Posted on Wednesday, August 12, 2015

Q & A: Do I Need an MRI for Low Back Pain?

Q. I have been dealing with low back pain on and off for the past several months. The pain is severe. I cannot participate in my normal exercise activities. In fact, I struggle just getting in or out of my car. My doctor says my X-ray results are fine, but do I need an MRI? -Brad

A. Thanks, Brad, for the question! I am often asked if an MRI is necessary when someone is experiencing low back pain (LBP). You state that your X-ray results are fine, so that immediately rules out the possibility of certain types of injuries such as a fracture or more chronic conditions like spinal stenosis. Fortunately, most LBP is mechanical–meaning it is from a physical or structural cause and isn’t related to conditions such as fractures, cancer or infections.

The answer to your question is no. An MRI is not needed in a majority of cases of LBP. It is best to diagnosis the cause and the best treatment strategy through a thorough physical assessment because most LBP is mechanical. There is definitely a time and place for an MRI. There are very clear indications when additional follow up such an MRI is necessary. Your physician will take a thorough history and determine if it’s necessary based on your history and examination. (To learn more about the different types of imaging, including an X-ray, CT Scan, and MRI, please refer to Q & A: Which Type of Imaging to Use?)

To safely self-treat your low back pain, first take a moment to assess your symptoms and pain level. What led to your pain and/or injury? Did the pain come on suddenly or slowly? Evaluate the severity of the injury. If you’re experiencing any of the following, please seek immediate medical attention:

Loss of bowel/bladder function.
Uncontrollable pain. The pain is so severe you cannot function or move.
You are losing muscle function or control. The muscles in the legs will no longer work. (This is different than pain preventing the muscle from working.) This sensation of paralysis occurs when the muscles will not actually function.
Significant loss of sensation in the leg or groin area. This is not a tingling sensation, but an actual loss of sensation. For example, you cannot feel the toilet paper when you wipe after using the toilet.
Numbness, pins and needles or severe pain in the toes or lower leg.
Any history of cancer or tumor. The pain did not have a specific and correlated mechanism for injury.
Onset of pain without any known mechanism for the injury. (Thoroughly consider your activity. Many times, a slow onset of pain begins several hours after performing an activity.)
A high fever or any other symptoms in relation to your low back pain or you generally start to not feel well.

Most LBP will have a directional preference for extension. A majority of injuries occur when performing a forward biased (flexed movement) like chronic slouching or a spinal flexion biased movement. I will discuss an extension biased program because it is by far the most common directional preference. Flexion biased programs are often found in older adults particularly in cases of spinal stenosis.

In the case of mechanical LBP, you should be able to alter and change your LBP within a short period of time. First, establish a directional preference by identifying a pattern to the pain. Does the pain get worse when you bend over or does it improve? What happens when you repeat this movement? Determine how your pain responds. If it spreads away from the spine and down into the leg, beware that you are moving in the wrong direction. Stop that particular movement, and instead try moving in the opposite direction. If you were moving into flexion, try extension. If you had trialed extension biased movements, try flexion.

The rule of thumb for movement: If the pain worsens by spreading peripherally down the buttock and into the leg and/or foot, then the condition is worsening. We must stop that activity. If the pain centralizes and returns back toward the spine (even if the pain worsens slightly), then keep moving as the condition is actually improving. For a thorough discussion and an excellent treatment resource, please refer to Treat Your Own Back by Robin A. McKenzie.

In my experience, most episodes of LBP tend to respond better to extension biased movements. If flexion or extension doesn’t help or change the pain in any way, then you may need assistance from a medical provider. I highly suggest seeking a qualified and competent physical therapist who works with clients suffering from LBP. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it may be a good idea to seek your physician’s opinion as well).

Thanks again for the question, Brad, and good luck with resolving your pain! For more self-treatment strategies for low back pain, including specific exercises and recommendations, please refer to the following posts: How to Safely Treat Low Back Pain, 12 Sure Fire Ways to Injure Your Back, and My Top 7 Tips to Prevent Low Back Pain While Traveling.

Don’t let LBP affect your ability to stay active and keep enjoying your favorite activities! Learn how to prevent, self-treat, and manage LBP so you can get back to your daily life and exercise goals more quickly without additional unnecessary and costly medical bills!

AVAILABLE NOW ON AMAZON!

In my book, Treating Low Back Pain during Exercise and Athletics, you will learn how to address specific causes of LBP as well as the best practices on how to prevent and self-treat when you experience an episode of LBP. In this step-by-step LBP rehabilitation guide (complete with photos and detailed exercise descriptions), you will discover how to implement prevention and rehabilitation strategies to eliminate pain and get back to training and exercise sooner.

BUY NOW

Posted on Wednesday, June 24, 2015

Q & A: 10 Tips to Prevent Dementia

Q. My mother had dementia, and I have heard that it can run in families. Is there anything I can do to prevent dementia? – Judy

A. Thank you, Judy, for the question. Dementia is a very popular topic lately, especially as cases of dementia continue to rise at a startling rate. One aspect of the Physical Therapy Advisor web site is to provide “how to” advice on successful aging as well as how to manage your health and well-being. Preventing dementia is definitely a critical component in successful aging and a healthy lifestyle.

Let’s first define exactly what dementia is, and then we will address the symptoms and risk factors. Dementia is not actually a specific disease. It’s a term used to describe a group of symptoms affecting a person’s memory or ability to perform activities of daily living (ADLs). There are six basic ADLs: eating, bathing, dressing, toileting, transferring (walking), and continence.

At least two brain functions, such as memory loss and impaired judgement, need to be affected for a person to be diagnosed with dementia. A person may experience memory loss along with difficulty of performing ADL tasks, such as how to cook or drive. Loss of memory only would not necessarily mean that a person has dementia. Although there are many potential causes of dementia, Alzheimer’s disease is the most common form of dementia. Other possible causes include:

Vascular dementia
Lewy Bodies dementia
Frontotemporal dementia
Parkinson’s dementia
Huntington’s dementia
Hydrocephalous
Dementia like symptoms caused by nutrient deficiencies or reactions to medications

Dementia is a serious health problem facing many industrialized nations including the United States. Actual numbers of people diagnosed with dementia vary between 2 and 5 million people. Even more troubling is that 5-8% of people over the age of 65 have some form of dementia and that number doubles every 5 years after the age 65.

Symptoms of Dementia may include the following:

Memory loss
Difficulty communicating
Difficulty with complex tasks, such as driving or math
Difficulty with motor programming or coordination
Easily disoriented or getting lost easily
Personality changes
Difficulty with logic or reason
Loss of safety awareness or judgement
Paranoia
Agitation
Hallucinations

Dementia like symptoms should be evaluated by a medical physician and should be openly discussed with all parties involved. Many forms of dementia are progressive. Early diagnosis allows for proper planning and time to make crucial decisions. Depending on the type of dementia, there may be medical options to slow down the progression. In addition, some causes of dementia like symptoms are reversible if caught early. Your physician can assist you in determining your specific diagnosis and prognosis.

Risk Factors for Dementia:

Age – Dementia can occur at any age, but the risk significantly increases after the age of 65. Dementia is not considered a normal aging process.

