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Excel PT and Workout Blog

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November 3, 2016 // No Comments

Tale of 8 total hips

eight-hips

This past Friday, without planning, I had the unique pleasure of introducing four awesome patients that had 8 total hip replacements between them. It was an inspiring moment to share their instant connection and their common passion for staying active and healthy.

In my 29 years of being a Physical Therapist I have treated hundreds of patients with total hip joint replacements. However, throughout my career I have taken care of only two patients who elected to have both hips replaced at the same time.

Adee Hendler had both of her hips replaced at HSS in 2007 and has been a loyal client ever since. I have seen her through all kinds of aches and pains, and our lasting relationship has been based on maintaining a healthy lifestyle, and remaining strong and balanced to keep up with her grandkids. Charlotte Francis had both of her hips replaced at HSS this past August. Only 54 years old, Charlotte is a recently retired NY State trooper. She exemplifies a tough, and hard working patient and within 8 weeks has already gotten back to her passion of refereeing basketball and volleyball. Adee and Charlotte are both wonderful patients and unique in my professional career so it was with great joy that I had the opportunity to introduce them to each other.

At the same moment that I was introducing them I realized that my patient Steven Holtz and one of Excel’s Pilates instructors Marjorie Waller were exercising in the gym as well. Marjorie had her first hip replacement in 2015 and her second hip replacement four weeks ago. Remarkably, Marjorie was back at work teaching her reformer classes 10 days after surgery and aspires to share her experience and insights to help other total hip patients through Pilates. Steven Holtz has been a client and patient of mine for over 10 years and I consider him a friend as well as a client. Steven, only 54 years old, had his first hip replacement in 2010 followed by his second hip in 2015. I’ve also seen him through a surgically repaired distal biceps tendon as well as a shoulder labral repair.

So, on this random Friday it was with great joy and pride that I realized here in our gym were four amazing people with 8 total hip replacements between them. Each one of them representing this new age of what total joint replacement can mean, and how Excel is uniquely qualified to help them get back to an active lifestyle.

October 18, 2016 // No Comments

Power for the Cyclist, All in

road-bike

 

 

 

In-season strength maintenance training increases well-trained cyclists’ performance.

Rønnestad BR1, Hansen EA, Raastad T.

https://www.ncbi.nlm.nih.gov/pubmed/20799042

The first article by Rønnestad, Hansen, and Raastad explores pre-season and in-season strength training. Two groups of cyclists were compared for cycling performance, oxygen consumption, muscle cross-section area, and strength during a twelve-week preparation phase followed by a thirteen-week in-season program. During the twelve-week preparation phase, one group followed a program of endurance and heavy strength training twice per week. The other group undertook a program of endurance training only. During the thirteen-week competition phase, the previous strength training group undertook strength maintenance training once per week. The exercises were designed to resemble cycling motion and included half squat, recumbent single leg press, standing one leg hip flexion, and ankle plantar flexion.

It is perhaps, no surprise that the leg strength increased by 23% in the weight training group and was maintained. Leg strength did not increase in the endurance group. Additionally, in forty-minute time trial tests, the strength group increased their mean power by 8% during the preparation phase and then a further 6% by the end of the competition phase. The endurance group increased mean power by 4% at the end of the preparation phase and this was not increased in the competition phase.

 

Strength training improves 5-min all-out performance following 185 min of cycling.

Rønnestad BR1, Hansen EA, Raastad T.

https://www.ncbi.nlm.nih.gov/pubmed/19903319

A year later in 2011, Rønnestad, Hansen, and Raastad executed another test to see what would happen if cyclists undertook a longer submaximal activity of 185 minutes followed by a five-minute sprint. This might be similar to a road race with the final finish. As before, one group performed strength and endurance training, while the other group performed just endurance training. The strength group showed a lower heart rate and oxygen consumption during the last hour of the 185-minute exercise compared with the endurance group. The strength group also increased mean power output during the final five-minute sprint by 7.8% compared to no increase by the endurance group.

