Keep People Moving
REHAB
Encourage Modification Instead of Halting Activity
Ed Le Cara
I had a medical procedure performed on my lower leg due to venous insufficiency that was causing extreme pain while running. Not being able to run had affected my fitness routine, so I decided to have the elective surgery to remove some veins. After the vascular surgeon completed the procedure, he said I couldn’t exercise for two weeks. I was floored. I asked if the concern was about too much pressure
on the venous system, which would disrupt the ligation. He said, “No, I just don’t want the sutures to pull out.” I then asked if, as long as I don’t pull the sutures out, could I do other forms of activity? While shaking his head in disgust, he said fine, but that he thought I was crazy for being so into my fitness routine. I told him that I am not crazy—just trying to stay healthy.
As a society, we are physically moving less and less, and as a result, we are getting sicker and sicker. With the advent of the desk job, smartphone, TV, and computer, we’re sitting down more than ever. It is estimated that Americans sit 9.3 hours a day, which is even more time than we spend sleeping (7.7 hours). Our bodies weren’t built for so much inactivity, and it is taking a toll on our longevity. Sitting six or more hours per day makes you up to 40% more likely to die within 15 years than someone who sits less than three hours. Even if you exercise for one hour a day, your mortality risk is still higher if you sit for long periods in the day. Some experts are predicting the next generation will have shorter lives than their parents due to poor diet and lack of activity.
Few people would argue that people need more exercise in their lives. It has been well documented that exercise training promotes good body composition3’4 and improves the cardiovascular3’5 and metabolic systems.3’4’6’7’8 Many of these beneficial effects occur after an acute bout of exercise or after a very short-term training period. For example, Arciero9 demonstrated that body weight and fat mass decrease and insulin action significantly increases with as little as 10 days of exercise training in obese men and women.10 In addition, a single acute bout of endurance exercise significantly increases insulin sensitivity in healthy young men and women.11
Just as my surgeon did with me, the medical recommendation around injuries includes rest—too much rest. The abrupt cessation of physical training abolishes any previous muscle strength gains in both older7’12’13 and younger individuals.7’14 In addition, Arciero3 and Vukovich15 have previously shown that six to 10 days of inactivity are associated with reduced glucose tolerance, insulin action, and GFUT-4 transporter levels. Others have reported reductions in total aerobic capacity,16’17 deltoid muscle respiratory capacity, and muscle glycogen content, compared with levels during peak season training.6 Still, others have reported significant increases in body weight (4.8 kg) and body fat (BF ; 4.3 kg) after two months of detraining.18
Are you prescribing rest when your patients have an injury, or are you telling them what they can do? I think it comes down to the provider’s mentality. I choose to modify rather than halt activity when I need to do so. There ai e many aspects of what contributes to fitness, so there are many options to give patients when they have an injury.
How Do You Define Fitness?
Fitness means different things for different people. The professional athlete looks at what it means to “be fit” differently than the weekend warrior or the mother of three does. There is no “right” answer for the definition of fitness, but having an
idea of what being “fit” encompasses helps develop a program of what types of activities people should do, at what frequency, and at what intensity, even while recovering from injury.
To me, the definition of fitness is “the ability to perform the tasks or activities one wants to perform at their discretion.” Notice that this definition of fitness has nothing to do with body composition or becoming an elite athlete. For a small percentage of folks, becoming an elite athlete may be part of their fitness journey, but for most of us, it’s about improving how we live our lives. As such, the fitness journey never truly ends as every one of us can strive to consistently improve our fitness levels to support our daily activities, habits, and hobbies. The unique consequence of constantly striving for improved fitness is that we usually become healthier by having decreased body fat, increased lean mass, improved cardiovascular fitness, and increased work capacity.
If an injury prevents us from working on one component of fitness, we can modify and work on others temporarily until the injury heals. In my case, I can’t run or do any high-intensity activity for my lower extremity for two weeks, but I can work on my upper body strength, contralateral leg strength, flexibility, and cardiovascular fitness on a rower. I can at least maintain my fitness levels while recovering versus just taking two weeks off as prescribed and losing strength and cardiovascular fitness as previously described.
What Components Make Up Fitness?
There are 10 general physical skills widely recognized by exercise physiologists, according to The CrossFit Journal. These are cardiovascular/respiratory endurance, stamina, strength, flexibility, power, coordination, agility, balance, and accuracy. You are as fit as you are competent in each of these ten skills. A good fitness routine develops fitness to the extent that it improves each of these ten skills.
1. Cardiovascular/respiratory endurance - The ability of body systems to gather, process, and deliver oxygen.
2. Stamina - The ability of body systems to process, deliver, store, and utilize energy.
3. Strength - The ability of a muscular unit, or combination of muscular units, to apply force.
4. Flexibility - The ability to maximize the range of motion at a given joint.
5. Power - The ability of a muscular unit, or combination of muscular units, to apply maximum force in minimum time.
6. Speed - The ability to minimize the time cycle of a repeated movement.
7. Coordination - The ability to combine several distinct
movement patterns into a singular distinct movement.
8. Agility - The ability to minimize transition time from one movement pattern to another.
9. Balance - The ability to control the placement of the body’s center of gravity in relation to its base of support.
10. Accuracy - The ability to control movement in a given direction or at a given intensity.
The most important aspect of this definition for someone who is injured is that while one component is restricted during recovery, other components aie not restricted and can be worked on. Personally, I am going to take these next two weeks and focus on areas that I know are deficient. In particular, my lower body flexibility, core, and shoulder mobility need some attention. By the time I can return to high intensity training, my overall fitness should be better by being more flexible and mobile. In addition, if I fall out of my fitness routine, then returning can be very difficult. Humans ai e creatures of habit.
