess at how good your sleep is based on how rested you feel in the morning or how soundly you slept through the night. However, the best way to really find out if you are getting high quality sleep is to track it. One sleep tracking device that we use at Performance is the Oura ring. You wear the Oura ring for three to four weeks to establish a baseline for yourself. It tracks how well you sleep, how frequently are you sleeping well and how much sleep are you getting. Once that is complete, you can reassess your approach to sleep.

If you are not getting good quality sleep or enough of it, there are many strategies to help, outlined below. We suggest implementing one or two at a time and seeing what works best for you.

Tips For Improving Sleep Quality:

  • Avoid caffeine late in the day. Caffeine has a half-life of six hours, so if you have a cup of coffee at 12 p.m., at 6 p.m. there is still half of it left in your system, and it is not fully out of your system until midnight.
  • Avoid alcohol, as just one drink can create sleep problems. Yes, alcohol is a sedative and may help you fall asleep, but it will not be a natural sleep, but fragmented with periods of wakefulness throughout the night. Drinking decreases REM sleep and learning capacity and can even affect memory formation days later.
  • Decrease artificial light throughout the day. Our bodies release melatonin in response to darkness, so getting more light later in the day decreases our levels of circulating melatonin.
  • Use blue light glasses for LED bulbs, such as those found in screens such as phones, tablets and TVs. Blue light is a daytime stimulus, so try minimizing exposure two to three hours before going to bed.
  • Keep your bedroom dark. Avoid putting a TV in your room and use blackout curtains or a sleep mask.
  • Keep your bedroom cool. 65 degrees Fahrenheit or lower has proven to be ideal for sleep.
  • Help lower your body temperature: wash your hands or face before bed to stimulate body temperature change. Do not wear socks and try keeping your hands and feet out of the sheets.
  • Make time to wind down. Dial into your parasympathetic nervous system, practice mediation, mindfulness or deep breathing.
  • Maintain a regular sleep schedule, even on weekends.