Getting Back Into Your Exercise Routine (Finally)?

Don’t Jump Into that “Deep Water” Too Soon!!!

I’m seeing a lot more of my total patients reporting generalized fatigue, lack of energy, weakness, being unsteady on their feet and maybe even a little down in the dumps.  Sometimes there are falls involved.  There can be many reasons medically as well as pharmaceutically that can contribute to the above symptoms, but it doesn’t take a rocket scientist to realize that these are all 100% explainable as the longer-term effects of having our lives contained during an extended Pandemic.  We’re not getting out as much or for as long.  We’re likely not socializing nearly as much.  Maybe we’re enjoying a little too much sitting time, whether it’s video calling friends, family, teachers, etc., or enjoying a little too much TV entertainment, many of us have been sitting a whole lot more than usual.  Our relative increase in inactivity over the past two years will not come rushing back to “normalcy” without some work on your part.

That’s right – this won’t be a passive process and the work can be extensive but does not need to be grueling misery.  I like to tell my patients, “We’re goin’ swimmin’ but we won’t jump in that deep water just yet.”  What does that mean?  It means we’re going to start slow and easy and carefully gauge the response, which then guides our way forward in terms of advancing safely and effectively.  This is the best way to get back into a fitness routine if it’s been a while for any reason – medically or otherwise.  If our bodies are not used to the uptick in activity/exercise we’re planning on, then we stand a pretty good risk of injuring ourselves or at least making ourselves more sore and inflamed than, presumably, most of us care to have to experience.

Let’s face it, the old adage, “No Pain, No Gain” is certainly pragmatically true when it comes to developing strength and stamina, which require physical work and conditioning.  Pushing those very physical boundaries involves physical challenge.  That challenge stresses our muscles and joints and our bodies push back with tenderness and inflammation as we heal and rebuild ourselves.  Regular exercise results in regularly better physical health — so you should consider this a long-term investment in your Quality of Life.  Committing with discipline is hard and it’s helpful to have some guidance if you don’t know what you’re doing.  How many times have you “started back” to your exercise routine just to have it end up being another “one and done” experience?

The fact is, you don’t want to go after it with uber-intensity as you’ll most likely develop more scar tissue than anything else, which is counter-productive to the development of good physical health in so many ways, such as flexibility and overall muscle function and capacity.  Another favorite expression of mine with patients is, “If you wanna PLAY at THIS level, you have to TRAIN at THIS level.”  So simple a concept but worth explaining a bit.  Think of a marathon runner.  That’s someone who can run for over 26 miles.  Imagine if someone who has not been engaging in any regular exercise program or progressive running program tried to run a marathon.  Maybe their adrenaline and inner drive would get them across the Finish Line, but they’re almost 100% certain to have injured themselves badly with severe damage to their muscles that will cause significant pain and inflammation that could take a few weeks or months and maybe even substantial medical attention to resolve (e.g., see “Rhabdomyolysis”).

Over-doing-it aggressively when starting out on, or getting back to, an exercise program is a common mistake, but if you think about it, you’re probably less likely to continue any exercise program that causes substantial pain and even if you do that pain is your body’s way of telling you you’re likely over-doing-it and actually injuring yourself.  So – “No Pain, No Gain” is a YES so long as the pain is minimal and easily manageable with giving yourself even time to rest/rebuild, which usually takes only a day or two, and maybe a little ice if you’re particularly inflamed or tender.  You should not be experiencing sharp or intense pain or a lot of swelling.  If you can barely move the next two days, you’ve over-done-it!  It’s not necessary!

So if you’re headed back into the garage weight room, the local gym or out on the road or trail – take my advice:  START SLOWLY and PROGRESS GRADUALLY.  You will not rebuild in a day what’s been lost over the course of two years, two months or even two weeks.  Take your time.  Consider asking your PCP about whether you’re ready to return to exercise.  Definitely consider working with a personal fitness trainer.

If you’re feeling like your balance is off or you’re just so weak that you’re having trouble with your mobility, consider seeing your doctor or a physical therapist to help guide you back toward your fitness or mobility goals without jumping in over your head.

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

When it comes to training to improve physical health and well-being, there are five essential components to address: (1) strength, (2) flexibility, (3) balance, (4) core stabilization and (5) endurance (aka, “aerobic conditioning”).  Physical therapy is an excellent choice if you need help in any or all of these areas, but today we’re going to focus on the importance of having adequate functional endurance.

