Sunday, September 29, 2013

Is Your Foam Roller Your Friend?

It should be! So, I have to confess, I have a new lasting relationship over the last few years, and it’s not with any human being; it’s with my foam roller. So, before I was going to write to all of you to tell you how great it is, I thought I should do some evidence-based medicine, and see what’s out there on the subject. But let’s start simple:

What exactly is myofascial release?

Are you new to this “fad” in training and conditioning? Don’t worry. That’s why I’m writing this blog! J It’s becoming more of a growing accessory to training. Somatic dysfunction can cause pain and restriction of motion. When you train intensely or when you work muscles that have not been used in a while (it happens, right, when we’re trying to get back into working out and then all the sudden the next day or the day afterward you wonder why you thought that it was such a good idea to start back with a full body lift at the weights you had done 6 months ago when you were training consistently), you end up with tighter muscles. 

The overlying soft tissue component that encases the muscles in your body is surrounded by fascia, connective tissue that supports your muscles. It’s awesome stuff, but it can get a little angry at you when there is inflammation. So there’s a form of soft tissue therapy that people are now using (and some would argue that it has existed in a certain form since the invention of massage techniques—whenever that was) to treat somatic dysfunction and prevent pain and restriction of motion.

Passive myofascial techniques include techniques when the patient stays completely relaxed. This would be if someone else is providing the myofascial pressure—this can be done with pressure points, with connective tissue massage, etc.  On the other hand, active myofascial techniques include techniques when the patient provides resistance as necessary, so foam rolling, active release therapy (ART), and strain-counterstrain techniques would fall under this category.

How does it work?

A study out of Japan that was published in the Journal of Strength and Conditioning earlier this year showed that self myofascial release techniques using a foam roller actually reduce arterial stiffness and improve vascular endothelial function. And what muscles need in order to perform at their best and also recover at their best is blood flow with adequate endothelial function to deliver nutrients and remove toxic chemicals. Amazing stuff!

So, do studies support that this stuff really works?

Myofascial release is something that entered the world of medicine through osteopathic medicine and complementary or alternative medicine (one could argue that acupuncture is even a varied form of this) and has now become the new trend in sports training over the last 10 years. But what studies have been done to support its use for athletes and the every-day healthful exerciser?

Guess what? Not a lot is very conclusive! In 2013, the Journal of Strength and Conditioning did a study on foam rolling and performance. They found no significant effect of foam rolling on actual performance of athletic maneuvers in comparison with the control group. However, they did find that post-exercise fatigue after foam rolling was significantly less than after the control group. The conclusion they came to was that the reduced feeling of fatigue when using foam rolling may allow athletes to extend acute workout time and volume, which can lead to chronic performance enhancement. So it hasn’t exactly been proven in the literature.

What do I think?

I think it’s awesome. I didn’t get it into until I started triathlon and realized that biking hard one day and running hard the next was giving me crazy knots in my quads. Foam rolling saved me. And then I started training smarter, got some better training plans in terms of coordinating workouts effectively, and I still realized that a foam roller either at the end of the day with stretching or pre-workout really helped maximize my ability to achieve the results that I wanted. It makes me wonder, what if we had known about this when we were playing college basketball back in the day?

The stuff that’s out there on the market:

Foam roller

The stick

How to use it:

Limit your foam rolling or whatever your chosen technique is to 30 seconds on each muscle, especially if you’re using an injured one. It’s like stretching in that regard; you don’t want to overdo it. The stick is good but doesn’t work for gluts and back unless you have a very loving training partner who’s willing to help you out. You can reach almost every muscle of interest with your foam roller, and you can use your body to help add the amount of pressure that you can tolerate.

Your IT bands and whatever other area of interest will scream bloody murder at you while you’re rolling, but later on, trust me, your body will thank you and give you the present of happier muscles and a stronger workout or competition, whatever you’re going for. I would argue that myofascial release has become the new ballistic stretching pre-workout, and I have to say, when part of a dynamic warm-up, it can’t be beat. It’s also a great addition to your agility workouts and to your flexibility routine if you have one (and you should).