 

Maximal strength training improves cycling economy in competitive cyclists.

Sunde A1, Støren O, Bjerkaas M, Larsen MH, Hoff J, Helgerud J.

https://www.ncbi.nlm.nih.gov/pubmed/19855311

In 2010, Sunde et. al. studied the effect of maximal strength training on cycling economy, work efficiency, and time to exhaustion between a strength training group and an endurance group. The strength group performed half squats three times per week to supplement endurance training over an eight-week period. The strength training group exhibited significant improvements in rate of force development (16.7%), cycling economy (4.8%), work efficiency (4.7%), and time to exhaustion at maximum aerobic power (17.2%). The endurance group showed a small increase in work efficiency (1.4%), but the other factors were not improved.

 

Combining explosive and high-resistance training improves performance in competitive cyclists.

Paton CD1, Hopkins WG.

https://www.ncbi.nlm.nih.gov/pubmed/16287351

And back in 2005, Paton and Hopkins subjected cyclists to a combination of explosive and high intensity training during the competitive season. They found a program of explosive single leg jumps and high intensity thirty-second intervals contributed an 8.7% improvement in power during a 1km time trial, an 8.4% improvement in power during a 4km time trial, and a 6.7% improvement in peak power. The changes observed for the control group were less than 0.3%.

 

Strength training improves cycling efficiency in master endurance athletes.

Louis J1, Hausswirth C, Easthope C, Brisswalter J.

https://www.ncbi.nlm.nih.gov/pubmed/21638070

One study in particular showed some very promising results. Louis et al. (2011) studied the effect of three weeks of strength training on cycling efficiency on two groups — young athletes and masters-age athletes. Both groups improved torque production and cycling efficiency but the older athletes improved significantly more. Younger athletes were found to be more efficient than masters-age athletes prior to training but this difference disappeared after three weeks of strength work.

The study states: “In masters, the strength training induced an enhancement in maximal and endurance torque production and cycling efficiency, thus reducing age-related differences in performance recorded before training… These results suggest that strength training added to endurance training might be a complementary strategy to preserve functional capacity and performance with ageing.”

 

 

 

 

 

 

 

October 6, 2016 // No Comments

Getting ready for the slopes

Snowboarder

This is the time of year that all of our winter athletes should be fine tuning their fitness to be ready to shred.  For some individuals it is not only preparing for performance but also recovering from injury and surgery.  In these cases achieving mental preparedness and the psychological readiness can be a daunting process.  Being physically ready is the first step.  In this Burton Blog excerpt Snowboarding superstar Kelly Clark describes her journey recovering from hip surgery.

May 21, 2016 // No Comments

Beijing policeman pulls off eight-hour plank world record

Planks have become increasingly popular in the world of exercise and rehab.  “How much you bench?” is now replaced with “how long you plank?”.

For the first time ever a highly regarded spinal surgeon specifically prescribed “Plank exercise” for a patient with severe and chronic back pain.

Are Planks the greatest exercise for trunk stability and controlling back pain?

What determines the quality and therefore benefit of a plank exercise.  Position? (I would say so), muscle recruitment patterns? (absolutely), Duration (not so much!)

Huge kudos to Mao Weidong.  He displayed remarkable strength, endurance and mental focus.  Back pain?

May 9, 2016 // No Comments

Excel’s John Petrizzo lifts 1,380 pounds

John Petrizzo DPT competed in the National “Starting Strength Challenge” which was held in gyms all across the country over the weekend of 4/23-4/24.  John hoisted some amazing numbers (600 deadlift, 525 squat, 255 overhead press) and  came in 9th overall out of a of 96 men who competed nationally.  We could not be more proud of him.  As a Doctor of Physical Therapy and Starting Strength Coach John not only talks the talk but clearly walks the walk. However, most impressive is his passion and never ending generosity in sharing his knowledge and wisdom with our clients who want to excel in strength.