Family History – Genetics play a role. A family history of dementia and certain specific genetic mutations increase your risk.

Down syndrome – Down syndrome increases your risk of developing dementia.

Alcohol Abuse – Heavy drinking and alcohol abuse increases your risk. Mild to moderate alcohol consumption may help to prevent dementia (particularly when consumed in the form of red wine).

Microvascular diseases such as diabetes or atherosclerosis, which is the fatty build up in the arteries. Any disease process that has an inflammatory effect on the small blood vessels of the body increases your risk.

High Blood Pressure

Depression

Hearing Loss

Obesity

Smoking

Now that we have identified exactly what dementia is and many of the risk factors that increase your risk for developing dementia, let’s address Judy’s question regarding prevention.

10 Tips to Prevent Dementia:

Eliminate known risk factors. This includes eliminating smoking and avoiding heavy alcohol consumption.
Stay social. To experience purpose in your life, it’s key to maintain your social outlets and friendships. It also helps to decrease your risk of developing depression, which is a risk factor for dementia. Be active in your community by interacting with family, friends, church, civic organizations or volunteer projects.
Maintain sharp mental health. Regardless of age, it’s important to remain engaged and mentally sharp through constant and varied mental stimulation. Read, play engaging games, and avoid excessive TV watching.
Get hearing aids. Poor hearing is associated with an increased risk of dementia. When a person loses his/her hearing, he/she tends to disengage with the environment. He/she becomes less social, more depressed, and no longer participates in stimulating activities. Stay engaged by quickly addressing hearing loss.
Exercise. Walk daily or take a yoga or Tai Chi class. Participate in a strength training and high intensity training (HIT) program. Exercise can help you to maintain a suitable weight by insuring your metabolism stays elevated and your hormone levels remain balanced. It also insures good blood flow to the smaller vessels in the brain and helps to regulate insulin levels, which prevents diabetes (a risk factor for dementia).
Do not eat anything that comes in a package. Most of our food should be from low sugar fruits and vegetables as well as protein and healthy fats (primarily from plant sources such as avocados and coconut or olive oil). Any animal fat should be from organic and grass fed animals. Your brain and body tissue need nutrients to be able to perform at a high level. Avoid processed food as much as possible. Limit sugary food and add more protein and healthy fat in your diet. Maintaining a diet with adequate healthy fats is essential in providing the nutrients to support all hormone function in the body as well as support the brain and nervous system. Adequate protein intake is necessary to support muscle health and development.
Stay hydrated. The human body is primarily made of water, which is critical for all body functions. Dehydrated tissues are prone to injury as they struggle to gain needed nutrients to heal and repair. Dehydrated tissues are less flexible and tend to accumulate waste products. Water intake supports proper brain, muscle, and hormone function as well as lubrication of the joints and skin appearance. Stay hydrated by drinking water. Try to avoid beverages that contain artificial sweeteners or chemicals with names that you can’t spell or pronounce.
Manage your weight. Obesity places additional strain on your cardiovascular system and increases your risk of diabetes—thus increasing your risk of stroke, heart disease, and dementia. When attempting to lose weight, aim for 1-2 pounds per week.
Sleep more. While sleeping, your brain clears out metabolic waste, known as neurofibrillary tangles, which are associated with dementia. Your body must rest in order to grow and develop. Most people are not getting adequate sleep and rest. Sleep is critical to maintaining your growth hormone and testosterone production as well as stabilizing your metabolism.
Supplements. There is some evidence that certain vitamins, minerals, and/or herbal supplements may help to reduce your risk of dementia. Folic acid, vitamin B12, vitamin D, magnesium, and fish oil are believed to preserve and improve brain health. Although results are less conclusive, vitamin E, ginkgo biloba, coenzyme Q10, and turmeric may also be beneficial in the prevention of or delay the onset of dementia like symptoms. Please consult with your healthcare practitioner to determine if these supplements are ideal for you.

Dementia is quickly becoming a major public health crisis. The risk for developing dementia rapidly increases as baby boomers (and others in the western world) age. Although the exact cause of the spike in dementia cases is unknown, it’s pertinent that we live a healthy lifestyle and avoid known risk factors. To learn more about how to age successfully, please refer to My Top 10 Anti-Aging Tips. For inspiration regarding the aging process, I also recommend reading Ken Dychtwald’s Age Power: How the 21st Century Will Be Ruled by the New Old. Thank you, Judy, for this question!

Do you have a loved one or friend who is experiencing dementia? Which tip will you implement in order to prevent dementia? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please comment below or submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Disclaimer: The Physical Therapy Advisor blog is for general informational purposes only and does not constitute the practice of medicine or other professional health care services, including the giving of medical advice. No health care provider/patient relationship is formed. The use of information on this blog or materials linked from this blog is at your own risk. The content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Do not disregard, or delay in obtaining, medical advice for any medical condition you may have. Please seek the assistance of your health care professionals for any such conditions.

Posted on Wednesday, June 3, 2015

Q & A: My Top 10 Supplement Recommendations

Q. Ben, you often recommend different supplements as part of treatment recommendations as well as for sports performance or recovery. Which supplements do you actually use? -Seth

A. Thanks, Seth, for this excellent question! Opinions on the best supplements to use vary widely and can be quite controversial. Your dietary belief system and what type of exercise or activity you mainly participate in will determine which supplements may work best for you.

I tend to use certain supplements, such as protein, coconut oil, magnesium and super greens, on a regular basis. I take Creatine more intermittently as part of a cycling protocol. I use other supplements intermittently for a specific purpose such as fueling for a long run or improved recovery. I have tried many different types of supplements. I have personally experienced the most benefits from consuming these specific supplements.

My Top 10 Supplement Recommendations:

1. Protein. I prefer to supplement with a plant-based protein source because I regularly consume animal-based protein. Lifetime Life’s Basics Plant Protein is an organic vegan option that contains a blend of proteins which makes a complete amino acid profile. I prefer the vanilla, but it’s available in chocolate as well. It doesn’t have any other preservatives, chemicals or sweeteners. If you are used to mass produced supplements, your taste buds will have to adjust.

I also supplement with a goat-based protein source. Goat protein is a smaller particle size and may be more easily digested and utilized by the body. Mt. Capra Double Bonded Goat Milk Protein is an organic goat-based protein. Mt. Capra offers multiple flavor options. I prefer the chocolate, which is only flavored with organic cocoa powder. It doesn’t have any preservatives, chemicals or sweeteners. Again, if you are used to mass produced supplements, your taste buds will have to adjust.

If you’re interested in a whey supplement, Thorne Research Whey Protein Isolate doesn’t contain artificial flavors, colors, sweeteners, carrageenan or gluten. It is sourced from cows not treated with hormones. For more information on protein supplementation, please refer to How Much Protein Do I Really Need?

2. Amino Acids. Branch chain amino acids (BCAA) are the building blocks to protein. Runners and endurance athletes should pay particular attention to protein intake as maintaining muscle mass is critical for performance and injury prevention. Consuming amino acids before and during endurance events is an excellent method to keep your blood sugar stable and to maintain a high level of performance. It is also muscle sparing. You are more likely to metabolize energy from fats or carbohydrates stores (rather than muscle) when there are plenty of BCAA particles floating around in your digestive system and blood stream. I often combine supplementing BCAA with a carbohydrate fuel source such as Generation UCAN SuperStarch. If you prefer a ready-made product, I recommend Hammer Nutrition Perpetuem Ultra Endurance Fuel, which includes a carbohydrate source, protein, and fat source, and Hammer Nutrition Hammer Gel, which contains some amino acids.