For more ways to warm-up, cool-down, and stay fit in between, ask your trainer, ask your coach, ask my husband. ;) But that’s the science and the anecdotal evidence, folks. My advice? Just try it, and see how you feel! J

Healey KC, Hatfield DL, et al. “The Effects of Myofascial Release with Foam Rolling on Performance.” J Strength Cond Res 2013 Apr 12.
Okamoto T, Masuhara M, Ikuta K. “Acute Effects of Self-Myofascial Release Using a Foam Roller on Arterial Function. J Strength Cond Res. 2013 Apr 9.
Lin MT, Chou LW, et al. “Percutaneous soft tissue release for treating chronic recurrent myofascial pain associated with lateral epicondylitis: 6 case studies.” Evid Based Complement Alternat Med. 2012 Dec 2.
Roach S, Sorenson E, et al. “Prevalence of myofascial trigger points in the hip in patellofemoral pain.” Arch Phys Med Rehabil. 2013 Mar;94(3): 522-6.

Saturday, September 14, 2013

National Childhood Obesity Month

September is National Childhood Obesity Month, so I'm postponing my myofascial release blog another week because this is an important topic. I guess we could start by saying that it’s upsetting that we have to have a month dedicated to obesity in kids. This is not just an adult problem anymore. Neither is Type II diabetes. Or high cholesterol. Or high blood pressure.

What is obesity, what are the complications, and who is at risk?  

Those are the details from the American Academy of Pediatrics, but basically, folks, obesity is bad, and it can give you old people problems at a young age. It can keep you from enjoying the life you want to live, it can give you more doctor visits, it means more medications, and it can shorten your life. And life is already too short.

The stats:
French fries...they taste yummy... but "french fries"
should not be in a toddler's vocabulary! I know,
he's so cute, you just want to give him whatever
he wants....but, don't.
¤ Childhood obesity has more than doubled in children and more then tripled in adolescents in the last 30 years
¤ Currently, more than 1/3 of children and adolescents are overweight or obese
¤ It is hard to predict the incidence of Type II diabetes in children because it can go underdiagnosed for a long time, but we are diagnosing it more and more
¤ 1 in 8 preschoolers in the U.S. is obese!!!! Preschoolers!!! AGE TWO to FOUR!!! 
¤ If you’re a minority, then that number goes up—1 in 5 black children and 1 in 6 Latino children are obese.
¤ These obese preschoolers are 5 times more likely as normal-weight preschoolers to be overweight or obese as adults

Adults:  you can watch how obesity has grown in America among adults since 1991 if you go to this page and scroll down: It’s kind of like watching The Day After Tomorrow or some apocalypse movie where they show how the end of the world will occur in 72 hours after the storm of the century or the zombies or whatever encompasses more and more of the globe. We have an obesity apocalypse approaching… 

What is going ON, America??!!  Let’s fix it!

What the AAP recommends to help preschoolers: 

Some of my own tips…

Family Fitness: Be a Role Model, Encourage Your Whole Family to Lead an Active Lifestyle

1. Take the stairs and encourage others to do so. It’s not enough to lose weight (unless you work in a football stadium), but it’s not enough to curb those little extras that you don’t always account for, and it’s enough to get a mid-day energy boost and contribute to your goals of staying active and healthy. Feeling a little winded after 3 flights? Maybe that’s the extra motivation you need not to skip the gym tonight ;)

2. City commuters, get off your mode of transit (bus, subway, etc.) 2 stops early and walk the rest of the way home.

3. Commute with your bike in nice weather (Refer to last blog for helmet incentives and bicycle riding safety).

4. Get a real lunch break every day? Grab a co-worker and go for a walk/jog/run! You can eat a PB&J on the way and get some fresh air and sunshine AND feel more rejuvenated going into your afternoon when you might usually feel sluggish.

5. Take your kids to the park after work/school. A healthy and active lifestyle should be a family thing! Remember, parents are the ultimate role models for their kids, especially when they’re younger. Walk to the park together, play soccer, play football, walk or jog a loop at the park while your kid rides his scooter or bicycle. They love any time with you; why not make some of it the active time that you both need?

6. Sign up for a race! I signed up for my first race (a 5k) because I wanted to raise money for the American Heart Association. I had never ran more than a mile in a timed situation in my life, and after that first 5k, I was hooked. If you need a purpose, find an organization, find a friend, find a co-worker, join a team, start a club. Find what works for you and will get you training for your event on those snowy winter days or those dreary mornings when you would rather sleep in. A race gives you a deadline (some of us are just procrastinators and need that motivation to stay fit). Make a goal and go for it! (They have fun-runs and other races for kids, too! Look for later blogs on what exercises are best for what age kids.)