 

April 9, 2016 // No Comments

A Potential Breakthrough in ACL Surgery

Check out this interesting article in the Wall Street Journal that highlights one of the remarkable advancements  on the horizon  in our field.

One of the most common dilemmas facing patients with ACL ruptures is what graft or technique is best for them.  These days we see a lot of the best surgeons utilizing Allografts and Hamstring grafts to spare the complications of harvesting a Patella Tendon autograft.  Wouldn’t it be great if you could heal the torn ligament!  This may be the beginning of a game changer.

March 30, 2016 // Comments are off for this post.

Baseball players protect your arm!

Little league players drinking juice boxes and eating oranges

Spring means sunshine, warmth and flowers in bloom.  It also means BASEBALL.  Young and old get out on the field and begin whipping the ball around.  You might notice that your arm is a bit stale at first or you notice a shoulder pain that abates after a few days.  Or worst case,  your arm really begins to hurt and you are out for the early part of the season.

Overhead throwing and pitching produces tremendous forces in the arm.  It is very helpful to be pro-active and learn guidelines and  exercises designed to prevent injury and improve performance.

This is an excerpt taken from Hospital For Special Surgery’s Website that summarizes some of the concepts.

Little League and adolescent throwers are as susceptible to many of the same stresses on their arms as adult players. Often, injuries that develop at a young age may become more serious as the player becomes older. However, certain precautions can be taken to prevent or minimize injuries.

The following are guidelines that parents and coaches should follow with this goal in mind:

  1. Limit the number of game pitches thrown. Excessive pitch counts have been linked to increased incidences of shoulder and elbow injuries. (Most leagues have developed guidelines for pitch counts). The USA Baseball Medical and Safety Advisory Committee has established the following pitch count guidelines:
    AGE PITCHES PER GAME PITCHES PER WEEK PITCHES PER SEASON
    9-10 years 50 pitches 75 pitches 1000 pitches
    11-12 years 75 pitches 100 pitches 1000 pitches
    13-14 years 75 pitches 125 pitches 1000 pitches
  2. Prevent young pitchers from throwing curveballs or sliders in games until their elbow and shoulder growth plates have closed. Generally, growth at the elbow and shoulder is complete (with growth plate closure) between the ages of 14 to 16 years, but this varies from one individual to another and must be determined by taking an x-ray of the joint. These particular pitches have been associated with an increase in shoulder and elbow injuries. In addition, they require the stress and repetition of mastering new skills.
  3. Learn to throw a changeup as an effective alternative. It has been demonstrated to be a safe pitch [1].
  4. Avoid pitching in multiple leagues during the same season. This makes it difficult to monitor the pitch count of a player. Playing another position may minimize the stresses on the throwing arm.
  5. Avoid throwing year-round, as the throwing arm needs time to recover. A minimum of three months of rest is required for recovery between seasons.
  6. Work with a coach to develop good throwing mechanics. Learning at an early age to utilize the core, larger muscles of the hips, trunk, and legs may not only enhance performance, but reduce the risk of injury to the shoulder and elbow. In addition, striding towards home plate and having a good, long follow through will also reduce the strain on the shoulder and elbow.
  7. Avoid trying to “overthrow” pitches. Throwing pitches too hard in order to gain pitch speed may predispose a pitcher to injury. In addition, it is mechanically inefficient and may decrease performance.
  8. Pitch only to the point of fatigue, not through it. This can decrease the risk of injury.
  9. Never ignore persistent shoulder or elbow pain — do not try to pitch through it. Your physician should be consulted. It is important to remember that many minor injuries can become major problems. Signs of deterioration may include: loss of motion, loss of strength or velocity, and tenderness.
  10. Maintain good all-around strength and flexibility with a year-round training program provided by your physical therapist or other qualified health professional. Throwers who are strong and flexible may have a reduced risk of injury and recover faster from an injury.

