Category Archives: EXERCISE

Excessive Dieting and Exercising

Strict Dieting and Excessive Exercising: How Do They Affect Your Health?

Extream Exercising jwilliamsModern people live in stressful times. We are constantly barraged by new information, connected to our devices such as phones and computers, and have too little time for anything else except our jobs and household chores. Realizing the pressure of everyday lives, many people do their best to stay healthy by eating right, exercising regularly, and avoiding bad habits such as smoking and drinking alcohol. However, some people take their healthy habits too far by exercising excessively, adhering to very restrictive diets, or taking too many vitamins and different supplements. Many well-regarded studies have shown that such behavior, instead of making one healthier, might in fact harm one’s well-being.

The United States is a country with one of the highest obesity rates in the world According to 2013 UN report, it ranks second—after Mexico—with 31.8 percent of population being obese. Although in the last few years the obesity growth rate has slowed a little bit, it is still a very alarming issue. Many obese people suffer from a wide array of diseases such as diabetes, cardiovascular diseases, stroke, and generally bad health which negatively affect the overall economy of the country (lower productivity, higher health costs, etc). As such, it is a very positive development when a person decides to take control of his/her health and embark on a healthy lifestyle. However, one of the main rules one needs to remember is that everything is good in moderation.

For example, if a person eats a well-balanced, nutrient-rich diet, he or she rarely needs to consume additional vitamins or supplements because all essential nutrients are already provided by food. According to Cynthia Sass, MPN, RD if one takes an excessive amount of such popular supplements as omega 3 fatty acids, iron, vitamin C, zinc, calcium, to mention just a few, he or she can seriously harm one’s health.

Man Drinking after ExerciseTo illustrate, high levels of omega 3 fatty acids can lead to weakened immune system, too much vitamin C and calcium can cause kidney stones, excessive zinc can cause many undesired effects such as vomiting, diarrhea, and lowering of bad cholesterol, and excessive iron can build up in tissues and organs such as heart and liver. Consequently, it is much better to commit to eating healthy combination of vegetables, proteins, and good carbs than risk overloading one’s system with unnecessary, and potentially hazardous, nutrients. Very strict diets also negatively affect peoples’ health by depleting their bodies of essential nutrients.

Another extreme behavior to which people become susceptible when trying to living healthfully is excessive exercising. Some people run every day for many miles, others enroll in such demanding fitness programs as CrossFit without being physically prepared for them, and third spend many hours at the gym. Once again, many researchers maintain that health benefits fall dramatically when person puts his or her heart and cardiovascular system under high pressure during strenuous and prolonged exercising. In fact, there are always stories when people collapse or even die when they run marathons, as was a case in Raleigh, NC when two people have died while running Rock’n’Roll half-marathon on April, 13, 2014. Usually, runners’ deaths are cardio-related, as it was in this tragic case.

While everyone should be mindful of their health and committed to eating well-balanced diets, exercising regularly, and avoiding bad habits—one also needs to remember that everything is good in moderation. – Becky Kospanova

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Exercise in our Fast Paced Lives

-B. Arora

As soon as we hear or read the word exercise, the first thing that comes to our mind is crunches, weight lifting, push-ups, pull-ups and other such workouts that make us drip. But, this not what exercise is all about. Such workout or weight training does help us in building our physique, but not everyone has enough time or mental strength to persevere for weight training, especially in this fast paced life.

Working out in a gym helps you to reduce the stress hormones and stiffen your muscles to look good and improve your sex appeal. However, in this fast paced life most of us are not able to find enough time to fit gym in our busy schedules. An early morning walk in the park followed by light stretching or a sweltering jog is the need of the hour for all such individuals. This will help you cope up with stressful situations in life and look at the world with a new perspective. Physical well being is the first step to happiness and our complete well being.

Exercise is defined as any activity that is responsible for the well being of our body, mind or soul. Exercise could be anything from a walk in the park to a whole-hearted laugh, as they relieve us of the stresses accumulated in our mind and body.

Physical exercise plays a vital role in our well being, however that is not enough, for most of the exercises are meant for strengthening our muscles and physical well being, but what about our mind and soul? Yoga is a form of exercise that results in the well being of our mind and soul along with the physical well being.

Yoga can be performed by individuals of all age groups and can even heal most of our ailments which is not possible with any other form of exercise. It improves the flexibility of our muscles, relieves stress and takes us closer to our inner self or conscience. It makes our spirit pure and genteel. Yoga involves various deep breathing techniques, light physical exercises and meditation. It is an ancient Indian technique that was mostly adopted by ascetics or yogis which made them live longer and healthier lives. People have realised the importance of yoga lately and groups from all over the world are involved in its promotion.

For the individuals who can never find time to exercise, yoga is the way to go. It is performed for 15-30 minutes daily with not even a single drop of sweat and will leave you feeling fresh and healthy unlike weight training exercises that leave you feeling drenched and tired. Even the aged can easily perform yoga and will benefit a lot from it. Although, it involves professional training for at least a month to be able to perform it on your own in the appropriate manner.