It doesn’t matter if you’re 18 and wanting to be your best on the football or soccer field, basketball or tennis court or in the ballet theatre, or 85 and wanting to be able to keep dancing with your favorite partner, improve how far you can mobilize your wheelchair or continue playing and walking safely in the community with your favorite grandchild, you would be wise to include endurance work on a regular basis.  It’s one thing to have good strength or power. It’s another matter all together to have good functional endurance.  After all, who really cares if you can take one or two strong steps if you can’t handle the 50 steps it takes to get to your restroom in the middle of the night because you run out of steam?

You can get stronger through endurance training, but you can’t improve endurance much at all by working solely on strength and power.  To improve your endurance, your muscles need to be engaged in healthy and progressively longer bouts of aerobic conditioning, so your heart and lungs will need to be able to sustain your level of activity as well as your muscles being able to go the distance.  This does not happen overnight, and you can easily over-do-it and wind up in the ER.  I like to tell my patients, “If you want to PLAY at a certain level, you have to TRAIN at a certain level.”  So, don’t think you can go from couch potato to running (or even walking) the local marathon the next weekend – you’re very likely to hurt yourself or even suffer a stroke or heart attack.  It takes time to condition your body to have better functional endurance – so you’ll need to be patient as well as diligent

Since improving your functional endurance necessarily requires cardiovascular training, if you want to improve your endurance, you must incorporate progressive cardio challenge regularly.  Examples of this might be: (1) walking or jogging at progressively faster speeds for progressively longer distances or periods of time; (2) exercising with a stationary bike, elliptical machine, treadmill or jump rope at progressively faster speeds for progressively longer periods of time; or (3) marching in place, mobilizing your wheelchair manually or performing sit to stand exercises for progressively more repetitions or progressively longer periods of time or distance.

How many times did you see the word “progressively” in those examples?  That’s because our bodies tend to acclimate to our typical amount of activity.  Or worse yet, our bodies will progressively decline in functional endurance if we engage in less and less physical activity.  So, when you try to do more than what your body is used to doing, you feel it in the form of rapid muscle fatigue, usually along with some burning in the muscles being worked, some muscle trembling due to simple muscular fatigue and shortness of breath.  There would also be increased risk of muscle injury if you’re not doing enough to keep your muscles adequately healthy to support the intensity of the work they’re being asked to perform.  The burning is lactic acid build up in the muscles and occurs when those muscles deplete their oxygen stores, which are used as fuel that allows the muscles to expend energy and continue working.  Only through regular and progressive amounts of aerobic conditioning activity will your body train to be able to handle more physical activity without having to wave the white flag and surrender because you can’t catch your breath or take another step without potentially falling.

Improving your functional endurance does not require misery – it just requires consistency and progressive challenge.  It’s very possible to work toward your goals of improved fitness and endurance without wiping yourself out for the entire day or subjecting yourself to substantial risk of injury.  However, it’s always best to get some good advice from the experts and you should make sure you’re healthy enough to engage in a fitness training regimen.  So, if you’re interested in “going the distance” by improving your functional endurance, you should start with your doctor to make sure you’re healthy enough to exercise in such a capacity.  Once medically cleared, consider seeing your favorite physical therapist or fitness trainer to properly guide you through a strength and conditioning program.  You’ll be glad you did and will actually be able to improve your quality of life, and isn’t that the kind of return on investment we all want?

Online Resources:

“Endurance: Endurance, or aerobic, activities increase your breathing and heart rate.” (NIH: Go4Life. found online July 12^th, 2019 at: https://go4life.nia.nih.gov/exercise-type/endurance/).

“Fitness training: Elements of a well-rounded routine.” (Mayo Clinic: found online July 12^th, 2019 at: https://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/fitness-training/art-20044792).

“Basics of strength and conditioning manual.” Dr. William A. Sands, Jacob J. Wurth & Dr. Jennifer K. Hewit: (The National Strength and Conditioning Association (NSCA): (found online July 12^th, 2017 at: https://www.nsca.com/contentassets/116c55d64e1343d2b264e05aaf158a91/basics_of_strength_and_conditioning_manual.pdf).

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

When I was a new graduate PT, I had endless energy and thought I could help everyone.  After nearly 30 years in practice, I’m still passionate and optimistic about what I do, but now at 50++ years old instead of 24, I recognize that I can’t change the world – at least not all by myself.

Your chances of getting better require a lot more than just having a good PT.  It’s truly a TEAM effort, and Mother Nature (e.g., what you’ve inherited genetically, how you heal, etc.), your lifestyle choices and many other factors impact your health and capacity for improvement.  However, there are some common threads that apply to us all, and they’re very, very important. Simply put, it takes good old-fashioned teamwork to achieve success in PT.  Despite what you’ve heard, there’s most definitely an “I” in Team (me as your PT), but there’s also most definitely a “U” in Team (you as the patient getting PT). 

