Osteoporosis and osteopenia both refer to bone density. Bone density refers to how strong the bone is; if the bone gets weak enough it can fracture or “break” easily.

To understand these conditions it is important to know that your bone is constantly remaking itself. Bone acts in a similar fashion as when your skin changes or heals itself. You observe this when things like bruises, pimples, or scars go away or take a different form over time.

As you age, the rate that your bone rebuilds itself can slow down a bit. When you undergo a bone scan, we can see the results of how strong the bone is. Based on statistical ranges and age norms your bone density can be determined as it relates to where it should be for an individual your age.

Classification — Osteopenia vs. Osteoporosis

When the bone is a bit weaker than normal it is termed osteopenia. When the bone is significantly weaker and at risk for fracture it is termed osteoporosis.

Above, you can see a model of what the bone may look like in an individual diagnosed with osteoporosis versus what is considered normal bone.

The good news is, there is a way to avoid this process, to keep your bones strong or get them stronger if this process begins.

The key is to do strength training exercises as well as standing balance exercises. For more details on ways that exercise can help, please read my other post.

Exercises that are not weight-bearing such as swimming or cycling would not help bone density. While they are great for heart health, they do not offer enough stimulus to the bone to make them stronger.

Important Safety Concerns

Since your bone might be weaker it is vital to watch your form during exercise. Keep the weights light at first until you begin to feel comfortable enough to advance the weight. Putting your body in compromised positions from poor form or carrying too much weight can put you at risk for fracture.

Consulting with a physical therapist can help you figure out a program that is right for you as well as teach you ways you can avoid fracture with your everyday activity.

Nutrition

Diet is another key way to keep your bones healthy. Being underweight is a key risk factor for osteoporosis. This can stem from decreased protein intake as some individuals do not take in enough protein, especially as we get older.

Another way to address bone density is your calcium intake. Consult with your physician and see what specific needs you may have for supplementation.

It is always better to address nutritional needs with real, whole foods before they become a deficiency. Both men and women’s recommended daily allowance is between 1,000–1,300 and can vary through the life cycle. However, the calcium from food and supplements should not exceed 2,000mg/day according to the Institute of Medicine’s Dietary Guidelines

Foods high in calcium include dark leafy greens, canned salmon or sardines with bones, soy products, and dairy products.

Vitamin D

Vitamin D is an important vitamin for our body. In fact, it is so important that it actually acts more like a hormone in our bodies. Vitamin D helps your body absorb calcium and improves bone health in other ways.

The way we get vitamin D is from the sun. This is why it is vital to pay attention to these levels, especially in colder climates when you won’t be outdoors in the sun as often.

There is currently much debate about how much vitamin D is needed. A good starting point for adults is 600 to 800 international units (IU) a day, through food or supplements. Most multivitamin products contain between 600 and 800 IU of vitamin D. Up to 4,000 IU of vitamin D a day is safe for most people.

Bottom Line

• Osteoporosis and osteopenia refer to different levels of bone weakness
• Osteoporosis refers to a greater bone loss than osteopenia
• Those with osteoporosis are at a high risk for fracture
• Weight-training can help improve bone density at any point in the process, however, outcomes are better the earlier you start
• You can also address your bone health with diet by making sure you take in adequate amounts of protein, calcium, and vitamin D
• It is best to consult with a physical therapist in collaboration with your physician to find the best program for you

Follow us on Instagram and Twitter @RiseRehabFit and on Facebook. For those in Northern New Jersey, Bergen County area, visit our website at RiseRehabFit.com to come in for a tour and consultation.

The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.

What is Osteoporosis or Osteopenia and what do you need to know? was originally published in Rise Rehabilitation and Fitness on Medium, where people are continuing the conversation by highlighting and responding to this story.

Has your physician told you that you have osteopenia or osteoporosis? Does it run in your family? It does not have to be as scary of a diagnosis and there is a way to keep your bones healthy.

Get Ahead of It to Avoid Medications

There are a number of medications given to people in later stages of the condition however that can cause many side-effects. One proven way to improve bone health while minimizing negative side-effects is exercise.

Numerous studies detail to us that we can make a bone stronger with weight-training. When bone is compressed and loaded, such as when lifting weights, the bone responds by becoming denser — or put another way, it becomes stronger. Whether you have osteoporosis, osteopenia, or trying to avoid both there is still some form of exercise you can do.

Muscle gets stronger with tension — as in the bicep curl (pictured below). The human body has the ability to respond to a load placed on it by getting stronger. This same principle applies to bones as well; it is called Wolff’s Law (named after the anatomist and surgeon who developed it).

