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Improve longevity and performance with Pilates

Improve longevity and performance with Pilates

At Performance Optimal Health, we often recommend Pilates to our clients, as it allows them to target specific muscles and teaches them about their body more than any other form of exercise. Whether you want to decrease joint pain, play better on the courts or simply live healthier, Pilates is an excellent choice for many.

February 21, 2024 | Jennifer Bohn

 


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Jennifer Bohn

Jennifer Bohn

Jennifer Bohn is a Pilates Instructor based in North Naples who is certified in a variety of Pilates disciplines, including mat, Reformer, Cadillac, and more. She enjoys working with clients of all ages, especially young athletes, and has been teaching Pilates since 2018.

Meet Jennifer

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How to optimize your pickleball game

How to optimize your pickleball game

At Performance Optimal Health, we want to serve as a resource​ and share with you simple, tangible steps you can implement​ to empower you to live better and play more pickleball.

February 10, 2024 | Larry Piretra, DPT, CSCS

pickleball

Top exercises for pickleball athletes

  • Dynamic warm-ups
    • Butterfly skips
    • Walking quad
    • Hamstring/calf reach
    • Walking lunges
    • High knees
    • SL kicks (Frankensteins)
  • Resistance training
    • Pushups (chest, triceps)
    • Rowing (back strengthening)
    • Internal/external rotation w/bands or weights (shoulder stabilization)
    • Lunges and squats (glute and hamstring activation)
    • Planks/bridges - w/ or w/out bands (core stability)
    • Wrist curls/extension (strength and stability in wrist)

Recommended recovery strategies

  • Stretching post matches
    • Sets: 3-5 reps; duration: 30-60 sec
    • Muscle groups: hamstrings, calves (Gastrocnemius/Soleus), quadriceps, wrist flexors/extensors, latissimus dorsi
  • Modalities
    • Normatec compression therapy reduces inflammation, improves circulation, flushing of lactic acid, promotes lymphatic drainage
    • Sauna reduces of muscle soreness, improves heart health, stress modulation, improves sleep
    • Cryotherapy reduces pain (reduces delayed onset muscle soreness), promotes recovery, improves metabolic panel, endorphin rush

Staying hydrated

  • Risks of dehydration
    • Can have a negative impact on performance, leading to cramping, fatigue, and a decrease in overall performance
  • How to stay hydrated
    • Drink plenty of water pre, during and post-match
      • Pre: 17-20 oz (2-3 hours before)
      • Warm-up: 8 oz
      • During 7-10 oz (every 10-20 minutes)
      • After: 8 oz within 30 min of playing, 20 oz over the next 2 hours
    • Incorporate electrolyte-rich drinks, which replenish the body's mineral levels, ensuring optimal muscle function and hydration

Healthy Carbohydrates

  • Carbs like quinoa, sweet potatoes, or whole grain pasta, replenish glycogen stores and enhance muscle recovery further.

Protein

  • Protein plays a pivotal role in repairing damaged muscle tissues and promoting muscle growth.
  • Including a protein source in your post-game meal or snack can help kickstart the recovery process.

Fats

  • Fats such as avocados, nuts, and olive oil, provide essential fatty acids that support joint health and reduce inflammation.
  • Healthy fats improve performance and decrease injury risk.

Vegetables

  • These food groups replenish micronutrients and antioxidants that support overall health.

Larry Piretra

Larry Piretra

Larry Piretra, PT, DPT, OCS, CSCS, TPI-M2, is a physical therapist and strength and conditioning specialist who serves as the Naples Site Lead. He specializes in working with racquet sport athletes, including pickleball, tennis, padel and more. As a Titleist Medical and Fitness Professional, Larry also serves as the Golf Programming Lead for Performance.

Meet Larry

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Nutrition and heart health at Performance

Nutrition and heart health at Performance

See how Performance Optimal Health utilizes nutrition to help keep our clients' hearts happy and healthy. From preventative care to management, the Performance team takes a whole-body approach to nutrition.

February 8, 2024 | Ashley Jerry, MS

 


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Schedule an Optimal Health Assessment! Our team of experts will put a coordinated and highly-personalized strategy in place so you can reach your goals... and exceed them.

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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. Her expertise includes gut health issues, weight loss, self-image and an overall understanding of nutrition, as well as treating a diverse range of medical conditions such as high cholesterol, high blood glucose levels, obesity, pregnancy, gastrointestinal function, anxiety, depression, and overall health.

Meet Ashley

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Optimizing cardiovascular fitness: a collaborative approach for health and performance

Optimizing cardiovascular fitness: a collaborative approach for health and performance

At Performance Optimal Health, we value a collaborative approach to improving cardiovascular fitness. Through personalized programs and adherence to ACSM guidelines, clients have seen significant improvements in their cardiovascular health and overall well-being.

February 6, 2024 | William Manzi, CEP

running on a treadmill

At Performance Optimal Health, our work revolves around collaboration, including doctors and other healthcare professionals in order to create a team for the client. When someone comes through our doors, we identify a baseline estimated V02 max, in order to establish a baseline of cardiovascular fitness. VO2 max is the amount or volume of oxygen your body uses while exercising vigorously, and it's a common tool to understand your fitness level. Knowing your VO2 max can help you train for sports, track your fitness improvement, and improve your overall heart health.

Once this number is established, we work with you and your healthcare team hand in hand in order to directly increase this number. That can involve checking in with the client's doctor, working with one of our nutritionists to establish a healthy diet, or collaborating with our physical therapists to address any potential musculoskeletal issues. Putting it all together allows for the best results for our clients, no matter their goals.

For example, in our 3 month cardiovascular care program where we work with you one on one, monitoring your heart rate, blood pressure, EKG, and MET levels, we have seen one individual increase her numbers by 155%! Another individual even increased her MET level from 32.4 to 50.2 mL/kg/bw in her 3 month program. Protocols were as followed, laid out by the American College of Sports Medicine (ACSM) FITT-VP principle.

At the end of the day, it's about establishing an exercise prescription given to you by your trainer who works with you extensively one on one and communicates with your healthcare team. In our initial intake we sit down to not only get to know you, but also to discuss the four pillars of health — exercise, recovery, nutrition, and stress management, to get a complete picture of your health. At Performance, we look at the body as whole and try to understand what the root cause of the problem is, and not just treat the underlying symptoms.

Here is what a FITT exercise program for cardiovascular exercise looks like:

  • Frequency: 3-5 days per week of moderate to vigorous exercise
  • Intensity: Low is 40-60% of MaxHR (Heart Rate); Moderate is 60-80% MaxHR; Vigorous is 80-95%MaxHR
  • Time: At a moderate intensity, minimum of 150 minutes per week or minimum of 75 minutes per week at a vigorous intensity. This could be 30 minutes of moderate exercise per day or 15 minutes of vigorous exercise per day.
  • Type: Aerobic, continuous, rhythmic exercises that incorporate large muscle groups, i.e treadmill, elliptical, rower, bicycle
  • Volume: Increase total duration of exercise 2-10 min each week
  • Progression: Increase duration before intensity, pushing from 150 min/week to 250 min/week of total duration

William Manzi

William Manzi

William Manzi, CEP, is an exercise physiologist and personal trainer who specializes in the ability to take care of any individual, regardless of any limitations. Over the past ten years, he has trained a variety of different individuals for over ten years, including US Navy SEALs, heart attack patients, and more.

Meet Will

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The role of nutrition in promoting heart health

The role of nutrition in promoting heart health

Heart disease is the leading cause of death in both women and men in the United States; maintaining a heart healthy diet is key to lowering your risk. Here's a case example of a client who is looking to improve her health and body composition, and what a sample menu representing the recommended diet.

February 6, 2024 | Francine Blinten, MS, CCN, CNS

heart healthy diet=

Heart disease is the leading cause of death in both women and men in the United States. Risk drivers include high blood pressure, high low-density lipoprotein (LDL) cholesterol, high triglycerides, diabetes, smoking and secondhand smoke exposure, obesity, unhealthy diet, and physical inactivity.

As a clinical nutritionist, I work with clients seeking to lower their risk factors through dietary modifications. The dietary pattern I most often recommend is the Mediterranean diet*. Conformity with the traditional Mediterranean Diet is associated with better cardiovascular health outcomes, including clinically meaningful reductions in rates of coronary heart disease, ischemic stroke, and total cardiovascular disease.

The nutrition consultation starts with a review of the client’s current clinical data. Specifically, I’m interested in fasting glucose, lipid panel, blood pressure and C-Reactive protein (a measure of inflammation). Body weight and waist circumference are also measured. We establish metabolic targets for out-of-range markers.

Together we evaluate the baseline diet and identify areas for improvement to meet the targets. We discuss lifestyle factors such as cooking skills, meal and hunger patterns as well as food preferences.

If the client has extra bodyweight, we need to address it because being overweight influences several risk drivers of disease. In my experience, a 5% reduction in baseline weight leads to significant clinical improvement.

The diet plan is tailored to the client’s age, gender, activity level and metabolic goals. Food allergies and sensitivities are noted. Portion sizes for each food category are outlined. In my experience, it is better to make small permanent changes rather than a complete overhaul; the latter usually fails.

Case Example

A 50-year-old woman presents with:

LDL cholesterol elevated at 145 mg/dL

Borderline fasting glucose at 110mg/dL

Borderline triglycerides at 150 mg/dL

Normal weight but waist measures 38”

Blood pressure is normal 120/80

Her target is:

< 100 mg/dL

80 – 95 mg/dL

< 100 mg/dL fasting

maintain weight, waist < 35”

maintain 120/80

She eats three meals and an afternoon snack. Breakfast is cereal or a muffin; lunch is a sandwich or salad; dinner is chicken with a starch and a vegetable or pasta and a salad. She likes eggs but is afraid to eat them because of her cholesterol, so she eats cereal or a muffin instead. She likes fish but doesn’t prepare it at home. Snacks are protein bars or chocolate. She also exercises three times a week playing pickleball.

The remedy:

Her breakfast is low in protein and fiber. She plays pickleball after breakfast, so I recommended she start the day with more protein to better fuel her game.
I suggested 7 eggs/week for her, preferably with vegetables or fruit, as well as adding more fish and a few vegetarian meals each week. She should limit refined carbohydrates such as cereal and muffins, as they are likely raising her LDL, triglycerides, and blood sugar. The pancreas must produce more insulin in response to the rise in glucose. Over time, insulin resistance leads to fat placement in the abdomen.

Sample menu:

Breakfast

Yogurt with almonds and berries

or

Eggs with spinach and mushrooms

Lunch

Minestrone soup, cucumber and tomato salad

Or

Grilled chicken and chickpea salad with olives and feta, olive oil and balsamic vinegar

Snack

Bell pepper with humus

Or

Apple and almond butter

Dinner

Roasted salmon with garlic and brussels sprouts

Or

Turkey chili and roasted butternut squash

Or

Sweet potato black bean chili


Want to get started on achieving your goals?

Schedule an Optimal Health Assessment! Our team of experts will put a coordinated and highly-personalized strategy in place so you can reach your goals... and exceed them.

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Francine Blinten

Francine Blinten

Francine Blinten, MBA, MS, CCN, CNS, is a nutritionist who specializes in disease prevention, management of chronic disease, weight management, gastrointestinal disorders and bone support. She also has a subspecialty in oncology nutrition.

Meet Francine

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Effects of stress on cardiovascular health

Effects of stress on cardiovascular health

In recognition of heart health month, our hosts shed light behind some of the science on how stress interacts with the cardiovascular system and provide education on stress so that you can increase your ability in managing or having more control over it.

February 6, 2o24 | Brendan Copley, CSCS, ATC | Arianna Martignetti, Ed.D.

Stress and heart health

Personal trainer Brendan Copley and mental performance consultant Arianna Martignetti team up once again to discuss the effects of stress on cardiac health. In recognition of heart health month, they shed light behind some of the science on how stress interacts with the cardiovascular system and provide education on stress so that you can increase your ability in managing or having more control over it.

Brendan and Arianna delve into defining both normal healthy cardiovascular health and abnormal cardiovascular health, explore the definitions and responses to stress, and examine how mental well-being can affect cardiovascular health. They also discuss physiological and mental ways individuals experience stress, methods to manage and relieve stress, including exercise, meditation, and breathwork, and the associations of chronic stress with cardiovascular health.

Listen here, or wherever you get your podcasts.


Brendan Copley

Brendan Copley

Brendan Copley, CSCS, ATC, is a personal trainer who specializes in working with endurance athletes and post-rehab clients. Brendan is a marathoner and former cross-country runner and has worked as an athletic trainer for Quinnipiac University’s cross-country and track teams.

Meet Brendan

Arianna Martignetti

Arianna Martginetti

Arianna Martignetti, Ed.D., is a mental performance consultant who works with individual athletes, weekend warriors and teams at all levels, including competitive youth, high school, and collegiate levels, as well as recreational athletes.

Meet Arianna

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Unlock Your Best: Performance Golf Assessments

Unlock Your Best: Performance Golf Assessments

Maximizing the weather in Florida is a must, which is why the golf community is so vibrant down south. With personalized programming and a team approach to care, you can optimize your golf performance by improving your strength and mobility, allowing you to play stronger, longer, and without pain.

January 16, 2024 | Larry Piretra, PT, DPT, TPI-M2 | Garrett Rasmussen, CPT, TPI-F1

 

 

Improve your golf game with a Performance Golf Assessment!

Our team of golf experts will put a coordinated and highly-personalized strategy in place so you can reach your goals... and exceed them. Learn more about golf fitness at Performance.

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Larry Piretra

Larry Piretra

Larry Piretra, PT, DPT, OCS, CSCS, TPI-M2 is a physical therapist and strength and conditioning specialist who serves as the Naples Site Lead. As a Titleist Medical and Fitness Professional, Larry also serves as the Golf Programming Lead for Performance.

Meet Larry

Garrett Rasmussen

Garrett Rasmussen

Garrett Rasmussen, CPT, TPI-F1, is a golf trainer based in Naples who specializes in strength and conditioning. He has worked with a diverse population in one-on-one settings as well as small group training, having taught over 10,000 group fitness classes and worked with hundreds individually. As an avid golfer, he is constantly pursuing higher levels of education around the sport, and he is currently working to achieve the TPI Level 2 Power Certification.

Meet Garrett

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How can I golf longer — and with less pain?

How can I golf longer — and with less pain?

Here are some key strategies to help you extend your golfing years and play the game pain free.

January 11, 2024 | Garrett Rasmussen, CPT, TPI-F1

golfer=

Golf is a sport that can be played year-round in southwest Florida, and with the average daytime temperature reaching the mid 70s, it's a perfect time to get out and play. The game offers a lifetime of enjoyment and challenge; however, as with any physical activity, golf can take a toll on the body, leading to discomfort — and even pain. Here are some key strategies to help you extend your golfing years and play the game pain free.

The foundation for a pain-free round is a thorough warm-up routine. Engage in light cardiovascular exercises to increase blood flow to your muscles: this could be anything from a brisk walk or a short bike ride, followed by dynamic stretching to improve flexibility. Focus on the major muscle groups of the golf swing, which includes legs, shoulders, hips, and lower back, to enhance your range of motion. Flexibility is a key component to a powerful and pain free golf swing.