Another form of exercise is ‘laughter’. More and more people are accepting this fact and are opting to laugh instead of dripping at a gym. “Laughter is the best medicine”, is a doctor’s favourite quote, but hardly any follow. Laughing hard can have the same effects as that of jogging and other stretching exercises. A laugh reduces the stress level instantaneously, though it’s not easy for each of us to develop the habit of laughing when we are stressed, but it can be adapted with perseverance and would definitely prove to be helpful.

It a nutshell, exercise is a must for every individual and must not be limited to its physical form, but extended to its mental and spiritual forms as well.

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The Benefits Of Exercise

ex When we talk about exercise, we nearly always refer to physical exercise. Exercise is the physical exertion of the body – making the body do a physical activity which results in a healthy or healthier level of physical fitness and both physical and mental health. In other words, exercise aims to maintain or enhance our physical fitness and general health. People exercise for many different reasons. Some of them are included below:

Strengthening muscles
Optimizing the cardiovascular system
Practicing specific athletic skills
Controlling bodyweight
For fun
To win
To socialize
To get away from it all

People don’t exercise for various reasons. A study found that stress levels and cultural considerations affect how much and for what reasons college students exercise.

There are three broad Intensities of exercise:

  • Light exerciseThe exerciser is able to talk while exercising. Going for a walk is an example of light exercise.
  • Moderate exerciseThe exerciser feels slightly out of breath during the session. Examples could be walking briskly, cycling moderately, or walking up a hill.
  • Vigorous exerciseThe exerciser is panting during the activity. The exerciser feels his/her body is being pushed much nearer its limit, compared to the other two intensities. This could include running, cycling fast, and heavy weight training.

Exercise can be divided into three broad categories, aerobic, anaerobic, and agility training:

Aerobic exercise

Aerobic exercise has the aim of improving the body’s consumption of oxygen. The word aerobic means with oxygen. Aerobic refers to our body’s use of oxygen in its metabolic process (energy-generating process). Most aerobic exercises are done at moderate levels of intensity for longer periods, compared to other categories of exercise. An aerobic exercise session involves warming up, exercising for at least 20 minutes, and then cooling down. Aerobic exercise involves mainly the large muscle groups.

A physical therapist, Col Pauline Potts, and an exercise physiologist, Kenneth Cooper M.D., both in the US Air Force, were the first to use the term aerobic exercise during the 1960s. Dr. Cooper wanted to find out why some very strong people were poor at long-distance running, swimming and cycling. He researched people’s performance in terms of their ability to use oxygen with the use of a bicycle ergometer. In 1968 Dr. Cooper published his book Aerobics. The book included scientific programs using aerobic exercises, such as swimming, running, cycling and walking. The book became a bestseller. All present aerobic programs use Cooper’s data as a baseline.

Aerobic exercise is generally performed at a moderate level of intensity over a long period. Running for 20 minutes is an aerobic exercise, while sprinting 200 meters is not. Playing badminton for 30 minutes is an aerobic activity if the movements of the players are fairly continuous. Golf, on the other hand, is not seen as aerobic because the heart rate has not been raised at a sustained level for long enough.

Aerobic exercise is considered to have the following benefits:

  • Strengthens the muscles that are involved in respiration – exercises that facilitate the flow of air in and out of the lungs.
  • Strengthens and enlarges the heart muscle. This improves aerobic conditioning – pumping of blood and the heart rate (lowers the pulse of a person when he/she is resting).
  • Tones muscles throughout most of the body.
  • Reduces blood pressure.
  • Improves circulation.
  • Raises the number of red blood cells, which in turn facilitates transportation of oxygen.
  • The sleep quality of insomnia patients can improve with moderate exercise, a study found.
  • Improves mental health.
  • A study found that exercise reduces migraine suffering.
  • Reduces the risk of heart disease and cardiovascular problems.
  • Helps improve survival rates of patients with cardiovascular diseases significantly, as this study found.
  • Stimulates bone growth (high impact aerobic exercise), reduces risk of osteoporosis.
  • Increases stamina or endurance. Aerobic activity increases the body’s ability to store energy molecules such as fats and carbohydrates within the muscle.
  • Increases blood flow through muscles.
  • Improves muscles’ ability to use fats during exercise, thus preserving the intramuscular glycogen.

What is Anaerobic exercise?

The aim of anaerobic exercise is to build power, strength and muscle. The muscles are exercised at high intensity for short durations. A short duration usually means no more than about two minutes.

Anaerobic means without air. Anaerobic exercises improve our muscle strength and our ability to move with quick bursts of speed. When thinking of anaerobic exercise, think of short and fast or short and intensive. Anaerobic exercises include:

  • Weight lifting
  • Sprinting
  • Intensive and fast skipping (with a rope)
  • Interval training
  • Isometrics
  • Any rapid burst of hard exercise

Oxygen is not used for energy during anaerobic exercise. During this type of exercise a by-product – lactic acid – is produced. Lactic acid contributes to muscle fatigue and must be used up during recovery before that muscle can be subjected to another anaerobic session. During the recovery period oxygen is used to give the muscle a “refill” – to replenish the muscle’s energy that was used up during the intensive exercise.