Bone, on the other hand, responds with compressive loads. That means doing squats not only improves the strength of your leg muscles but while carrying that weight, the bones of your spine, hips, thighs, shins, and feet are responding by getting stronger as well.

This does take time but it is certainly worth it as it can help you keep your bone strong, avoid fractures, and stay off medications. Sticking to a consistent, progressive weight-lifting program can potentially reverse, slow, or avoid any bone degradation.

Tell Me More

It is important to note that the specific bone density and/or level of bone “softening” you may have determines what exercises are safe for you to perform. It is advised that you consult with a physical therapist prior to starting a training program as they can outline a program specific to your needs.

You want to make sure to avoid too much weight too early. It is more about consistency and repetitions than it is about how much weight you lift. As you progress and get more comfortable lifting weights, you can slowly increase the weight.

It is especially important that those with suspected weakness in the bone be mindful of their form as they are more likely to be injured if they do not lift weights properly. This is another reason why it is advisable to start a supervised, medically-based exercise program with your physical therapist.

It is NEVER Too Late

Also, it is important to mention that you can do this at any age regardless of your experience lifting weights. There are ways to slowly progress the load you can handle.

To further emphasize, the goals is not to lift the most amount of weight it is just about slowly progressing to more weight than you lifted 2–4 weeks ago.

Keep track and enjoy the progress!

Success Story

See below an example of a Rockstar in our clinic who was able to improve her bone density to levels that she tested at 7 years prior!

Bottom Line

• Exercise can help those with osteoporosis or osteopenia
• Weight-training can help improve bone density
• Start with light weight and be consistent
• Focusing on your form is vital as decreased bone density can make you susceptible to injury
• It is never too late and you can always benefit from some form of exercise
• It is best to consult with a physical therapist in collaboration with your physician to find the best program for you

Follow us on Instagram and Twitter @RiseRehabFit and on Facebook. For those in Northern New Jersey, Bergen County area, visit our website at RiseRehabFit.com to come in for a tour and consultation.

The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.

What you must do if you are at risk for osteoporosis — BEFORE medications was originally published in Rise Rehabilitation and Fitness on Medium, where people are continuing the conversation by highlighting and responding to this story.

What is “good pain”?

I know it sounds hard to believe but there actually is a good pain.

It is called DOMS, or delayed-onset muscle soreness. This is your body’s positive response to exercise that makes you grow stronger. If you exercise your arms and, a day or two later, the area of your arms you worked is tight and tender to touch, you are experienced DOMS.

DOMS can peak at 1–2 days after a challenging exercise. The challenge can come in the form of doing an exercise you have never done before, or increasing resistance for an exercise that you have done before.

What is “bad pain”?

Bad pain is pain that we want to pay attention to. It is your body’s negative response to a weight that was too much load, too quickly or it was a light-weight/load but for too long a period of time.

How can you tell if you need to seek a physical therapist?

1. Did you have poor-technique with an exercise or even when you did something around the house requiring force? Did that result in a pain that lasted longer than two-three days (beyond the DOMS-window)?
2. Does your pain interfere with your everyday activity? Things such as bathing, meal-prep, walking, stairs, etc. These are all things that shouldn’t be severely impacted for days.
3. Does the pain have a very localized point? Generally, “good pain” is in a wide-spread area around muscles that were trained.

If you answered “yes” to the above, it is advisable to seek out a physical therapist near your to help determine the nature of your pain, give you tips on better ways to move as well as help you recover in a safe and efficient way.

Follow us on Instagram and Twitter @RiseRehabFit and on Facebook. For those in Northern New Jersey, Bergen County area, visit our website at RiseRehabFit.com to come in for a visit and consultation.

The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.

Good Pain vs. Bad Pain: When do you need attention? was originally published in Rise Rehabilitation and Fitness on Medium, where people are continuing the conversation by highlighting and responding to this story.

“Do you think I need an MRI?”

I hear this frequently; Oftenly, patients in pain wonder when or if they need to get an MRI (magnetic resonance imaging).

From an orthopedic (muscle, bone, tendon) standpoint, it is not needed as often as you may think. Most aches and pain in your joints can be determined with a good examination, looking at how you function/move, and possibly x-rays to rule out any serious pathology such as a bone fracture or other bone lesions.

In fact, research is indicating more and more that MRIs lead us to overdiagnose conditions.

Take back pain for example. An MRI should not be a routinely ordered test, it should only be used if severe dysfunction is noted, and should be used if a patient is a candidate for surgery and/or spinal injection based on strong research and recommendations.