On off days, incorporate a well-rounded fitness routine into your regimen, focusing on strength, stability and flexibility. A Certified Titleist Performance Institute (TPI) trainer can screen you for stability, mobility and strength deficiencies and create a custom fitness plan to address these areas. The addition of a golf specific exercise routine enhances your body's ability to move through the golf swing with greater ease, preventing stiffness and discomfort while building power and endurance.

A factor that often gets overlooked in injury prevention is recovery. Take time after your round to assess how the body feels and identify any discomfort. Your TPI trainer can prescribe a cool down and stretch routine to relieve any stiffness or pain and help speed up the recovery. Be sure to hydrate and refuel with a healthy meal as well to assist in the recovery process.

Golf is a sport that can be played all year by all levels and ages. To continue playing as long as possible and with as little pain as possible,  remember to always warm up properly, work with a TPI trainer to improve your fitness, and take some time to cool down. By incorporating these strategies into your golfing routine, you can pave the way for a more extended and pain-free golfing journey.

 

Improve your golf game with a Performance Golf Assessment!

Our team of golf experts will put a coordinated and highly-personalized strategy in place so you can reach your goals... and exceed them. Learn more about golf fitness at Performance.

Contact Us

Garrett Rasmussen

Garrett Rasmussen

Garrett Rasmussen, CPT, TPI-F1 is a golf trainer based in Naples who specializes in strength and conditioning. He has worked with a diverse population in one-on-one settings as well as small group training, having taught over 10,000 group fitness classes and worked with hundreds individually.

Meet Garrett

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Break up with New Year’s Resolutions

Break up with New Year's Resolutions

Meet Paul Steed: an avid runner, tennis player, and horseback rider, who is looking stronger than ever. After starting with Performance as an physical therapy client for a torn abductor, he now trains with Will Manzi. As he continues to improve his strength and endurance, Paul doesn't actually believe in New Year's Resolutions — instead, he seeks to be the best form of himself year round.

January 2, 2024 | Will Manzi, CEP

 


Want to get started on your goals for the year?

Schedule an Optimal Health Assessment! Our team of experts will put a coordinated and highly-personalized strategy in place so you can reach your goals... and exceed them.

Contact Us


Will Manzi

Will Manzi

William Manzi, CEP, is an exercise physiologist and personal trainer who specializes in the ability to take care of any individual, regardless of any limitations. Over the past ten years, he has trained a variety of different individuals for over ten years, including US Navy SEALs, heart attack patients, and more. Through this, Will has been able to build his expertise, and add an arsenal of exercises to his toolkit that can be progressed or digressed depending upon the individual.

Meet William

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The psychology behind goal setting & behavior change

The psychology behind goal setting & behavior change

The beginning of a new year is a common and motivating time to want to set new goals. One way people achieve their goals is through systematic goal setting. Sometimes, however, we may have trouble achieving the goals that we set. Here are some reasons why reaching our goals may be easier said than done, explanations for how goal setting works, and what you can do about it.

January 2, 2024 | Arianna Martignetti, Ed.D

psychology behind goal setting=

The beginning of a new year is a common and motivating time to want to set new goals. One way people achieve their goals is through systematic goal setting. Sometimes, however, we may have trouble achieving the goals that we set. Outlined below are some reasons why reaching our goals may be easier said than done, explanations for how goal setting works, and what you can do about it.

Changing a behavior is difficult and complex, especially if it is a behavior that we have been exhibiting for a very long time, or learning a brand new one! The transtheoretical model of change (TTM), originally theorized and researched amongst smokers, breaks down stages to better understand the process of changing a behavior.(1) Five of them are briefly outlined below:

Precontemplation: In this stage, people do not intend make a change within the next six months, and may not consider or be aware that their behavior is problematic or unhealthy.

Contemplation: People intend to begin changing their behavior within the next six months, and start to consider the pros and cons of changing such a behavior.

Preparation: People are ready to take a step towards changing their behavior within 30 days and believe that a change can influence a healthier life.

Action: People have changed their behavior within the past 6 months. They intend to keep working on it by altering their problematic behavior and/or adopting new/healthier behaviors.

Maintenance: People have maintained their changed or new behaviors for more than six months, and intend to continue doing so.

It is important to note that there are limitations to the TTM, two of which include socioeconomic status and social contexts. Depending on which stage someone is in, there are interventions known as processes of change that can be implemented to help with changing/maintaining behaviors by altering our thinking and feelings.(1) Two examples are consciousness raising and reinforcements. Consciousness raising refers to information (either directly or indirectly) that raises our awareness of a problematic behavior and/or a healthy behavior. Social media and commercials do this a lot! An advertisement might share statistics of an unhealthy behavior or share images and anecdotes to promote healthy a behavior. Reinforcements are used to reward the desired behavior with hopes in reducing the unwanted behavior. For example, if you hit your exercise goal for the week, you might reinforce your behavior by purchasing a new workout shirt.

Consider the goal(s) that you are thinking about for the new year and which stage you think you are in. As for systematic goal setting, researchers suggest that setting goals can direct your focus, thus affecting your effort, influence and prolong your persistence, and help you develop new or improved strategies.(2) Factors that affect our goal setting process include the level of goal difficulty, how specific you are, and the use of both short-term and long-term goals.(3) Goals that are moderately-difficult-to-difficult are recommended compared to goals that are either too easily achieved or unrealistic and unattainable. Furthermore, if a goal that you set is too vague, it can be difficult to evaluate whether you are making progress.

When considering the relationship between goal setting and your performance, evaluation is a crucial factor. It is common to experience anxiety related to evaluating your progress; however, evaluation is necessary as it will allow you to adjust, re-consider, or set new goals for yourself. As for short-term goals, setting ones that are relevant to your long-term goal can help maintain persistence, and influence your motivation and confidence; this is especially true when you achieve those short-term goals! Some other forces that contribute to the relationship include the knowledge or resources that you have access to, your ability, and your commitment level. When assessing your level of commitment, reflect on the source of your goal. Are you setting it for yourself, or is it being influenced by somebody/something else? This can affect our motivation, and whether we feel more in control of our goal versus it being controlled by someone/something else.

Consider the above information in reference to directing your focus, acknowledging how it affects your effort and persistence, and the influence of new strategies along the way. It is important to note that goal setting is not necessarily a one-size-fits-all approach. For more information on systematic goal setting, feel free to check out our previous post on how to set a New Year's Resolution.

References

1. Prochaska, J. O., & Norcross, J. C. (2001). Stages of change. Psychotherapy, 38(1), 443-448.

2. Locke, E. A., & Latham, G. P. (2019). The development of goal setting theory: A half century retrospective. Motivation Science, 5(2), 93-105.

3. Jeong, Y. K., Healy, L. C., & McEwan, D. (2021). The application of goal setting theory to goal setting interventions in sport: A systematic review. International Review of Sport and Exercise Psychology, 16(1).


Want to get started on your goals for the year?

Schedule an Optimal Health Assessment! Our team of experts will put a coordinated and highly-personalized strategy in place so you can reach your goals... and exceed them.

Contact Us


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, including competitive youth, high school, and collegiate levels, as well as recreational athletes.

Meet Arianna

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RECIPE: White bean and kale soup, perfect for balancing blood sugar levels

White bean and kale soup, perfect for balancing blood sugar levels

During the holidays we tend to eat delicious foods that are higher in sugar, carbohydrates, etc. A great way to balance this out is to focus on foods that help to maintain steady blood sugar levels throughout the day. Here's a recipe perfect for doing so.

January 2, 2024 | Ashley Jerry, MS

white bean and kale soup

Recipe from Culinary Hill, with modifications from nutritionist Ashley Jerry, MS.

This white bean and kale soup is a nourishing dish packed with the benefits of kale and creamy white beans recommended by nutritionist Ashley Jerry. During the holidays, we tend to eat delicious foods that are higher in sugar, carbohydrates, etc. A great way to balance this out is to focus on foods that help to maintain steady blood sugar levels throughout the day. Foods that help to balance blood sugar levels include oatmeal, beans, and other high fiber foods such as nuts, seeds, raspberries and apples.

This hearty soup is lightly seasoned with garlic and herbs, creating a delicious blend of flavors. Kale is known as a “superfood” because it is packed with properties that can help lower blood sugar levels, such as fiber and flavonoids antioxidants.

Beans are rich in magnesium, fiber, and protein, all that can also help lower blood sugar. Beans are also high in soluble fiber and resistant starch, which slows down digestions and helps against post-meal blood sugar spikes.

Ingredients

  • 1 tablespoon olive oil
  • 1 onion, chopped
  • 3 cloves garlic, minced
  • 2 carrots, sliced
  • 2 celery stalks, diced
  • 1 bunch kale, stems removed and leaves chopped
  • 1 can (15 oz) white beans, drained and rinsed
  • 4 cups low-sodium vegetable broth
  • 1 teaspoon dried thyme
  • 1 teaspoon dried rosemary
  • Salt and pepper to taste

Steps

  1. In a large pot, heat olive oil over medium heat. Add onions and garlic, sauté until fragrant.
  2. Add carrots and celery, and cook until slightly softened.
  3. Add kale and cook until wilted.
  4. Add white beans, vegetable broth, dried thyme, dried rosemary, salt, and pepper. Stir well.
  5. Bring the soup to a boil, then reduce heat and let it simmer for 15 minutes.
  6. Adjust seasoning according to taste.
  7. Serve hot, and enjoy this nourishing bowl of goodness!

Want to get started on your nutrition goals for the year?

Schedule an appointment with one of our nutritionists!

Contact Us


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. Her expertise includes gut health issues, weight loss, self-image and an overall understanding of nutrition, as well as treating a diverse range of medical conditions such as high cholesterol, high blood glucose levels, obesity, pregnancy, gastrointestinal function, anxiety, depression, and overall health.

Meet Ashley

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RECIPE: Zucchini frittata, a high protein start to your day — and year

Zucchini frittata, a high protein start to your day — and year

Protein is one of the most important nutrients for weight loss and creating balanced meals; increasing the amount of protein you eat may help support weight loss by balancing certain hormones and helping you feel satiated longer, among other benefits.

January 2, 2024 | Ashley Jerry, MS

zucchini frittata

Recipe from EatingWell, recommended by nutritionist Ashley Jerry, MS.

Start your day — and the new year — strong with a protein-packed, delicious frittata. Protein is one of the most important nutrients for weight loss and creating balanced meals; increasing the amount of protein you eat may help support weight loss by balancing certain hormones and helping you feel satiated longer, among other benefits.

This Italian dish, similar to a flat omelet, can be filled with a variety of ingredients and makes for a perfect impromptu meal any time of day, but I especially love to eat it for breakfast. Whether you're in need of a hearty breakfast like me, a light lunch, or a satisfying dinner, frittatas are the perfect solution, and a great way to incorporate more protein and vegetables into your daily intake. You can also add smoked salmon for additional protein!

Ingredients

  • 4 teaspoons extra-virgin olive oil, divided
  • 1 cup diced zucchini, (1 small)
  • ½ cup chopped onion
  • 1/2 cup grape tomatoes, or cherry tomatoes, halved
  • ¼ cup slivered fresh mint
  • ¼ cup slivered fresh basil
  • ¼ teaspoon salt, divided
  • 2 large eggs 4 egg whites
  • Freshly ground pepper, to taste
  • 1/3 cup crumbled goat cheese, (2 ounces)

Steps

  1. Heat 2 teaspoons oil in a 10-inch nonstick skillet over medium heat. Add zucchini and onion; cook, stirring often, for 1 minute. Cover and reduce heat to medium-low; cook, stirring occasionally, until the zucchini is tender, but not mushy, 3 to 5 minutes. Add tomatoes, mint, basil, 1/8 teaspoon salt and a grinding of pepper; increase heat to medium-high and cook, stirring, until the moisture has evaporated, 30 to 60 seconds.
  2. Whisk eggs, the remaining 1/8 teaspoon salt, and a grinding of pepper in a large bowl until blended. Add the zucchini mixture and cheese; stir to combine.
  3. Preheat the broiler.
  4. Wipe out the pan and brush it with the remaining 2 teaspoons oil; place over medium-low heat. Add the frittata mixture and cook, without stirring, until the bottom is light golden, 2 to 4 minutes. As it cooks, lift the edges and tilt the pan so uncooked egg will flow to the edges.
  5. Place the pan under the broiler and broil until the frittata is set and the top is golden, 1 1/2 to 2 1/2 minutes. Loosen the edges and slide onto a plate.
  6. Cut into wedges and serve.

Want to get started on your nutrition goals for the year?

Schedule an appointment with one of our nutritionists!

Contact Us


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. Her expertise includes gut health issues, weight loss, self-image and an overall understanding of nutrition, as well as treating a diverse range of medical conditions such as high cholesterol, high blood glucose levels, obesity, pregnancy, gastrointestinal function, anxiety, depression, and overall health.

Meet Ashley

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RECIPE: Carrot and celery soup, using a seasonal ingredient

Carrot and celery soup with thyme pecan crumble

Throughout the year, there are certain vegetables that are considered "in season," which means they are purchased and consumed around the time that they are harvested — when they are freshest, and typically tastiest.

January 2, 2024 | Ashley Jerry, MS

carrot and celery soup

Recipe from It's a Veg World After All, recommended by nutritionist Ashley Jerry, MS.

Seasonal eating is a term used to describe the practice of eating foods, produce in particular when it’s at its harvest peak. For this reason, seasonal food is fresher, contains higher nutrient levels, and tastes better than out of season foods. Seasonal fruits and vegetables produced on local farms are often fresher, as they do not require long distances for transport. Eating seasonally may have health benefits and may offer a sustainable alternative to other practices. That's why our nutritionist, Ashley Jerry, recommends to her clients to eat seasonally when possible, and shop at your local farmers market to find the highest quality of seasonal produce depending on the season!

Here are some of January's in-season foods:

  • Beets
  • Brussels Sprouts
  • Carrots
  • Citrus
  • Kale
  • Leeks
  • Parsnips
  • Pomegranate
  • Turnips
  • Winter Squash

To celebrate one of the highly nutritious veggies of the season, the carrot, here's the recipe for a carrot and celery soup Ashley recommends, perfect for the winter. This recipe serves four people, with each serving totaling 340 calories.

Ingredients

  • 2 tablespoons olive oil
  • 1 sweet onion peeled and diced
  • 2 cloves garlic pressed or minced
  • 4 carrots sliced
  • 6 stalks celery sliced
  • 4 cups vegetable broth
  • 1 tablespoon butter
  • 1 cup pecans chopped
  • 2 tablespoon fresh thyme
  • 1 teaspoon brown sugar or coconut sugar

Steps

  1. In a large soup pot over medium heat, heat the olive oil and add the garlic and onion. Sautee for a few minutes before adding the carrots and celery. Cook for 5-7 minutes, or until the vegetables are slightly tender, then add the vegetable broth and bring to a boil. Cover, reduce heat to a simmer/low boil, and cook for 20-25 minutes or until the carrots are tender.
  2. When the carrots are tender, remove the soup from heat and use an immersion blender to puree it. You can also transfer the soup in batches to a regular blender to puree it.
  3. While the soup is cooking, heat the butter in a small skillet over medium heat. Add the chopped pecans, thyme, and brown sugar. Cook, stirring frequently, until the pecans are fragrant (about 3-5 minutes). Be careful not to burn them. Remove from heat and set aside.
  4. Ladle the soup into bowls and top with the thyme pecan crumble. Enjoy!