Overall, anaerobic exercise uses up fewer calories than aerobic exercise. The cardiovascular benefits of aerobic exercises are greater than the cardiovascular benefits of anaerobic exercises. However, anaerobic exercise is better at building strength and muscle mass, while still benefitting the heart and lungs. As you build more muscle you will burn more fat, even at rest. Muscles burn more calories per unit volume than any other tissue in the body. A muscly person burns more calories than a non-muscly person, even if while he/she is resting. This study found that resistance training may aid in weight loss.

How Does Anaerobic Exercise Work?

When a short, intensive burst of activity occurs there is a temporary shortage of oxygen being delivered to the working muscles at first. The production of anaerobic energy creates a by-product; lactic acid. As mentioned above, lactic acid causes muscle fatigue, which is the reason the session cannot last long. However, after regular training the person’s body becomes better equipped to handle lactic acid. After several practice sessions the body becomes better at getting rid of lactic acid – it also learns how to produce less of it. The body also produces buffers that postpone the onset of fatigue during an anaerobic session. Anaerobic exercises offer the following benefits:

  • The exerciser gets stronger
  • The exerciser experiences growth in muscle mass
  • Strengthens bones
  • Strengthens and protects the joints
  • Helps control bodyweight
  • The exerciser can withstand a greater buildup of lactic acid and other waste substances, and can eliminate them more rapidly

What is agility training?

Agility training aims to improve a person’s ability to speed up and slow down, change directions while maintaining balance and control. In tennis, for example, agility training helps the player maintain control over his/her court positioning through good recovery after each shot. A crucial skill in tennis is to be able to position yourself in the court so that you can hit the ball to maximum effect. Agility does not only help the tennis player get to the ball more effectively and set up for a better shot, it also gives him/her better balance in order to hit the ball.

Agility training is practiced extensively by people who practice certain sports where positioning, coordination, balance and the ability to suddenly change posture and speeds are essential.

Agility and coordination are two key attributes for a successful soccer (UK/Ireland: football) player. Such compound movements as dribbling, turning, passing and intercepting require a wide assortment of balance, coordination and other skills, such as the ability to accelerate and decelerate quickly. A good soccer player also needs excellent special awareness and accurate timing. Soccer players often practice improving their ability to change the direction of the body abruptly, or shift stance without losing balance.

Agility includes speed, strength, balance and coordination. The following sports are known to require agility (there are many more than on this list):

  • Tennis
  • Soccer
  • Rugby
  • American football
  • Squash
  • Hockey
  • Badminton
  • Volleyball
  • Basket ball
  • Martial arts
  • Boxing
  • Wrestling

Yoga and Pilates

Some exercises include a combination of stretching, muscle strengthening, balance, etc. A good example is Yoga.

Many experts say stretching is an exercise in itself. Yoga exercises, or movements, improve your balance, flexibility, posture and circulation. Yoga originated in India a long time ago, and is aimed at unifying the mind, body and spirit. Modern yoga – the type of yoga practiced by most people in western countries – uses a combination of meditation, posture, and breathing exercises. Yoga can be tailored to meet the needs of individuals, such as those with arthritis, asthma, or certain body pains. Pilates is similar to Yoga, but it focuses more on the core abdominal and back muscles.

Some facts about exercise and lack of exercise

Most of us know how beneficial exercise is for our health. It is surprising, however, how little many of us know about the dangers of being unfit. In Western Europe, North America, Japan, Australasia, and much of the rest of the world, the number of overweight/obese people is growing alarmingly fast.

Finding the time to exercise

Many people who do not exercise say they do not have the time. However, it is possible to increase the amount of time you are physically active, even if you are extremely busy. For example:

  • See how many trips you take by car and decide which ones could be replaced by walking or cycling. This does not have to be a black or white measure. It could include parking your car half a mile from your destination and walking the rest of the way. Traffic experts throughout most of the world say that the majority of car trips are very short ones.
  • If you are using public transport try getting off at an earlier stop and walking the rest of the way.
  • A study found that interactive video games – such those played on the Nintendo Wii – may raise heart rate and provide exercise intensity levels high enough to meet federal physical activity guidelines.
  • When you are in a building and want to go upstairs, try walking it, rather than taking the elevator or escalators. This does not have to be a black or white measure – you can do half and half.
  • There are several gentle exercises you can do while watching TV. Especially when the adverts are on.
  • If you do not have time to exercise but have time to watch TV, think about how much of that TV time could be replaced by some physical activity. Most people say they do not have time to exercise, but we are all watching more TV than ever before. Even short bursts of 30 second exercises are good for improving metabolism, a study found.
  • Migraine – there are many safe exercises for migraine sufferers.
  • If you do housework, see if you can do it a bit more vigorously and turn it into an exercise session.