Often times in major research reviews we see phrases such as this:

“The rate of false-positive imaging is substantial. Anatomic abnormalities have demonstrated a poor correlation with patient symptoms and may lead to increased surgical rates without improved outcomes.”

Simply put, we are finding things on MRIs that do not correlate with pain and dysfunction. Even worse, people are getting surgery off those meaningless findings!

How to proceed without an MRI

The next logical question I get is, “but how can you know what is wrong without seeing an image?”

The truth is, if your bony structure and other serious issues are taken off the table by a thorough examination, we can usually isolate the pain by testing the structures that are not easily visualized by an x-ray.

This is not to say that MRIs are not useful; they just have their indications and appropriate use.

With greater amounts of research reporting that a small snapshot can show us (at great detail) anatomical variations that are completely normal and not related to your symptoms.

Great News

If we can pinpoint a movement or an activity that you do that can bring on your pain, it is more likely we can design a program that can rehabilitate it.

Think: If there is a way we can provoke and irritate the pain, we can most likely find the solution to the pain.

At RISE Rehabilitation and Fitness, your physical therapy evaluation will work to find any tightness, weakness, or troublesome tissue in order to get you to return to pain-free activity. We use a wide array of therapeutic strategies to eliminate your pain such as manual therapy, instrument-assisted soft tissue massage, cupping, dry needling, therapeutic taping, joint mobilizations, as well as other techniques to get your pain down and your function improving.

Physical therapy prior to an MRI can help many individuals limit medication, avoid expensive procedures (such as an MRI) and avoid surgery. If you have pain and want to seek out treatment prior to more invasive procedures and live in or around Bergen County, NJ, please contact us at RISE Rehabilitation and Fitness.

Follow us on Instagram and Twitter @RiseRehabFit and on Facebook. For those in Northern New Jersey, Bergen County area, visit our website at RiseRehabFit.com to come in for a tour and consultation.

The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.

What you must know before getting your MRI was originally published in Rise Rehabilitation and Fitness on Medium, where people are continuing the conversation by highlighting and responding to this story.

The effects of posture on pain is misunderstood. To answer the question, posture does not cause pain alone.

The body has a tremendous ability to adapt. It adapts by responding to whatever load or stress that is placed on it. That is why a body builder can curl weights to grow his biceps over a period of time. Strength training as it relates to muscle building is a common example of how a body responds to load.

Other structures adapt as well in various predictable patterns. Simply put, as you sit and slump, your posture will respond accordingly. Where this can lead to pain is when you load your body in a way that it is not used to.

Here is a common example that might make things a bit clearer. Take a person that works at a desk such as an administrator. As the administrator is slouched in their chair, their back may round and the shoulders may come forward.

The rounded, or forward-flexed, back and forward shoulders make it less advantageous to do things that require you to extend your back say as with an individual reaching over-head.

That can manifest itself in that same administrator if they decide to paint a room in their house one day, or throw a ball with a friend or family member. Reaching overhead can increase stress on the low back since it is not accustomed to that position.

How about the forward shoulders? That puts the shoulder — and shoulder blade — in a disadvantageous position. This can make reaching overhead stressful on the shoulders; something such as throwing a ball which then adds speed and force to a motion that is already restricted due to posture.

So as you can see, it isn’t necessarily the posture that effects people however being in one position for too long can create muscle imbalances across the body. Static postures can make other activities more difficult or, place you at a higher risk for injury.

Ultimately, staying active while varying your exercise type is the best way to maintain fitness and prevent risk for injury. Challenge yourself with exercises in different positions and postures. This will keep you physically prepared for any and all tasks you enjoy doing.

Remember, your body responds to whatever load and stress you give it. If it is in one posture and doing the same activity every day, your body will start accommodating to form its body to handle that task. A seated, slumped posture is not a good training position for much else other than sitting.

Next week’s post will address common stretches to perform for those that find themselves having to sit a lot.

An evaluation by a physical therapist can help determine any areas that can be improved upon to prevent risk for injury as well as help recover from any injury and design the right program for you.

Follow us on Instagram and Twitter @RiseRehabFit and on Facebook. For those in Northern New Jersey, Bergen County area, visit our website at RiseRehabFit.com to come in for a tour and consultation.

The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.

Does posture cause pain? was originally published in Rise Rehabilitation and Fitness on Medium, where people are continuing the conversation by highlighting and responding to this story.

“Every time I squat I get this pain right here. Is that normal?”