Companies such as RockTape manufacture products to help providers keep their patients active. Products such as foam rollers, gym bands, and resistance bands are useful tools to prescribe for home activities to keep patients active during their recovery.
The next time you have a patient that you want to put on total rest, think about the 10 components of fitness and encourage healthy and safe activity that the patient can do to stay active. Being active is a habit we all must maintain to live a healthy and happy life.
References:
1. Walton A. Efficacy of myofascial release techniques in the treatment ofprimary Raynaud ’s phenomenon. JBodyw Mov Ther. 2008 Jul;12(3).274-80.
2. MiernikM, WieckiewiczM, Paradowska A, Wieckiewicz W. Massage therapy in myofascial TMD pain management. Adv Clin Exp Med. 2012 Sep-Oct;21 (5):681 -5.
3. Arciero, PJ, Gentile, CL, Martin-Pressman, R, Ormsbee, MJ, Everett, M, Zwicky, L, and Steele, CA. Increased dietary protein and combined high-intensity aerobic and resistance exercise improves body fat distribution and cardiovascular risk factors. Int J Sport Nutr Exerc Metab 16: 373-392, 2006.
4. Arciero, PJ, Gentile, CL, Pressman, R, Everett, M, Ormsbee, MJ, Martin, J, Santamore, J, Gorman, L, Fehling, PC, Vukovich, MD, and Nindl, BC. Moderate protein intake improves total and regional body composition and insulin sensitivity in overweight adults. Metabolism 57: 757-765, 2008.
5. Volaklis, KA, Douda, HT, Kokkinos, PF, and Tokmakidis, SP. Physiological alterations to detraining following prolonged combined strength and aerobic training in cardiac patients. Eur J Cardiovasc Prev Rehabil 13: 375-380, 2006.
6. Costill, DL, Fink, WJ, Hargreaves, M, King, DS, Thomas, R, and Fielding, R. Metabolic characteristics of skeletal muscle during detraining from competitive swimming. Les caractéristiques métaboliques du muscle squelettique lors du desentrainement de la natation de compétition. Med Sei Sports Exerc 17: 339-343, 1985.
7. Giada, F, Vigna, GB, Vitale, E, Baldo-Enzi, G, Bertaglia, M, Crecca, R, andFellin, R. Effect of age on the response of blood lipids, body composition, and aerobic power to physical conditioning and de conditioning. Metabolism 44: 161-165, 1995.
8. Ormsbee, MJ, Thyfault, JP, Johnson, EA, Kraus, RM, Myung, DC, andHickner, RC. Fat metabolism and acute resistance exercise in trained men. JAppl Physiol 102:1767-1772, 2007.
9. Arciero, PJ, Smith, DL, and Calles-Escandon, J. Effects of short-term inactivity on glucose tolerance, energy expenditure, and bloodflow in trained subjects. J Appl Physiol 84: 1365-1373, 1998.
10. Arciero, PJ, Vukovich, MD, Holloszy, JO, Racette, SB, and Kohrt, WM. Comparison of short-term diet and exercise on insulin action in individuals with abnormal glucose tolerance. J Appl Physiol 86: 1930-1935, 1999.
11. Brestoff JR, Clippinger, B, Spinella, T, von Duvillard, SP, Nindl, BC, and Arciero, PJ. An acute bout of endurance exercise but not sprint interval exercise enhances insulin sensitivity. Appl Physiol Nutr Metab 34: 25-32, 2009.
12. Fatouros, IG, Kambas, A, Katrabasas, I, Nikolaidis, K, Chatzinikolaou, A, Leontsini, D, and Taxildaris, K. Strength training and detraining effects on muscular strength, anaerobic power,
and mobility of inactive older men are intensity dependent. BrJ Sports Med39: 776-780, 2005.
13. Harris, C, DeBeliso, M, Adams, KJ, Irmischer, BS, and Gibson, TAS. Detraining in the older adult: Effects of prior training intensity on strength retention. J Strength CondRes 21: 813-818, 2007.
14. Izquierdo, M, Ibañez, J, González-Badillo, JJ, Ratamess, NA, Kraemer, WJ, Häkkinen, K, Bonnabau, H, Granados, C, French, DN, and Gorostiaga, EM. Detraining and tapering effects on hormonal responses and strength performance. J Strength Cond Res 21: 768-775, 2007.
15. Vukovich, MD, Arciero, PJ, Kohrt, WM, Racette, SB, Hansen, PA, and Holloszy, JO. Changes in insulin action and GLUT-4 with 6 days of inactivity in endurance runners. J Appl Physiol 80: 240-244, 1996.
16. Coyle, EF, Martin, WH, Sinacore, DR, Joyner, MJ, Hagberg, JM, and Holloszy, JO. Time course of loss of adaptations after stopping prolonged intense endurance exercise. J Appl Physiol 57: 1857-1864, 1984.
17. García-Pallarés, J, Sánchez-Medina, L, Pérez, CE, IzquierdoGabarren, M, and Izquierdo, M. Physiological effects of tapering and detraining in world-class kayakers. Med Sei Sports Exerc 42: 1209-1214, 2010.
18. Aimeras, N, Lemieux, S, Bouchard, C, and Tremblay, A. Fat gain in female swimmers. Physiol Behav 61: 811-817, 1997.
Dr. Ed Le Cara is a chiropractor who also holds a PhD ■ NS hi athletic training. He is the co-owner and a clinician at KinetikChain, a rehabilitation and sports recovery clime in ^ Dallas, Texas. Ed is a Master Instructor for RockTape and
teaches internationally You can follow him on Twitter or Instagram ((cfdrlecara) for healthand wellness-related information, or reach him by e-mail at edafinetikchain.com
