In five days, the gun will go off for a truly spectacular race in the Shawangunk Mountains.  The Josh Feldt/After the Leaves Have Fallen 20k race is set on the beautiful carriage trails of Minnewaska State Park and takes its competitors around two serene glacial lakes and up to Castle Point which has some of the best views in the park.  Even though it has a later start time of 11am, it might still be on the chilly side with temps in the high 40s and current forecasts suggesting clouds and a slight chance of showers.  But don't let that deter you from participating in a great race put on by the Shawangunk Runners especially if you're looking for one more serious challenge for your racing season before winter comes.

Here is a brief preview of the course:

The first 2 miles offer modest ascents/descents as you run clockwise around Lake Minnewaska.  The next 3 miles mainly alternates between flat and gradual but steady climbs up to Lake Awosting.  After that you'll hang a right to circumnavigate Lake Awosting counterclockwise for about 3 miles.  The loop around the lake is mostly flat with a few rollers mixed in but the footing here is a little more challenging than the rest of the course since it is certainly a trail less traveled in the park.  Leaving the lake you begin your ascent to Castle Point which has some steeper sections.  After reaching Castle Point and taking in the views the rest of the course (roughly 3 miles) is almost all downhill.  There are a few rollers but you can make up some time here after all of the climbing done in the first 9 miles of the course.  The last hill is right before the finish line as you make your way back around Lake Minnewaska.  Overall a fairly challenging course but one of the most beautiful trail races in the area.

As you can probably gather, I will be there racing but I will also be setting up before the race to offer free knowledge, information and advice as well as fielding any questions you may have for me or about Momentum Physical Therapy of New Paltz.  Take advantage of this opportunity while you can!

For any last minute runners, there is still time to register online by going to the Shawangunk Runners website or by clicking this link to take you directly to the registration page.  By the way, this race is a bargain at only $15 so hurry up and join all the other runners for a great event this weekend.

Hope to see you there!

If you read Parts I, II, and III, this topic got into some heavy material which is important to be aware of but there is also some good news out there which was touched upon in each post.  That good news can really be summarized in one word: MOVE.  Something I find myself sharing with my clients is a very simple analogy I wish I could take credit for but Sir Isaac Newton beat me to it with his first law of motion: A body at rest stays at rest and a body in motion stays in motion.  Granted he was talking about physical objects but it is amazing how much this relates to the dynamic organisms human beings are and their overall health, well being and mobility.  And based on the current body of research, if you move more, you tend to live longer.  That is pretty darn good news!

Avoiding sitting for prolonged periods of time and/or adding movement into your daily routine can be accomplished in any number of ways.  You are truly only limited by your imagination.  It could be simple things like taking 1-2 minute walking breaks each hour at work, taking the stairs instead of the elevator/escalator, parking farther from your destination, etc.  Each of these ideas often seems trivial in isolation but it is amazing what happens cumulatively over weeks, months and years, and they can become normal routines you don't even have to actively think to do.  (Your car will probably have less dings in it too from car doors and grocery carts...you're welcome.)

The more challenging change is actually engaging in more sustained activities instead of sitting because that involves time and we all know time is precious.  However, if you take an honest look at your schedule you can probably find at least 30 minutes during the day to engage in some type of activity.  You may have to tweak your schedule and routines a bit at first but again, sticking with good habits becomes a new routine.  Instead of passively watching television, actively watch your favorite shows by incorporating some simple bodyweight exercises (pushups, squats, lunges, etc.), stretching or matwork style routines (Pilates), or if you really want to get your heart rate up, shadowboxing (one of my favorites).  Or better yet, trade an hour of television altogether for an activity you like to do.

The easiest thing you can do and a great starting point is highlighted in this short video which addresses a few different things but relates very well to this topic.

The moral of this story is not to cause a panic or to suggest strict rules to live by because that would be unnecessarily extreme.  Instead it is meant to be food for thought so that you can take advantage of this information and incorporate it into your life as you see fit.  You know your schedule, you know your life and how you want to live it.  Hopefully this information can help you optimize the ways in which you live your life so that you can be a happy, healthy and mobile person for a long time coming.

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In this latest installment, I will summarize a couple of studies that address sitting time and associated health risks.  You can catch up on Parts I & II if you missed those the first time around here and here.

At this point there is a growing body of literature studying different outcomes, disease progressions and chronic conditions as they relate to sitting and they all have the same conclusions.  Prolonged sitting essentially has a dose response outcome: the more sitting you do, the more likely you are to suffer from chronic health issues and a shortened life span.  In many studies, these results are independent of other factors like diet and activity level which is even more concerning.  Even if you get your 5 mile run in everyday but you sit for 8 hours, it turns out there is still an increased risk for chronic health issues.  That being said, things like diet, exercise and sleep have profoundly positive effects in other ways so be sure to keep those good habits in your life.