Tips on adding exercise to your routine

Experts say that for a physically inactive person to become active, and remain active for the long-term, the activity needs to be convenient and enjoyable. The activity needs to be something you can easily fit into your routine for several days each week. Even if you end up adding just 30 minutes of physical activity to your day, that is fine. Some of the examples below are the easiest to fit into a daily routine:

  • Go for a brisk 30-minute walk five times each week. Ideally, it should be done in one session. If you can’t, two 15-minute sessions would also be good.
  • Walk you dog more often. If you do not have a dog but know a nearby friend who has one, offer to walk it for him/her.
  • Find out whether there are any swimming pools nearby. Try to add some swimming to your weekly routine. This does not have to be every day.
  • During your lunch break at work go for a walk.
  • Join some exercise classes.
  • Join a martial arts club. Beginner’s sessions can be gentle and fun.
  • Beginners must remember that the secret is “little and often”. A little bit every day is great – one big session once a week is not. Make sure your progress is gradual. Make sure you drink plenty of water during and after you exercise. Check with your doctor if you are not sure about your health.
  • Experts say an exercise program should include both aerobic and anaerobic activities. This is true. However, if you are currently inactive, anything is better than nothing.

Some advice when you start an exercise program

When people start an exercise program they may experience various emotions, from elation to anxiety about not being able to keep it up. Remember the following tips which may help you achieve long-term success:

  • Remember why you startedPeople start exercising for many reasons: weight loss, health, vanity, the doctor told them to, and to recover from an illness. Keep remembering why you started as this will help keep you motivated.
  • Do everything at your own paceHumans tend to be competitive animals. This is great for the winner, and those who come second or third. However, being competitive in the wrong way can kill motivation. If you have to compete, compete with your past self. Compare your performance today with your performance in two weeks’ time. Check your weight, heart rate, blood pressure – then take it again in about three weeks and see the difference.
  • You have to like itFor long-term success the activity has to be something you enjoy. There are so many activities to choose from. Perhaps there is an activity you really enjoyed when you were a child.
  • Join a club with a friendIf you join a fitness club with a friend, or exercise with a friend you may enjoy the sessions more. Some people prefer not to have the stress of someone else around. This depends on you.
  • Experts can be very usefulA study found that exercise and behavioral intervention improves fitness and lowers systolic blood pressure.
  • VariationEvery few weeks change your exercise program. This is important for your motivation and also for best results. The body improves faster if you change your program now and again. This does not mean you have to change walking/running to something else. It could mean changing your speed and distance, and pacing yourself in a different way, perhaps altering your route.
  • Be realistic about your goalsSome people are motivated by goals, others find them stressful. If you need goals make sure they are realistic – and work towards them.
  • The longer you keep it up the longer you will continue to do itAfter a few weeks your exercise routine starts to become a habit. Even if you find it a bit of a chore at first, remember that after a few weeks it will really become a habit.

Written by Christian Nordqvist

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New Drug Delivers “Fitness”

pillsfitnessA New Drug Delivers “Fitness” Without the Workout

Take a pill and simulate the effects of exercise. By Nicholas Bakalar

It sounds too good to be true, but scientists announced in August that they have found drugs that simulate the effects of exercise.

Endurance training alters metabolic processes in muscle fiber, increasing the expression of the genes that control the muscles’ ability to contract, recover, and grow. It does this by activating two proteins, AMPK and PGC1-alpha. The scientists, writing in the journal Cell [subscription required], theorized that AICAR and GW1516, drugs that increase production of these proteins, might mimic the biochemical changes associated with exercise, and they seem to be right. “The drugs activate the endurance gene network, which promotes energy metabolism and revs the muscle up to be able to burn fats,” says Ronald Evans of the Salk Institute in La Jolla, where the work was done.

These drugs have been tested in mice with impressive results: a 44 percent increase in endurance in sedentary animals after four weeks of treatment with AICAR, and a 70 percent increase when GW1516 is combined with exercise. Both drugs are currently in clinical trials. AICAR is in trials for use in treating a heart condition and has been tested with other diseases over the past decade. GW1516 is being explored for controlling cholesterol. But neither compound has yet been tested for improving strength or endurance in humans.

What about athletes who want to use them for performance enhancement? “You can’t keep a drug that has obvious potential benefits to individuals away from them,” Evans says. “Athletes will definitely want to go for these drugs, as will other people.”

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Myofascial Pain in Athletes

myoMyofascial Pain in Athletes

Voluntary, or skeletal, muscle is the largest single organ of the human body and accounts for nearly 50% of the body’s weight. The number of muscles in the body depends on the degree of subdivision that is considered and on the number of variable muscles that are included. Not counting heads, bellies, and other divisions of muscles, the Nomina Anatomica reported by the International Anatomical Nomenclature Committee under the Berne Convention lists 200 paired muscles, or a total of 400 muscles. Any one of these muscles can develop myofascial trigger points (MTrPs). MTrPs are hyperirritable tender spots in palpable tense bands of skeletal muscle that refer pain and motor dysfunction, often to another location.