In my practice I get to deal with all kinds of people with various goals. From professional athletes, grandparents, collegiate athletes, desk-jockeys, weekend warriors, etc. I am happy that regardless of population, most people understand the importance of incorporating squats into their regimen. However, another commonality across these very different groups of people is they may approach hip pain while squatting incorrectly. Whether it be stopping squats all together because of their pain or, even worse, just continuing to squat through the pain.

The goal of this article is to help you understand the potential causes of this pain during a squat, give some troubleshooting tips, and determine when it could be time to see a healthcare professional.

Back Position

The “incorrect” position labeled above may make you feel stronger and steadier however, it relies on taking the low back to it’s end range. This end range alone isn’t terrible but with added weight brings added risk of injury.

You also don’t want to exaggerate the arch in your low back as that limits the amount of range the hip has to move. Essentially, you are bringing the pelvic bone closer to the hip bone at the beginning of the movement which means there isn’t much more room for increased motion from there. This will limit your range of motion into a squat and subsequently, it can lead to groin pain.

In this particular case, groin pain can be as a result of the absolute end range of your bony anatomy or it can be hip musculature tightening/spasming to avoid you going there; your body’s way of protecting itself from going into a compromised position.

This is not something to squat through. First step: keep a “neutral” spine. How do we do that? When standing (start position) think of your pelvis as a bucket that you want directly under your shoulders. That’s a tough concept in black and white text but when you are standing you can feel it. Put your hands on your hips/pelvis and feel what happens to your pelvis if you over-arch your back (as in the picture above) or when you round-out your back (think: slumped posture). The ideal position is in the middle of the two extremes in which the pelvis feels directly under the shoulders. The picture below does a nice job of reflecting this concept in a simple way.

With this starting position, brace the core (to keep the pelvis there), and then lower your torso into a squat. It can help to sit to a bench first to get a better feel for the movement.

Foot Placement

Another factor for groin pain during a squat could be your foot position. People have variations in their exact anatomy and bone shape. If your workout partner squats with their feet straight, that might not mean yours have to be as well.

If your feet are turned in too much (clockwise for your left foot and counter-clockwise for your right foot), then you may also get to the end range of your anatomy during your squat and you can have pain in the groin/front of the hip.

I find a quick, down-and-dirty way to determine good foot position is to have the individual jump. Typically the way you jump and land will be your ideal position. Think about it: if you have to forcefully get your legs to generate enough power to get you airborne, how do your feet naturally plant? This is likely the way you should squat and your most efficient form.

A common follow-up question I may get is, “Shouldn’t I squat with my feet straight until I get better at it?” Well, simply, no. It can be beneficial to change your foot position but that is dependent on a number of variables. For this article and to keep it broad, you wont go wrong using this “jump trick” outlined above.

One caveat is you don’t want to go too wide where you don’t feel like you can squeeze your gluteal muscles to help with your squat. Again, not likely to be the position of choice when you jump either. Gluteal activation brings me right into the next troubleshooting point.

Not “Activating” The Gluteal Muscles

This is the tougher of the three cues but can certainly go a long way to helping your squat and reducing groin pain. An extreme manifestation of “under-active” gluteals during a squat would result in the knees caving in toward each other as seen below on the right.

Now you might be thinking: I don’t do that. Again, this is the extreme manifestation of weakness at the hips. You however may have some subtle version of this and when trying to squat with a heavy enough weight, this can accentuate any weakness or deviations and exacerbate your problem.

One cue to help this is to tell people to slightly push their knees out during the squat. Another way to facilitate this is to squat with a band around your knees as seen with the individual below seen at RISE Rehabilitation and Fitness.

Seen in the video above, this particular case you can see how we use a band to promote proper form and avoid the knees from collapsing inward. If you find that you have pain from squatting, try squatting in front of a mirror and apply a band if you notice your knees naturally want to deviate inwards.

When to see a healthcare professional

One key thing to note is if your pain level stops you from working out at all, and especially if it prevents you from doing your normal day-to-day activity (such as sleeping, walking, stairs, sitting, standing, etc.) then it would be best to seek out a physical therapist as soon as possible. Often, people who come to see me wonder if they need to get a scan done of any kind. For a variety of reasons, rarely does an individual need any x-rays or MRIs to help us determine what is preventing you from squatting and moving properly. In fact, a physical therapist can help you move better, more efficiently, give you strategies and exercises for healing, and can help eliminate pain prior to spending money on getting extensive imaging done.

If you try the above recommendations and don’t see a change in your symptoms then it would be best to be evaluated by a physical therapist. At Rise Rehabilitation and Fitness, you will be examined by a board-certified doctor of physical and orthopedic specialist. We can work together to determine the cause of your pain and treat it to prevent any long-term issues.