That’s right – let’s talk about what we each need to bring to the table in order to make Your PT as successful as possible in terms of the outcomes You achieve!!!

“TEAMWORK Makes the DREAM WORK?” 

ABSOLUTELY YES!!!

You’ve got to embrace the Team perspective in PT and understand your part, which is NOT a passive role most of the time.  It’s likewise important to understand that we’re all different and experience things quite uniquely, so Patient A is not likely going to experience a total knee joint replacement the same ways that Patient B does, even if they both have the same condition (e.g., arthritis), the same highly skilled Orthopedic Surgeon and the same awesome PT throughout the process of surgery and rehab.

So — what wisdom can I share with you after 30+ years of doing this PT thing?

When it comes to “successful outcomes” in PT, it’s been my experience that it’s pretty clear there are some key concepts in play.  Some research tells us that the patient’s attitude about their circumstances is critical, as is having a trusting relationship that’s forged between patients and their PT (NOTE: we’ll need to agree that “TRUST” is a 2-way street here!)  This trusting relationship is referred to as the “therapeutic alliance.”  Now take a deep breath because equally as important is the patient’s compliance with the overall plan you and your PT decide upon.  That’s right — you actually have to be disciplined enough and able to forge through the Process of your PT.  Perhaps the single-most important factor to having the best chance for success is this: Showing up for your appointments on time and ready to do whatever you need to do. Remember – PT is an investment in your Quality of Life!  How much you’re willing to invest plays a huge part in your chance of having successful outcomes!  Being “All In” means actually following the plan that’s been developed by you and your PT, which includes: realistic goals, a realistic time frame for achieving your goals, a rational decision about how often you should attend PT and what you should be doing outside of PT, such as a home exercise program.

If you have a negative outlook on your circumstances and your potential to improve, you’re not likely going to be successful in PT because you don’t believe in it — you’re simply not invested — therefore you’re not likely to comply with the plan and you’re certainly not likely to work very hard throughout the process.  If you don’t trust your PT and don’t believe in your heart and soul that your PT is both competent and motivated to facilitate your success, you’re not likely going to give PT much of a chance.  But even if you have a great attitude and trust your awesome PT with all your heart, if you don’t actually show up for your PT or don’t remain true to the home exercise plan (i.e., you’re noncompliant with the plan of care), then your chances of having a successful outcome are slim at best.

I would argue that there is one really, really, REALLY important “wild card” to this discussion.  Let’s face it – many patients who need PT are dealing with pain on some level.  Pain is a real you-know- what, and I don’t know too many people who like or invite pain, to be sure.  I’ve seen many instances when pain dictates everything.  More than that, I’ve seen many cases when fear of pain (i.e., expecting an activity or exercise to hurt) causes an avoidance of the activity altogether or results in pain-avoidance behaviors like excessive muscle or postural guarding, offloading (i.e., shifting yourself around to make what you really should be doing a lot easier), and excessive substitution (e.g., using muscles other than the targeted muscle to do what the targeted muscle is being asked to do, such as when a person hikes their shoulder up to try and raise their arm overhead instead of activating the primary shoulder muscles.) 

Q: Why would someone do that?  A: To avoid pain, whether real or anticipated. 

Since PT so often involves painful conditions (e.g., having a knee replacement or rotator cuff surgery, tennis elbow, Achilles tendonitis, severe neck or back pain, etc.), the extent to which these pain avoiding behaviors exist plays an extremely important part when it comes to your chances of having successful outcomes.

Your PT experience should NEVER BE MISERY and, therefore, should NEVER BE FEARED!  Your best chances for success in PT must always take this into consideration!

If you’re suffering from a painful condition, consider seeing your physical therapist for an evaluation to see how they can help.  Here at Summerville PT & Balance we have everything you need to get through your Rehab and we know that it’s not a cookie-cutter approach.  We treat each patient individually according to each patient’s tolerance.  It might be challenging at times, but you can bet that we’re right there in it with you!  Your success is our success, so should you need outpatient PT, be sure to check us out to see if we’re the right match for your needs!