Serve with fish or chicken breast for a complete meal.


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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. Her expertise includes gut health issues, weight loss, self-image and an overall understanding of nutrition, as well as treating a diverse range of medical conditions such as high cholesterol, high blood glucose levels, obesity, pregnancy, gastrointestinal function, anxiety, depression, and overall health.

Meet Ashley

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Telehealth is here to stay: a client interview

Telehealth is here to stay: a client interview

Telehealth and virtual training over platforms like Zoom have proven to be more than just a temporary solution; they are here to stay. The convenience and accessibility offered by remote health services make them particularly beneficial for individuals who travel frequently. Virtual sessions eliminate geographical barriers, allowing people on the move to access personalized training or healthcare guidance seamlessly. Here's how one of our trainers works remotely with his client.

December 7, 2023 | Carter Bushway, CPT

telehealth

Telehealth and virtual training over platforms like Zoom have proven to be more than just a temporary solution; they are here to stay. The convenience and accessibility offered by remote health services make them particularly beneficial for individuals who travel frequently. Virtual sessions eliminate geographical barriers, allowing people on the move to access personalized training or healthcare guidance seamlessly. This shift not only accommodates the demands of a mobile lifestyle, but also underscores the enduring value of remote health services in providing flexibility and continuity for individuals on the go.

A great example of a client of mine who primarily works with me remotely is Tara N., who we interviewed for this article. Tara has been a phenomenally dedicated client that has been with me for the last three years. She started with me in person as a client coming off of physical therapy with Todd Wilkowski. She's always looking for challenges, but knows her own limitations and what is smart for her to do. To be able to work with someone who not only wants to push herself, but is also smart about how she goes about it and really cares about the how and why of what we are doing every session, it’s been such a privilege for me.

At first, coming out of physical therapy with Todd for a meniscectomy, we initially focused on regaining strength in her legs and stability in her knees to hopefully eventually return to playing tennis. This resulted in a lot of accessory work, focusing on her glutes and inner hip muscles to stabilize gross movement, as well as heavier compound lifts such as squats and deadlifts. As she went to grad school, and then later moved across the country for a job, I shifted programming her workouts that would prepare her for other activities, like volleyball and hiking.

When she moved for grad school, we shifted to all Zoom, with her coming back for evaluations and check-ins during her breaks. Now that she lives across the country, we are basically 99% Zoom, and whenever she comes back to the area to visit family, she stops in and has a session with me, which always warms my heart. We've always been open and honest about what she can do with her schedule, and we've always found a way to make things work.

I think that one of the reasons Tara is doing so well is because she has a great support system around her. Even though she moved locations, she still had her support system with them no matter where they go. I am always a text, phone call, or Zoom call away, and if she ever needs any help, guidance, support, or confidence boost, I'm there for her. Training is tough, anybody who tells you otherwise is selling you something. So, for anyone looking to train virtually, continuing to have their support system to help them do the tough stuff makes all the difference.

Technology is here to stay, and it's up to us to make the most of it.


Our interview with personal training client, Tara N.

  1. How did you first join Performance?
    I first joined Performance when I was about 14 years old. I had sustained an injury while I was rowing in high school and shortly after, was recommended to visit Todd. Fast forward a decade or so, I ended up tearing my meniscus in graduate school and came in for physical therapy and got set up with Carter!
  2. What has your recent training experience been like?
    Carter is genuinely the best. I am a relatively reserved person when working out; all I want is to be worked hard, and for someone to push me when I need to be pushed. Carter did exactly that and more. When I would feel low and not comfortable in my body, or unhappy with my post-surgery recovery progress, Carter would always be quick with encouragement, and a kind word. He truly understands his clients and is not only an amazing trainer, but a friend as well.
  3. What are your goals?
    Funnily enough the very first goal was to just walk comfortably and without pain again. The second goal was to be able to do one pushup! But my serious, overarching goal was to just feel strong, to not have any pain, and to become a better athlete by working on my full body conditioning. I am happy to say that I'm good on goals 1 and 2, and am very happy with my progress on 3.
  4. Now that you are training virtually, do you miss coming to your workouts in person?
    Personally, I do love being in person. However, I moved out west for a new job, and being virtual has allowed me not only to stay connected to Performance, but has also allowed me to continue working with Carter! While I do miss coming in and the routine of going to a physical location, I have found that remote working gets rid of any of my excuses to workout and instead has allowed me to really flourish in my space.
  5. How did training virtually impact or improve your journey or your goals?
    Initially it was challenging. Coming into the Performance location in Greenwich was so much fun, and I loved using the equipment. That said, Carter's expertise and ability to use what was available to me to achieve the same results was impressive! If anything, training remotely also helped me realize that I can be just as strong, just as productive in my home and that I can achieve physical success anywhere if I know how to look for it.

Carter Bushway

Carter Bushway

Carter Bushway, CPT, has channeled his passion for exercise into everything he does. Carter has a passion for basketball, balance and stability training, group fitness classes and working with older adults.

Meet Carter

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Revolutionizing physical therapy: the transformative role of AI in diagnosis, treatment, and patient care

Revolutionizing physical therapy: the transformative role of AI in diagnosis, treatment, and patient care

As we look into the future, the field of physical therapy stands on the brink of a profound revolution, driven by the potential of AI. Much like a skilled practitioner, AI can play a pivotal role in differential diagnosis, determining prognoses, developing personalized treatment plans, and in communication, monitoring and progression of treatment plans from afar.

December 7, 2023 | Shane Foley, PT, DPT, OCS, CSCS

physical therapy and AI

In the ever-evolving landscape of healthcare, the integration of artificial intelligence (AI) has already proven to be a transformative force. Many large hospital organizations are already utilizing this these technologies in things like reading x-rays and MRIs, and for pattern recognition in diagnosis disorders. As we look into the future, the field of physical therapy stands on the brink of a profound revolution, driven by the potential of AI. Much like a skilled practitioner, AI can play a pivotal role in differential diagnosis, determining prognoses, developing personalized treatment plans, and in communication, monitoring and progression of treatment plans from afar. AI is poised to elevate the practice of physical therapy into a more dynamic service offering, by improving precision and efficiency in diagnosis and treatment while fostering enhanced communication between therapists and patients.

One of the primary challenges in orthopedic physical therapy lies in consistency and accuracy of diagnosing a condition, and then developing the best treatment plan to return back to activity without pain and mitigate risk of injury recurrence. AI, with its ability to process vast datasets, synthesize research and identify patterns beyond human capacity, becomes a powerful tool in this regard. Physical therapists, Board Certified Orthopedic or Sports Clinical Specialists, those in Residency or Fellowship post-doctoral training, can all benefit from this tool. By analyzing patient history, imaging, and clinical data, AI algorithms can assist therapists in pinpointing the root cause of musculoskeletal issues with specific accuracy. With this, from the evaluation, patients can know that best guidelines are used to create the framework for the therapist to begin care. This then allows the experience and true artistry of the therapist’s manual therapy and patient specific rehab program design to come into play. This is the real differentiator!

The marriage of human expertise and AI prediction capabilities promises a more dynamic and responsive approach to patient care. This will allow both synchronous and asynchronous analysis of technique and form with prescribed exercises, communication, and the assimilating patient data, lifestyle factors, and treatment responses. AI models can help to forecast the likely trajectory of a condition in real time, providing foresight that enables therapists to proactively adapt treatment plans, optimize outcomes and potentially prevent the exacerbation of symptoms.

Personalization is the cornerstone of effective physical therapy and in high quality patient care. With the busy clinic environment in many physical therapy practices across the country, too often, a 16 y/o patient who tore their ACL and a 65 y/o patient with a knee replacement begin their treatment with the cookie-cutter “Knee Program.” AI helps to develop an evidence based framework for the patient, that the therapist can then use their creativity and expertise to tailor treatment plans to individual needs.

Continuous learning capabilities enable real-time adjustments to treatment plans based on patient progress. Although there is an expected timeline of recovery, as we have seen many times in professional sports, there are many specific and individualized factors which may cause someone to be on one side of the rehab timeline or the other. This iterative and adaptive approach ensures that therapy evolves dynamically, addressing the unique challenges each patient faces throughout their rehabilitation journey and that the determination of time to return to activity is appropriate.

Effective communication is integral to a successful therapeutic alliance between physical therapists and their patients. AI contributes to this aspect by facilitating seamless and personalized communication channels. AI-powered platforms can offer patients real-time guidance, support, and educational resources. These tools not only empower patients to actively participate in their rehabilitation, but also foster a continuous feedback loop between the therapist and the individual. The result is a collaborative and informed approach where patients feel engaged and motivated throughout the treatment process.

As we look toward the future of physical therapy, the symbiotic relationship between human expertise and artificial intelligence promises a paradigm shift in healthcare delivery. The integration of AI in differential diagnosis, prognosis determination, treatment plan development, and patient communication holds the potential to revolutionize the field, providing practitioners with unprecedented tools for precision and efficiency. Utilization of AI in physical therapy is the evolution of their field, a progression to a true hybrid-rehab model.

The hands-on manual artistry of a physical therapist will always be an irreplaceable skill to not just fact-check AI, but to help alleviate pain, decreased muscle tightness, improve mobility, provide tactile cuing for correct exercise performance, and build a trusting relationship between two human beings. It is my position that in the hands of a highly educated, experienced clinician, the utilization of AI is the future of best practice in clinical base healthcare. The utilization of AI across all levels and experiences of clinicians in the field of physical therapy helps to raise the floor, and overall quality of care that can be provided by anyone, anywhere. Thus, helping more people get better both completely and faster.


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 has a deep passion for building relationships, helping people accomplish their goals and leading people to optimize their performance.

Meet Shane

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Food is primary care: the role of food in preventing and managing chronic diseases

Food is primary care: the role of food in preventing and managing chronic diseases

Long a blind spot of medicine, nutrition has stepped into focus in recent years. Yet it can be a powerful tool to promote a healthy life, if used correctly. "Food Is Medicine" is defined as the provision of healthy food resources to prevent, delay, manage, or treat specific clinical conditions in coordination with the health care system.

December 7, 2023 | Francine Blinten, MBA, MS, CCN, CNS

food is medicine

Long a blind spot of medicine, nutrition has stepped into focus in recent years. Yet it can be a powerful tool to promote a healthy life, if used correctly. "Food Is Medicine" is defined as the provision of healthy food resources to prevent, delay, manage, or treat specific clinical conditions in coordination with the health care system.

According to the Centers for Disease Control and Prevention, six out of every ten adults in the United States have at least one chronic disease, and about four in ten have two or more chronic diseases. Chronic diseases are conditions of long-term duration and require ongoing medical care; they include cardiovascular disease, atherosclerosis, hypertension, cancer, type 2 diabetes, Alzheimer’s disease, and osteoporosis, among others. Healthful nutrition practices are an essential component of efforts to prevent or control these diseases.

While nutrition cannot replace medicine, it can be an important part of a care plan; one the patient can control. Importantly, people are demanding it and if their healthcare providers are not incorporating therapeutic lifestyle options in their patient encounters, they will seek it out elsewhere, often from scientifically unsupported sources.

Fortunately, several organizations and associations are recommending guidelines, research, and funding for food as medicine programs. The American Heart Association (AHA) recently called for more research on integrating food and nutrition into healthcare. In September 2022, the AHA launched a Food Is Medicine research initiative designed to determine the impact of nutrition-based interventions on disease prevention and treatment, compared with standard medical care.

The National institute of Health published a study that showed preventable cancer burden is associated with poor diet in the United States, which means we can decrease our risk of cancer by maintaining a healthy diet.

Another example is preventing diabetes: the National Diabetes Prevention Program is the CDC-recognized lifestyle change program, a research-based program focusing on healthy eating and physical activity which showed that people with prediabetes who take part in a structured lifestyle change program can cut their risk of developing type 2 diabetes by 58% (71% for people over 60 years old).

Below are some examples of how your healthcare providers can integrate nutrition in their care, empowering clients to live a healthy lifestyle.

  • Providing educational materials such as handouts on diet related disease with sample meal plans and recipes.
  • Providing support for clients experiencing treatment related side effects. Dietary modifications can provide symptom relief so they can better tolerate treatment.
  • Appropriate referrals to dietitians or nutritionists. A feedback loop is crucial so providers can reinforce diet recommendations during patient visits.
  • Nutrition competency training for staff so everyone can participate in the effort and provide support.

Here's what you can do on a daily basis to improve your eating habits and lower your risk of chronic disease, or manage its symptoms:

  • Prioritize Plant-Based Foods
    • Increase the proportion of plant-based foods in your diet, such as vegetables, fruits, legumes, and nuts, which are rich in vitamins, minerals, and antioxidants.
  • Limit Processed Foods and Sugars
    • Reduce the intake of processed foods, sugary snacks, and beverages. Opt for whole, unprocessed foods to minimize added sugars and artificial ingredients.
  • Choose Healthy Cooking Methods
    • Opt for cooking methods such as baking, grilling, steaming, and sautéing instead of deep frying. These methods help retain the nutritional value of food.
  • Include Omega-3 Fatty Acids
    • Incorporate sources of omega-3 fatty acids, such as fatty fish (salmon, mackerel), flaxseeds, chia seeds, and walnuts, which are beneficial for heart and brain health.
  • Regular Physical Activity
    • Combine a healthy diet with regular physical activity for optimal health. Exercise contributes to overall well-being and can complement the benefits of a nutritious diet.
  • Consult with Healthcare Professionals
    • Seek advice from healthcare professionals, such as registered dietitians or nutritionists, for personalized guidance based on individual health needs and goals.
  • Cultivate Healthy Eating Habits
    • Aim for consistency in making healthy food choices, and view food as a form of self-care. Cultivate a positive relationship with food for long-term well-being.

Francine Blinten

Francine Blinten

Francine Blinten, MBA, MS, CCN, CNS, specializes in disease prevention, management of chronic disease, weight management, gastrointestinal disorders and bone support. She also has a subspecialty in oncology nutrition.

Meet Francine

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Unleashing the power of wearable technology in healthcare

Unleashing the power of wearable technology in healthcare

Wearable technology aids in improving healthcare outcomes in various ways. What sets these apart from your standard blood pressure cuff monitors, pulse oximeter, or other devices you see in a doctor's office or other medical setting, is the fact that these are devices you can wear every day. Here's how to make the most of them.

December 7, 2023 | Robert Mahlman, PT, DPT, OCS

wearables

Healthcare is a rapidly evolving landscape in which wearable technology has emerged as a game changer by offering individuals, an unprecedented opportunity to take control of their well-being. Wearables provide continuous monitoring and personalized insights which aid in exercise performance, recovery, nutrition, and overall stress management.