Follow us on Instagram and Twitter @RiseRehabFit and on Facebook. For those in Northern New Jersey, Bergen County area, visit our website at RiseRehabFit.com to come in for a tour and consultation.

The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.

Why Your Groin Hurts When You Squat And How To Avoid It was originally published in Rise Rehabilitation and Fitness on Medium, where people are continuing the conversation by highlighting and responding to this story.

Deadlifts have grown in popularity and have a lot of misconceptions as it relates to back-health. Aren’t deadlifts bad for your back? Can’t you herniate a disc that way? How do you perform them?

Deadlifts are not bad for your back when done correctly. I also believe, that in today’s society the majority of people should be incorporating deadlifts into their exercise regimen. That doesn’t mean everyone’s deadlift will look the same, but there is certainly a healthy way you can deadlift!

An “exercise for society” is quite a bold claim but I have reasons. Today we find ourselves in the seated position often with many individuals working desk jobs. Even if you are standing most of your day, we tend to be buried in screens and phones which keeps us in a slouched position most of the day.

Enter the deadlift. Aka The Anti-Sloucher. The Posture-Builder. The Back-Defender. The Body-Composition-Changer. Ok, ok…I am hyping it a lot but it is a great lift.

Above are just key muscles. There are secondary muscles in the arm as well as the latissimus dorsi (“lats”) that are worked during a deadlift. This is why it is such a great lift. Progressively increasing resistance using this lift can help prevent a lot pain or injuries when doing the things you love to do. The deadlift can help improve your lifting mechanics and can be part of a complete program to prevent back pain.

Proper Form

There are multiple variations to the deadlift. You can perform conventional deadlifts, sumo deadlifts, trap-bar deadlifts, deficit deadlifts, block deadlifts, single-leg deadlifts, and Romanian deadlifts. Each have their own advantages and disadvantages which I hope to discuss in future posts. All of the variations are great if used correctly.

For this particular post I will discuss the conventional deadlift and how to properly perform it.

In the video above you see the individual performing a deadlift. I admit it isn’t conventional per se as we adjusted the speed at which he did the lift and did not let him place the bar on the ground. This is a more advanced technique and I wouldn’t start with this.

However, the video does show great form. We will go in greater detail about deadlift form but for simplicity, think of these three points:

1. Keep your back straight. He doesn’t round at his lower back and,
2. The motion is from the hips: to prevent the back from rounding, he hinges at his hip (as if to sit).
3. Bend your knees at the end (when lowering the bar), if you feel the stretch in the hamstring is too much that you would round at your back.

Modifications

There are numerous ways to modify this lift. Working with your physical therapist you can find the best variation for you as well as an optimal progression to get the results you need.

An example of a modification includes elevating the bar on blocks — termed, block deadlifts. This is great for individuals with limited hamstring or hip mobility.

The reason is, if you can not fully bend forward while keeping your back straight then you can risk hurting your back during the lift. To avoid back pain during a deadlift, make sure to set the bar at a height that allows you to maintain proper form.

Check out the video below where you can see as an example, a few plates can be used to elevate the bar to a safe height:

I chose this particular variation of the deadlift from the many you can perform because it is the most common one I would use with individuals with low back pain. This is assuming they have been treated out of the initial stages of pain and can now progress to strengthening. Limiting the range performed during the lift will allow you to work the correct muscles but staying within a range that would have you keep the best form.

If the above does not work, it is advisable to seek out the help of a physical therapist. Physical therapists at RISE Rehabilitation and Fitness are board-certified orthopedic specialists that focus on manual therapy techniques as well as other approaches to help you improve your function. Book an appointment or just speak with a therapist through RiseRehabFit.com.

Follow us on Instagram and Twitter @RiseRehabFit and on Facebook. For those in Northern New Jersey, Bergen County area, visit our website at RiseRehabFit.com to come in for a tour and consultation.

The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.

Do Deadlifts Hurt Your Back? was originally published in Rise Rehabilitation and Fitness on Medium, where people are continuing the conversation by highlighting and responding to this story.

I hear this a lot from people that come to my clinic for help with their knee pain during or after they squat. I first would like to start by saying that squats are one of the best exercises an individual can do. The health benefits are tremendous and far exceed just leg strength. I will save those details for another post. Also, squatting is not bad for your knees and is a common misconception. In fact, not squatting is more likely the cause of generalized knee pain.

With the importance of squats emphasized, what do you do if you have knee pain with squatting? Pain with squats can arise from many different sources however I will discuss three of the most common ones I see with people I treat at my clinic, RISE Rehabilitation and Fitness.

