A simple trick we like to incorporate with our marathon runners in training, as well as our elite athletes, is to introduce the use of alternating ice and heat on the lower extremities following a long run, rigorous workout or even an acute soft tissue injury.  This modality  has been popular for years in treating acute injuries, in particular those of the lower extremity.  The theory behind alternating ice and heat, or contrast baths, is to create a “pumping” mechanism of opening up the vasculature (vasodilation) with heat and closing the vasculature (vasoconstriction) with the application of ice.  The protocol can be introduced by alternately submerging the extremity in hot and cold baths, or by simply applying alternating hot and cold packs.  I find both methods sufficiently effective. A standard protocol follows below ( but a modified version with fewer cycles is acceptable as long as we always start with, and end with ice):

-10 min ice followed 10 min heat

-8 min ice then 8 min heat

-6 min ice then 6 min heat

-4 min ice then 4 min heat

-2 min ice then 2 min heat

-End with 1-2 min of ice.

Although the research on this subject is limited and frankly, not very supportive of the efficacy of  alternating ice and heat, I remain a hugh fan of this approach! If heat brings healthy blood into an area, and ice helps to flush out lactic acid and other inflammatory agents, then incorporating both heat and ice will provide both therapeutic benefits.

Traditionally, this approach was thought to be most effective in the sub-acute phase of healing after the inflammation has mostly subsided, but I find the approach more beneficial than ice alone, especially in the acute or early phase of injury.  My only disclaimer is that you may experience some additional soreness initially, but the benefits will quickly follow.

If you are training for a a sport, in particular an endurance sport OR have recently suffered a soft tissue injury, try incorporating the use of alternating heat and ice to flush out lactic acid, speed up recovery and reduced post workout soreness.

I ran the Inaugural Woodrow Wilson Half Marathon this past weekend.  Having trained for a full marathon in the past, I took the challenge of 13 miles a bit lightly.  Although the race went fairly well, my various post race symptoms ranged from soreness through my lower body to an unyielding case of lightheadedness. I was reminded of the 6 Post Race Must Do’s For All Distance Runners:

1.  Re-hydrate: This is an obvious one.  What may not be as obvious is that your re-hydration must include mineral replenishment.  Most people think of Calcium and Sodium when we talk of minerals, and although these essential minerals are important, the replenishment of Potassium and Magnesium are more critical.  Look for sports drinks that list Potassium and Magnesium high on their list of replacement minerals.

2. Re-Load The Carbs: Most endurance athletes are familiar with the concept of “Carbo-Loading” prior to long distance races.  What often goes overlooked is the need to replenishing your body with carbohydrates after the race.   During exercise the body breaks down glycogen in the liver into glucose, your body then converts glucose into energy. When the liver stores of glycogen run dry, the athlete may experience the effects of “hitting the wall”. Following a race, your body continues to burn up whatever glycogen it can find.  Replenishing with carbs will replenish the glycogen stores.

3.  Ice Bath : I understand that the immediate desire following a race is to take a nice hot shower.  But remember, all of that running and wear and tear has put your body in a full- on state of inflammation.  Ice baths will help to close off the vasculature, and will help to pump the inflammation and lactic acid out of the soft tissue and into the blood stream. It’s not a whole lot of fun, but your body won’t be as sore and you will be thankful you did it.

4.  Foam Roll: Create a mechanical advantage by using a foam roller to gently roll out the knots, adhesions and scar tissue that may have formed in the hamstrings, IT band, quads and calves. Every runner I work with who owns a foam roller swears by it. You will too.

5.  Double Down on You Multivitamins: I recommend you take a another serving of your daily multivitamin and Omega 3 Fatty Acid (fish oils).  If you took them the morning of the race, take another dose, if you forgot to take them before the race, double down after the race. Your body is depleted of important vitamins, yet needs them more than ever immediately following a race or long run.

6.  Schedule your visit with your trusty Massage Therapist or Active Release Technique Specialist. Long periods of running will result in overactive muscles, and overactive muscles will result in injuries of the Joints as well as the other surrounding muscles.  Muscle work 24-48 hours Post Race is not just a special treat for a job well done, it is often the key to a speedier “Post race recovery.”

I’m willing to bet that some of you are still having nightmares of all of the snow from this winter! Didn’t it seem like the snow might not ever go away?With all of that snow, what’s a runner to do? Head to the gym of course. Local gyms certainly had their work cut out for them, as suddenly tread mills and other exercise equipment were in high demand! But finally, SPRING HAS SPRUNG! And although we love the benefits of an indoor workout, there’s nothing like the great outdoors! So before we enter the ‘dog days of summer,’ trade in some of your regular gym sessions and go for some outdoor fun!

Recent studies suggest that even just a few minutes outdoors can have a positive impact on your mind, body, and soul. Build your self-esteem, give your mood a boost, and increase your overall lifespan just by spending a few minutes a day outside. Not to mention, you are doing everything you can to “go green” right?? Help out the environment by limiting your use of machines and head outside for your next run…feel the breeze, smell the fresh air, check out the trees…all along the way. Don’t worry; outdoor activities are not limited to runners! Need some outdoor activity ideas?? Try working on a garden, take a stroll through your area zoo, walk to the grocery store, or even play hide and seek with the kids. No matter what your activity, take advantage of the GREAT OUTDOORS!

http://www.thatsfit.com/2010/05/04/outdoor-workouts-how-a-little-green-time-could-save-your-life/