Wearable technology aids in improving healthcare outcomes in various ways. What sets these apart from your standard blood pressure cuff monitors, pulse oximeter, or other devices you see in a doctor's office or other medical setting, is the fact that these are devices you can wear every day. From Apple Watches to Oura Rings, FitBits to Whoop Straps, there are plenty of options for everyone.

When it comes to exercise, we are all used to wearables that will track steps, calories burned, and even heart rate while exercising. But with the current wearable technology, your average heart rate and current heart rate, heart rate variability, respiratory rate, stress levels, and even an EKG can be provided to you pre, during and post workout. This information is important with exercise as it allows the individual to see how their body responds to a specific program during the activity, and after. You can personally determine how hard the workout is, not only by a subjective feel, but also by the metrics your wearable provides.

Something that has become more important in optimizing your health and exercise is how you recover. While there are various ways you can promote recovery, such as getting appropriate sleep, mindfulness and massage therapy, wearable technology provides insight on how well those recovery tactics work on your body specifically. For example, after a stressful day or difficult workout, you may notice certain metrics will be out of their usual range. Then, by using certain recovery techniques, you can see how long and how effectively they return to baseline. This is important as it can help with managing injury risk, and overall optimization of an exercise program.

The use of wearable technology allows the average person to gain insight on their bodies, response to activities or stress, and then make an educated decision with objective data on how to recover best from that stress and build a program around it. With wearable technology, you are able to monitor your overall health regularly and watch for trends. This is some thing that when used appropriately can help decrease risk of injury across all ages, improve overall quality of life and health, and decrease stress on the healthcare system by promoting more accountability from the individual.


Robert Mahlman

Robert Mahlman

Robert Mahlman, PT, DPT, OCS, is 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 Rob

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Understanding metabolic health through key biomarkers

Understanding Metabolic Health Through Key Biomarkers

Metabolic health is all about having ideal levels of certain biomarkers, such as obesity, elevated triglycerides, HDL levels, insulin resistance, and blood pressure, among others. These markers are like checkpoints on the road to a healthy metabolism — here's what you need to know.

November 1, 2023 | Claire Petri, CPT

metabolic panel

In the fast-paced world we live in, it's easy to overlook the intricate processes that keep our bodies running smoothly. One such vital process is metabolism, responsible for converting the food and beverages we consume into the energy we need to function. But how do you know if your metabolism is healthy and operating efficiently? In this article, we'll delve into the world of metabolic health and the essential biomarkers you should be keeping an eye on.

Metabolism at a glance

The metabolism is the engine that drives our bodies, determining how efficiently we burn and utilize calories. It's a complex network of chemical reactions that allows us to harness the energy we get from our diet. But just like any engine, it can experience hiccups. That's where metabolic health comes into play.

Metabolic health and biomarkers

Metabolic health is all about having ideal levels of certain biomarkers. These markers are like checkpoints on the road to a healthy metabolism. They include:

  1. Obesity: This can be measured using waist circumference or Body Mass Index (BMI), with waist circumference often being a more accurate reflection of your health. This is because abdominal fat is strongly associated with increased health risks, particularly metabolic and cardiovascular issues.
  2. Elevated triglycerides: Triglycerides are fats found in the blood and are a significant component of body fat. Elevated levels can be a sign of metabolic issues, as they are linked to an increased risk of heart disease and can indicate an imbalance in the body's energy storage and utilization.
  3. HDL Levels (cholesterol): High-density lipoprotein (HDL) cholesterol is often referred to as "good" cholesterol. Maintaining healthy HDL levels is crucial for metabolic health because it helps remove excess cholesterol from the bloodstream, reducing the risk of plaque buildup in arteries and promoting overall cardiovascular well-being.
  4. Insulin resistance: This condition can impede your body's ability to process and store sugar efficiently, potentially leading to various health problems, such as type II diabetes.
  5. Blood pressure: High blood pressure is another important indicator of metabolic health; it can reflect the body's ability to regulate blood flow and energy utilization, and it is often linked to metabolic syndrome and related conditions.

Assessing your metabolic health

You might be wondering how you can assess your metabolic health. The most comprehensive tests are typically done in a medical setting, where a Comprehensive Metabolic Blood Panel (CMP) can provide a detailed look at these biomarkers, as well as other critical information about your health, such as fluid balance, electrolyte levels, kidney function, and more.

But did you know that there are also at-home metabolism tests available? These can give you a basic idea of your metabolic health and are a convenient option if you'd like to monitor your progress regularly. These at-home metabolism tests include options like metabolic rate calculators, home blood sugar monitors, and wearable fitness trackers that provide insights into your daily activity and calorie expenditure.

Improving your metabolic health

Once you have the results of your metabolic tests, what can you do to enhance your metabolic health? Let's break it down by the key biomarkers:

  1. Obesity: Combat obesity by adopting a healthy lifestyle. Both proper nutrition and regular exercise and physical activity can help you maintain a healthy weight and boost the efficiency of your metabolism. In other words, your body will process and use calories more effectively.
  2. HDL & triglycerides: The power of exercise and nutrition shines here. Just 60 minutes of moderate-intensity aerobic activity per week, combined with a diet rich in healthy fats like olive oil and nuts, can increase your HDL levels while reducing triglycerides.
  3. Insulin resistance: Exercise, once again, is your best ally in the fight against insulin resistance. Regular physical activity helps your body process and store sugar correctly, with muscles playing a crucial role in this process. By ensuring your muscles are actively taking in glucose, you can prevent the accumulation of excess sugar in your body, which can lead to conditions like diabetes, PCOS, non-alcoholic fatty liver disease, and stroke.
  4. Blood pressure: Stress management is a key player in maintaining healthy blood pressure. By finding effective ways to manage and reduce stress, you can significantly lower your blood pressure. Techniques like good sleep hygiene, regular massages, and meditation can be invaluable in improving your metabolic health and overall well-being.

In conclusion, keeping an eye on your metabolic health is essential for maintaining a healthy and vibrant life. By monitoring key biomarkers and making positive lifestyle choices, you can ensure that your metabolism is working optimally, keeping you energized and ready to face life's challenges. So, remember, it's not just what you eat, but how your body metabolizes it that truly counts!


Claire Petri

Claire Petri

Claire Petri, CPT, is a personal trainer based in Greenwich and Darien who specializes in strength training and functional fitness. She enjoys working with both athletes and general population clients, and has experience with Pilates techniques, weight loss and pain management, helping clients overcome gym anxieties and learning proper movement patterns.

Meet Claire

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Serendipity Magazine’s Medical Leader: Danielle Pasquale

Serendipity Magazine's Medical Leader: Danielle Pasquale

Redefining healthcare

Fall/Winter 2023 | Serendipity Magazine

Physical Therapist Danielle Pasquale PT, DPT was honored as a medical leader by Serendipity Magazine for her outstanding work creating a bridge between the highest clinical standards and exceptional levels of care. Check out her feature below.

Serendipity Magazine featured Danielle Pasquale


Danielle Pasquale

Danielle Pasquale

Danielle Pasquale, PT, DPT, is a physical therapist certified in dry needling, women's pelvic health, and pre/post-natal fitness. She has always had a passion for helping people, and decided to funnel that drive into physical therapy and teaching others how to live their healthiest life.

Meet Danielle

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The effects of body composition and insulin resistance on the heart

The effects of body composition and insulin resistance on the heart

There are ways to prevent and manage cardiovascular disease through the lens of body composition and insulin resistance. Here's what you need to know.

November 1, 2023 | Optimal Health Uncovered

heart health and insulin

Dr. Alon Gitig joined host and physical therapist Michael Beecher to provide evidence-based insights into preventing and managing cardiovascular disease through a unique perspective. They emphasize that maintaining optimal muscle mass is not only beneficial for strength and mobility but also plays a significant role in reducing the risk of cardiovascular issues. In fact, studies show that individuals with higher muscle mass have a 30% lower risk of developing cardiovascular disease.

Furthermore, they highlight the alarming fact that insulin resistance, which isi often overlooked, is a hidden contributor to the development of cardiovascular disease and dementia, making it a critical aspect of overall health to address. Recent statistics indicate that approximately 34% of adults in the United States have some level of insulin resistance, underscoring the importance of addressing this silent epidemic. Join us in gaining a deeper understanding of these connections and the factual basis for better cardiovascular well-being.

Dr. Alon Gitig, MD, is a cardiologist based in Yonkers, New York who has been practicing for over two decades. He is affiliated with Mount Sinai Hospital.

Listen here, or wherever you get your podcasts.

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What constitutes a healthy metabolism?

What constitutes a healthy metabolism?

While genetics play a role in determining metabolic rates, there are several ways to optimize your metabolism for better overall health.

November 1, 2023 | Ashley Jerry, MS

clock with food

The metabolism, often associated with weight management and energy levels, is the complex process of maintaining homeostasis by regulating energy balance, nutrient availability, and cellular functions necessary for survival and proper function. While genetics play a role in determining metabolic rates, there are several ways to optimize your metabolism for better overall health.

First, it is important to understand the signs of a healthy metabolism. Individuals with a well-functioning metabolism tend to maintain weight without excessive fluctuations. They have consistent energy levels throughout the day and experience minimal fatigue. Additionally, their digestion is efficient, leading to regular bowel movements and optimal nutrient absorption.

Physical Activity

One important factor in optimizing your metabolism is physical activity. Engaging in regular exercise not only helps burn calories, but also improves muscle mass. Since muscles require more energy than fat cells even at rest, having more lean muscle leads to an increased metabolic rate. Incorporating both cardiovascular exercises like running or swimming and strength training activities such as weightlifting can contribute to an active and healthy metabolism. Additionally, High-Intensity Interval Training (HIIT) workouts involving short bursts of intense activity followed by brief rest periods can boost your metabolic rate and increase calorie burn even after the session is over.

Nutrition & Hydration

Following a well-balanced diet also significantly impacts metabolic health. It is important to incorporate whole foods like fruits, vegetables, whole grains, lean proteins, and high-quality fats. Avoiding excessive consumption of processed foods high in added sugars and low-quality fats is key, as they can negatively impact your health and metabolism.

On the other hand, consuming more protein-rich foods, which have a higher thermic effect compared to carbohydrates or fats, leads to a higher metabolic rate. Protein also helps build and maintain muscle mass. Aim for lean sources such as chicken breast, fish, Greek yogurt, and legumes. Additionally, incorporating adequate fiber from sources like whole grains, fruits, vegetables, and legumes can support a healthy metabolism. Fiber aids digestion and helps regulate blood sugar levels.

Another way to optimize your metabolism is through proper hydration. Drinking enough water helps maintain cellular function and supports various metabolic processes within the body. Dehydration can temporarily slow down your metabolism; therefore, it is important to focus on water and electrolyte intake.

Stress Management

Adequate sleep is often overlooked, but it plays a crucial role in metabolic health. Sleep deprivation can disrupt hormone production, leading to increased appetite and cravings for high-calorie foods. It also affects the body's ability to regulate blood sugar levels properly. Aim for seven to nine hours of quality sleep each night to promote optimal metabolic function.

Lastly, stress management is essential for maintaining a healthy metabolism. When we experience chronic stress, our bodies release cortisol, a hormone that can lead to weight gain and hinder metabolic processes. Engaging in relaxation techniques such as meditation, deep breathing exercises, or hobbies that bring joy can help reduce stress levels and support a well-functioning metabolism.

To summarize: A healthy metabolism exhibits stable weight maintenance, consistent energy levels, efficient digestion, and regular bowel movements. Optimizing your metabolism involves incorporating regular physical activity into your routine, consuming balanced meals with an emphasis on protein, staying hydrated, prioritizing adequate sleep, and managing stress effectively. By adopting these lifestyle changes, you can enhance your metabolic health and overall well-being.


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. Her expertise includes gut health issues, weight loss, self-image and an overall understanding of nutrition, as well as treating a diverse range of medical conditions such as high cholesterol, high blood glucose levels, obesity, pregnancy, gastrointestinal function, anxiety, depression, and overall health.

Meet Ashley

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How menopause affects the metabolism

How menopause affects the metabolism

Among the many changes that occur during menopause, including hot flashes, night sweats, and changes in mood, a shift in metabolism also occurs which can lead to further issues as a direct result of the decrease in estrogen production. Here's what to expect.

November 1, 2023 | Ashley Moriarty, PT, DPT, OCS

woman looking out the window

Among the many changes that occur during menopause, including hot flashes, night sweats, and changes in mood, a shift in metabolism also occurs which can lead to further issues as a direct result of the decrease in estrogen production. Some of these changes include:

Slower basal metabolic rate

Basal metabolic rate is the rate at which your body burns calories at rest. If BMR slows down, which some studies suggest it does by 100 kcal/day, but energy intake (food consumption) does not decrease in a similar way, then you may be at risk of increased fat mass.

Changes in lipid profile

Menopause causes an imbalance of cholesterol, low-density lipoprotein cholesterol, (LDL), triglycerides, and high-density lipoprotein (HDL) due to a sharp decrease in estrogen. This imbalance, termed dyslipidemia, is a risk factor for cardiovascular disease.

Changes in fat distribution and insulin resistance

This is a shift in which weight is distributed throughout the body, causing more fat to accumulate in the abdomen. Abdominal fat can increase the risk of metabolic disorders, cardiovascular disease, hypertension, and diabetes due to changes in insulin resistance. The accumulation of abdominal fat in women during menopause is associated with a decline in the production of the protein adiponectin. Adiponectin is important for the metabolism of glucose, as it makes the cells muscles and the liver more sensitive to the actions of insulin. Low adiponectin levels are associated with insulin resistance and thus higher levels of glucose.

Decreased muscle mass

Other hormonal changes the occur during menopause can lead to sarcopenia, or loss of muscle mass. This decrease in muscle mass can also contribute to a slower metabolism as muscle burns more calories than fat. As you already know, there is a higher risk of increasing fat mass in the postmenopausal stage, which accompanied by a decrease in muscle mass, can put you at increased risk of musculoskeletal injury.

Recommendations

In addition to consulting with a doctor who specializes in menopause and hormone replacement therapy, you can benefit from meeting with an optimal health provider who can assess and intervene with exercise, nutrition recommendations, and help create a comprehensive plan to minimize the effects of these changes.


Ashley Jerry

Ashley Moriarty

Ashley Moriarty, PT, DPT, OCS, is a board certified orthopedic clinical specialist who is certified in dry needling and pre- and post-natal fitness.

Meet Ashley

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A comprehensive recipe for weight loss: it’s not just about exercise

A comprehensive recipe for weight loss: it's not just about exercise

When it comes to weight loss, the two commonly discussed factors include exercise and nutrition. But can someone lose weight by changing their exercise habits, but not their nutrition? Research says no: to lose weight, it is necessary to both increase physical activity and adopt a healthy, balanced diet.

October 6, 2023 | Ashley Jerry, MS

food and measuring tape

When it comes to weight loss, the two commonly discussed factors include exercise and nutrition. But can someone lose weight by changing their exercise habits, but not their nutrition? Many believe that to lose weight, it is necessary to both increase physical activity and adopt a healthy, balanced diet.