The myofascial pain syndromes (MPS) owe their ever-widening acceptance to the pioneering work of Travell and her later collaboration with Simons. In 1983, they combined their clinical experience in a detailed description of the multiple pain syndromes attributed to this disorder. In doing so, they further defined the major clinical components that are characteristic of myofascial pain, the most important being the TrP, the taut band, and the local twitch response.

Frequency

United States

MTrPs are extremely common and become a painful part of nearly everyone’s life at one time or another. Latent TrPs, which often cause motor dysfunction (eg, stiffness, restricted range of motion) without pain, are far more common than active TrPs that cause pain.

Active TrPs are commonly found in postural muscles of the neck, shoulder, and pelvic girdles and in the masticatory muscles. In addition, the upper trapezius, scalene, sternocleidomastoid, levator scapulae, and quadratus lumborum muscles are commonly involved.

Reports of the prevalence of MTrPs in specific patient populations are available. The data indicate a high prevalence of this condition among individuals with a regional pain complaint, as shown in Table 1.

Table 1. Prevalence of Myofascial Pain

Table

Region Practice Number Studied Prevalence of Myofascial Pain, %
General Medical 172 30
General Pain medical center 96 93
General Comprehensive pain center 283 85
Craniofacial Head and neck pain clinic 164 55
Lumbogluteal Orthopedic clinic 97 21
Region Practice Number Studied Prevalence of Myofascial Pain, %
General Medical 172 30
General Pain medical center 96 93
General Comprehensive pain center 283 85
Craniofacial Head and neck pain clinic 164 55
Lumbogluteal Orthopedic clinic 97 21

The wide range in the prevalences of myofascial pain caused by TrPs is likely due to differences in the patient populations examined and in the degree of chronicity, at least in part. Probably even more important are differences in the criteria used to diagnose MTrPs and, most important, differences in the training and skill of the examiners.

Functional Anatomy

Some isolated large round muscle fibers and some groups of these darkly staining, enlarged; round muscle fibers appear in cross-sections. In longitudinal sections, the corresponding feature is a number of contraction knots. An individual knot appears as a segment of muscle fiber with extremely contracted sarcomeres. This contractured segment has a corresponding increase in diameter of the muscle fiber.

The structural features of contraction knots presents a likely explanation for the palpable nodules and the taut bands associated with TrPs. Three single contraction knots can be seen scattered among normal muscle fibers. Beyond the thickened segment of the contracture muscle fiber at the contraction knot, the muscle fiber becomes markedly thinned and consists of stretched sarcomeres to compensate for the contracture ones in the knot segment. In addition, a pair of contraction knots separated by empty sarcolemma may represent one of the first irreversible complications that result from the continued presence of the contraction knot.

Sport Specific Biomechanics

The activation of a TrP is usually associated with some degree of mechanical abuse of the muscle in the form of muscle overload, which may be acute, sustained, and/or repetitive. In addition, leaving the muscle in a shortened position can convert a latent TrP to an active TrP; this process is greatly aggravated if the muscle is contracted while in the shortened position.

In paraspinal muscles (and likely other muscles, too), a degree of nerve compression that causes identifiable neuropathic electromyographic (EMG) changes is associated with an increase in the numbers of active TrPs. These TrPs may be activated by disturbed microtubular communication between the neuron and the endplate because the motor endplate is involved in the path physiologic process of the peripheral core TrP.

The histopathologic complications that could contribute to the chronicity of the condition and make treatment more difficult include the following:

  • Distortion of the striations (sarcomere arrangement) in adjacent muscle fibers for some distance beyond the contraction knot (see Image 1). This produces unnatural shear forces between fibers that could seriously and chronically stress the sarcolemma of the adjacent muscle fibers. If the membrane were stressed to the point at which it became pervious to the relatively high concentration of calcium in the extracellular space, it could induce massive contracture that could compound the shear forces.
  • The occasional finding of a segment of an empty sarcolemmal tube between 2 contractions knots may represent an additional irreversible complication of a contraction knot.

Latent TrPs can produce other effects characteristic of a TrP, including increased muscle tension and muscle shortening; but these do not produce spontaneous pain. Both active and latent TrPs can cause significant motor dysfunction. The same factors that are responsible for the development of an active TrP can, to a lesser extent, cause a latent TrP. An active key TrP in one muscle can induce an active satellite TrP in another. Inactivation of the key TrP often inactivates its satellite TrP without treatment of the satellite TrP itself.

The intensity and extent of the pattern of referred pain depends on the degree of irritability in the TrP, not on the size of the muscle. MTrPs in small, obscure, or variable muscles can be as troublesome to the patient as TrPs in large familiar muscles.