7. My new favorite—you have to think this is cool even if you don’t want one immediately…  Your phone lost its charge today? Go for a bike and recharge your phone as well as your body and mind J

It’s not all about exercise (although I am a huge fan of exercise). It’s also about nutrition. Having a healthy lifestyle means staying active AND eating healthily. Eating hamburgers and fries and drinking milkshakes catches up even to an Ironman athlete exercising 5-8 hours a day, trust me. A calorie really is a calorie, so apps for your phone like LoseIt and MyFitnessPal are great with figuring out how many calories you should have per day for your activity, body weight, and fitness goals. They’ll also help you keep track of how you’re doing each day, week to week, and over time. I highly recommend them for weight loss or for maintaining your current weight. You can add your activity and glasses of water per day, too. It’s like positive reinforcement, right on your phone, and you can add workout and weight-loss friends. Stay fit together! Here are some more tips…

Nutrition Tips:

1. Go Green
¤ if you can eat your 5 servings of vegetables a day, you are well on your way to eating healthily.

2. Add fruits for your sweet tooth.
¤ 2-3 fruits a day instead of those cookies and chocolate candies and ice cream you’ve been craving, and you will feel better and realize the wonder of nature’s own sugars! And, no, fruit juice ABSOLUTELY does not count, and no, you do not ever need it in your fridge. It’s the same thing as soda (BAD, sugary beverage, don’t drink it).

3. Know your weaknesses. And make your own remedies.
I have the worst sweet tooth known to man. It gets worse when I’m stressed out, working really long hours, working the night shift, or don’t find time for a workout that day. A dessert once a week won’t kill you (especially if you rev up your cardio that day or if you know that the rest of the day will be lots of low-calorie fruits and vegetables). So a dessert once in a while is my remedy…or a small piece of chocolate as a treat. I also have learned that if I eat all the fruits and veggies I am supposed to each day, I am honestly too full and have fewer dessert cravings. Hint, hint: fruits are actually sweet! Eat them J

4. Protein
It’s important, but don’t go nuts, folks. Protein bars and drinks can have a ton of extra calories that you don’t need unless you’re a body builder or trying to gain weight. Know your supplements, and know that you probably don’t need to supplement if you get your protein from a few servings of lean protein per day. How much do you need?
A general rule is 0.8g protein / kg body weight per day. If you are very active and do a lot of strength training, then 1.0-1.2 g protein / kg body weight is more like it.
Protein can help with sweet cravings, and it can also help you stay full longer, but, like in Indiana Jones and the Last Crusade, “choose wisely.” Chicken, fish, low-fat dairy, beans/legumes. Red meat is a treat, once per week or in small servings. Get your iron from leafy greens that are lower in calories.

5. Follow the new and improved food pyramid:

Or the food plate:

6. Stay active.
¤I like the pyramid because it actually includes what we talked about at the beginning—staying active.
¤ 30 to 60 minutes of moderate to high intensity cardiovascular exercise each and every day à seems easier said than done but start small and work up and you will realize that you feel better and actually eat healthier when trying to fit in workouts. Want a hamburger and fries for lunch? Probably not a good idea if you are meeting your friend for a run after work…your GI tract will thank you later for making a healthier choice! ;)
¤ Water is your friend! Avoid diuretics (coffee and tea make you pee!) and try to get in 10-12 glasses of water a day. You will feel much better, and you will realize that sometimes your brain is actually trying to tell you that it’s thirsty when you think it’s hungry. ;)

What the American Academy of Pediatrics recommends for fighting the obesity epidemic, one family at a time:

Until next time, stay healthy my friends.

Tuesday, September 10, 2013

Do you like your brain? (then wear a helmet)

You have such a nice brain! Why not protect it?

I know, I know, I promised that my next blog would be about myofascial release, BUT, this past Sunday was the first Westchester Bicycle Sunday since June, and as I was out enjoying the PERFECT autumn weather and sunshine, I couldn’t help but notice how many people weren’t wearing helmets while riding their bicycles. Those of you who know me know that this is one of my one-woman campaigns—to make all the kids in the Bronx where bicycle helmets.
Don't worry. This was in New Zealand. That's why
I'm on the other side of the road. The cars do it too.
As a resident pediatrician, I have taken care of more kids than I would like to admit who were riding their bicycles in the Bronx without helmets and got hit by motor vehicles. Traumatic Brain Injury is a very serious thing. Some kids are luckier than others after being struck by a car (what normally happens in cities) or riding down a dangerous hill a little too fast (Let’s face it, we all love doing it) and taking a nasty fall. But what it boils down to is that if you like riding a bike, if you like running, if you like walking, if you like talking to your friends and eating food by mouth—all things this amazing thing called your brain helps you do—then wear a helmet.