3. Creatine. Creatine monohydrate is helpful for increasing skeletal muscle size, strength, and power production. It may also have a preventative effect for dementia and neurodegenerative diseases. I recommend 5 g per day. I typically consume it in 6-8 week cycles.

4. CapraFlex. My most recommended supplement to help recover from injury is CapraFlex by Mt. Capra. It combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently. I use it to help recover from acute injury. I also use it as a preventative measure when in periods of high volume or high intensity training (HIT). For instance, I consume it during the final month of preparation for a race or an event.

5. Generation UCAN SuperStarch. Generation UCAN produces my favorite synthetic carbohydrate source. Generation UCAN SuperStarch is a gluten-free complex carbohydrate that is non-GMO. It has been specially formulated to stabilize blood sugar and not cause an insulin reaction. I typically utilize this product for any prolonged activity which exceeds 1.5 hours. Although it can be consumed throughout a race or prolonged activity, I typically consume a serving along with BCAA at the beginning of my activity. If additional fuel is needed during a longer run which exceeds 2 hours, then I typically utilize Hammer Nutrition Perpetuem Ultra Endurance Fuel and Hammer Nutrition Hammer Gel.

6. Magnesium. I use magnesium as a sleep and recovery aid. I consume it at night to help me sleep. This has been a major benefit for me as it significantly reduces muscle soreness, cramps and/or spasms. You can take Mag Glycinate in pill form or by eating foods higher in magnesium such as spinach, artichokes, and dates. Most people are deficient in the amount of magnesium they consume on a regular basis. I recommend beginning with a dose of 200 mg (before bedtime) and increasing the dose in 100 mg intervals as needed. I would caution you that taking too much magnesium can lead to diarrhea. Mag Glycinate in its oral form is the most highly absorbable. Although not as absorbable, Thorne Research Magnesium Citrate and magnesium oxide can also be beneficial.

7. Cinnamon. Cinnamon is a spice that has cholesterol lowering benefits and antifungal properties. It can reduce the proliferation of leukemia and lymphoma cancer cells. It has an anti-clotting effect on the blood which can reduce your risk of stroke or heart attack. Cinnamon may help treat Type 2 Diabetes by lowering blood sugar levels and increasing the amount of insulin production in the body.

The primary reason why I consume cinnamon is to stabilize blood sugar. Although I love the taste of cinnamon, you cannot eat enough to gain the noted health benefits. It must be consumed in a supplement form. I take about 1 g of cinnamon prior to consuming a high carbohydrate meal (particularly if I have not recently exercised). My blood sugar remains more stable, and I feel better between meals.

8. Caffeine. Many supplements contain caffeine. If you avoid caffeine, then you should continue to do so. Caffeine has many health and fitness benefits when used appropriately. Caffeine has been proven to increase cognitive performance. It may also help to mobilize fat stores, which aids your body’s ability to use fat as a primary fuel source. Better fat utilization can help to stabilize blood sugar and increase your energy levels. This may allow you to participate in longer bouts of exercise or push yourself harder during your high intensity training (HIT) workouts.

One way in which caffeine improves performance is by sparing glycogen. Glycogen is your body’s preferred fuel source (particularly during the first 15 minutes of exercise). The sparing of glycogen can help you to transition from primarily carbohydrate utilization to fat utilization. Caffeine peaks in absorption approximately 45 to 60 minutes after ingestion, but it likely has a much longer effect on fat utilization.

Caffeine has also been shown to lower submaximal heart rate. When considering a long distance event, this can be very beneficial in how long you can sustain your pace (meaning that you can push yourself harder for longer). Unfortunately, it has not yet been proven to lower maximal heart rate during maximal exercise such as HIT. This means its best indication for use is likely during submaximal activity such as distance running. The approximate amount needed for ergogenic benefits is 3 mg of caffeine per kilogram of body weight or 3 mg for every 2.2 pounds of body weight.

If you weigh 150 lbs., divide that by 2.2 lbs. which equals approximately 68 lbs. Next, multiple 68 lbs. by 3 mg for your needed caffeine dose. In this example, 204 mg of caffeine is needed for a person who weighs 150 lbs.

I recommend ingesting caffeine at least 15 minutes prior to your run and approximately every 45 minutes (depending how long you will be running). I would not over consume caffeine as potential side effects include: poor sleep quality; gastrointestinal distress; headaches; muscle cramping; and dehydration. Caffeine is a mild diuretic and can cause anxiety. If you are already taking a diuretic, please consult with your physician about using caffeine as an ergogenic or cognitive aid.

9. Super Greens. Most people do not consume enough greens. Green super foods, such as spirolina and wheat grass, are packed high in antioxidants. They can have a cleansing and an alkalizing effect. Super greens boost your immune system and are generally good for you. Super greens should be consumed daily, but it’s particularly important to supplement with during times of high stress (including high training stress). Amazing Grass Green SuperFood is easily consumed in a powder form and typically tastes best when mixed in with food. I usually mix it into hot oatmeal or a smoothie. You can also utilize a pill form. Energy Bits is spirolina in a pill form. I have utilized Energy Bits as part of a fueling plan for longer runs and activities with great success. I found them to have a blood sugar stabilizing effect while keeping my energy levels high. I also combined Energy Bits with Generation UCAN SuperStarch which seems to work particularly well.

10. Coconut Oil. I typically purchase Kirkland Organic Coconut Oil at Costco. Nature’s Way Coconut Oil is another option. I typically mix a protein supplement into my black coffee along with a teaspoon of organic coconut oil, which is full of medium chain triglycerides (MCTs). Coconut oil does not negatively affect cholesterol levels. It has no added flavor. It helps to stabilize my blood sugar and keeps me satiated for hours.

Coconut oil offers many health benefits including:

Helps to stabilize blood sugar
Helps metabolize energy stores more efficiently
May have protective effects on brain related disorders
Reduces the risk of illness and infections
Helps to control hunger cravings
Reduces the risk of seizures and heart disease
Moisturizes skin
Helps children’s brains develop by providing the correct nutritional building blocks for the nervous system

When choosing supplements, I tend to gravitate to supplements that can enhance performance, improve recovery, stabilize blood sugar or reduce inflammation. The ultimate goal with supplements is to aid your body in improving health and/or performance. Try to choose the most natural products as possible and experiment to see what works best for you. For a glimpse into my medicine cabinet (and other recommended products that I personally use), please visit my Resource Guide. Thanks, Seth, for your question!

What is your favorite supplement and why? Please leave your comments below.

If you have a question that you would like featured in an upcoming blog post, please submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!

Posted on Wednesday, May 20, 2015

Q & A: Is Weight Training Safe for Children?