Wilmot et al performed an analysis and summary of 18 moderate to high quality studies in 2012 all related to sedentary lifestyle and risk of diabetes, cardiovascular disease, and cardiovascular and all-cause mortality. (1)  In order to avoid discrepancies in analysis because of differing methods in each study, they compared highest sedentary times to lowest.  It is possible that this could skew their results by using the extremes but even taking that into consideration their results are striking:
112% increased risk of type II diabetes
147% increased risk of cardiovascular disease
90% increased risk of death by cardiovascular disease
49% increased risk of all-cause mortality

In 2010, Alpa et al looked at leisure time spent sitting and all-cause mortality rate. (2)  They compared sitting more than 6 hours vs. sitting less than 3 hours during leisure time and did not include occupational sitting time over the course of 14 years for over 120,000 people participating in the study.  Independent of physical activity women who sat for more than 6 hours had a 40% higher death rate than those who sat for less than 3 hours and men had an almost 20% higher death rate.  When combining sitting time with low physical activity, those numbers jump to 94% and 48% respectively!  Now you can imagine what happens if you add sitting time at work to these leisure numbers.  Conversely, those that sat less than 3 hours for leisure and were physically active had lower death rates.

I could continue to highlight other studies like the amount of time watching television and cardiovascular disease or the risk of obesity and prolonged sitting but I think it is quite clear already what the overall conclusion is.  Whether someone has to sit for work or chooses to sit for many hours during his/her leisure time (or both), that alone is a risk factor for his/her health and well being.

By pure coincidence, I came across an infographic basically addressing the same issues.  It is a bit sensationalized but even so it sheds some light on this important issue.  You can check it out here.

Wishing you many more healthy years before Mr. Reaper knocks on your door!  Then again, you may have some knocking on your door with much more reasonable requests of tricks or treats in the near future!

References:

1. E. G. Wilmot, C. L. Edwardson, F. A. Achana, M. J. Davies, T. Gorely, L. J. Gray, K. Khunti, T. Yates, S. J. H. Biddle. Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia. November 2012, Volume 55, Issue 11, pp 2895-2905.

2. Alpa V. Patel, Leslie Bernstein, Anusila Deka, Heather Spencer Feigelson, Peter T. Campbell, Susan M. Gapstur, Graham A. Colditz, Michael J. Thun. Leisure Time Spent Sitting in Relation to Total Mortality in a Prospective Cohort of US Adults. American Journal of Epidemiology. Volume 172, Issue 4, pp. 419-429.

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In the second installment of my sitting series, I will touch upon metabolic issues but if you missed Part I, you can catch up and read that here.

It is not rocket science to understand that your metabolism is directly related to your energy expenditure.  The more active you are, the higher your metabolism is to meet your energy needs.  Therefore the opposite is also true: the less active you are, the lower your metabolism is to meet your energy needs.  In our modern society, we have traded active lives out of necessity for sedentary lives by way of convenience.  Many of these conveniences involve sitting.  You sit in your car to do your errands, you take in information and entertainment when you sit to watch television and so many of us sit at a desk with a computer now to work for 8-10 hours each day.  That adds up to a lot of sitting every day of our lives which makes for a relatively sedentary lifestyle.

To illustrate this, I will briefly highlight a study performed in 2011 by Swartz et al (1) that looked at energy expenditure in four 30 minute situations.  The first involved sitting for 30 minutes without a break as the baseline measurement.  The second, third and fourth bouts of sitting were interrupted by periods of walking for 1, 2 and 5 minutes, respectively.  It should come as no surprise that each person expended more energy when they interrupted their sitting time with a period of walking and as expected walking for 5 minutes expended the most.  To put this into perspective you would burn an extra 24 calories on average over the course of an 8 hour work day if you walked for 1 minute every hour.  Do it every half hour and that number would double.  For a week that would be 120 calories (or 240).  660 calories would be burned per week if you walked for 5 minutes every hour but this may not be as realistic as 1 or 2 minute walking breaks.  Extrapolate these numbers over a year and you get the picture.

The obvious implication of this small study is for weight maintenance, and for many people that means weight loss.  Granted this particular regimen may not be possible on the hour, every hour, every day for every person but it does shine light on incredibly simple lifestyle and work style changes that can add up to very beneficial results.  Now it should be noted that the exact numbers will be different for everyone but the idea remains the same.  Simple changes in position and activity will lead to a positive change in your metabolism.  Even alternating periods of sitting and standing at your desk will boost your metabolism rather than sitting the whole day.  The ultimate would be those fancy treadmill desks but most offices aren't really equipped for that just yet.