To fully identify the potential outcome of only adjusting exercise habits, one must first understand the relationship between exercise and weight loss. Exercise plays a pivotal role in burning calories and increasing metabolism. It also builds lean muscle mass, which contributes to a higher basal metabolic rate. Simply stated, the more muscle one has, the more calories they burn even at rest. Additionally, exercise helps improve cardiovascular health, boosts mood, and increases overall energy levels. Exercise is undeniably a fundamental component of any weight loss journey.

However, relying solely on exercise to lose weight poses several challenges. The first challenge includes the caloric deficit equation. An hour of moderate-intensity exercise may burn around 300-500 calories, depending on various factors such as body weight, duration, and intensity. Additionally, exercise can also stimulate hunger and increase appetite, making it more challenging to resist unhealthy food choices. Research has demonstrated that intense exercise can lead to an increase in the hunger hormone, ghrelin, while simultaneously reducing the level of the hormone responsible for suppressing appetite, leptin. This hormonal response can create a vicious cycle, making it difficult to adhere to a calorie deficit solely through exercise, without controlling nutrition habits.

Some people believe that if one were to increase the intensity and duration of their workouts, they will burn enough calories to create a calorie deficit, resulting in weight loss. While this may be true to some extent, it is important to note that relying solely on exercise to achieve weight loss goals can be a challenging and unsustainable approach. Additionally, the body is highly efficient at adapting to increased physical activity. Over time, the body becomes more efficient at performing the exercise routine, which means fewer calories are burned for the same effort. This is known as exercise adaptation, which can further impede weight loss efforts if nutrition is not addressed.

Studies have consistently shown that diet plays a more significant role in weight loss than exercise alone. In fact, numerous studies strongly support the view that changing dietary habits is fundamental for long term successful and sustainable weight loss. This is because it is much easier to consume calories than it is to burn them through physical activity.

Incorporating a balanced diet consisting of lean proteins, carbohydrates, and healthy fats (macronutrients) and one that is limited in calories will create a caloric deficit, ultimately leading to weight loss. Individuals can support their overall exercise performance and recovery by consuming nutrient-rich foods such as fruits, vegetables, nuts, whole grains, and lean proteins which promotes satiety and prevents overeating.

Another important factor to consider is the importance of post-exercise nutrition. After a workout, the body requires proper nourishment to replenish glycogen stores, repair muscles, and support recovery. Consuming a balanced meal or snack that includes adequate protein and carbohydrates can enhance the benefits of exercise and maximize weight loss. Protein consumption is particularly crucial, as it promotes muscle synthesis and boosts metabolism, helping to sustain weight loss efforts in the long run.

While it is possible for some individuals to lose weight solely by changing their exercise habits. It is often more efficient to address both exercise and nutrition simultaneously to achieve sustainable weight loss and optimize overall well-being.

It is essential to recognize that no one-size-fits-all approach exists and it is best to consult with a qualified nutritionist or healthcare provider who can provide personalized guidance for sustainable weight loss.


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. Her expertise includes gut health issues, weight loss, self-image and an overall understanding of nutrition, as well as treating a diverse range of medical conditions such as high cholesterol, high blood glucose levels, obesity, pregnancy, gastrointestinal function, anxiety, depression, and overall health.

Meet Ashley

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Best approaches to treat your low back pain

Best approaches to treat your low back pain

Low back pain is one of the most common conditions someone will experience at some point in their life. The good news is that majority of individuals with low back pain will experience complete recovery, especially when utilizing various conservative treatment approaches.

October 6, 2023 | Renee Lascarides, PT, DPT

man clutching his chest

Low back pain is one of the most common conditions someone will experience at some point in their life. Studies have found lifetime prevalence rates for experiencing low back pain range from 70-84%. While low back pain initially may be scary, there is no reason to worry. The good news is that majority of individuals with low back pain will experience complete recovery, especially when utilizing various conservative treatment approaches that can be customized to fit someone’s needs and interests. These treatments will help control pain, improve disability, and improve quality of life. Surgery is usually only indicated for a small percentage of people with low back pain, and is not the go-to treatment option.

Stay on the move

The spine is built to be strong and resilient. When someone is experiencing low back pain, the first thought is usually to stay in bed and let it rest. However, he best thing to do when low back pain starts up is to modify, not restrict, activity, and keep moving. Avoiding painful movements or activities is okay, but bedrest is going to prolong pain and limitation of daily activities. Motion is lotion for our joints. The more we move, the better our bodies will feel. This is why exercise is the best treatment for low back pain. It may initially seem scary to exercise while you are in pain, but it will not cause any damage or further the injury, especially when it is under the guidance of a trained professional, such as a physical therapist.

Use hands on techniques

Utilizing physical therapy and massage therapy can also drastically reduce pain levels. In the early phases, hands on techniques in physical therapy can help improve how the joints in the low back move and reduce pain levels. It can also help mobilize tight and restricted muscles. Exercises can include gentle and progressive strengthening of the core, hip musculature, trunk, and legs. Aerobic exercise has been found to be one of the most effective treatments for patients who have been experiencing chronic low back pain. This can include walking, swimming, or riding a bicycle.

Other exercise methods that help people with low back pain include Pilates and yoga. Building strength will help reduce pain, restore disability, and improve robustness of the spine. Exercising also allows the body to release pain alleviating chemicals, which reduces the amount of medication needed to control pain.
Another very important aspect of recovering from low back pain is sleep.

Encourage good sleep hygiene

Good quality sleep will allow the body to heal and recover. Good sleep hygiene is crucial for us to function at our highest capacity. There are things we can modify to set us up for success; a cold, dark room along with a consistent sleep and wake time are ideal for good quality sleep.Creating a routine before bed can help signal to our body that it is time to start winding down. Taking a hot shower or bath, stretching, meditating, or doing breathe work are all good activities that will help prime our bodies for sleep and reduce low back pain. Performing this routine at or around the same time every night also helps create a regular sleep schedule. Try to avoid caffeine four to six hours before bed and avoid eating a late dinner. All these tips can help prime our body to reach REM sleep and deep sleep, where our muscles repair and grow and our body and mind recover. This is why good quality sleep will optimize recovery from low back pain.

Overall, there are a variety of methods you can use to decrease your back pain without resorting to surgery unless necessary. Remembering to stay mobile and avoiding bed rest is crucial, as well as getting a good night’s sleep and using hands on recovery methods such as massage or physical therapy.


Renee Lascarides

Renee Lascarides

Renee Lascarides, PT, DPT, is a physical therapist in the Hamden office, as well as an adjunct faculty member at Sacred Heart University. As a youth athlete, Renee was constantly active and played soccer and participated in cheerleading and gymnastics.

Meet Renee

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Should you stretch before or after a workout?

Should you stretch before or after a workout?

Warming up effectively will increase blood flow to muscles, prime joints and tendons, and lower the risk for injury. So, let’s settle the debate: what’s the best way to accomplish this, dynamic or static stretching?

October 6, 2023 | Claire Petri, CPT

woman stretching

Why limber up? A proper warm up will signal to your muscles that they are about to be called into action. Warming up effectively will increase blood flow to muscles, prime joints and tendons, and lower the risk for injury. So, let’s settle the debate: what’s the best way to accomplish this, dynamic or static stretching?

The difference between dynamic and static stretching is all about movement. Dynamic stretching is controlled movement, with the goal of taking the body through its full range of motion. These maneuvers often mimic the functional movements that will be performed during the workout. Some benefits of dynamic stretching include an increased range of motion in muscles and joints, improved blood flow, and mind-muscle connection. When a proper dynamic warm up is implemented, we also see superior muscle engagement and strength gains.

A noteworthy example is the World’s Greatest Stretch. When performed correctly, this movement effectively mobilizes the thoracic spine, hips and ankles!

woman performing the World's Greatest Stretch
Image courtesy of MindBodyGreen.

Static stretching is also extremely beneficial! However, this is best used in the cool down portion of the workout. For this style of stretching, muscles are held in an elongated position for 30 seconds or longer. Static stretching will increase flexibility, help prevent muscular soreness in the days following a workout, and will have long term effectiveness in reducing the risk of muscle strain injuries. When paired with breathwork, static stretching at the end of a workout will signal a physiological cool down response in the body, allowing heart rate to slow and blood pressure to return to pre-exercise levels. Talk about effective movement from start to finish!

References

  1. https://www.hss.edu/article_static_dynamic_stretching.asp
  2. https://news.hss.edu/9-of-the-best-dynamic-stretches-to-warm-up-with-before-a-workout-according-to-personal-trainers/
  3. https://www.physio-pedia.com/Impact_of_Static_Stretching_on_Performance#:~:text=Static%20stretching%20has%20a%20relaxation,postural%20awareness%20and%20body%20alignment.
  4. https://www.uhhospitals.org/blog/articles/2023/07/dynamic-stretching-how-to-properly-warm-up-for-exercise#:~:text=%E2%80%9CStatic%20stretching%20takes%20your%20body,University%20Hospitals%20TriPoint%20Medical%20Center

Claire Petri

Claire Petri

Claire Petri, CPT, is a personal trainer based in Greenwich and Darien who specializes in strength training and functional fitness. She enjoys working with both athletes and general population clients, and has experience with Pilates techniques, weight loss and pain management, helping clients overcome gym anxieties and learning proper movement patterns.

Meet Claire

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Are men more susceptible to heart disease?

Are women more susceptible to heart disease?

There is a common misconception that men have an increased risk of cardiovascular disease (CVD) compared to women. Recent studies have refuted this claim, stating that aging women have an increased incidence and severity of CVD compared to men.

October 6, 2023 | Chris Donato, PT, DPT

man clutching his chest

There is a common misconception that men have an increased risk of cardiovascular disease (CVD) compared to women. Recent studies have refuted this claim, stating that aging women have an increased incidence and severity of CVD compared to men.

The American Heart Association (AHA) reported in 2019 that males ages 60-79 had a 77.2% incidence of CVD, while females in the same respective age range had 78.2% incidence of CVD. In adults over 80 years of age, AHA reported females also had an increased incidence of CVD (91.8%) compared to males (89.3%). AHA also stated that from 2014-2017, 77.8% of women and 70.8% of men were diagnosed with high blood pressure or hypertension (HTN). The incidence of HTN in adults over 75 years old was 85.6% in females and 80% in men.

In women with diabetes, the risk of heart failure and risk of mortality due to CVD is increased compared to diabetic men. It was reported that incidence of mortality due to diabetic cardiomyopathy is higher in women than men, as diabetes is believed to negatively impact the protective effect of estrogen against CVD in premenopausal women.

The decline in sex hormones is also shown to increase the risk for CVD with onset of increasing age in both genders. While both genders experience a decrease in sex hormones, the decline is more significant in women following the onset of menopause. Estrogen is correlated with a lower overall incidence of CVD in premenopausal women. This further supports the indication that the steep decline in estrogen following menopause leads to an increased risk for CVD in aging women by 2-4x. Menopause also leads to increased incidence of high LDL cholesterol, HTN, diabetes, and obesity, which further elevates the risk for CVD in aging females.

However, men also experience an increased risk for CVD following a decline in the production of sex hormones. For example, studies report an increased risk for CVD in aging adult men associated with hypogonadism. This decrease in testosterone has an independent association with increased risk for acute MI in males with type 2 diabetes, as well as an overall increased incidence of CVD in men. In aging men, low testosterone levels have been linked to a higher risk for stroke. At 40 years old, men with serum testosterone levels below the recommended threshold have a higher risk of mortality due to CVD.

Other risk factors that put women at an increased risk for CVD include the steeper increase in systolic blood pressure in aging women. In adults over 75 years of age, hypertension is 14% more prevalent in females, leading to an increased risk for left ventricular hypertrophy, heart failure, and stroke. Also, women with a history of hypertensive disease during pregnancy also have an increased incidence of CVD later in life.

As mentioned earlier, although the risk of CVD in females is slightly higher than in men, increasing age has been found to have a significant correlation with the increased incidence of CVD in both genders. Therefore, it is essential to promote physical activity and lead a healthy lifestyle in order to minimize the modifiable risk factors and comorbidities associated with cardiovascular disease.

References

  1. Rodgers JL, Jones J, Bolleddu SI, Vanthenapalli S, Rodgers LE, Shah K, Karia K, Panguluri SK. Cardiovascular Risks Associated with Gender and Aging. Journal of Cardiovascular Development and Disease. 2019; 6(2):19. https://doi.org/10.3390/jcdd6020019
  2. Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J. 2010 Dec;18(12):598-602. doi: 10.1007/s12471-010-0841-y. PMID: 21301622; PMCID: PMC3018605.

Chris Donato

Chris Donato

Chris Donato, PT, DPT, is a physical therapist based in New Canaan who enjoys working with all populations. He specializes in working with athletes, especially overhead athletes, drawing from his time playing five years of club baseball at Sacred Heart University.

Meet Chris

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Marathon Mondays: Make it to the start healthy

Marathon Mondays: Get to the start healthy

In the final episode of our Marathon Monday mini-series, 5x Boston Marathon Division Winner Heather Pech joins the podcast to talk about her training process and how she keeps winning gold.

September 11, 2023 | Britt Gunsser, PT, DPT, OCS, CSCS | Brendan Copley, CSCS, ATC

Get to the start healthy

Hosts physical therapist Britt Gunsser and personal trainer Brendan Copley, who are marathoners themselves, discussed what exactly makes Heather such a successful runner — from her nutrition to mentality, Heather breaks down everything that makes her a world record holder.

During the interview, Heather shares her running journey, highlighting the importance of paying attention to the finer details in training that can set athletes apart, as well as the crucial role of community and support in her running life and how she has cultivated a network over the years.

The hosts delve into Heather's approach to optimal health, touching on the four pillars of exercise, stress management, recovery, and nutrition. Heather shares insights into how she has evolved her recovery and rest strategies throughout her running career and provides valuable advice on balancing running with other life commitments. She also discusses the significance of cross-training to prevent burnout and shares her mental resilience strategies.

Heather wraps up the interview by recommending resources for aspiring runners, sharing her upcoming running goals, and reflecting on memorable races that have shaped her remarkable running career.

Listen here, or wherever you get your podcasts.


Britt Gunsser

Britt Gunsser

Britt Gunsser, PT, DPT, OCS, CSCS, 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.

Meet Britt

Brendan Copley

Brendan Copley

Brendan Copley, CSCS, ATC, is a personal trainer who specializes in working with endurance athletes and post-rehab clients. Brendan is a marathoner and former cross-country runner and has worked as an athletic trainer for Quinnipiac University’s cross-country and track teams.

Meet Brendan

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Marathon Mondays: Listen to your “foot brain”

Marathon Mondays: Listen to your "foot brain"

Megan Searfoss, owner of Ridgefield and Darien Running Company, joins Britt and Brendan to dive into the rigorous running shoe fitting process that includes a 3D scanner, detailing why the brand and type of shoe matters for the wearer. The trio also discuss the latest trends in footwear, including carbon plating, as well shoe life expectancy and how to deal with companies updating your favorite pair of running shoes.

August 21, 2023 | Britt Gunsser, PT, DPT, OCS, CSCS | Brendan Copley, CSCS, ATC

Listen to your

On this episode of Marathon Mondays hosted by physical therapist and RRCA Running Coach Britt Gunsser and personal trainer Brendan Copley engage in a discussion about running footwear with Megan Searfoss, the owner of Ridgefield and Darien Running Company.