Q. My son is 11 years old and wants to start lifting weights with me. Is it safe for him to do this at such a young age? -Matt

A. Great question, Matt! I believe weight training and activity in general should be encouraged in whatever form the child prefers. Research regarding the effects of heavy weight training or high intensity training in younger children continues to evolve. The long standing belief that weight lifting will stunt a child’s growth has never been proven. In fact, current research indicates that weight lifting may actual help to increase a child’s growth rate. This may be due to hormonal improvements or actual physical stress (in response to the training) on the child’s body. Most likely, the positive effect on growth rate is due to a combination of both factors.

When addressing weight training, keep in mind that children’s physical, mental, and emotional development will vary widely and is not necessarily correlated to their chronological age. Most children will have varying degrees of muscle strength and asymmetry in that strength as they grow and develop. Encouraging activity and exercise is a critical component to how the child will ultimately develop. When choosing which type of activity and exercise is appropriate for a child, his/her physical, mental, and emotional development need to be considered.

Physiological considerations include:

Growth Plates. The epiphyseal plate (growth plate), which is a cartilaginous plate at each end of a long bone, in children typically closes between 18-25 years old. It is most active when the child is younger. There is no evidence that weight lifting will negatively affect the growth plates. The question that research has failed to answer is: How much stress and strain is too much? A child’s boney structure is not the same as that of an adult. Lifting excessively heavy loads with poor technique could cause damage to these growth plates. In order to insure your child’s safety and limit the risk of injury, his/her weight lifting schedule or program should not be the same as that of an adult.
Muscle Strength. Adolescent muscle development will vary widely. It’s highly dependent on proper hormonal balance. Most children don’t have the proper hormonal balance to develop muscle like an adult. Therefore, a child should not be trained as an adult.

Weight training can be appropriate at a young age. Focus on learning the techniques while developing proper motor patterns and motor control (particularly, if he/she is performing advanced activities such as Olympic weight lifting). Children’s growth and development tends to occur in spurts. They often have evolving issues with muscle tightness and asymmetric muscle development. A weight lifting program that stresses proper movement patterns and full range of motion (ROM) is an excellent method to help insure proper muscle development. Weight lifting is just one of many training activities for a child. I highly encourage children to participate in many different activities in order to develop a wide physiological and neurological baseline.

Consider the following when designing a training program for your child:

Keep it fun! This is your child’s time to learn and have fun. There is no need to push heavy weights on his/her young body. However, it’s perfectly acceptable to progress strength gains when he/she is able.
Develop proper motor programs. Focus on optimizing patterns and mobility. A weight lifting program that stresses proper movement patterns and full range of motion (ROM) is an excellent method to help insure proper muscle development.
Encourage variety. For other strength development and motor program development options, encourage body weight exercises such as the TRX system. A CrossFit class, designed specifically for kids, may also be fun option.
Proper programming. A child should not be trained as an adult. The exercise programming should be tailored to your child. I recommend an emphasis on technique and a slower progression of resistance and load compared to that of an adult. For young children, double the time it takes for an adult to progress the load. Physical ability will widely vary in the teenage years. Focus on form and technique while developing proper movement patterns. Encourage participation in many different activities in order to develop a wide physiological and neurological baseline. Training volume should be less than an adult.

If your child is experiencing pain or you suspect a developing problem, consult your pediatric physician or a qualified physical therapist about your concerns. I would also caution you that many pediatric physicians may not be too keen on the idea of weight training in pre-teen children. Seek a physician who is open to the idea and can work with you and your child to insure optimal health.

As parents, we want to encourage activity and exercise while instilling a life time love of exercise in all of its many forms. When weight training at a young age, focus on proper ROM and symmetrical strength development. Thanks, Matt, for the question!

Does your child lift weights and/or participate in sports such as CrossFit? Why or why not? Please share your thoughts below.

Posted on Wednesday, May 6, 2015

Q & A: Should Children Run Long Distances?

Q. My son is 14 years old. He wants to run a marathon this summer. He has participated in many races ranging from 5k to 5 miles in the past. Is long distance running safe for children? -Mark

A. Thanks, Mark, for this great question! The topic of children running extreme distances from marathons to ultra-marathons is still debatable (as is strength training in younger children). In general, the science and research supporting adolescent runners is inconclusive and continues to evolve. Children’s physical, mental, and emotional development varies widely and isn’t necessarily correlated to chronological age. When choosing which type of activity and exercise is appropriate for a child, his/her physical, mental, and emotional development need to be considered.

I believe that children are capable of running longer distances even at an early age although most will not want to. The real question is: Should they? Running and activity should be encouraged in whatever form the child prefers. There has been very little research on the effects of long distance mileage on younger children. Physiological considerations include:

Growth Plates. The epiphyseal plate (growth plate), which is a cartilaginous plate at each end of a long bone, in children typically closes between 18-25 years old. It is most active when the child is younger. Excessive stress (either in the form of overload such as weight lifting very heavy loads with poor technique or repetitive loading such as running long distances) could cause damage to these growth plates, which affects the child’s ability to properly grow.
Muscle Strength. A child’s muscle development is not the same as that of an adult. This means that the repetitive strain of long distance running (particularly on hard surfaces) could again increase the risk of repetitive motion injuries. A child’s musculature may not be mature enough to handle the repetitive load.
Energy Metabolism. Children typically have a very high metabolism. They require more carbohydrates than adults as well as additional fat consumption to insure adequate cholesterol to promote normal brain development. A child’s ability to store carbohydrates is less than that of an adult due to a smaller body mass size. Issues with fueling during longer runs could have more consequences for younger runners.

A child’s ability to tolerate longer distances will widely vary based on his/her physical, mental, and emotional development. If a younger child desires to run a long distance race, then he/she will require supervision. A healthy eating plan that is high in fat and protein is critical. A proper fueling plan for carbohydrate intake will insure that the child acquires additional nutrients for the activity and for normal growth and development.

Typically, younger kids and teens will not be as proficient of runners compared to most adults because children’s lungs and VO2 max don’t peak until the 20s. However, they can run surprisingly fast! A younger child’s body is more adept at handling shorter distance intervals or bursts of running than longer distances.

Consider the following when determining if long distance running is appropriate for your child:

Assess your child’s physical, mental, and emotional development. Could he/she handle long distance running in these three crucial areas?
What kind of surface will the majority of the running take place on? I highly advise grass, trail or dirt path versus concrete and sidewalks. Definitely avoid long runs on hard surfaces. Keep to softer surfaces, such as dirt or grass, when possible. This decreases the strain on a child’s growth plates and body in general.
What is the anticipated training volume? How many actual miles of running? I would advise a lower mileage program.
A proper fueling and rehydrating plan must be addressed. This needs to be closely monitored by a parent (and not only by the child involved).
Consider tackling a shorter distance such as the half marathon. Increase the mileage as the child ages and matures.

A new runner (of any age) should spend more time initially working on an adequate running base and proper running form. Encourage your child to develop good habits and proper technique now, so that running can be a lifelong pursuit.

I’m a supporter of children who participate in cross country programs at school. It provides an opportunity to run 3-5 mile distances regularly on softer surfaces while developing a wonderful base (and comradery as well). I also highly encourage children to participate in a school track program. Run different distances, such as the 800 or 1200 meter distance, in order to develop proper running form and technique. It also helps to develop the child’s ability to run faster, not just longer.