An active exercise program is essential to maintain good health….FOR EVERYONE! Exercising should be a part of your daily routine whether you are 10, 20, 40, or 60. Regular exercise is proven to lead to better long-term health. For seniors, ages 60 and up, we want you to keep living, actively, for as long as you can, to increase your chances of longevity. But before starting any daily exercise routine, it is important for everyone, seniors in particular, to remember to Warm Up! Warm up exercises help to stimulate blood flow, to prepare your body for the elevated exercise that is to follow, and to help reduce the risk of injury while exercising. Check out the following examples of warm up exercises to help you start your daily routine off right:
1) Walking – Start by walking in place for 5 to 10 minutes. This helps to gently raise your heart rate and breathing before beginning more strenuous exercise.
2) Bicycle Riding – Hop on your stationary bicycle for 5 to 10 minutes if you are not into walking in place. Maintain your pace to ensure a proper warm up.
3) Rowing – Either stationary or actually on the water, use this warm up exercise to increase blood flow, while using your arm and leg muscles.
4) Stretching – Take care to do slow, thorough movements, to build flexibility and to avoid muscle injury.

http://www.livestrong.com/article/129030-warmup-exercises-seniors/

With race season well under way I have had my nose buried in every runners/health magazine out there looking for different training advice, best foods to eat, and alternative recovery drinks.  I found a great article by liz applegate ( fridge wisdom) in the January 2010 issue of runners world that sparked my interest runners world .  The article talks about health benefits of drinking milk while training.  We all know that milk has lots of essential vitamins and minerals that are good for the body.  But according to a UK study that is mentioned at the bottom of the article, drinking chocolate milk between exhaustive bouts of exercise improves endurance more than a carb recovery drink.  Researchers think chocolate milk has a superior ratio of fats, carbs, and protein, making it ideal for recovery.   This made me very happy!  Not only can I drink one of my favorite drinks between workouts but ill also be saving money in the process!

Check out a few other articles I found on the subject (yes, one of them is from chocolatemilk.com  ha)

http://www.chocolatemilk.com/

http://nutrition.about.com/b/2007/09/27/chocolate-milk-a-sports-drink.htm

I came across a good article on AOL addressing the ongoing movement to incorporate exercise with seniors as the preferred treatment for chronic pain.  People in the rehab industries have been preaching this for years. I like to remind my senior population that “exercise is not optional” and this goes for everyone over the age of 5!

Our bodies are living, breathing organisms that require movement and activity. In simple terms, Use It Or Lose It!

It is also important to remember that pain or chronic pain is not simply a function of age.  I have patients who complain of chronic pain at 30 years old, and I have marathon runners who are 80.  To a large extent, the level of chronic pain is determined b the person’s willingness to simply get up and move!

Here are the recommended exercises by Liz Neporent of AOL:

1.  Wall Ball Slides: An excellent, no-impact way to strengthen the thighs, hips and buttocks.  These crucial areas are susceptible to early atrophy and weakness due to prolonged sitting.

2.  Bridges: Another excellent movement to strengthen and lengthen the buttocks, hips and core. Especially good for people with knee problems who may have trouble getting into the squat position.

3.  Trunk Curl-Ups: ** This is the only exercise on this list that I highly recommend people avoid.  The research is overwhelmingly opposed to this exercise as it puts tremendous stress on the lower spine.  I have included a video of a more suitable exercise, one that can be easily modified based on ones ability. Click on side bridges to view the video.  **

4.  Water Aerobics: When it comes to cardiovascular exercise the common question I get is, “What is the best cardio exercise?” And my answer is always the same, “The best cardio exercise is the one that you are willing to do!” Water aerobics are fun and they reduce a tremendous amount of stress to the spine and knees.  So if you are a fan of water aerobics, then they are the perfect cardio exercise for you.

5.  Arm Curl: Can be done in the gym, or in a water aerobics class, but the use of resistance training for the upper arms is very important, especially in cases of arthritis and chronic pain of the upper body.

For more information regarding exercises for the senior population, feel free to email me at DrBooker@CapitolRehab.com and enter “Seniors” in the subject line.

To read the complete AOL article, click (Read Full Article Here)

Interesting note: I have had the opportunity to attend several workshops with Dr. McGill and incorporate much of his methodology to our patient approach.

Shin Splints is a general term used to refer to a painful condition of the shins. The most common cause is inflammation to the periosteum, the outer sheath of the shinbone (tibia). Specifically, the pain associated with shin splints is the result of fatigue and trauma to the muscles and tendons where they attach to the tibia.

Dr. Booker and Dr. Beck co-author the article below which provides more information for those with athletic injuries and shin splint ailments.

Active Release Technique: Athletic Injuries & Shin Splints

Dr. Booker breaks down this exercise into three phases:

• the Bent Leg Side Bridge
• the Straight Leg Side Bridge
• …and the Straight Leg Side Bride with Rotation

Perhaps the most well-rounded spinal stabilizing exercise, the side plank has been widely studied by the top spinal biomechanical experts in the world. This one movement trains all of the primary stabilizers of the abdominal wall, and can be modified to be more challenging to even the most athletic individual.

Health and ergonomics expert, Dr. James Rota has developed an exercise system designed to rapidly increase weight loss by combining strength training, aerobic exercise and muscle stretching. The “secret” to Dr. Rota’s new technology “The Freedom Spring System“, is that it combines theraband resistance training with trampoline training.

In short, I endorse Dr. Rota’s exercise system, but then again, I endorse almost every form of exercise, and why? Because the best type of exercise is the one that you will do!

Regardless of whether your exercise program of choice is pilates, yoga, free weights, Jiu Jitsu or The Freedom Spring System, the goal of a complete exercise program is to incorporate flexibility, aerobic and resistance training into a program that compliments your lifestyle. If you are able to combine a complete training system with a reasonable and well rounded diet, the research has long supported the fact that you will increase your metabolism, accelerate weight loss and experience a higher quality of life. But you will only be able to recognize these benefits when you find a program that you enjoy and works for you.

If you have any questions regarding fitness and health, feel free to contact me directly at 703-527-5492.