Weak Hips

This is the most common issue I come across. The hip, specifically the gluteal muscles, don’t support the knee sufficiently to allow for a proper squat. The knee is a ‘hinge joint’ and just wants to bend and straighten essentially. When the hips can’t keep the knee steady in place, the knees can cave-in. Doing this repeatedly will cause knee pain and, with enough load, may cause tissue damage.

It looks a bit like the image below:

THE FIX! A great way to fix this is to strengthen the gluteal muscles. That includes the series of exercises below:

Limited Ankle Mobility

You might not even realize this but the ankle is critical to a proper squat. Many people pay close attention to the hip as well as strengthening the muscles of the thigh to improve the squat. While these are all important, if the ankle does not have sufficient mobility, no amount of strength will allow proper form and range of motion to have a complete squat.

THE FIX! A skilled manual therapist can help do various mobilization techniques to the ankle. At RISE Rehabilitation and Fitness, I work with individuals to target specific tissue or joint restrictions with my hands-on, manual therapy techniques. That essentially works on improving the mobility of the ankle joint.

Poor Form

I would say if you have knee pain with squatting, your form is likely not optimal. Granted there can be exceptions to that but we can review a couple key points.

1. As we mentioned above, we never want your knees to collapse inward toward each other. You always want a stable base for your legs with your knee/thigh tracking in-line with your toes, or even slightly lateral/outside of your toes — never inward.
2. We also want you to squat as if sitting back in a chair. Too often people do not bend at their waist to sit back and rather go forward with their knees. This creates tremendous stress on the patellar ligament in the front of the knee (see image below). This could be the cause of your pain for those that have excruciating, sharp pain, in the front of the knee. Often, this is diagnosed as patellofemoral pain.

Above you see the knees travel well-beyond the toes and the heels are elevated. Some individuals (say, with long thigh bones) can have their knees safely pass the toes, however, the heels should always stay firmly on the ground. This much pressure through the front of the knee can be dangerous and could contribute to your knee pain (aka, patellofemoral pain).

THE FIX! I find a great way to improve technique with the squat is to do box squats. To execute a box squat you want to be about 8–12 inches away from a box, bench, or chair that is tall enough to allow you to sit on it while keeping your feet firmly planted on the floor (no heel elevation).

If the above does not work, it is advisable to seek out the help of a physical therapist. Physical therapists at RISE Rehabilitation and Fitness are board-certified orthopedic specialists that focus on manual therapy techniques as well as other approaches to help you improve your function. Book an appointment or just speak with a therapist through RiseRehabFit.com.

Follow us on Instagram and Twitter @RiseRehabFit and on Facebook. For those in Northern New Jersey, Bergen County area, visit our website at RiseRehabFit.com to come in for a tour and consultation.

The above is not a substitute for medical advice and does not take place for seeking a healthcare provider.

Top 3 Reasons Why Your Knee Hurts When You Squat and Their Fixes was originally published in Rise Rehabilitation and Fitness on Medium, where people are continuing the conversation by highlighting and responding to this story.

This article is aimed at giving you an update on fundamental principles to exercising. This can help those new to exercising and want to know what to do and where to start. It can also assist if you are a regular gym-goer and want to double-check your program against the research or, if you just don’t know what is the most efficient way to reach your exact goals.

A current model for success and development, Elon Musk, once said, “People work better when they know what the goal is and why”. The why is up to you, however, you must also know your “what” — what is your goal? Is your goal to get leaner (Here is why this is what most people want when they say they want to ‘lose weight’), gain weight, train for (insert craft/hobby), or is it to improve your cardiovascular health?

Of course there is some overlap but, greater success will be given to those with singular focus. You can change this goal over time but for a given training period, you should hone your focus on one goal. Once your goal is chosen, this will dictate how we approach each major exercise parameter.

Type of Exercise

Should you be doing cardiovascular exercise (running, cycling, walking, arm bike, etc), should you be lifting weights, should you do both? Of course both would be ideal; there is nothing ground-breaking there. If you are pressed for time, leave it at both (with more time on resistance training) and move on to the next section. For those that can give their training more of a time commitment and want a more precise answer, read on..

If your goal is to lose weight (get leaner) your time is better spent doing some cardio (15–30% of your session) and mostly resistance training (70–90% of your session). More and more research is supporting resistance-training (or weight-training) as the exercise of choice for weight loss (more on that here.)

