Tips for Weekend Warriors

Are you a weekend warrior?  For many busy professionals, the weekend is the only real time we can get to workout.  Here are some tips to help maximize the weekend warrior experience and prevent injury.

1. Start light.  

Warm-ups in general are a bit overrated, but for the weekend warrior, they are important to help loosen the muscles up.  

I find some light jogging intermixed with a few deep squats helps loosen up the legs, and arm circles to warm up the shoulders can be helpful.

2. Pay special attention to the groin.

The groin is particularly susceptible to injury in weekend warriors.  The groin muscles (technically the adductor muscle group) are not commonly used in every day activity, but are used frequently in sports, and therefore are prone to overuse injuries if you only use them on the weekend.

The reason we don't use them much during the week is that when you walk at a normal pace, the way your bring your thigh forward is with a group of muscles called the hip flexors (muscles in the front of your thigh and pelvis, including the rectus femoris and iliopsoas).

When you run or move more quickly, you rotate your pelvis, which engages your groin muscles to bring the thigh forward.  One way to image this is to stride as far forward as you can with your left thigh, which will rotate your pelvis so that the left side is further forward than your right side.  From this position, if you want to bring your thigh forward, you would have to use your right groin muscles in addition to your hip flexors.

Some strategies to help protect your groin:

1. Some deep squats and light jogging, as noted above

2. The butterfly stretch (http://www.ehow.com/how_2312300_do-butterfly-stretch.html) after warming up

3. The upward facing dog stretch (http://www.ehow.com/how_2277775_do-upward-facing-dog-pose.html) to help stretch the abdominal muscles.  This is important because the groin muscles and your rectus abdominus muscle (the six-pack muscles) share a common insertion point on your pubic bone.  I sometimes remind patients of this by referring to their adductor longus (one of the groin muscles) as the "seven pack" to remind them that it is part of the same group as the abdominal muscles, and therefore need to be stretched together.

4. If you are doing a kicking sports (e.g., soccer), be careful on your first few kicks that you don't slam your instep into the ground instead of the ball.  This is a common mechanism where soccer player often give themselves a particularly hard-to-heal type of groin injury called a sports hernia.

3. Try to fit in one high intensity workout during the week

Try to spend at least 30 minutes during the week in which you are exerting yourself to more than 50% of your maximum capacity.  This will help stave off de conditioning during the week.

As a practical matter, you may need to do this in short spurts.  Things like sprinting up the stairs every day when you get to work, or racing your son across the backyard when you get home, are great ways to build in short bursts of high intensity contractions.

In another upcoming essay, I will be talking more about strategies for "How to be more Awesome," which I consider an important part of the Kinemedics Philosophy.  One part of this, for parents in particular, is the importance of being excellent in the presence of your children.  I can't stress enough how important this is.  So, even little things like having your child see you do 10 push ups or  2 pull ups in front of them has some important ancillary benefits beyond their obvious health impact.

So, think of this nugget about short bursts of high intensity exercise as a variation of finding time to put more Awesome into your day.

4. Prime yourself for the weekend

One key way to make sure your weekend workouts go well is to make sure you don't go into the workouts tired.  The most important thing you can do to optimize your Saturday workout is to be healthy Friday night, and the same applies for Sunday morning and Saturday night.  

Some strategies:

1. Don't drink too much- 2 drinks is a reasonable number for most people

2. Get enough sleep.  Don't stay out more than 2 hours past your normal bedtime, and try to stay close to your normal bedtime

I realize this is tough for some people, as they prize their social time, may be in a new relationship that requires more effort, etc.  What I say is that optimizing your health is about embracing a healthy lifestyle.  As we learned recently, not even Dennis Hopper can continue to live the Dennis Hopper lifestyle forever (it may even catch up to Jack Nicholson eventually).  So if you are a partier and carouser, you will have to change some time.  That time is now.

Have a fantastic weekend!

Happily Growing Older Together!