Encourage your child to be active and participate in various activities. If he/she desires to engage in long distance running, progress slowly and closely monitor for any symptoms of pain or injury. If you suspect a developing problem, consult your pediatric physician about your concerns. I would also caution you that many pediatric physicians may not be too keen on the idea of long distance running in pre-teen children. Seek a physician who is open to the idea and can work with you and your child to insure optimal health.

Pre-teens and teens are best suited for shorter distance running, but with proper training they could safely run longer distances (ranging from the 10k to the half marathon). Most children’s physical, mental, and emotional development is not suitable for running distances such as the marathon and especially, ultra-marathons. I typically don’t recommend those distances until at least mid to late teens. If attempted, special care should be taken to avoid over taxing their young bodies.

Thanks, Mark, for the question. I wish you and your son all the best in his future running endeavors!

Do you have a child or know of one who has participated in long distance racing? Please share your thoughts below.

Posted on Wednesday, April 8, 2015

Q & A: How to Increase Hip Strength and Improve Mobility

Q. Hi. I have been noticing that even with my current strength training I’m pretty weak in my hip area. I’d like to work on strengthening this area, so I don’t have problems when I’m older. Can you recommend a few exercises that I can add to my routine? Thanks, I love your posts and utilize the information as often as I can. -Amy

A. Thanks, Amy, for this fantastic question! It’s wonderful that you are aware of this particular weakness and you’re being proactive now versus experiencing potential issues later. Maintaining adequate hip and pelvic strength is important for many reasons. The hip muscles control or influence most of the lower leg mechanics, including the hip, knee, and foot. They also play a role in lumbar stability and mobility. Both hip strength and mobility is vital to insure proper lower extremity movement.

Weakness and/or poor mobility in the hips can lead to potential problems including:

Hip pain
Knee pain
Lumbar pain
Abnormal gait patterns
Increased fall risk
Early development of osteoarthritis in the hips and knees
Iliotibial band syndrome
Hip bursitis
Shin splints
Plantar fasciitis

Many other conditions and pain can also be attributed to poor hip strength and mobility. This is by no means an all-inclusive list. I have written specific blog posts regarding many of these conditions. In each case, one of my recommended tips is to improve both hip strength and mobility. Many of the hip muscles are located deep in the pelvis and buttock area. They are not necessary large, but they are critical. These hip muscles can also be responsible for pain, particularly when spasming. Piriformis Syndrome occurs when the piriformis muscle (a deep hip rotator muscle) spasms. The spasm can cause buttock pain. Due to its proximity to the sciatic nerve, it can also cause radiating pain down into the leg known as sciatica.

How to Increase Hip Strength and Improve Mobility:

Squat. The squat activates nearly all of the muscles in the lower leg. It is particularly effective at activating the muscles in the legs referred to as the posterior chain, which includes the hamstrings, the glutes (or buttock muscles), and the hip adductors (or the groin muscles). It also activates muscles in the hips, the calves, the stabilizing muscles in the ankles, the quadriceps, as well as the core (the abdominals and lumbar extensor muscles). These muscles are critical for all functional mobility related movements, including walking; getting up from a chair or a toilet; or picking up someone or something. For more information on squatting, please refer to 7 Reasons Why the Squat is Fundamental to Life.
Target the hip muscles. Many of the muscles of the hip require specific exercises to insure that the correct muscle is activated. Please refer to Hip Strengthening Exercises for detailed descriptions and photos of my recommended exercises.

Improve your mobility. Tightness and restrictions in the hip and pelvic musculature are often associated with pain in the legs and low back. Please refer to Hip Stretches and Mobilizations for detailed descriptions and photos of specific stretches for the hip and pelvis and how to self-mobilize by using a foam roller and lacrosse ball. Tightness and restrictions increase your risk of injury due to improper mobility. For example, tightness in the hip internal rotator muscles causes the hip and lower leg to roll in, which is associated with Patellar Femoral Pain Syndrome (also known as runner’s knee). For more information on this condition, please refer to How to Self-Treat Patellar Femoral Pain Syndrome.
Self-mobilize. Using a foam roller is an excellent method to decrease pain and improve mobility throughout the hip and pelvis. For more information on how to use a foam roller, please refer to Foam Rolling for Rehabilitation.
Walk more frequently. Walking is a critical component to healthy aging. Walking on various surfaces and terrain is an excellent way to improve your health, fitness, and hip strength. To discover other benefits walking, please refer to Why You Should Walk, Not Run.

Maintaining adequate hip and pelvis mobility and strength is an important strategy in avoiding many lower extremity orthopaedic conditions. Being aware of a particular area of weakness and being proactive now could save you from experiencing pain in the future. Thanks, Amy, for your question!

Which strategy will you use to increase your hip strength and improve mobility? It could be as simple as using the foam roller or walking. Most importantly, just get started! Please leave your comments below.

Looking for that exercise or book I mentioned in a post? Forgot the name of a product or supplement that you’re interested in? It’s all listed in the Resource Guide. Check it out today!

Posted on Wednesday, March 4, 2015

Q & A: Why Am I Dizzy Upon Standing?

Q. Almost every time I stand up, I feel dizzy. It seems to be worse if I am lying down before standing up. Should I be concerned? –Jill

A. Great question, Jill! We have all likely experienced the sensation of dizziness upon standing at one time or another. You are likely experiencing a sensation known as orthostatic hypotension (also known as postural hypotension). Orthostatic hypotension (OH) is defined by a drop in blood pressure that is greater than 20 mm of mercury during contraction of the heart muscles (systole, the top blood pressure number) and more than 10 mm of mercury during the expansion of the heart muscles (diastole, the bottom blood pressure number).

Suddenly standing up can cause blood to pool in the blood vessels of the body and legs. For a short period of time, a decreased supply of blood is carried back to the heart to be pumped to the brain. This results in a sudden drop in blood pressure which causes a feeling of dizziness.

Unless you’re experiencing severe symptoms or losing consciousness (blacking out), OH is typically not a concern and can happen to anyone. In my clinical experience, I have treated highly active adults and athletes as well as the elderly for OH. The concern is greater for the elderly as it may be a sign of additional cardiac related illness such as congestive heart failure (CHF). OH can increase the risk of falling which is already an issue for many elder adults.

The following conditions may increase the likelihood of developing OH:

A low blood volume from dehydration can cause OH, fatigue, and weakness. Be sure to adequately re-hydrate after activity. Soda and other processed drinks do not optimally hydrate your body. Water is best. Other options include coconut water, caffeine-free tea, and consuming fruits and vegetables.
Postprandial hypotension is a sudden drop in blood pressure after eating. The body shunts blood to the stomach and digestive system to aid in the digestion and transport of nutrients out of the gut. This can lead to low blood volume in other parts of the body and could cause OH. Eating small, low-carbohydrate meals may help to reduce symptoms.
When I am in a high volume cardiovascular training cycle, I tend to experience low blood pressure. Average blood pressure (BP) should be around 110/70 mm mercury. My blood pressure will be close to 100/60 mm mercury when I struggle with OH. To eliminate this problem, I increase my salt intake. Sherpa Pink Gourmet Himalayan Salt is my preferred type of salt to use. The extra sodium retains more fluid in my system which keeps my blood pressure up while providing important trace vitamins and minerals.
Bradycardia (slow heart rate) can increase your risk of OH. A slow heart rate is generally considered a healthy side effect of being cardiovascularly fit. A heart rate less than 60 beats per minute (bpm) is considered low. This is a common finding in well trained athletes as they range between 40-60 bpm. Other more serious heart conditions, such as heart valve related issues and CHF, can be associated with bradycardia. OH is also common post cardiac surgery or heart attack. If your heart rate is low or you’re experiencing cardiac issues, please consult with your physician.
Diabetes, thyroid dysfunction, and adrenal insufficiency as well as other hormone (endocrine) related issues can cause OH.
Many illnesses affecting the nervous system (spinal paralysis, Parkinson’s disease, and some forms of dementia) can cause OH related symptoms.
Many medications have side effects that can result in OH symptoms. If you develop symptoms of OH, address your medications with your medical physician or pharmacist.