Megan dives into the rigorous running shoe fitting process that includes a 3D scanner, detailing why the brand and type of shoe matters for the wearer. The trio also discuss the latest trends in footwear, including carbon plating, as well shoe life expectancy and how to deal with companies updating your favorite pair of running shoes.

They dive into the advantages of visiting a running store over buying shoes online, emphasizing the importance of a personalized fitting process, such as using a 3D scanner to determine arch height, size and width, as well pressure points, pronation, supination, and foot flexibility while walking. The purpose of the shoe is also evaluated during the fitting process to determine whether road, trail, cross-training, or walking shoes are right for the customer based on their different needs.

No one shoe will work for everyone, and depends on personal style preference (traditional vs. minimalist vs. maximalist shoes), how they run (forefoot running vs. heel striking) and how much support their feet require. Megan discusses the purpose of shoe rotation, wear and tear considerations, and recovery time for shoes, as well as her specific recommendations for marathoners.

Near the end, Megan touches on the phenomenon of "super shoes," or high-tech sneakers that claim to make their users run faster, explaining who they benefit and their key differences from regular training shoes. She also goes over common myths and misconceptions about running shoes, finally answering the question, "which brand or shoe is the best?"

Finally, the hosts address common myths about running shoes and seek Megan's response to the age-old question of what constitutes the best shoe or brand. The episode concludes with a fun question about pump-up songs for races, offering a well-rounded and informative exploration of the world of running footwear.

Listen here, or wherever you get your podcasts.


Britt Gunsser

Britt Gunsser

Britt Gunsser, PT, DPT, OCS, CSCS, 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.

Meet Britt

Brendan Copley

Brendan Copley

Brendan Copley, CSCS, ATC, is a personal trainer who specializes in working with endurance athletes and post-rehab clients. Brendan is a marathoner and former cross-country runner and has worked as an athletic trainer for Quinnipiac University’s cross-country and track teams.

Meet Brendan

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Marathon Mondays: Mental strategies to help you the finish line

Marathon Mondays: Mental strategies to help you the finish line

Hosts Britt Gunsser, physical therapist and RRCA Running Coach, and Brendan Copley, personal trainer, are joined by mental performance consultant Arianna Martignetti as they dive into the realm of sports psychology, aiming to unravel the mental aspects of training and racing. They explore the often-quoted sentiment that running is primarily a mental endeavor, and seek insights into how athletes can enhance their mental strategies to complement their physical preparation..

July 3, 2023 | Britt Gunsser, PT, DPT, OCS, CSCS | Brendan Copley, CSCS, ATC | Arianna Martignetti, Ed.D

Mental strategies to help you the finish line

Hosts Britt Gunsser, physical therapist and RRCA Running Coach, and Brendan Copley, personal trainer, are joined by mental performance consultant Arianna Martignetti as they dive into the realm of sports psychology, aiming to unravel the mental aspects of training and racing. They explore the often-quoted sentiment that running is primarily a mental endeavor, and seek insights into how athletes can enhance their mental strategies to complement their physical preparation.

The group explores methods to cope with challenging moments in training, handle negative self-talk, and prevent the cascade effect of bad days or weeks in a training cycle. The conversation extends to race-specific strategies, including pace management, setting realistic expectations, and dealing with race-day jitters. Arianna sheds light on the physiological aspects of these mental strategies and discusses how they impact performance. She also touches on scenarios involving unfamiliar races or returning to training after injury or time off.

Arianna provides insights into daily mental strategies for promoting peak performance using techniques such as visualization and offers
guidance on overcoming common mental traps that can hinder an athlete's progress. She finished with a discussion on how to work through negative self-talk and how to implement daily mental strategies to promote peak performance, among other topics.

Listen here, or wherever you get your podcasts.


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, including competitive youth, high school, and collegiate levels, as well as recreational athletes.

Meet Arianna

Britt Gunsser

Britt Gunsser

Britt Gunsser, PT, DPT, OCS, CSCS, 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.

Meet Britt

Brendan Copley

Brendan Copley

Brendan Copley, CSCS, ATC, is a personal trainer who specializes in working with endurance athletes and post-rehab clients. Brendan is a marathoner and former cross-country runner and has worked as an athletic trainer for Quinnipiac University’s cross-country and track teams.

Meet Brendan

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Marathon Mondays: Nutrition and hydration for the long distance runner

Marathon Mondays: Nutrition and hydration for the long distance runner

On this episode of Marathon Mondays, hosts Britt Gunsser and Brendan Copley bring in nutritionist Ashley Jerry to discuss essential fueling strategies for long-distance runners. They cover the importance of macronutrients, hydration, and carbohydrate intake, providing practical tips to manage GI distress, optimize nutrition during taper phases, and make informed choices regarding supplements, all aimed at helping runners enhance their performance and recovery.

June 5, 2023 | Britt Gunsser, PT, DPT, OCS, CSCS | Brendan Copley, CSCS, ATC | Ashley Jerry, MS

Nutrition and hydration for the long distance runner

On this episode of Marathon Mondays hosted by physical therapist and RRCA Running Coach Britt Gunsser and personal trainer Brendan Copley invite nutritionist Ashley Jerry to share insights on fueling strategies for long-distance runners. The episode kicks off by emphasizing the importance of proper nutrition throughout the entire training plan, and especially as training intensity and duration increase. Ashley underscores the essential role of macronutrients — carbohydrates, fats, and proteins — in meeting a runner's energy needs. Additionally, she offers practical advice on maintaining proper hydration, especially in hot weather, and ensuring an adequate intake of electrolytes.

The discussion deepens into the significance of carbohydrates in sustaining energy levels during long runs, and they discuss recommendations based on the timing and types of carbohydrates that runners should consume. Ashley also provides examples of pre and post-meal options for marathon runners and explores strategies to manage gastrointestinal distress during and after runs, shedding light on common triggers for such issues and how to prevent them.

Over the course of the episode, Ashley, Brendan and Britt cover a range of topics related to running nutrition, including fueling on days involving both running and weightlifting, the use of supplements like BCAAs and green powders, recognizing signs of under-recovery, and the importance of incorporating rest days into a training regimen.

Listen here, or wherever you get your podcasts.


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. Ashley specializes in sports-specific nutrition guidance, including for sports such as running, powerlifting, bodybuilding, crew, football, and more.

Meet Ashley

Britt Gunsser

Britt Gunsser

Britt Gunsser, PT, DPT, OCS, CSCS, 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.

Meet Britt

Brendan Copley

Brendan Copley

Brendan Copley, CSCS, ATC, is a personal trainer who specializes in working with endurance athletes and post-rehab clients. Brendan is a marathoner and former cross-country runner and has worked as an athletic trainer for Quinnipiac University’s cross-country and track teams.

Meet Brendan

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Marathon Mondays: Building a marathon training plan

Marathon Mondays: Building a marathon training plan

In this introductory episode, Britt and Brendan dig into what you should be looking for in a thorough training program, answer frequently asked questions, and debunk common myths. They cover developing a personalized training plan, the importance of different types of runs, how to incorporate strength training, and more.

May 8, 2023 | Britt Gunsser, PT, DPT, OCS, CSCS | Brendan Copley, CSCS, ATC

Building a marathon training plan

The inaugural episode of the Marathon Monday podcast, hosted by physical therapist Britt Gunsser and personal trainer Brendan Copley, sets the stage aimed to prepare runners at all experience levels for their next race, hosted by marathoners themselves. Their goal is to be as helpful as a post-race banana, offering insights into topics like personalized training plans, types of runs, strength training, and more. They discuss various options for training programs, including pre-formulated online plans, hiring a coach, or going the DIY route, each with its pros and cons. They also touch on how to find the right coach, emphasizing factors like experience, coaching platform, and finding the right personality match.

The episode delves into the five main workout categories in a training plan: long runs, interval training, easy runs, cross training, and recovery runs. They discuss the importance of not overemphasizing the long run, debunking the myth that the long run is the only critical workout. Britt and Brendan also discuss interval training, easy run percentages, and the purpose of recovery runs and cross training.

For those who are just starting out, Britt and Brendan also provide insights into what a typical beginner's strength and conditioning program for runners might look like, stressing the importance of starting with bodyweight or light weights for those new to strength training. They also touch on how strength training requirements might change when training for a marathon, including adjusting to busy schedules or integrating running into other fitness classes effectively.

Listen here, or wherever you get your podcasts.


Britt Gunsser

Britt Gunsser

Britt Gunsser, PT, DPT, OCS, CSCS, 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.

Meet Britt

Brendan Copley

Brendan Copley

Brendan Copley, CSCS, ATC, is a personal trainer who specializes in working with endurance athletes and post-rehab clients. Brendan is a marathoner and former cross-country runner and has worked as an athletic trainer for Quinnipiac University’s cross-country and track teams.

Meet Brendan

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The missing link to successful rehab and return to sport

The missing link to successful rehab and return to sport

While much is understood about the importance of physical therapy when rehabilitating from an injury and returning to sport, there is less focus on the role of mental performance. Overall, psychological readiness has been undervalued and underassessed when determining if an athlete is ready to return to sport at their previous competitive level.

August 1, 2023 | Ashley Moriarty, PT, DPT, OCS

woman with an injured thigh

While much is understood about the importance of physical therapy when rehabilitating from an injury and returning to sport, there is less focus on the role of mental performance. Overall, psychological readiness has been undervalued and underassessed when determining if an athlete is ready to return to sport at their previous competitive level.

While research continues to emerge regarding the importance of incorporating mental performance to all injuries, there is a strong body of evidence related specifically to anterior cruciate ligament reconstruction (ACLR). It has been suggested that the single most important factor influencing return to pre-injury sport participation is psychological readiness, and current data suggests that only 50% of people who have undergone ACLR return to their previous level of activity. Of those that do return, up to 30% sustain a second injury within two years.

In order to return to sport after ACLR, there are a battery of physical tests that are usually administered to assess strength, power, and range of motion, among other things. However, it is speculated that the primary reason that half of injured athletes fail to return to sport is because of psychological barriers, not physical barriers, yet this area of recovery is overlooked. Despite a strong link between fear of reinjury and failure to return to sport, many rehab programs fail to include a formal assessment of psychological readiness, namely the Tampa Scale of Kinesiophobia (TSK-11). The TSK-11 assesses pain related fear of movement and fear of reinjury, using a grading scale of 11-44, with higher scores being associated with more fear, and a score of greater than 17 falling into a “high fear” category. In one study by Paterno et al, those who reported high fear were four times more likely to report lower levels of activity, indicating they may not return to their sport. Additionally, those who did return to cutting and pivoting sports with high fear were at an increased risk of reinjury within the first 2 years. successful rehab and returning to full participation in sport.

Psychological readiness should be an integral part of an athlete’s rehab process. Objectively, assessing fear of movement and fear of reinjury should happen in a similar vein as assessment of strength and range of motion. It should be addressed early and continuously in the rehab process, as the athlete progresses toward running, cutting, pivoting, and return to contact. Mental performance consultants should be involved in every athlete’s return to sport journey to address fear of reinjury, improve confidence in their movement abilities, and help implement strategies to cope with possible setbacks. Concerns about return to sport should be addressed well before the time comes to make a decision so we can eliminate or minimize fear before return to the field or court.

Despite the growing body of literature that emphasizes the importance of mental performance training for injured athletes, there are large gaps in its implementation. This is the missing link between traditional rehab and return to sport at pre-injury levels, which is the ultimate goal for these athletes.

Citations:

Paterno MV, Flynn K, Thomas S, Schmitt LC. Self-Reported Fear Predicts Functional Performance and Second ACL Injury After ACL Reconstruction and Return to Sport: A Pilot Study. Sports Health. 2018 May/Jun;10(3):228-233. doi: 10.1177/1941738117745806. Epub 2017 Dec 22. PMID: 29272209; PMCID: PMC5958451.

Baez SE, Hoch MC, Hoch JM. Psychological factors are associated with return to pre-injury levels of sport and physical activity after ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2020 Feb;28(2):495-501. doi: 10.1007/s00167-019-05696-9. Epub 2019 Sep 5. PMID: 31486916.


Ashley Moriarty

Ashley Moriarty

Ashley Moriarty, PT, DPT, OCS, is a board certified orthopedic clinical specialist who is certified in dry needling and pre- and post-natal fitness.

Meet Ashley

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golfer near a hole

Mental performance: the key to unlocking your golfing potential

Mental performance: the key to unlocking your golfing potential

Golf is a sport that demands both physical and mental prowess. While the significance of physical fitness in golf is well-established, the importance of mental performance cannot be overlooked.

August 1, 2023 | Patrick Vierengel, CPT, TPI-F1

golfer on the green

The relationship between mental performance and the game of golf is a topic of great importance and interest in the field of sports science. As an avid golfer and a professional in the field, I believe this discussion holds tremendous value for both players and researchers alike.

Golf is a sport that demands both physical and mental prowess. While the significance of physical fitness in golf is well-established, the importance of mental performance cannot be overlooked. The ability to think strategically, maintain focus, manage emotions, and handle pressure are all crucial elements that can greatly impact a golfer's performance on the course.

Countless studies have highlighted the link between mental performance and golfing success: researchers have found that golfers who possess strong mental skills, such as concentration, visualization, and self-confidence, exhibit superior performance compared to those who neglect their mental game. Furthermore, mental performance has been shown to directly influence a golfer's ability to make effective decisions, execute shots with precision, and recover from setbacks.

Understanding the intricate relationship between mental performance and golf is essential for improving training programs, enhancing coaching strategies, and maximizing player performance. By comprehending the mental challenges faced by golfers and implementing appropriate interventions, we can potentially unlock untapped potential and elevate the overall standard of the game.

One of the most important aspects of mental performance in golf is the ability to stay present, focused, and in the moment. Golf is a game that requires players to make precise shots, and any distraction or loss of focus can lead to disastrous results. Professional golfers have mastered the art of staying present, shutting out the noise and pressure around them, and fully committing to each shot. They understand that one bad shot should not define their round, and as a result have the ability to bounce back quickly from any setbacks.

Visualization

Visualization is another key component of mental performance in golf. Professional golfers spend time visualizing each shot before they even step up to the ball. They see the trajectory, the landing spot, and the roll of the ball in their mind's eye. By visualizing the shot, they are able to execute it with more confidence and precision. This technique not only helps with performance on the course, but also aids in managing nerves and anxiety during high-pressure situations.

Mental toughness

Mental toughness is a trait that distinguishes the great golfers from the good ones. Professional golfers have learned to cope with the pressures of the game and bounce back from adversity. They understand that golf is a game of highs and lows, and a bad shot or round does not define their career. Developing mental toughness takes time and practice, but it is essential for success in golf. Golfers with strong mental toughness are able to maintain a positive attitude, stay composed under pressure, and make smart decisions — even when the game is not going their way.