One of my patients from Pittsburgh recently sent me a sweet letter, and she was kind enough to let me talk about her on the blog.

Margie is a very kind woman I worked with for several years in Pittsburgh.  She had a few separate musculoskeletal conditions, but I always emphasized to her that she was a person, not a collection of body parts, and that we should focus on her bigger dreams and goals, which including writing.  I told her I wanted to "grow old together" with her.  One of the highlights of my visits with her was when she would bring me something she had written, which helped me see what wonderful person she is.

One of the hardest parts of moving on to my next stage of life here on the Eastside is feeling like you are abandoning the patients you come to love.  So it was such a joy to get a letter from Margie seeing how well she is doing.

This is Margie, looking as spry and beautiful as ever, trimming some bushes.  She's wearing the Recovery Aid brace that I developed as Chief Medical Adviser for ActivAided (www.ActivAided.com), which helps her get back to action without her back pain limiting her.

Margie- thanks for letting me grow old with you!

Love- the secret ingredient in patient care!

A few years ago, I was flying home from a conference where I was teaching musculoskeletal ultrasound, and I was fortunate enough to sit next to a very kind woman who had moved to Pittsburgh from India a few years earlier.  She had been an engineer in India, but since coming to the United States, her primary focus was raising her 12 year old son, who was a child prodigy already taking college classes.

She related to me a story of how one time her son was upset that her mom made her dinner every night rather than going to restaurants.  I thought her response was very sweet, and changed the way I think about things:

“I explained to him that when you go to a restaurant, no matter how good it is, they were making that meal for a generic person.  When I make dinner for you every night, I am making dinner for YOU.  Every decision I make, whether it’s how firm to make the rice, or much coriander to use in the seasoning, I am making that decision because I want you to be happy.  Most importantly, there is one ingredient that I can give you than no restaurant can give you, and that’s love.”

I was obviously touched.  I think back to that kind woman often when I am taking care of patients.  One of the things I most love about working in a small physician owned practice like Lake Washington Sports & Spine is the love that our team can put into the care of each patient.  Being small, this empowers us to customize the patient experience.  Whenever we make a decision, we are making it for YOU.

Welcome to our family!

Meet the Team: Jami Schmitt

To help our patients meet members of the Lake Washington Sports and Spine Family, we will roll out some short interviews with our team members.  Up first, the great Jami Schmitt, our Medical Assistant extraordinaire:

What is your role on the Team at Lake Washington Sports & Spine?
My role in our team at LWSS is to assist with patient care. From greeting and rooming the patient to assisting with referring them to facilities that are convenient for them. When they have extra questions about care, I do my best to answer them and return phone calls as soon as possible. I like to make the patients feel comfortable and welcomed to the office. They should always know we have their best care in mind while helping them.

How does working for a small, physician-owned practice contribute to the family environment at Lake Washington Sports & Spine?
Working for a small physician- owned practice contributes to the family environment in many ways. One, since we all spend so much time together and the office is like a second family we, as a team, become closer. I feel that there is open communication and we all feel "safe" to talk to one another. In regards to patients, I feel that they feel more welcomed by coming to a small practice rather than a large facility with multiple doctors and staff members. Here we are able to be more personal with our patients. They can feel safe coming to the clinic and know they are receiving our full attention with their care. Since we are not part of a large corporation, we are able to get to know the patients on a more personal level. They seem to open up more when they feel comfortable with the staff and know that their doctors care about them.

What are some of the "little things" you like to do to improve the patient experience?
Some of the "little things" I like to do to improve patient experience is to make sure they know what the plan is before they leave, to make sure the patient is clear about the next step in their care. If they need prior authorization for imaging or therapy, I like to make sure they know what to expect before leaving the office. Making sure the patient knows where to go for imaging or therapy and has all referrals they need and contact numbers is helpful. If the patient has a "special request" and wants me to look into information for them, I try and complete it before they leave and, if not, try and call them by the end of the day.