Treatment options for OH include:

Compression. Lower extremity compression serves to help prevent blood from pooling in the lower extremities and can aid the venous return system. With compression, the heart doesn’t work as hard to pump blood to and from your toes. You can utilize a common ACE wrap, but I highly recommend that you purchase a mild over the counter compression sock (at least thigh high) such as Jobst Relief Therapeutic Thigh High Stockings. Do not apply any compression too tightly that it causes numbness or tingling in the legs, feet, or toes. In cases of spinal paralysis, an abdominal corset (binder) may be necessary to maintain a normal blood pressure.
Stand up slowly. If you’re suffering from OH, take your time when you first sit up after lying down or after you first stand up. Moving slowly will decrease your risk of injury (should you fall) while feeling dizzy.
Perform a cardiac warm up to get the blood in your legs moving prior to standing and performing an activity or exercise. Begin with tapping your toe 15 times on each foot. Then perform a seated knee extension by moving your leg straight out 15 times on each leg. Next, remain sitting, but march in place 15 times on each leg. Once you have completed this routine, stand up slowly (if you don’t feel dizzy) and proceed with your activity. Be sure to pause briefly to insure that you’re not experiencing dizziness as a delayed response of a few seconds is typical.

In most cases, OH is a common and benign condition. It can affect anyone for many different reasons. In most cases, dizziness can be easily treated with hydration and possibly a small increase in salt intake. Elder adults should take care if they are experiencing dizziness. Seek medical advice to determine if dizziness is a symptom of a more serious condition. If the condition worsens or you lose consciousness, please consult with your medical physician as OH is just one of many forms of dizziness.

Thank you, Jill, for your question. I hope these treatment options for OH will not only help you to determine the cause of your dizziness, but that they also decrease the frequency of your symptoms. For additional information on dizziness, please refer to Q & A: Vertigo – Causes & Treatment and Q & A: How Do I Improve Balance? (Part I).

Have you ever experienced OH symptoms? Which treatments for dizziness are the most effective for you? Please share any recommendations that you may have by leaving your comments below.

Posted on Wednesday, February 18, 2015

Q & A: How to Self-Treat a Baker’s Cyst

Q. My knee started hurting about two weeks ago. I have noticed swelling in the back of my knee. It’s painful when I bend or straighten the knee. I looked up the symptoms on WebMD. I think I might have a Baker’s cyst, but I’m not sure what to do now. Your insight would be appreciated, thanks! –Patti

A. Great question, Patti! The symptoms you are describing sound like they may be caused by a Baker’s cyst. Another common diagnosis with similar symptoms would be a meniscus injury. I recommend that you read my previous post on meniscus pain, Q & A: 7 Tips to Get Rid of Knee Pain. Much of the advice will carry over to either condition.

A Baker’s cyst, also known as a popliteal cyst, is a fluid-filled sack that forms in the back of the knee. Synovial fluid from inside of the knee pushes out into a fluid-filled sack in the back of the knee. Sizes of the cysts can wildly vary as do the symptoms. The cyst can typically best be seen when a person is standing. It may or may not be tender to the touch. In fact, you may or may not have any symptoms at all.

Baker’s cyst symptoms include:

Stiffness or tightness in the back of the knee, thigh, or upper calf.
Swelling noted behind the knee. If the cyst ruptures, then the swelling may be also be in the lower leg and calf area.
Pain is most typically described behind the knee, particularly with full flexion (bending) or extension (straightening). A person may also experience pain in the upper calf or back of the thigh.
Another common complaint is pain when sitting due to the chair touching or rubbing the area behind the knee (known as the popliteal space).

It is not always entirely known why a Baker’s cyst will develop. In my clinical experience, I have seen them form for the following reasons:

Rheumatoid arthritis (RA)
Osteoarthritis (OA)
Recent knee injury or post knee surgery
Poor lower leg biomechanics, which can lead to other forms of knee pain in addition to a Baker’s cyst.

Baker’s cysts should be diagnosed by a medical doctor. Medical treatment of the cysts usually involves a course of anti-inflammatory medication (orally), a cortisone injection, aspiration of the fluid by utilizing a needle, and/or surgical removal. The good news is that often a Baker’s cyst will typically resolve on its own if you just give it time. Rest and treat any symptoms you may be experiencing.

Physical therapy may also be indicated, particularly if the cyst formed due to osteoarthritis pain, recent knee injury/trauma/surgery, or due to poor lower extremity biomechanics. In most cases, I have witnessed Baker’s cysts successfully and conservatively treated by both a physical therapist and a medical physician who are working together to address the issue.

The rehabilitation for a Baker’s cyst is very similar process to treating meniscus pain. The following 10 tips will help you to rehabilitate your knee. You should experience improvement of your symptoms within in a few of weeks or less when initiating this program. Depending on the severity, it could take longer for a full recovery. If your pain continues or worsens, then additional assessment and follow up is likely needed.

10 Tips on How to Self-Treat a Baker’s Cyst:

1. Rest. Initially, take extra time to rest the painful area. The pain and swelling has likely worsened due to a change in activity level. If the pain is more severe, you may choose to use a cane or a crutch initially to take weight off of the knee.

2. Ice. Apply ice to the knee and behind the knee in particular. The rule of thumb is to ice no more than 20 minutes per hour. Do not place the ice directly against the skin especially if you are using a gel pack style Cold Pack. Individuals with poor circulation or impaired sensation should take particular care when icing. A bag of frozen peas can be ideal in this situation.

3. Compression. Compression helps to prevent and decrease swelling. Swelling can cause increased pain and slow the healing response. Limit it as much as possible. You could utilize a common ACE bandage wrap or you could purchase a pair of mild over-the-counter compression socks. If you utilize a compression sock, it will need to be at least thigh high like these Jobst Relief Therapeutic Thigh High Stockings. Do not use a knee high version–you may make the swelling and pain worse. Do not apply any compression too tightly as it could cause numbness or tingling in the leg, foot, or toes.

4. Taping Techniques. Kinesiological style taping has been proven to be effective in reducing inflammation. Due to the location of the swelling, you will need help from someone trained in the specific style of kinesiological taping. Many physical therapists (PTs), athletic trainers (ATCs), or chiropractors have training in these techniques. Learn How to apply Kinesiology Tape for a swollen (edema) Knee Joint by watching this YouTube video that demonstrates the proper technique. (However, the taping would be on the back side of the knee, not on the front as shown.) I have had luck using the KT TAPE, RockTape Kinesiology Tape, and Mummy Tape brands. The technique is fairly basic, so your spouse or a friend may be able to apply it for you.