The nitty gritty:
The Centers for Disease Control notes that only 48% of kids age 5-14 years wear bicycle helmets while riding. Older children were even less likely to wear helmets.
Data from 2010 shows that 800 bicyclists were killed, with an estimated 515,000 who sustained injuries requiring emergency department care.
Lastly, each year, 26,000 of the children and adolescents who experienced bicycle related injuries actually developed TBI, traumatic brain injury.

From the AAP, helpful tips to get your child to wear a bicycle helmet:

I know now more each day that I was very lucky to have the parents that I had growing up. One of the many things they did for me besides encouraging sports and staying active was that they encouraged safety, health, and nutrition. I never considered riding a bicycle without a helmet. Why? There was a law in the state of Georgia that all children under the age of 16 had to wear one in order to ride a bicycle. But, more importantly, my parents not only bought me a helmet when I got my first bike from Santa, but they also always wore helmets themselves. When you’re a little kid, you don’t make fun of your parents yet, so when they wear a helmet, you might actually model them and think that it’s the cool thing to do. Isn’t that a great opportunity that parents have? Model good behavior. Model safe bicycle riding. Explain rules. Kids want to learn this stuff; we just have to teach them J

Maybe we don’t need to argue about why kids should be wearing their helmets. I mostly see adults not wearing them when I am out running or riding myself. So, to adults, I say, don’t you like your brain? Doesn’t it do awesome things for you? Do you like being able to contribute to society, work at your job, play with your kids? Then wear a helmet. I know, I know, you just got the NYC Citi Bike to go downtown a bit. I love the idea of Citi Bikes and what this could do for healthy transit in NYC. I think they should also have helmets at each little station. But that’s just me. And yes, those fun hipster cycling hats look cooler than helmets, but they don’t do much to protect your brain! You’re going to have hat hair either way, so just wear a helmet.

The right fit for your helmet:
¤ Helmet should sit slightly above the eyebrows and not slide around the head.
¤ Should be worn level on the head with straps forming a Y shape immediately under the wearer’s ear.
¤ Strap should be securely fastened to the point where the helmet stays still on the ehad but without being painfully tight around the chin. When you open your mouth, your helmet should pull down tightly on your head.

Other safety concerns while riding:
Since more and more folks are using bikes to commute (YAY! Fight obesity, America!), I thought some riding rules would be helpful for novice and even seasoned riders:
  1. No headphones! Being able to hear what is going on around you is half of the fun of being outdoors but more importantly it is for your safety! You need all your senses to alert you if a vehicle, runner, or other cyclist is approaching.
  2. Obey traffic signs and signals just as if you were in a car.
  3. Use hand signals to let drivers and even other cyclists know what you’re doing.
  4. Ride on the right with traffic, not against traffic. (Unless you’re in Australia, New Zealand, Japan, or anywhere else where they like doing things a big opposite.)
  5. Stop and look both ways before entering a street.
  6. If on a path, make sure you ride to the right to allow others to pass. If on a road closed to traffic, the right lane is typically the slower lane. Be courteous of others.
  7. Don’t ride side-by-side or multiple riders across. (Be courteous to others.)
  8. Wear a helmet. (Sorry. I just didn’t think we had said it enough here.)
    The closest I could find to Gatorade out
    on the road in Chiang Mai.
  9. Bring adequate nutrition/hydration. Always err on the side of over-estimation because we tend to underestimate what we need and sometimes go farther than we think we will. If you are riding with kids, bring a snack and beverage for each of them. You know they’ll need/want it; they want it if they go to run errands with you.
  10. Wear sunscreen (trust me).
  11. Wear protective eyewear. Eyes, like a brain, are pretty nice to have around.
  12. Teach your kids! Make sure they know the rules before they go out of the parking lot or the backyard where they have been learning how to ride their bicycles.

On an even more personal note, I have ridden some crazy climbs in the mountains of Montana with sheer cliffs to the side of me, and I have ridden in the busy streets of Bangkok and Chiang Mai in Thailand. 

I have to say, I would not have done any of it without a helmet. During Ironman Texas, about mile 106 of the bike, I was so tired and dehydrated that I took my eyes off the road for a moment (Don’t do that, guys.), and I crashed. I was not going very fast at all because it was just after a nutrition station and I was adjusting water bottles, but I hit the ground and slid several feet, my head hitting a telephone pole. Guess what I was really glad I had on? My helmet. Thank you, Giro helmet, for cracking and withstanding the force that could have smashed my brain and kept me from going on to begin my residency in pediatrics. Here’s a photo of my cracked helmet.
Wouldn’t you rather have a cracked helmet than a cracked brain? I would.