TrPs are activated directly by acute overload, overwork fatigue, direct impact trauma, and radiculopathy. TrPs can be activated indirectly by other existing TrPs, visceral disease, arthritic joints, joint dysfunctions, and emotional distress. Satellite TrPs are prone to develop in muscles that lie within the pain reference zone of key MTrPs or within the zone of pain referred from a diseased viscus, such as the pain due to myocardial infarction, gastric ulcer, cholelithiasis, or renal colic. A perpetuating factor increases the likelihood of overload stress that can convert a latent TrP to an active TrP.

With adequate rest and in the absence of perpetuating factors, an active TrP may spontaneously revert to a latent state. Pain symptoms disappear; however, occasional reactivation of the TrP by exceeding that muscle’s stress tolerance can account for a history of recurrent episodes of the same pain over a period of years.

Clinical

History

  • Symptoms
    • Active TrPs produce a clinical complaint, usually pain, that the patient recognizes when the TrP is compressed digitally. The patient is aware of the pain caused by an active TrP, but he or she may or may not be aware of the dysfunction it causes.
    • Latent TrPs characteristically cause increased muscle tension and limit the stretch range of motion, which often escapes the patient’s attention or is simply accepted. The patient becomes aware of pain originating from a latent TrP only when pressure is applied to it. Spontaneous referred pain appears with increased irritability of the TrP; then, the TrP is identified as active.
    • The patient usually presents with complaints due to the most recently activated TrP. When this TrP is successfully eliminated, the pain pattern may shift to that of an earlier key TrP that must also be inactivated. If the key TrP is inactivated first, the patient may recover without further treatment.
    • Patients with active MTrPs usually complain of poorly localized, regional, aching pain in subcutaneous tissues, including muscles and joints. They rarely complain of sharp, clearly localized coetaneous-type pain. The myofascial pain is often referred away from the TrP in a pattern that is characteristic for each muscle. Sometimes, the patient is aware of numbness or paresthesia rather than pain.
  • Dysfunction
    • In addition to the clinical symptoms produced by the sensory disturbances of referred pain, dysesthesias, and hypoesthesia’s, patients can also have clinically important disturbances of autonomic and motor functions.
    • Disturbances of autonomic functions
      • Disturbances of autonomic functions caused by TrPs include abnormal sweating, persistent lacrimation, persistent coryza, excessive salivation, and pilomotor activities.
      • Related proprioceptive disturbances caused by TrPs include imbalance, dizziness, tinnitus, and distorted perception of the weight of lifted objects.
    • Disturbances of motor functions
      • Disturbances of motor functions caused by TrPs include spasm of other muscles, weakness of the involved muscle function, and loss of coordination by the involved muscle, and decreased work tolerance of the involved muscle.
      • The weakness and loss of work tolerance are often interpreted as an indication for increased exercise, but if this is attempted without inactivating the responsible TrPs, the exercise is likely to encourage and further ingrain substitution by other muscles, with further weakening and deconditioning of the involved muscle.
      • The combination of weakness in the hands and loss of forearm muscle coordination makes the grasp unreliable. Objects sometimes slip unexpectedly from the patient’s grasp. The weakness results from reflex motor inhibition and characteristically occurs without atrophy of the affected muscle. Patients are prone to intuitively substitute muscles without realizing that, for instance, they are carrying the grocery bag in the nondominant but now stronger arm.
    • The motor effects of TrPs on the muscle in which they are located are considered in detail under Surface electromyography in Other Tests.
  • Sleep disturbances
    • Disturbance of sleep can be a problem for patients with a painful TrP syndrome. Authors of a series of studies have shown that many sensory disturbances, including pain, can seriously disturb the patient’s sleep.
    • This sleep disturbance can, in turn, increase pain sensitivity the next day. Active MTrPs become more painful when the muscle is held in the shortened position for long periods and if body weight compresses the TrP. Thus, for patients with active TrPs, sleep positioning can be critical to prevent unnecessary disturbances of their sleep.

Physical

Each muscle has a characteristic elicited referred pain pattern that, for active MTrPs, is familiar to the patient. Without a laboratory test or imaging method, diagnosis of MTrPs depends entirely on history and physical examination. MTrP symptoms follow muscle overload, are activated acutely by sudden overload, or develop gradually with prolonged contractions or repetitive activity. The diagnostic skill required depends on considerable innate palpation ability, authoritative training, and extensive clinical experience.

Pain prevents a muscle with a MTrP from reaching its full stretch range of motion and also restricts its strength and/or endurance. Clinically, the lip is a localized spot of tenderness in a nodule within a palpable taut band of muscle fibers. Restricted stretch range of motion and a palpable increase in muscle tenseness (ie, decreased compliance) are more severe in more active MTrPs.

Active MTrPs are identified when patients recognize the pain induced by applying pressure to a MTrP. The taut band fibers usually respond with an MTrP when the taut band is accessible and when the TrP is stimulated by properly applied snapping palpation. The taut band fibers have a consistent twitch response when a needle penetrates the MTrP.