5. If it hurts, don’t do it! Modify the activity or discontinue it completely. If your knee is hurting when performing a squat, then initially don’t move as deep into the exercise. This would also be true for a lunge position or step up. Modify any exercise as you need to, and don’t compromise technique to complete an exercise. Poor technique will only increase your risk of injury elsewhere or make the knee more painful and irritated.

6. Warm up prior to exercise. I recommend that you increase your normal warm up time by at least 10 minutes in order to increase blood flow to the area. This allows for better mobility and also promotes healing as movement is necessary to bring in the nutrients. Use a stationary bike or the rower machine initially to get the muscles warm and the knee joint more lubricated.

7. Improve your Range of Motion (ROM). The goal of the rehabilitation program is to regain full pain free ROM. This can be accomplished many ways. Perform heel slides by lying on your back and sliding your heel toward your buttocks. Riding the stationary bicycle can be helpful, too. Remember, the major goal is to regain full pain free ROM. If you experience muscle tightness and soreness, I recommend using a foam roller to assist with any myofascial symptoms. To learn how to use a foam roller, please refer to Foam Rolling for Rehabilitation. Do not use the foam roller directly behind the knee.

8. Work on strengthening. The primary goal of a strengthening program is to work on quadriceps and glut medius (hip abduction) strengthening. These areas are commonly weak which can lead to poor knee biomechanics and cause pain and instability. Weight lifting is an appropriate choice, but you may have to initially limit your range of motion (ROM). Most of my clients begin on a non-weight bearing program, then progress to partial weight bearing, and eventually, full weight bearing. The more severe the symptoms, the longer it will take for an individual to progress to more difficult exercises.

To initiate a physical therapy program, please refer to Baker’s Cyst Rehabilitation Exercises. This exercise guide is designed to address the muscles that I find to be the weakest in most individuals. The exercises are listed from easiest to most challenging and are designed to primarily improve quadriceps and hip strengthening. Start with exercises like a straight leg raise (possibly with an ankle weight) and bridging (either one or both legs). Wall squats holding for time also works well. A Thera-Band Exercise Band can be tied around the thighs above your knees to make your hips more engaged.

Weight training exercises (with machine weights or free weights) should be geared toward general leg strengthening and may include: squats; leg press; hip abduction machine; step ups; dead lifts; and straight leg dead lifts. If further instruction is needed, search YouTube to watch the proper technique for a specific exercise. If full ROM is causing an increase in your pain, then you need to stay within your pain free limit as you work on the ROM separately from weight training.

Initially, you will likely need to taper down your activities. The speed at which exercise is performed while in group exercise classes is typically too fast for an individual who is properly and safely exercising his/her knee during a rehabilitation and recovery phase. You can still participate in group exercise classes or CrossFit WODs (Work out of the Day), but your specific knee program should be separate from any group structured activity. You will need to modify some of the activities performed in your structured class to avoid further pain.

9. Cool down. After performing your exercises, take extra time to cool down and stretch. Use either a stationary bike (at a causal/slower pace) or the rower machine. Both are reduced weight bearing exercises that promote movement and circulation to the knee as well as increasing ROM.

10. Add a joint supplement. If you are experiencing osteoarthritis pain, you may want to consider adding a glucosamine and chondroitin supplement. CapraFlex is my preferred supplement for knee related injuries. I have recommended this supplement for years as my clients have had successful outcomes with use. It has also assisted me in recovery from my many injuries. Essentially, it combines an organic glucosamine and chondroitin supplement with other natural herbs which are designed to reduce inflammation. CapraFlex can be taken long term or intermittently to help heal from an injury. I recommend that you try it for 30 days to see if it improves your knee pain, but do not use it in combination with other traditional anti-inflammatory medications. If you are under the care of your physician, please inform him/her that you are taking this medication. (If you are taking blood thinners, please consult with your physician prior to use as the herbs could interact with some medications.)

In most cases, you should expect a complete resolution of your symptoms upon completion of the rehabilitation process. To prevent the condition from re-occurring, address any ROM or mobility restrictions as well as any weak areas that are causing altered lower leg biomechanics.

If your symptoms and pain continues or worsens after two to three weeks of rehabilitation, please seek additional assistance from your physician or a qualified physical therapist. The American Physical Therapy Association offers a wonderful resource to help find a physical therapist in your area. In most states, you can seek physical therapy advice without a medical doctor’s referral (although it would be a good idea to seek your physician’s opinion as well).

Thank you, Patti, for your question. I hope these 10 tips will help you to rehabilitate your knee and recover quickly!

Which treatments for knee pain are the most effective for you? Please share any recommendations that you may have by leaving your comments below.

Posted on Monday, January 5, 2015

My Top 5 Most Popular Posts of 2014!

For many of us, the healthcare system is too expensive or unapproachable as we try to improve our health and live life to its fullest. My desire is to provide you with useful information to achieve both objectives. Thank you for supporting The Physical Therapy Advisor website since its launch in April. I appreciate your questions and feedback, and I look forward to serving you in 2015!

My Top 5 Most Popular Posts of 2014:

My Top 7 Tips to Prevent Low Back Pain While Traveling – Low back pain is one of the most prevalent and pervasive problems in the western world. Whether you’re traveling or working in an office, review these 7 tips to prevent low back pain.
7 Reasons Why the Squat is Fundamental to Life – When was the last time you moved into a full squat? Why does it even matter? Find out 7 reasons why we should continue squatting as a lifelong pursuit.
How to Self-Treat Plantar Fasciitis – Plantar fasciitis is a very painful and potentially very debilitating condition. Don’t let foot pain stop you from reaching your goals in 2015! Learn how to self-treat plantar fasciitis and prevent it from slowing you down.
Q & A: How to Prevent My Mom From Falling Out of Bed – Falling is the number one cause for fracture in the elderly. Many times, a fracture will lead to a cascading decline in mobility and function. Finding methods to limit falling, without restraining or inhibiting important functional mobility, is critical. Discover tips to keep your loved ones safe.
5 Ways to Improve Range-Of-Motion (ROM) – As we age, we naturally lose elastin, an important component to our skin, muscles, and tendons. Elastin is responsible for the elasticity in the body’s tissues. Maintaining Range of Motion (ROM) is critical to maintaining our mobility and for injury prevention and sport performance. Poor ROM can also lead to pain and dysfunction as the body’s ability to move freely is impaired. Discover different methods to maintain your ROM and prevent injury.

2014 was a wonderful start for the blog. I look forward to empowering you to reach your optimal health in 2015! Don’t forget subscribe to my e-mail newsletter! I will send you weekly posts on how to maximize your health, self-treat those annoying orthopaedic injuries, and gracefully age. To thank you for subscribing, you will automatically gain access to my FREE resource, My Top 8 Stretches to Eliminate Neck, Upper Back, and Shoulder Pain.

Posted on Sunday, December 21, 2014

Q & A: How Much Protein Do I Really Need?