 

Excel Physical Therapy + Workout is offering “The Throwing Athletes  shoulder screen and exercise prescription”.  The screen is performed by Physical Therapists and assesses muscle imbalances (weakness and tightness) in the shoulder, arm and core, postural alignment and range of motion of the shoulder.

At the conclusion of the screen the athlete will be instructed in exercises that are specific to the their needs with the goals of avoiding injury and improving throwing performance.

CALL NOW TO MAKE AN APPOINTMENT

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March 30, 2016 // No Comments

Golf Injuries and Fitness

Man Playing Golf on Beautiful Sunny Green Golf Course. Hitting Golf Ball down the Fairway from the Tee with Driver.

The spring season is upon us.  To be sure that you enjoy a progressive and injury free season, Excel strongly recommends that you get your body ready.   What do Tiger Woods, Jack Nicklaus, Fred Couples and Davis Love III have in common, besides the ability to hit a golf ball farther than most mortal men? All have missed significant time during their playing careers because of lower back pain. And they’re not alone.   Approximately one third of professional golfers and one half of recreational golfers suffer from lower back pain.

According to Dr. Vijay Vad at Hospital for Special Surgery studies have shown that those golfers who did suffer from lower back pain had substantially less mobility in their lead hip (which is the left hip for a right-handed golfer and the opposite for the southpaw) than those players with healthy backs. Repetitive stresses placed on the joints in the lower back, due to a lack of internal rotation in the lead hip after impact with the golf ball–or during the deceleration phase of the swing–was the primary cause of back trouble.

Lower back injuries are very common this time of year, when many recreational golfers are breaking out their clubs for the first time in months. A weak, deconditioned core–the muscles and tendons that make up the midsection of the body, including the hips, “glutes,” hamstrings and abdominals–is a contributing factor. Most people just aren’t physically ready to play 18 holes of golf right out of the gate; therefore they are more susceptible to injuries. It also doesn’t help that the vast majority of recreational golfers sit behind a desk for 8 to 10 hours a day.  This creates shortened hip flexor muscles, leading to more back pain in golfers.

Other common golf-related injuries include those to the wrists, elbows, and shoulders.  Pre-season golf conditioning can prevent these injuries and also serves as a performance enhancement tool during the season for more yards on drives.

GOLF PHYSICAL COMPETENCY ASSESSMENT

The first step toward injury prevention is a thorough physical competency assessment.  The Golf Physical Competency Assessment (GPCA) establishes a starting point for training. Trunk, shoulder and hip mobility; Core, lower and upper extremity strength; Muscular flexibility; Balance.  Have you paid any attention to these physical attributes during this past long winter?

The GPCA will assess muscular flexibility; spinal, hip and shoulder mobility; core, upper and lower extremity strength and overall balance.  The results of the GPCA will identify areas of strength and weakness, deficiencies and limitations and therefore allow for the development of individually prescribed exercise routines.

March 19, 2016 // No Comments

Excel Exhibits at Tri-Athlete Convention

unnamed-1

I had a fantastic time at the first annual NY TRI EXPO at Citifield on March 19th. The venue was packed with multisport athletes from newbie to pro. John Petrizzo, DPT and I were there to represent Excel PT & Workout.

We spoke to countless athletes (and their supporters) about injury prevention, the importance of strength, flexibility and recovery body work. I spoke on a panel alongside other great professionals for a more in-depth discussion of injury prevention for the triathlete.

I enjoyed seeing many of my racing colleagues in a non-competitive environment. We are all friends trying to do our best when the gun goes off at the swim.

I was so happy to see Matt Long, author of The Long Run, an inspirational true story about Matt’s life. We all have something to learn from Matt and the IWill Foundation.

If I helped a few athletes have a better season then it was a huge success. Thanks to Hilary Topper and HJMT for putting this great event together.

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