Beyond the direct impact sitting has on metabolic rate and calories burned (or not burned), prolonged periods of sitting have been linked to a long list of chronic diseases and conditions associated with metabolic changes detrimental to a person's health.  These include but are not limited to Type II Diabetes, Cardiovascular Disease, Metabolic Syndrome, Atherosclerosis, Obesity and Breast and Colon Cancers.  At best, you may be inconvenienced by not fitting into a pair of jeans or having to go to your physician more often for tests to keep track of any signs or symptoms.  At worst, your life becomes more challenging as you get sick more often, suffer major health setbacks like amputations and risk premature death from largely preventative health issues.

On that note, start a good habit by getting up wherever you're sitting to read this and walk around for a minute or two.  Next time I will discuss some of the long term health risks in more detail.

References:

1. Ann M Swartz, Leah Squires, Scott J Strath. Energy expenditure of interruptions to sedentary behavior. Int J Behav Nutr Phys Act. 2011; 8: 69.

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It took a little bit longer than anticipated but I am excited to finally announce the Grand Opening and Open House for Momentum Physical Therapy of New Paltz!

When: Saturday, October 5th from 12-3pm
Where: The group exercise room of Ignite Fitness
             246 Main St. (Cherry Hill Plaza)
             New Paltz, NY 12561
Why: Your chance to meet me, ask questions, and learn about Momentum Physical Therapy of New Paltz
          and how it can benefit you.  I will also have soft lacrosse balls to demonstrate soft tissue mobilization
          techniques that you can perform on your own if and when the time arises.  If that's not enough,
          there will be free food provided including some local and homemade treats.

Come visit, say hi  and bring your friends because knowing a good physical therapist will help you move better, feel better and live better.

Sitting.  It didn't take long before I remembered why I don't like sitting for prolonged periods of time.  It is only recently that I have spent more time parked on my posterior between marketing, blogging, (I am currently standing for this one), and reviewing new research along with many other administrative items as owner of my practice.  Prior to my leap as a business owner, I was on my feet and moving more during the day as a staff physical therapist in several different clinics.  Sitting was something to be cherished when I had the chance.

Now under normal circumstances when you are sitting for a while, that soreness sensation, generally in your lower back/sacroiliac region, is the brain and body's gentle way of telling you to MOVE!  ANYWHERE!  JUST MOVE!  It's quite an ingenious alarm system because it works really well....as long as you listen to it.  Unfortunately I failed to listen to that initial alarm system recently and that soreness turned into a more constant and very annoying pain to the point where any static position was uncomfortable.  It was even a bit challenging to fall asleep and my sleep is not something to be messed with.  However, the solution was still an easy one....all I had to do was start moving more.  Walking, running, (even a 10 mile trail race), and changing positions all felt great so it is no surprise that my constant pain has decreased almost back to its baseline of normal soreness if I sit for too long.

With this experience in mind, I wanted to share some issues related to sitting beginning with a basic understanding of the biomechanics involved and soft tissue considerations.  There are different classifications of sitting but for the purpose of this discussion, I will focus on the very technical version that we all succumb to at some point during the day with or without knowing it: the slumped sitting position. 

Before going any further, it is important to have a reference point, which would be standing in this case.  In stance, the spine is naturally curved when looking at it from the side.  More specifically, the lumbar spine, roughly the bottom third of the spine, has a lordotic curve which changes when we sit.  Using the L1 vertebrae to the top of the sacrum, Lord et al measured the average decrease in lumbar lordosis angle from standing to an upright sitting position, (90 degree angle at the hips and knees).  It was 49 degrees in stance and decreased to 34 degrees in sitting. (1)  When the body gets lazy, gives in to gravity and slumps, this change is even more dramatic further decreasing the lordosis and sometimes eliminating it altogether.  This by itself is not a cause for concern as it happens normally with many activities like putting your socks on or bending over to tie your shoes.

Something else also happens as a result of this position: stretching of posterior structures and tissues of the lumbosacral region.  These can include muscles, tendons, ligaments, fascia, etc.  In order to accommodate the decrease in lordosis, tissues must lengthen and stretch compared to their length in stance, which is a more neutral position for the spine and pelvis.  It should be noted that this by itself is also not a cause for concern because tissues are stretched all of the time throughout the body as we move during the day.  Time, on the other hand, is the enemy.  When tissues are stretched, they trigger mechanoreceptors which are responding to the mechanical deformation of being lengthened.  Initially the messages sent from the mechanoreceptors to the brain are not enough to trigger any type of soreness or pain response but the longer the time being stretched, slumped sitting in this case, the more frequent and "louder" those messages become.  If it is long enough without a change, the brain processes the increasing messages and begins to perceive this as a potentially "dangerous" or "threatening" situation, and the output is sensations of soreness first followed by pain.  This is the ingenious alarm system mentioned above as the expectation is that you will move so those tissues are not being stretched, (or not in "danger"), anymore allowing the mechanoreceptors, (and your brain), to chill out.  This can obviously be overridden, as I did for too long and over several days, since most of the time you know that you are not actually in any danger, just uncomfortable.  As I described above, any kind of movement, especially if you get on your feet for a bit to return the normal lordotic curve to your lumbar spine, usually relieves this type of soreness and discomfort.  Unfortunately, many of us are stuck sitting, often slumping, for prolonged periods of time for work or in that super soft sofa you love.  So do the easy thing: listen to that alarm system, get up and move a little bit.  Your body, (and brain), will thank you for it.