Q. Depending on my level of activity, how much protein should I be consuming in my diet? -Amy

A. Thanks, Amy, for this excellent question! Opinions on this controversial topic vary widely. Your dietary belief system and what type of exercise or activity you participate most in may determine your protein consumption. Most power lifters, body builders, CrossFitters, and Paleo diet followers partake in a very high protein diet. Vegans and many endurance athletes do not. The research is still mixed on whether a high protein diet can be helpful or harmful.

The answer may be more subtle and complicated than you think. It depends on how your body responds to protein in general. The type of protein you eat (and its bioavailability) is also a factor when considering health optimization. An important point may not be about protein at all. Instead, how many carbohydrates do you eat and from which sources?

Plant-based protein sources, such as hemp, pea, and quinoa, and animal-based protein should be included in your diet for two reasons. First, animal protein is a complete protein, a protein with a full amino acid profile. Amino acids are the building blocks for protein. Some amino acids can be manufactured in the body. Others cannot and must be obtained from dietary sources. This is why you must ingest a full amino acid profile either through an animal source or multiple plant-based sources. Finding the right combination of plant-based foods to obtain a complete amino acid profile can be tricky.

Second, certain types of important fats come with animal protein. Fats, such as Docosahexaenoic Acid (DHA) found in fish, can be synthesized via alpha-linolenic acid (ALA), which is plant-based, but the conversion rate is very poor. Animal protein sources should include fish, chicken (free range), beef (free range), turkey (free range), and any wild game. Why wild game and free range animals? They are relatively free from likely contamination, hormones, or other chemicals used in commercial processing, and their fat profiles are healthier. They also tend to be leaner protein, especially wild game. A good percentage of calories from protein should be 20% (although it may be higher based on your dietary beliefs). I recommend taking in a variety of protein sources that are both animal and plant-based.

Although there are different methods to calculate protein needs, the following is the most common. The standard minimum amount of daily protein needed is .37 grams per pound of body weight (or .8 grams per kilogram of body weight). This is the bare minimum. Research has shown between 1.2 and 1.8 grams of protein per kilogram of body weight (approximately .5-.8 grams per pound) is important to maximize health and for athletes. (Use 2.2 lbs. divided by your body weight to calculate kilograms). Other methods recommend even more protein, but I’m not convinced it is necessary.

Please see the following examples for the average male and female. Then enter your own weight to determine the recommended amount of protein per day.

Male, 180 lbs. 180 lbs. / 2.2 = approximately 82 kilograms. 82 kg. x 1.2 = 98 grams. 82 kg. x 1.8 = 148 grams. The range is from 98 to 148 grams of protein per day.
Female, 130 lbs. 130 lbs. / 2.2 = approximately 59 kilograms. 59 kg. x 1.2 = 71 grams. 59 kg. x 1.8 = 106 grams. The range is from 71 grams to 106 grams of protein per day.

Another method to calculate protein needs is based on lean body mass rather than total weight. You will need to know exactly how much body fat you have. This calculation is not practical for most people, and it’s typically an inaccurate body fat percentage number. The method asserts that fat tissue needs less protein to support it.

If you’re interested in reading more about this method, please refer to Enter The Zone: A Dietary Road map by Barry Sears and Protein Power: The High-Protein/Low Carbohydrate Way to Lose Weight, Feel Fit, and Boost Your Health-in Just Weeks! by Michael R. and Mary Dan Eades.

Precautions regarding protein:

Excessive protein intake may be hard on the liver and kidneys. If you have kidney or liver related issues or a predisposition, I recommend that speak with your physician prior to over consuming protein.
Many protein powder supplements contain artificial sweeteners, preservatives, and other chemicals. Choose the healthier options, and read the labels on the products.
Many protein powder supplements contain whey protein. Whey, a complete protein, has an excellent price point. However, many people may be intolerant to whey. While supplementing, keep track of how you feel to insure that you aren’t experiencing a negative reaction to the protein source.

My Top Protein Supplement Recommendations:

I prefer to supplement with a plant-based protein source because I regularly consume animal-based protein. I also supplement with a goat-based protein source. Goat protein is a smaller particle size and may be more easily digested and utilized by the body.

Mt. Capra Double Bonded Goat Milk Protein is an organic goat-based protein. Mt. Capra offers multiple flavor options. I prefer the chocolate, which is only flavored with organic cocoa powder. It doesn’t have any preservatives, chemicals, or sweeteners. If you are used to mass produced supplements, your taste buds will have to adjust.
Lifetime Life’s Basics Plant Protein is an organic vegan option that contains a blend of proteins which makes a complete amino acid profile. I prefer the vanilla, but it’s available in chocolate as well. It doesn’t have any other preservatives, chemicals, or sweeteners. Again, if you are used to mass produced supplements, your taste buds will have to adjust.
If you’re interested in a whey supplement, Thorne Research Whey Protein Isolate doesn’t contain artificial flavors, colors, sweeteners, carrageenan or gluten. It is sourced from cows not treated with hormones.

I am often asked how I prefer to consume protein supplements. I typically mix the protein supplement with black coffee and a teaspoon of organic coconut oil, which is full of medium chain triglycerides (MCTs). The coconut oil has no added flavor. It helps to stabilize my blood sugar and keeps me satiated for hours. I typically purchase Kirkland Organic Coconut Oil at Costco. Nature’s Way Coconut Oil is another option.

Obtaining the proper amount of protein from a quality source (via both food and supplements) as well as diversifying protein sources are important components to healthy eating and maximizing performance. To maximize your benefit and performance, you will likely spend time self-experimenting to determine how much protein you need to consume and from which sources.

Runners and endurance athletes should pay particular attention to protein intake as maintaining muscle mass is critical for performance and injury prevention. Consuming amino acids before and during endurance events is an excellent way to keep your blood sugar stable and to maintain a high level of performance. I recommend Hammer Nutrition Perpetuem Ultra Endurance Fuel, which includes a carbohydrate source, protein, and fat source, and Hammer Nutrition Hammer Gel, which contains some amino acids.

As we age, it’s important to continue to eat adequate amounts of protein. Sarcopenia is a condition in which muscle mass decreases with age. Strength training and consuming an adequate amount of protein is critical in avoiding sarcopenia and aging successfully. Red meat is a complete protein source. Consuming an adequate amount of red meat is an easy method to increase your iron consumption. Iron can help to reduce anemia, a common condition in women and the elderly population. Proper protein consumption is also critical to effectively manage diabetes.

For a conservative opinion on the subject of protein supplementation, watch the following video, How Much Protein Do You Really Need? by Yuri Elkaim. Elkaim is a nutritionist with an interesting history and has a wide range of experience working with athletes (particularly soccer players).

For a more aggressive opinion and information on the general physiology of protein use in the body, please refer to 7 Rules to Optimize Protein Intake by Barbell Medicine.

How much protein do you typically consume? What is your favorite protein supplement? Please leave your comments below.

Looking for that exercise or book I mentioned in a post? Forgot the name of a product or supplement that you’re interested in? It’s all listed in the new Resource Guide. Check it out today!

Thanks, Amy, for your question! If you have a question that you would like featured in an upcoming blog post, please submit your question to contact@thePhysicalTherapyAdvisor.com. Be sure to join our growing community on Facebook by liking The Physical Therapy Advisor!