If you are trying to improve your cardiovascular health, you guessed it, do more cardio. Don’t abandon the weights totally though — more like 70% cardio and 30% weight training, as a very crude example. For those training for something specific, well then, your training should be specific; this would take greater detail and programming that would be out of the scope of this article.

Exercise Frequency

The goal here is to minimize the amount of time you are inactive. If you sit at a desk every day for hours, try and break that up with light to moderate daily exercise (to start). It can be as simple as going for daily brisk walk. If your job is more active, aim for higher intensity exercises 2–3 times per week. If you catch the trend here, the goal is to push your body beyond a level of what you do on a daily basis.

For weight-training, you want to “stress”/train a muscle group 2 times per week. Everyone splits up what muscles they train a little differently and each method has its own pros and cons. As a rough simplification, try doing legs twice a week and upper body twice a week. Keep it simple: for legs you can stick to squat and deadlift (add core). For upper body, bench press, rows, pull-ups (add core). Yes, I snuck in the core. Planks, reverse curls, and/or Russian-twists will do.

Core can be trained each time at high reps (it is not vital to put on resistance/weight with core work, generally). Think 3 sets of 15–30 reps.

One note would be to try and vary the exercise for each muscle group to prevent overuse injuries. If you are just beginning to exercise, start with the aforementioned exercises. Do not worry too much about varying the exercises. More importantly would be to watch your form — less weight and perfect form will always be better than more weight and not-so-great form. We “know” this, but do we do it? I, myself, am not exactly undefeated in that battle of the body verses pride.

Exercise Intensity

We touched upon this a little already — exercises should be more challenging than what you do on a regular-basis. If you sit at a desk or are mostly sedentary, start light-to-moderate intensity. If your day-to-day is active you may need to exercise at moderate to rigorous intensity to cause enough of a stimulus to the body to provoke a response (aka improved fitness).

There is an intensity “sweet-spot” where you are challenged just enough. Above is a scale that helps us grade exertion levels. For those individuals that are more sedentary aim for levels 2–5. For those that are more active day-to-day, try to exercise at levels 5–8.

Advance this intensity gradually to prevent injury. Each person is different in regards to starting point/tolerance. Part of the journey is becoming more in-tune with what your body can and can’t handle (more on that later) and then tinkering with that. The fun is in watching those limits stretch as you progress!

Logistics

Aim to do some warm-up such as 5–10 min on a bike, jog on the treadmill, or light aerobic work on the elliptical. It can be anything really, but, the goal is to find a minimally-strenuous (1–3 range on scale above) exercise that will transition you from your normal day-to-day to the challenge of exercise/training.

After the warm-up, perform your planned exercise; Follow that with a cool-down. A cool-down can be using lighter weights, return back to whatever your did for your warm-up, or anything that is less strenuous than your work-out to slowly bring down your heart rate. At this point you can try to stretch, if needed.

Stretching

Keep this simple. Stretching should be done 2–4 times per week, if needed. Your stretches should be held for 10–30 seconds, or 30–60 seconds for older individuals. Ultimately you want a 1 minute hold time for each muscle. Whether you hold the stretch for 10 seconds, 6 times or 60 seconds, 1 time — and anything in between — the goal is to get a 1 minute total hold time.

Rest and Recovery

I had said earlier, it is important to get more in-tune with your body and having an awareness of what it can and can’t do. This is as important for training as it is for rest and recovery.

If you are having a stressful week at work and already feel achy, picking up the weights for a rigorous plan is likely not a good idea. That will be too much stress on the body. Especially for those wanting to get leaner; over-stressing the body can lead to overeating.

Instead, when stressed, try focusing more on interval training on a bicycle, swim, or something a little less intense. This way you are still training (causing the body to adapt and improve) but managing the stress on the body.

Sleep is also vital to the equation. The effects of sleep can be a whole other topic and article. For brevity and simplicity, let’s leave it at sleep allows you to recover from stressful events — exercise as well as mental stressors — and it also is a key time your body rebuilds and develops. For example, it is during sleep that our body sees an increase in growth hormone (stimulates growth of most tissue in the body) and an inhibition of cortisol (the “stress” hormone).

Another aspect of rest and recovery — rest between sets. Ideal time between sets is 2–3 minutes, according to the American College of Sports Medicine.

Be mindful of what muscle a certain exercise targets and don’t overload a particular muscle/muscle group. For example, benching and doing dips BOTH work your pectoral (chest) muscles and should be considered as such. 3 sets of bench press and 3 sets of dips should be viewed as doing 6 sets of pectoral exercise. This is neither good or bad (depends on your goals and conditioning) however, it should be noted and accounted for in the program. If you are sore in your chest for 5 days after a workout containing both, try to do only one or cut the number of reps of both. It is normal for expert, high-level power lifters to be sore for days and even weeks, however, this is not the majority of people and is otherwise not advised.