Stay tuned for Part II as I discuss some of the metabolic issues associated with prolonged sitting.


References:

1. MJ Lord, JM Small, JM Dinsay, RG. Watkins. Lumbar lordosis. Effects of sitting and standing. Spine, 22 (1997), pp. 2571–2574.

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Whether you've just completed the SOS Triathlon or you've been stuck at your desk all day, we could all use some soft tissue love periodically.  Many of us don't have the time or money to devote to routine professional massage therapy sessions which is where a cheap, inanimate object becomes a great substitute: the lacrosse ball.  If you're just introducing yourself to soft tissue mobilization or you're a bit tender from a grueling race, I prefer to use a soft or indoor lacrosse ball.  Regular lacrosse balls can be a great option as well but there is always a time and place for each version.  If you don't have access to a lacrosse ball just yet, start with a tennis ball and graduate up to a lacrosse ball when you can. 
  
Using body position and leverage you can take advantage of the shape and firmness of a lacrosse ball to address any tender spots, tightness, trigger points, etc.  Addressing restrictions like these leads to better quality of movement which often means feeling better during your activities and with your recovery.  Since the SOS Triathlon was this past weekend I wanted to share a few videos by Kelly Starrett that would demonstrate ways to utilize lacrosse balls for hot spots you may be dealing with after the race.  That being said, these are by no means limited to triathletes and can be incredibly helpful for anyone.  Enjoy!

Areas around the thoracic spine and shoulder blade.  If the floor is too difficult or uncomfortable, the same thing can be done standing and leaning against a wall.

Areas around the anterior and posterior shoulder.

Areas around the calf, knee, and hamstrings.  There are a couple other alternatives to a lacrosse ball that you may like as well.

Areas around the hip, glutes and psoas.

Besides September being the start of apple picking season (which is exciting in its own right; Dressel Farms is my favorite) it also means the exceptional SOS (Survival of the Shawangunks) Triathlon is upon us.  Since 1983, this unique 8 stage triathlon has been taking place in the beautiful Shawangunk Mountains and has grown in popularity drawing athletes from all over the country and sometimes internationally.  Covering a total of 50.5 miles with 1 bike stage, 4 running stages and 3 swimming stages it is most definitely a test of strength and endurance but also of tactics and sheer willpower.  Race day is this Sunday, September 8th, and the gun goes off bright and early at 7am at the Ulster County Fairgrounds.

In addition to the race, the SOS Expo will debut this year on Saturday, September 7th from 10:30am to 3pm in the Rock & Snow parking lot on Main Street.  I am thrilled to have been invited to represent and introduce Momentum Physical Therapy of New Paltz to the community.  I will be available to answer any questions, offer post race recovery advice, chat about the 'Gunks or anything else as well as demonstrate some exercises and self treatment techniques.  Other vendors will be showcasing triathlon gear and apparel, health and wellness services, and information about community organizations.  For a full list of vendors and more details about the SOS Expo, you can find them here.

I strongly encourage everyone to come check out the SOS Expo on Saturday and head up to the mountains on Sunday to help support and cheer on some amazing and inspiring athletes.  Even if you don't like triathlons, you can spend the day enjoying all that Mohonk and Minnewaska State Park Preserve have to offer.  And in case you didn't have enough incentive yet, the weather forecast is looking perfect: mid 70s and sunny this weekend!

If you are looking for information about:

• Injury prevention, management and recovery
• Evidenced based treatment and techniques
  
• Training and performance tips
• Debunking training and activity myths
  
• Local events and community happenings

then you are in the right place.  Welcome to my blog where I will provide ongoing updates on current research and best practice with regard to injury prevention, management and recovery.  I will also be addressing how to get the most bang for your buck with training and performance.  Some of the material presented will describe self treatment techniques that can be performed to initiate the healing process, and in some cases resolve underlying issues, following injury.  Other times I will be highlighting material and techniques from very talented individuals who are innovating the way we think about and treat the human body, as well as the brain, in relation to recovery and training.

Without further ado, I'll start off with one of my favorite videos about pain.  In short, pain is an extremely complex process involving countless factors like tissue damage (or lack of), stress, diet and sleep but is ultimately an output of the brain.  That's right, the brain rules supreme and acts like a CEO deciding when you are in pain, how long you are in pain, what kind of pain, etc.  So take the next 5 minutes to enjoy this short video which is a good introduction to understanding pain.