  • Taut band
    • By gently rubbing across the direction of the muscle fibers in a superficial muscle, the examiner can feel a nodule at the MTrP and ropelike indurations that extends from this nodule to the attachment of the taut muscle fibers at each end of the muscle.
    • The taut band can be snapped or rolled under the finger in accessible muscles. With effective inactivation of the TrP, this palpable sign becomes less tense and often (but not always) disappears, sometimes immediately. See Image 2.
  • Tender nodule
    • Palpation along the taut band reveals a nodule exhibiting a highly localized and exquisitely tender spot that is characteristic of an MTrP. When the spot is tested for tenderness, displacement of the algometer by 2 cm produces a statistically significant decrement in pain threshold algometer readings. Clinically, displacement of the application of pressure by 1-2 mm at an MTrP can result in a markedly reduced pain response.
    • This strong localization of tenderness in the vicinity of an MTrP corresponds to the localized sensitivity of the experimental muscle for eliciting TrPs as demonstrated in rabbit experiments. A 5-mm displacement to either side of the trigger spot (at right angles to the taut band) results in almost total loss of response. However, the response fades out more slowly when stimulated over a range of several centimeters from the trigger spot along the taut band.
  • Recognition: Application of digital pressure on either an active or latent MTrP can elicit a referred pain pattern characteristic of that muscle. However, if the patient recognizes the elicited sensation as a familiar experience, this establishes the MTrP as being active and is one of the most important diagnostic criteria available when the palpable findings also are present. Similar recognition is observed frequently when a needle penetrates the MTrP and encounters an active locus.
  • Referred sensory signs: In addition to referring pain to the reference zone, MTrPs may refer other sensory changes such as tenderness and dysesthesias.
  • Local twitch response: Snapping palpation of the TrP frequently evokes a transient twitch response of the taut band fibers. Twitch responses can be elicited both from active and latent TrPs. Hubbard at al showed that no difference was noted in twitch responses whether elicited by snapping palpation or by needle penetration. See Image 3.
  • Limited range of motion
    • Muscles with active MTrPs have a restricted passive (stretch) range of motion because of pain. An attempt to passively stretch the muscle beyond this limit produces increasingly severe pain because the involved muscle fibers are already under substantially increased tension at rest length.
    • The limitation of stretch due to pain is not as great with active movement as with passive lengthening of the muscle; this finding at least partly due to reciprocal inhibition. When the TrP is inactivated and the taut band is released, range of motion returns to normal.
    • The degree of limitation produced by MTrPs is much more marked in some muscles (eg, subscapularis) than in other muscles (eg, latissimus dorsi).
  • Painful contraction: When a muscle with an active TrP is strongly contracted against fixed resistance, the patient feels pain. This effect is most marked when the patient attempts to contract the muscle when it is in a shortened position.
  • Weakness
    • Although weakness is generally characteristic of a muscle with active myofascial MTrPs, the magnitude is varied from muscle to muscle and from subject to subject.
    • EMG studies indicate that, in muscles with active MTrPs, the muscle starts out fatigued, it fatigues more rapidly, and it becomes exhausted sooner than normal muscles. The weakness may reflect reflex inhibition of the muscle by the MTrPs.

Causes

Causes of myofascial pain include or are related to the following:

  • The lack of motor unit action potentials due to the endogenous contracture of the contractile elements, rather than a nerve-initiated contraction of the muscle fibers
  • The frequency with which muscle overload activates TrPs, which may reflect the marked mechanical vulnerability of the synaptic cleft region of an endplate
  • The release of substances that could sensitize nociceptors in the region of the dysfunctional endplate of the TrP as a result of tissue distress caused by the energy crisis
  • The effectiveness of essentially any technique that elongates the TrP portion of the muscle to its full stretch length even briefly, which could break the cycle that includes energy-consuming contractile activity
  • Laborers who exercise their muscles heavily every day are less likely to develop active TrPs than sedentary workers who are prone to intermittent episodes of vigorous physical activity. This author’s clinical experience supports this observation.

Author: Auri Bruno-Petrina, MD, PhD, Clinical Trainee, Pemberton Marine Medical Clinic, N Vancouver

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Modify Breast Cancer Risk

breastcancerdeseaseWomen Age 30+ Modify Breast Cancer Risk With Exercise

Women over age 30 who regularly exercise decrease their chances of breast cancer, according to a study presented today at the American College of Sports Medicine’s 56th Annual Meeting in Seattle.

The comprehensive study narrowed in on specific age ranges, surveying 4,296 women about their physical activity practices during four key stages of life: 10 to 15 years old; 15 to 30 years old; 30 to 50 years old; and 50 years old and above.

Although incidence of breast cancer did not appear to change in relation to exercise levels between 10 and 30 years of age, women above 30 significantly decreased their chances of contracting the disease if they were more active.