This was a just a little glimpse of a huge topic in sports: sports related head trauma. Football season just started, so we will most surely be talking more about this! In the meantime, get out and enjoy this awesome weather, but if you’re on a bike (or skating or whatever you’re doing), wear a helmet. ;)

Megan Long, M.D.

More info:
Brain Injury Association of America

Wednesday, September 4, 2013

Staying Active with your Autumn Allergies

Happy September and welcome to my very first Sports Medicine blog post! Since it is becoming my very favorite time of year for outdoor running and cycling (and hiking if given the opportunity), I thought it might be nice to talk about the challenges some folks face during this time of year with regard to simple things like breathing. Depending on where you live, the mornings are becoming what I think is the perfect environment for running outdoors—60-70 degrees Farenheit, cool and brisk, refreshing, and invigorating…for the first few minutes until you realize—I can’t breathe through my nose! Hello, fall...hello, allergies.

If you’ve been doing outdoor activities for many years, you may have realized which times of year are particularly difficult for you in terms of allergic rhinitis/conjunctivitis (that’s fancy doctor talk for itchy, allergic nose and eyes) or allergic asthma symptoms. In New York, beginning in mid-August is the beginning of the grass pollen season. So for those of you starting to sniffle, clear your throat, or rub your red burning eyes when you go outside but not when you’re inside, and you don’t think you have a cold, you may have allergies to grass pollen. This can make enjoying autumn runs/bikes/hiking or any other outdoor activity difficult. How are you supposed to enjoy the clean cool air if you can’t breathe it in? So here are some helpful tips to keep you enjoying the change of season and breathing relatively normally.

1.   Know your trails...
Pay attention to the different flora on your favorite running trails. Maybe you have more symptoms when you run on a certain path at a particular time of year, and that could be one to avoid in the future. Don’t worry, if in the summer you don’t have symptoms there, you can exercise there to your heart’s content, and that trail will be all the more special and fun for you for the time you have spent away. Along the same line, if you live in a city or suburban area, make note of what day they cut the grass and plan to for an indoor workout that day.

2.   Relish the rain...
If you don’t have a mold allergy, running/biking in the rain or shortly after a rain can be the best time for you to be outdoors. Rain clears away some of the pollen. If you do have a mold allergy, this could be the worst time, so try it out and see.

3.   Shower and launder!
Your allergy season is not the time to try to stretch those workout clothes into next week. If you do an outdoor workout, make sure to shower, wash your hair, and launder your clothes. I guess that goes without saying, but I know how much I hate doing laundry. Pollen can linger! (Also workout harder and you won’t think twice about a second round for that outfit.)

4.   Medicate...
Allegra is probably the best oral antihistamine in my opinion. It’s non-drowsy but can still cause issues with dryness (dry eyes, dry mouth), so be sure to drink plenty of water on this medication (in addition to what you would for your normal hydration and training).
Claritin, Zyrtec, etc. are other options. Try them out and see what works for you. Many people find that the standard dose of Claritin isn’t enough to help their allergies significantly, but it is non-drowsy at that dose. Zyrtec is non-drowsy for about 70% of the population; you could be the 30% that becomes a Zombie on Zyrtec. Again, see what works for you. The older antihistamines (Benadryl) are very sedative, so these are really not the best when you’re about to go for a run.
Ask your doctor:
The above medications are systemic, in that they affect the whole body. If you just have eye symptoms or just have nose symptoms, try asking your doctor about eye drops (Naphcon, Pataday) or a nasal spray (Flonase, Nasonex). Some people with severe allergies need the oral medicine in addition to a nasal spray and eye drops to control symptoms effectively.
When to start:
Start your medicines about 2 weeks prior to your known allergy season.

5.   Hibernate...
Know your season and maybe spend a little more time on the treadmill or indoor trainer at that time of year if you are really struggling. It’s all up to you and how important those fresh air workouts are to you. and also have local pollen counts, which can be helpful for you to pick and choose the days that are maybe a bit better for indoor workouts.

6.     What’s your poison?
If all of the above still haven’t helped much, try asking your doctor about a referral to your local Allergy specialist (Allergy & Immunology is the field). He or she can do skin testing and determine what the common culprits are that are causing your symptoms. They may suggest other medications or strategies to help. In addition, they may recommend immunotherapy (allergy shots) to help desensitize you. You can go from a sniffling, red-eyed, throat-clearing, head-throbbing, wheezing runner to a happy, smiling one after 6 months or so of therapy 

Megan Long, M.D.

On deck: Foam rolling and the science behind myofascial release techniques!