What part of patient care makes you the happiest?
The part of patient care that makes me the happiest is when you see the joy on a patients face when their pain has improved. A few of our patients have come to us after huge car accidents where they suffered from many life changing injuries. You learn a lot about patients at the first visit and to see how they improve over time and how their mood improves truly makes me happy. I enjoy seeing our patients make progress and return to activity they were able to do before they were injured.

Many patients have never heard of PM&R or Sports & Spine Rehabilitation before.   What kind of patients do you meet who wish they had come to Lake Washington Sports & Spine earlier in their care?
Our sports patients, many whom don't know what type of doctor to go see.  Typically, they have seen their primary care or physical therapy, who then refer them here. I have found that many patients are unaware of all that we do here. Many have been pleasantly surprised to learn that we are able to use diagnostic ultrasound, nerve tests like EMGs testing, or guided injections like epidurals and ultrasound-guided joint injections.  

Creep

CREEP

CREEP:

- Creep refers to a material property, specifically the tendency for something to become distorted

- If you squeeze something for a short period, it will snap back into place

- If you squeeze something for a longer period, it will deform, and take time to go back into place (see, for example, the picture below of the cleaning wipe container that I squeezed)

- If you hold something in a deformed position long enough, it may permanently deform

This can happen to different structures in your body- e.g., the lumbar disk

- It is important to move on a regular basis to prevent this deformity

- You may need to perform specific exercises in a specific direction to mold tissue back into the correct place

To give yourself an example of how this may affect you in real life, pull back on your index finger so that it is an extended position, and then hold it in that position.  At first it may be a little bit uncomfortable, but as you continue to hold it in that position, it will hurt more.

I very commonly see this occur in patients who sit at their desk all day- the hunch forward, and this shortens the tissues in the front of their body (the "anterior chain") and stretches the back of their body (the "posterior chain").  This can cause significant spine pain, and needs to be reversed with postural control exercises that stretch the anterior chain and strengthen the posterior chain.  The specifics may vary with each patient, but the concept remains the same.

Bulgarian Squat

The Bulgarian Squat is a more advanced exercise- I'd make sure you can do a regular lunge and belt squat before trying.  When the front leg is forward more, it helps activate the gluteus maximus more, which is generally good.  It also helps stretch the hip flexor of the rear leg.

BULGARIAN SQUAT:

1. Stand in front of a chair

2. Place right leg onto chair, with the top of your foot flat against the chair

3. Left foot should be 2-3 feet in front of the chair

4. Slowly lower your body so that your butt moves downward, but not forward.  You will be doing a lunge with your left leg.  You should feel a stretch in the front of your right thigh (your right hip flexor), and you should feel your left buttocks and thighs contracting.

5. TIP: pay attention to the movement of your left knee.  It should move straight up and down, and not deviate side-to-side.  If you find that you are struggling to keep your left knee stable, move slower, and don't lunge as deeply

6. TIP: Concentrate on sitting back, rather than bringing your upper body or shin forward

7. Repeat for 10 repetitions

8. Switch sides

Do 3 sets of 10 repetitions for each side

Belt squats

This is another one of my favorite exercises- the Belt Squat.  It's a particularly good exercise to help activate the gluteus maximus muscle, which many patients have trouble activating

INITIAL PROGRESSION:

- Place a fat man's belt just above the knees

- Initially, started seated in a chair, with your hands on your belly

- Rotate knees outward, so that the outside of your knees are always pushing against the belt (external rotation)

- Stand up, focusing on pushing your thighs outward against the belt.  Pay particular attention to when you are sitting back down to not rotate your thighs inward

- As you come up from the squatted position, imagine that you are squeezing a $1000 bill between your butt cheeks, and don't forget to push against the belt

- Repeat for 10 repetitions, 3 sets

SQUAT PROGRESSION:

- Squat by sitting backward.  Do not let the shins move forward, try to imagine sitting back in a chair.  It often helps to have a rope or belt wrapped around a pole in front of you to help maintain balance.