Online Resources:

3 Keys to a Positive Outcome in Physical Therapy; (found online Feb. 10th, 2019) at: https://3dpt.com/3-keys-to-a-positive-outcome-in-physical-therapy/

The importance of pain-related fear and pain catastrophizing in physiotherapy; (found online Feb. 10th, 2019) at: https://physiotherapy.ca/importance-painrelated-fear-and-pain catastrophizing-physiotherapy

Fear-avoidance model; (found online Feb. 10th, 2019) at: https://en.wikipedia.org/wiki/Fear-avoidance_model

By David P. Brungo, PT, Expert Contributor, Summerville PT & Balance Rehab for Adults

Dizziness, vertigo (i.e., the sensation of your head spinning or the room spinning when you’re not actually moving) and even certain types of migraine headaches, which are common in cases of vestibular dysfunction, can all be caused by many things.  Sometimes there are problems with your brain or spinal cord (i.e., the central nervous system) that are the culprit, and other times it could be more of a peripheral nervous system issue such as crystals in your ears that trick your brain into thinking you’re moving when you’re not — a condition known as Benign Paroxysmal Positional Vertigo, or BPPV.  But did you know how important your DIET is when it comes to dizziness?  If you didn’t, here’s some food for thought:

Things that we eat, drink and smoke can have very significant impacts on our overall sense of balance and equilibrium by changing the manners in which our vestibular system and nervous system work.  For example, some things that enter our bodies will change the delicate pH balance or the volume or density of the endolymph – the fluid in our inner ear — and can cause abnormal function of the structures within our ears that are responsible for telling our brain what’s happening.  Our endolymph normally maintains a steady state of volume as well as chemical composition relating to potassium, sodium, chloride and other chemicals collectively called electrolytes.  Eating things that are high in salt or sugar can disrupt this important balance, as can heavy use of caffeine, nicotine or alcohol.  This probably seems pretty straightforward but did you know that a chemical in smoked meats call tyramine can actually trigger migraine headaches and dizziness?  If you love ‘ya some smoked pork and eat it regularly, maybe with a few beers or other adult beverages, don’t be surprised if these favorites are contributing to your dizziness or headaches.

You might be surprised at how powerfully our diets affect our sense of balance and equilibrium. Here’s a brief summary of the FOODS TO AVOID or at least be careful about in terms of how much and how often they’re consumed if you’re suffering with dizziness, vertigo, headaches or other vestibular symptoms:

1. Salt

2. Sugar

3. Caffeine

4. Alcohol

5. Nicotine

6. Processed food and meats

7. Bread and pastries

8. Fried foods

9. Pickled and/or fermented foods

Here are what experts suggest to EAT OR DRINK MORE OF to keep your vestibular system happier:

1. Water (be careful if you have kidney or liver issues or take a diuretic! Speak to your doctor first if you do!!!)

2. Foods rich in potassium (but be careful about over-doing it! Speak with your doctor first if you keep track of these levels!!!)

3. Foods rich in antioxidants, micronutrients and anti-inflammatory qualities

4. Ginger (but not good for patients who take diabetic or blood thinning medications! Speak with your doctor first if you do!!!)

5. Food rich in Vitamins B & C, Zinc and Magnesium (be sure to get guidance from your doctor first!!!)

There are some really great resources available online that will help you understand how your diet affects your sense of balance and equilibrium.  I’ve included four excellent resources below and strongly encourage you to review them as well as speak with your doctor about if you’re feeling dizzy, off balance or have headaches or migraines regularly.  Moreover, I’d encourage everyone to consider making changes to your diet and/or lifestyle choices BEFORE starting new medications or continuing long-term use of medications like Meclizine (an anti-histamine frequently prescribed to reduce dizziness), or anti-anxiety medications such as Lorazepam, Klonopin, Ativan, Valium or Xanax.  These are powerful vestibular suppressants that can actually prevent you from ever getting better in many cases of vestibular dysfunction.

Always speak to your doctor, nutritionist/holistic expert and/or physical therapist before you make any serious changes to your diet as they can have significant health consequences for certain people who take medications to control other problems!

Healthier diets and lifestyle choices benefit us in many, many ways.  If you’d like to discuss this topic further, please do not hesitate to ask an expert but be prepared to start making some tough choices about what you like to eat, drink or smoke!

ONLINE RESOURCES:

VERTIGO DIET – UNDERSTAND AND TREAT CONDITIONS SUCH AS MENIERE’S DISEASE AND VESTIBULAR MIGRAINE; found online (November 20, 2018) at: https://www.vertigotreatment.org/post/vertigo-diet-menieres

HERE’S A DIET TO HELP YOU WITH YOUR VERTIGO!; found online (November 20, 2018) at: https://www.neuroequilibrium.in/diet-to-help-you-with-your-vertigo/

DIETARY CONSIDERATIONS – Does Diet Really Matter?; found online (November 20, 2018) at: https://vestibular.org/understanding-vestibular-disorders/treatment/vestibular-diet

ALCOHOL INTOXICATION ON VESTIBULAR FUNCTION; found online (November 20, 2018) at: https://www.dizziness-and-balance.com/disorders/medical/etoh.html