Goal setting

Lastly, goal setting is a crucial aspect of mental performance in golf. Professional golfers set both long-term and short-term goals to keep them motivated and focused. Long-term goals help them stay on track and provide a sense of direction, while short-term goals give them something to strive for in the immediate future. By setting specific and achievable goals, golfers can stay motivated and track their progress over time.

In conclusion, mental performance plays a vital role in the game of golf. Professional golfers understand that success on the course is not solely determined by physical skill but also by mental resilience and performance. Staying present, visualizing shots, developing mental toughness, and setting goals are all strategies that professional golfers employ to unlock their full potential. So, the next time you hit the golf course, remember that the key to success lies not only in the swing, but also in your mental game.


Patrick Vierengel

Patrick Vierengel

Patrick Vierengel, CPT, TPI-F1, is a certified personal trainer and golf trainer who trains clients out of Greenwich and New Canaan. Patrick specializes in working with golfers, using his golf knowledge as a golf trainer and Titleist Professional Institute Level 1 Certified Golf Fitness Professional. He is currently studying to achieve the TPI Level 2 Fitness certification.

Meet Patrick

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woman meditating with her son

Avoiding parental burnout

Avoiding parental burnout

Parenting is a rewarding, stressful, fulfilling, and challenging endeavor. Parental stress is normal and common, but there may come a time when a parent’s stress becomes severe or long-lasting, which can affect their ability to cope; this can manifest into parental burnout. Here's what you can do about it.

August 1, 2023 | Arianna Martignetti, Ed.D.

mom meditating with her son on the couch

Parenting is a rewarding, stressful, fulfilling, and challenging endeavor. Parental stress is normal and common, but there may come a time when a parent’s stress becomes severe or long-lasting, which can affect their ability to cope(1); this can manifest into parental burnout.

Parental burnout consists of an exhaustion that can feel overwhelming, an ineffectiveness or lack of fulfillment in your role as a parent and feeling a sense of emotional distance from your child or children(2). It may also feel like you are not the parent that you want to be or used to be. Despite formal clinical interviews needing to occur to determine parental burnout, some risk factors include, but are not limited to, perfectionism, a lack of stress management skills, or a lack of co-parent support and/or emotional support(1).

With the summer winding down and the school year approaching, I encourage you to reflect on what might have caused you to feel burned out, or what is contributing to your stress. With those in mind, the following may be helpful in mediating parental stress:

  • Take a brief vacation(3) – It might not be possible to take an actual vacation whenever you want to, right? Taken from dialectic behavior therapy, the brief vacation approach is an attempt to slow down and re-energize yourself. Taking a brief vacation means finding a 15-minute (or more, if time permits) activity that will bring you some peace, grounding, or enjoyment. Some examples include taking a mindful shower, going to get yourself a cup of coffee or tea, reading an article, going for a walk, listening to a few songs alone, or practicing meditation. Consider implementing a brief vacation when you know your kids are safely engaged in their own activities. Shifting your mindset to perceiving a brief activity as a momentary vacation can help induce relaxation to address your needs at a particular time. The flexibility and spontaneity of doing so may also be a sense of relief or reward for parents that tend to be more rigid.
  • Evaluate your expectations – Reflect on whether you had expectations for this past summer, and whether those expectations were met. Why were they met, or what got in the way? What are your expectations for the upcoming school year? Additionally, where are your expectations coming from: the kids? Your spouse? Yourself? Recognizing what your expectations are and where they are coming from can help address whether they are realistic, manageable, or adjustable; this can help mediate stress, offer a clearer perspective, and possibly result in communication with those that are inducing expectations.
  • Effective communication – After becoming aware of your stressors, you may realize that some stress can be alleviated through conversations with others. For example, perhaps you had high expectations for your kids to enjoy their summer. Have you considered what your kids’ expectations were? What about for the upcoming school year? By communicating in a way that works for your family unit, you can understand each other’s expectations and whether they are realistic or need to be adjusted. Sometimes those that cause us stress are unaware of the effect they are having on us. Finding ways to effectively communicate with those closest to you can help others become more accountable and assist in setting boundaries for yourself (which may lead to a few more brief vacations).
  • Keep it simple – Remind yourself that things do not have to be perfect, and some things can be simple without compromising quality. If perfectionism tends to be your norm and simplifying feels difficult, then consider assessing your priorities and simplifying your lower ones. Chances are, you have had to adjust, pivot, or adapt numerous times in your journey as a parent already; you can do it again. Committing to keep things simple can mean carrying less “stuff” (literally and figuratively), spending less time getting out of the house (potentially resulting in more time to do things you can enjoy), and minimizing worry or stress.

References

1 Mikolajczak, M. & Roskam, I. (2020). Parental burnout: Moving the focus from children to parents. Child & Adolescent Development, 7-13.
2 Mikolajczak, M., Gross, J. J., & Roskam, I. (2019). Parental burnout: What is it, and why does it matter? Clinical Psychological Science, 7(6),
3 Cerula, S. (2023, February 9). Taking a Brief Vacation. The Behavioral Wellness Group.


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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confident soccer player

Mindfulness for the student athlete

Mindfulness for the student athlete

Student-athletes are subjected to a fast-paced, competitive lifestyle. Balancing academic and athletic demands are a natural source of stress for young athletes; developing mindfulness skills can moderate mental clutter and help maximize academic and athletic achievement.

August 1, 2023 | Ben Leibowitz

confident soccer player

We all experience our own stressors, anxieties, fears, confidence issues, and other mental struggles. Carrying a sense of mindfulness through our day-to-day lives, practicing thorough attention to the present moment, and sustaining a conscious awareness of our thoughts, sensations, and environment, can be beneficial in our abilities to work through the “noise” that we tend to experience in our minds.

Mindfulness is a process of entering into a state of mind, without judgment, which can be difficult to accomplish. Developing a strong sense of presence and attentiveness to the nature of our minds, bodies, and surroundings takes practice and commitment. For student-athletes in particular, practice and devotion are pertinent in the accomplishment of their goals; it is essential that the drive towards success extends beyond efforts left on the field, court, ice, or pool. It is equally important to tend to the mind and apply objectives and intentions towards mindfulness.

Student-athletes are subjected to a fast-paced, competitive lifestyle. Balancing academic and athletic demands are a natural source of stress for young athletes; developing mindfulness skills can moderate mental clutter and help maximize academic and athletic achievement.(1) As a former student-athlete, through practice I’ve learned that mindfulness is key in affecting stress, anxiety, confidence, motivation, and other mental challenges that can impact academic and athletic execution. Below are two strategies that student-athletes can utilize to work towards a greater sense of mindfulness and reduce the impacts of mental struggles on performance.

Attentiveness to the Breath

Breathing meditation is a way to begin engaging with mindfulness. Even if practiced for a short period of your day, learning to focus on your breath has been shown to quiet the mind, reduce stress, and increase relaxation.(2) Outlined are steps for a breathing meditation:

  • First, find a comfortable position with your spine erect.
  • Shift your attention to your breath and bodily sensations. Relax your jaw, shoulders, abdomen, and other areas of tension. Feel your body relax while sitting comfortably in your position.
  • Inhale, feeling the air fill your body. On the exhale, feel the release of all tension. Allow your breath to function on its own, without controlling or timing it, following the natural, cyclical flow of the breath.
  • Allow all thoughts that enter your mind to pass over, gently returning attention to your breath.

This breathing technique is key to accomplishing a sense of mindfulness and relieving mental clutter. These exercises have been extensively researched and prevalent across cultures, traditions, and philosophies. Mastering these techniques is a skill and is difficult. Just like a sport, or training a muscle, it takes practice and attention.

Beginning The Day: Imagining Success

Another effective way to relieve symptoms of mental obstacles is through imagery. Engaging in visualization has been shown to improve relaxation and an ability to cope with stress and anxiety, and increase emotional wellness, self-confidence, and athletic performance. We can engage in imagery in a multitude of ways, including the visualization of colors, loved ones, tension in the body, and environments. For student-athletes, visualization can serve as a beneficial tool. In pursuit of academic and athletic consistency, visualizing our goals can be an especially productive mode.

To visualize our goals, follow these steps in a comfortable and relaxed environment:

  • Begin with the breathing technique above.
  • Hold a specific goal in your mind (e.g., winning a competition, acquiring a skill, or engaging in a behavior).
  • Create a scene in your mind, as vivid and detailed as possible, in which you succeed at this goal. Imagine the environment where it occurs and the feelings that accompany the accomplishment Although difficult, try to minimize overthinking or forcing the creation of the image.
  • With the intention set, allow whatever arises and let the quieted mind take over without expectation.
  • If doubts arise, meet them with a believable affirmation: “I can do this,” “I am okay,” “I am confident,” “I am in control.”
  • Continue remaining attentive to the breath as you visualize.
  • Allow yourself the time and space to fully engage in this imagery. Performing this before you begin your day can be effective in setting yourself up for success.(3)

Overall, mindfulness is an essential apparatus for learning to live in the present moment. Although transforming one’s relationship with their thoughts is a complex, in doing so, we can become better equipped to understand and cope with our thoughts, stress, anxiety, and more. Being mindful is a key element in self-acceptance, presence, enjoyment of life, and mental clarity. For student-athletes: practice mindfulness like you practice your sport. Experience the difference!

Learn more about mental performance consulting

References

1 Anderson, S. A., Haraldsdottir, K., & Watson, D. (2021). Mindfulness in athletes. American College of Sports Medicine, 20(12), 655-660.
2 https://www.health.harvard.edu/mind-and-mood/breath-meditation-a-great-way-to-relieve-stress
3 https://www.healthline.com/health/visualization-meditation

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Maximize recovery with innovative treatments: blood flow restriction therapy

The vital role of physical therapy after regenerative medicine procedures: exploring the benefits of blood flow restrictive therapy

Regenerative medicine procedures have revolutionized the field of healthcare, offering innovative treatments for various conditions. While these procedures hold tremendous potential for tissue repair and regeneration, it is important to understand the critical role of physical therapy in optimizing outcomes and facilitating a successful recovery.

July 5, 2023 | Ashley Moriarty, PT, DPT, OCS

Man lifting weights with blood flow restriction cuffs on

Regenerative medicine procedures have revolutionized the field of healthcare, offering innovative treatments for various conditions. While these procedures hold tremendous potential for tissue repair and regeneration, it is important to understand the critical role of physical therapy in optimizing outcomes and facilitating a successful recovery. In recent years, emerging research has highlighted the benefits of incorporating blood flow restrictive therapy into the aftercare following regenerative medicine procedures. In this article, as a physical therapist, I will emphasize the importance of physical therapy after regenerative medicine procedures and shed light on the evidence supporting blood flow restrictive therapy.

The significance of physical therapy after regenerative medicine procedures:

Physical therapy plays a vital role in maximizing the benefits of regenerative medicine procedures. These procedures, such as stem cell therapy and platelet-rich plasma (PRP) treatments, aim to promote tissue healing and regeneration. However, without proper rehabilitation, the potential benefits may not be fully realized. Physical therapy helps optimize the healing process, prevent complications, and enhance overall function and mobility. In addition, a comprehensive physical therapy evaluation will help to identify the root cause of tissue breakdown in the first place. Mobility restrictions, muscle imbalances, and poor neuromuscular control all can lead to poor movement patterns which result in excessive stress to certain structures. It is these structures that break down and may require regenerative medicine procedures. However, without addressing the source of the problem these treatments may only lead to transient relief. When combined with physical therapy, a lasting outcome and full resolution is more likely.

Evidence supporting blood flow restrictive therapy:

One particular physical therapy technique that has gained attention in the realm of regenerative medicine aftercare is blood flow restrictive therapy (BFRT). BFRT, also known as occlusion training or KAATSU training, involves the use of specialized cuffs or bands to partially restrict blood flow to a specific limb or muscle group during exercise.

Research studies have demonstrated the benefits of incorporating BFR into the rehabilitation process after regenerative medicine procedures. A study published in the Journal of Orthopaedic & Sports Physical Therapy in 2019 revealed that BFR, combined with traditional rehabilitation exercises, led to significant improvements in muscle strength and function after ACL reconstruction surgery, a common regenerative procedure. The study reported greater quadriceps muscle size, improved knee function, and reduced muscle atrophy compared to traditional rehabilitation alone. Furthermore, a systematic review published in the Journal of Science and Medicine in Sport in 2020 examined the effects of BFR on muscle strength, hypertrophy, and endurance. The review included studies on both healthy individuals and patients with musculoskeletal injuries. The findings suggested that BFR, when properly implemented, can enhance muscle strength, size, and endurance even at lower exercise intensities, making it a valuable tool in the post-regenerative procedure rehabilitation process.

The benefits of BFRT can be attributed to the unique physiological response it elicits. Partial blood flow restriction during exercise creates a hypoxic environment, triggering metabolic and hormonal responses that promote muscle hypertrophy, increased capillarization, and improved muscle fiber recruitment. A study in the Journal of Applied Physiology also found that circulating hematopoietic stem/progenitor cells (HSPC) were increased following BFR compared with control, which may enhance outcomes after regenerative medicine procedures.

Incorporating blood flow restrictive therapy into aftercare:

To incorporate BFR into the aftercare following regenerative medicine procedures, it is crucial to work with a qualified physical therapist who is experienced in this specialized technique. They will assess your condition, develop an individualized rehabilitation plan, and guide you through the appropriate exercises while monitoring your progress and ensuring safety.  It is important to note that BFR should only be performed under the guidance of a trained professional, as improper use or excessive pressure can lead to complications. The appropriate pressure and exercise intensity will be determined based on your unique circumstances, ensuring optimal benefits without compromising your safety.

Physical therapy is an indispensable component of the aftercare process following regenerative medicine procedures. It helps maximize the benefits of these treatments, promoting tissue healing, and restoring function. Incorporating blood flow restrictive therapy into the rehabilitation process has shown promising results in optimizing muscle strength, hypertrophy, and endurance. Preliminary evidence indicates BFR leads to enhanced stem cell migration which may enhance outcomes after regenerative medicine procedures. As always, it is crucial to consult with a qualified physical therapist who can develop a tailored rehabilitation plan to ensure a safe and successful recovery.


Michael Beecher

Ashley Moriarty

Ashley Moriarty, PT, DPT, OCS, is a board certified orthopedic clinical specialist who is certified in dry needling and pre- and post-natal fitness. She has a passion for helping people move better and stay active, especially new moms.

Meet Ashley

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Decoding stem cell treatments: sources, contrasts, and PRP in regenerative medicine

A stem cell is not a stem sell: understanding the different types of stem cell treatments, sources, and platelet-rich plasma

In recent years, stem cell treatments have emerged as a promising field in regenerative medicine, offering potential solutions for various health conditions. In this article, we will explore the contrasts between different stem cell treatments, their sources, and the role of PRP.

July 5, 2023 | Shane Foley, PT, DPT, OCS, CSCS

Stem cells

In recent years, stem cell treatments have emerged as a promising field in regenerative medicine, offering potential solutions for various health conditions. However, with numerous types of stem cell therapies and different sources of stem cells available, it's crucial to understand the key differences and make informed decisions based on the best medical evidence. Additionally, platelet-rich plasma (PRP) has gained popularity as a therapeutic approach. In this article, we will explore the contrasts between different stem cell treatments, their sources, and the role of PRP.