“Regular exercise appears to have protective effects for this age group of women,” said the study’s lead researcher, Lisa Sprod. “Meeting physical activity recommendations can act like a prescription for prevention when it comes to breast cancer.”

Breast cancer is the most prevalent type of cancer in women.

The study supports data that links exercise to risk of breast cancer, particularly as it relates to the consistency of activity through a woman’s lifespan. This research consistently connects the benefits of exercise for women to a favorable effect on hormone levels, body weight, weight gain with age, and immune function.

ACSM guidelines support the 2008 Physical Activity Guidelines for Americans, which recommend that adults participate in at least 150 minutes of moderate-intensity physical activity, which can be achieved in 30-minute segments five days a week. ACSM provides tools for getting started with a physical activity program, including assessments to determine pre-exercise health level and potential barriers to fitness, at http://www.acsm.org/physicalactivity.

Source
American College of Sports Medicine

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Budgeted Exercise

Finding cheap exercise equipment

Exercise may be tough to fit into a busy day, but outfitting your home gym is easier than you think. Your home gym can be as lavish (mega-machines and expensive cardio equipment) or as simple (a good pair of athletic shoes) as you like and, for the budget-minded, it doesn’t have to cost a thing.

When I first started working out, I didn’t have much of a budget. I was in college and what little money I had went towards food (Ramen noodles) and drink (beer, of course). What I didn’t know was that I could’ve made my own set of weights without spending an extra dime. The nice thing about weight training is that anything with weight will work–a dumbbell, a full water bottle or a sock full of sand…your body doesn’t know the difference.

There are plenty of things you probably have in your house right now that could serve as weights–you just need to be a little creative to get started:

Making Your Own Weights

Whether you’re outfitting a home gym or traveling, there are a variety of things you can use as dumbbells such as:

Full Soup Cans. These are great for lighter weights. Some larger cans weigh up to a pound (or more) and could be used for upper body exercises.
Full Water Bottles. A large water bottle (say around 33.8 fluid ounces) can give you a little more than 2 pounds when full of water. Fill it with sand, rocks or change and you get even more weight.
Computer Bags or Small duffel bags. My husband carries around a small computer bag so stuffed with crap, it weighs about 10 pounds. Because computer bags usually have handles, these can be great for exercises like bicep curls, lateral raises or one-armed rows. Small duffel bags with handles can be filled with books and used for lower body exercises like squats, lunges and deadlifts.
Milk or Orange Juice Jugs. Save your old milk jugs and fill them with sand, change or water for weights with ready-made handles
PVC Pipes. I had one client who filled PVC pipes with sand, capping them off with duct tape to avoid spillage. This is a great idea since PVC pipes come in all shapes and sizes, many of which fit perfectly in your hand.
Tennis balls and cans. Shawn Keith, certified personal trainer, recommends filling tennis balls and tennis cans with sand or change for some great handheld weights.
Most of these materials can be found around your house or at your local hardware store. If you’re not into making weights yourself, there are some other alternatives for finding cheap equipment.

Cheap Exercise Equipment

If you don’t mind a little bargain-hunting, you can find cheap exercise equipment in a variety of places such as:

  • Garage Sales . I almost always see exercise gear at garage sales and some of it’s even worth buying. Pick up the newspaper to find weekend garage sales in your area–I guarantee you’ll find something .
  • Play it Again Sports . This store buys and sells used (and new) exercise equipment. If you have one in your area, it’s worth checking out especially for their dumbbell selection, which is usually pretty good.
  • Walmart . Nobody out-cheaps Walmart, especially when it comes to exercise equipment. While I wouldn’t buy a treamdill there, they have a great selection of hex weights that are reasonably priced. They also carry resistance bands–another cheap alternative to buying weights.
  • Classified Ads . Americans love to buy things…especially exercise equipment. They also love to sell things…especially exercise equipment they never used. Check your newspaper for cheap gear–you can often find some great deals.

What Not to Skimp On

While it’s a fine idea to bargain-hunt, there are a few crucial items you shouldn’t skimp on. Learn from my mistakes and make sure you spend good money on:

  • Portable CD players or MP3 players . If you’re using your walkman for exercise, you’ll want something sturdy and waterproof. My preference for CD players is the Sony Sport CD Player . Make sure you get decent headphones too.
  • Heart Rate Monitors . I bought a HRM from Target for about $20. Guess where it is now? In the trash, my friends. I’m not saying they’re completely useless but cheaper versions can be bulky, uncomfortable and not terribly accurate. Stick with companies known for quality HRMs like Polar .
  • Treadmills, Elliptical Trainers or other cardio equipment . This is definitely one area where you get what you pay for.
  • Athletic shoes . Your shoes may be the most important piece of equipment you own–if you don’t have supportive shoes that fit right and match your sport, you could have problems with injury or discomfort. Think quality–if your feet don’t work right, nothing else will either.

Creating a home gym with little or no money is easy if you’re on a budget. Anything with weight can be used for strength training exercises, so don’t be afraid to get creative and break the rules a little!

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