Embryonic stem cells (ESCs):

Embryonic stem cells are derived from human embryos. They possess remarkable pluripotency, meaning they can differentiate into any cell type in the human body. ESCs have immense potential for regenerative medicine, but their use is highly controversial due to ethical concerns surrounding the destruction of embryos. Currently, their clinical applications are limited.

Adult Stem Cells:

Adult stem cells are found in various tissues, such as bone marrow, adipose tissue, and blood. They are more specialized than ESCs and have a more limited differentiation capacity. However, they can still differentiate into multiple cell types, aiding in tissue repair and regeneration. Adult stem cell therapies have shown promising results in the treatment of conditions like orthopedic injuries, cardiovascular diseases, and autoimmune disorders.

Induced pluripotent stem cells (iPSCs):

iPSCs are adult cells that have been reprogrammed to revert to a pluripotent state, similar to ESCs. This breakthrough discovery has enabled the generation of patient-specific stem cells, avoiding the ethical concerns associated with ESCs. iPSCs have the potential to revolutionize personalized medicine, providing tailored treatments for individuals.

Cord blood stem cells:

Cord blood, obtained from the umbilical cord and placenta after childbirth, contains a rich source of stem cells. These stem cells are similar to adult stem cells and can differentiate into various cell types. Cord blood stem cells are commonly used in the treatment of blood disorders, immune deficiencies, and certain cancers. The collection of cord blood is non-invasive and poses no risk to the mother or baby.

Platelet-rich plasma (PRP):

PRP is a therapy that involves using the patient's own blood, specifically the platelet-rich portion, to promote healing. Platelets contain growth factors that facilitate tissue regeneration and repair. PRP is commonly used in orthopedics, dermatology, and sports medicine to treat conditions such as osteoarthritis, tendon injuries, and skin rejuvenation. Although PRP has shown promising results, more research is needed to establish its efficacy and determine the ideal application protocols.

Understanding the different types of stem cell treatments and their sources is crucial for making informed decisions about potential therapies. While ESCs possess immense potential, their use is limited due to ethical concerns. Adult stem cells, iPSCs, and cord blood stem cells offer more practical alternatives with promising therapeutic applications. Additionally, PRP has gained popularity as a regenerative treatment option, harnessing the body's natural healing capabilities.

It is important to note that the field of stem cell research and regenerative medicine is still evolving. As more evidence and clinical trials emerge, the efficacy and safety of these treatments will become clearer. It is recommended to consult with healthcare professionals who specialize in regenerative medicine to explore the most appropriate options for your specific condition. Being educated on the sourcing and type of stem cell is vitally important.


Michael Beecher

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 has a deep passion for building relationships, helping people accomplish their goals and leading people to optimize their performance.

Meet Shane

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Exploring the promising role of stem cell treatments in orthopedic conditions

Exploring the promising role of stem cell treatments in orthopedic conditions: unveiling the latest evidence

In this article, we will delve into the fascinating world of stem cell treatments and their potential for managing orthopedic conditions. As Dr. Peter Attia often emphasizes, staying informed about cutting-edge medical advances can help us make informed decisions regarding our health and well-being. So, let's embark on this enlightening journey, exploring the most recent evidence supporting the use of stem cells in orthopedic care.

July 5, 2023 | Michael Beecher, PT, DPT, OCS, SCS

Doctor injecting stem cells into a knee

Understanding stem cell therapy:

Stem cells are remarkable cells with the potential to develop into various specialized cell types in the body. Their unique regenerative properties have led researchers to explore their therapeutic applications in a wide range of medical fields, including orthopedics. Stem cell therapy involves using these cells to aid tissue repair, regeneration, and potentially even the reversal of certain degenerative conditions.

Orthopedic conditions, such as osteoarthritis, tendinitis, and ligament injuries, can significantly impact our quality of life. Traditional treatments often focus on managing symptoms, maintaining/improve quality of live or, in severe cases, surgical interventions. However, recent studies have shed light on the potential of stem cell treatments to revolutionize orthopedic care.  In a study published in the Journal of Bone and Joint Surgery, researchers examined the effectiveness of stem cell therapy in knee osteoarthritis. The results demonstrated significant improvements in pain reduction and functional recovery among patients who received stem cell injections. These findings suggest that stem cells have the potential to enhance the body's natural healing processes and mitigate the underlying causes of orthopedic conditions.

Furthermore, research has shown promising results for using stem cells in the treatment of ligament injuries. A study published in the American Journal of Sports Medicine explored the use of stem cells to repair torn anterior cruciate ligaments (ACL) in athletes. The findings revealed improved ligament healing and functional outcomes compared to conventional treatments, potentially reducing the need for extensive surgeries and lengthy rehabilitation periods.

Safety and ethical considerations:

While stem cell therapy shows tremendous potential, it is essential to address safety concerns and ethical considerations. Researchers and medical professionals diligently work to ensure the highest safety standards when conducting clinical trials and administering treatments. Regulatory bodies and scientific communities closely monitor these developments to strike a balance between innovation and patient well-being. Current sources of stem cells are more numerous than earlier options and pose less of an ethical concern. Current options primarily include an individual's own cells, cadaveric cells, and cord blood cells that can be taken from umbilical cords and placenta.

The future of stem cell therapy in orthopedics:

As the field of stem cell research continues to advance, the future of orthopedic care appears promising. Ongoing studies are exploring innovative techniques such as tissue engineering, combining stem cells with biomaterials to create functional replacement tissues.

Moreover, advancements in personalized medicine and genetic profiling enable scientists to tailor stem cell treatments to individual patients, optimizing outcomes and minimizing potential risks. This personalized approach holds immense potential for enhancing the efficacy of orthopedic interventions and improving long-term patient satisfaction.

Conclusion:

Stem cell treatments offer significant hope for individuals grappling with orthopedic conditions. As the latest evidence suggests, these therapies hold the potential to revolutionize the field of orthopedic care, providing effective alternatives and enhancements to traditional approaches. It is vital that these treatments are incorporated into standard physical therapy and wellness practice to enhance outcomes rather than replace these proven treatments all together. The root cause of tissue breakdown, typically muscle imbalance, malalignment and movement deficiency, need to be addressed in order for lasting results to be realized. It is crucial to stay informed and consult with trusted medical professionals before making any treatment decisions.

Remember, the field of regenerative medicine is constantly evolving, and our understanding of stem cell therapies will continue to expand. By keeping abreast of the latest research and advancements, we empower ourselves to make well-informed decisions regarding our health and well-being. So, let us embrace the fascinating world of stem cell treatments as we strive for optimal orthopedic health and a better tomorrow.


Michael Beecher

Michael Beecher

Michael Beecher, PT, DPT, OCS, SCS, is a Titleist Performance Institute medical professional, a Hospital for Special Surgery credentialed advanced hip clinician and a certified dry needling specialist.

Meet Michael

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Todd Wilkowski being interviewed on ABC7 News

HEALTHY LIVING: Deeper dive on direct access to physical therapy with Performance Optimal Health

HEALTHY LIVING: Deeper dive on direct access to physical therapy

Todd Wilkowski being interviewed on ABC7 News

SOUTHWEST FLORIDA — This morning, Todd Wilkowski, with Performance Optimal Health, joined us on More in the Morning, getting us more on how you can seek physical therapy without a doctor’s referral.

Direct access allows a patient to receive evaluations and treatments from a physical therapist without having to obtain a referral from a physician. It’s often challenging to set up an appointment with a physician in the same week, let alone on the same day.

By connecting with a physical therapist first, consumers can start getting care and treatment right away while waiting for their appointment with the physician.

Direct access helps ease stress by giving the patient more control over their healthcare needs, yielding faster recovery time and results. Direct access legislation may vary from state to state.

Visit The Original Article >

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Golf and Lower Back Pain

Golf and Lower Back Pain

Golf and Lower Back Pain

June 8, 2023 | Larry Piretra, PT, DPT, CSCS, TPI-M2

Golf and Lower Back Pain

Golf is a popular pastime for thousands of Americans. It is also a source of pain for many of those thousands. The torque and force used to swing a golf club can create significant risk for developing lower back pain, and this pain most commonly develops over time.

Some believe that back pain is just a side effect of their golf habit. It is the most often reported injury among golfers. In fact, as many as 25% of golfers over the age of 65 report lower back pain. However, it is important to know that it can be avoided with proper technique and training.

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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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How to prepare for spine surgery

How to prepare for spine surgery

How to prepare for spine surgery

Back surgery can potentially be a very scary and stressful procedure, but there are a variety of ways to ensure you have the best recovery possible.

May 26, 2023 | Larry Piretra, PT, DPT, OCS, SCS

Doctor looking at a spine diorama

Back surgery can potentially be a very scary and stressful procedure, but there are a variety of ways to ensure you have the best recovery possible. Some common back surgeries within the cervical, thoracic, and lumbar spine include diskectomies, laminectomies, fusions, scoliotic surgery, and kyphoplasty. The steps leading up to your surgery and after are vital to successful long-term outcomes.

The actions you take prior to surgery can help set up success immediately post-operation. Simply speaking, the better shape your body is prior to surgery, the better shape your body will be after surgery. Through the prehab process, your physical therapist can help discuss what the process following surgery and what motions will be beneficial vs potentially harmful. It is extremely important to follow your physician’s instructions as certain surgeries have restriction with movement (e.g. no bending, lifting, or twisting for six weeks).

Your body will be undergoing some trauma through the surgical process; therefore, aiding in the recovery is imperative to positive surgical outcomes. Cryotherapy is a great treatment to help naturally aid in your body’s own healing process. Benefits from cryotherapy include reduction in pain from inflammation, reduced muscle tenderness, immune system boost, and renewed skin/blood cells. Infrared sauna may also be a potentially useful tool post-surgery to aid in healing through improved circulation, stress reduction/improved sleep, detoxification, improved immunity, and natural wound healing. Both cryotherapy and sauna are great options, but they should both be cleared by a medical professional prior to utilization.

Proper nutrition should be at the forefront of every healthy individual’s mind, especially when recovering from a spinal surgery. One’s activity levels may be temporarily limited after surgery which makes the nutritional component that much more important. You will likely need to increase protein intake following spinal surgery, as it is one of the keystones within your diet that builds and repairs your body. Foods with high protein amounts include fish, poultry, beans, eggs, lentils, and nuts. Appropriate hydration is also imperative to healing process after spinal surgery, as this helps nutrients disperse throughout your body and support healthy joints and musculature surround the spine.

Spinal surgery can take a toll on one’s mental health just as much as their physical health, but there are plenty of strategies to help overcome this obstacle. Education and not being afraid to ask questions are key to understand the full process from surgery through recovery. This includes speaking with your physician, physician assistants, physical therapist, and friends/family who may have undergone a similar procedure. The best thing you can do leading to spinal surgery is prepare and plan the first weeks following, understand the timeline of recovery, and practice relaxation techniques. Your outlook can have a major influence on your recovery, as those with lower levels of stress/pain catastrophizing can have better surgical outcomes.
Always ensure you have your support system when undergoing spinal surgery, which can include your friends/family, physical therapists, physician, or even a support group. With these tips, you will set yourself up for success and ensure you have the best possible outcomes.


Larry Piretra

Larry Piretra

Larry Piretra, PT, DPT, CSCS, TPI-M2, is a physical therapist and strength and conditioning specialist who serves as the Naples Site Lead. As a Titleist Medical and Fitness Professional, Larry also serves as the Golf Programming Lead for Performance.

Meet Larry

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Women & Our Bodies

Women & Our Bodies: Taking charge of menopause through an integrated wellness approach

Women & Our Bodies: Taking charge of menopause through an integrated wellness approach

This informal gathering of women was an opportunity to share stories & gain valuable insights about our ever-changing bodies with experts in women's integrative health, nutrition, fitness and pelvic floor.

Women & Our Bodies

There is no “cure” for menopause, but there are ways to counteract the effects.

“So many women think that they have to go through perimenopause and menopause alone,” but that could not be further from the truth,” Jessica Klecki told the crowd. Jessica Klecki, PT, DPT, is a pelvic physical therapist at Performance Optimal Health, and she was on a panel of women’s health specialists at Performance’s first event geared toward women in their middle years.

The intimate gathering, “Women & Our Bodies: Taking charge of menopause through an integrated wellness approach,” was hosted by the Greenwich Water Club and attended by over 80 women from Greenwich, CT, and the surrounding areas.

The Midlife Truth Project founder Julie Flakstad was joined by a panel full of women’s health experts, each representing a key area of health: Dr. Bronwyn Fitz, MD, who is board certified in ObGyn and Integrative Medicine, certified dietetic nutritionist Koren Bradshaw, women’s health fitness specialist and pelvic physical therapist Danielle Pasquale, PT, DPT, and Klecki.

“Now that you’re in your middle years, you’ve probably thought, ‘this is it! The hard part is over, my kids are older, and I can relax.’ And then menopause hits. It’s like we can’t catch a break!” Julie Flakstad exclaimed, drawing laughs from the crowd. “But that is why we are here to help you find the tools you need to take charge of this part of your life, and not let it control you,” she continued.

Over the course of the evening, the panel discussed how a team approach to healthcare can best support women going through the complications that come with age. Dr. Fitz started the talk off by stressing the importance of surrounding yourself with people that make you feel heard, something especially crucial when choosing your ObGyn.

“Your ObGyn should be there to guide you, not dismiss your concerns or pain,” Dr. Fitz explained. There are many tools that can be used to combat the effects of menopause, such as hormone replacement therapy or vitamin supplements, but the best answer is usually an integrated approach.

“And it’s not just about balancing hormones. We need to find balance in everything: hormones, nervous system, metabolism, relationships, and help people in all arenas of life, not just gynecology,” Dr. Fitz explained.

Women & Our Bodies

As they approach menopause, many women start to see changes in their metabolism, gaining weight even though they continue to exercise and maintain the same diet. This requires a change in diet, with a larger focus on protein, healthy fats, and complex carbohydrates.

“Your most important goal during this time is to keep building muscle, support bone strength, support brain health, and keep inflammation low,” nutritionist Koren Bradshaw explained. “But nutrition is only one part of the equation. Any changes you make at this time need to be supplemented with enough exercise, sleep, and stress management.”

Fitness specialist Danielle Pasquale expanded on that, saying, “you need to shift your focus from weight gain, calories, and appearance to focus on your strength, mobility, and longevity.” Decreased estrogen levels lead to bone loss, making strength training critical to counteracting it.

Menopause also affects your pelvic floor, which also depends on estrogen to stay healthy. This can result in leakage, urinary incontinence, prolapse, or even pain during intercourse.

“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! Pelvic physical therapy can actually help people manage or treat these issues, and shouldn’t be ignored as an option to prevent pain or discomfort,” pelvic physical therapist Jessica Klecki emphasized.

“Aging can cause a lot of complicated emotions and various physical changes, but with a comprehensive team approach, you can take charge of your menopausal years and improve your quality of life,” Pasquale assured the crowd.

Learn more about our women's health offerings here.

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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.

Visit The Original Article >

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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.

Visit The Original Article >

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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.

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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?

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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

Listen now >

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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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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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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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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!