Repetitions

Amount of repetitions again also depends on your goal and can vary significantly from program to program. A couple things to note is to not train to “failure” if you are new to exercising. This can lead to injury if not handled correctly and monitored for form. The better approach would be to train to “fatigue”. This means, do not train till you physically can’t do any more reps, rather, train until you feel a significant drop in muscle performance (can’t do as many reps or can’t lift as much weight).

To significantly simplify the equation, do high weight and low reps to improve pure strength. Perform high reps with low weight to improve endurance. A theoretical example plan for improving strength would look like 4–5 sets of 3–6 repetitions. An possible example of endurance work would look like 3–4 sets of 12–20 repetitions.

Safety!

Less is always better. You can always do more weight or repetitions next set or session but you can never go back and do less. It is recommended that you check in with a healthcare professional such as your physician or physical therapist before exercising. For those just starting to exercise again, look through and complete a PAR-Q.

Thank you for taking the time to read my post. Please like and share if you enjoyed. Feel free to reach me with any questions, other article ideas, or comments at RiseRehabFit(at)gmail.com and @DrGayedDPT.

Jonathan Gayed PT,DPT,OCS

Exercise Basics: Does the science back what you do in the gym? was originally published in Rise Rehabilitation and Fitness on Medium, where people are continuing the conversation by highlighting and responding to this story.

Coenzyme Q10 (CoQ10) is a supplement gaining in popularity. I have been seeing it more and more in stores with some pretty grand claims. In addition, I just recently received an e-mail on this supplement and wanted to provide some answers for the reader. Let’s take a critical look at what evidence exists in regards to this supplement.

What is CoQ10?

CoQ10 is found naturally in the body and works at the mitochondria of the cell. The mitochondria is responsible for the energy of the cells in our body — therefore, the theory for further investigation is supplementation can help the energy production/efficiency of our cells.

CoQ10 is classified as a pseudovitamin in that it is vital for function however it is naturally produced in the body and therefore may not need to be supplemented under otherwise normal conditions.

When to supplement?

CoQ10 can be low in several disease processes that have been identified to date. Following a heart attack there have been notable decreases in CoQ10. CoQ10 as related to cardiac (heart) function has the most evidence, however, we will dive into that later.

Other conditions for consideration of CoQ10 supplementation include fibromyalgia, depression, male infertility, migraines, Parkinson’s, and Prader-Willi syndrome due to findings of low CoQ10 levels in such disease processes.

Mechanism of CoQ10?

What does CoQ10 actually do for those that are interested in the biochemistry?

To oversimplify, CoQ10 improves the blood flow and prevents plaque build-up in the arteries. We have all heard of the “bad” LDL cholesterol — CoQ10 prevents damaged (oxidized) LDL from forming plaques in the blood vessels. CoQ10 helps to preserve nitric oxide which helps to expand (dilate) the diameter of the blood vessels. Think: wider tube (blood vessel) more blood can flow through freely; Blood can transport and tissues stay healthy.

Does it really work?

Some supplement brands can have pretty ambitious claims for CoQ10. It doesn’t solve everything however certain populations/conditions can really benefit — and the research supports it.

The strongest evidence for CoQ10 supplementation is in cardiac function as well as fibromyalgia.

CoQ10 has substantial evidence that it prevents lipid perioxidation (damage to cell walls). As stated earlier, this supplement can help improve blood flow in those that are otherwise compromised such as those with atherosclerosis (plaque build up in arteries/”clogged arteries”).

Supplementation has shown strong evidence in those with heart failure and/or high blood pressure. Also of note is the potential benefit in those with pulmonary artery hypertension.

CoQ10 has also shown significant improvement in symptoms with those diagnosed with fibromyalgia. It has also shown to reduce feelings of fatigue.

How do you supplement with CoQ10?

Dosage for CoQ10 tends to be between 90mg-200mg. 90 mg seems to be the most recommended — balancing intended effect with cost. Greater dosage has not shown definitive improvements. However, those with heart conditions should certainly consult with their physician prior to supplementation for safest and best results.

CoQ10 supplements can be either the oxidized form (ubiquinone) or reduced form (ubiquinol). It seems that effectiveness does not differ with either form. Both ubiquinone and ubiquinol are effective in increasing circulating levels of total CoQ10 in the body.

It has also been reported that it is best to take CoQ10 with a meal as it absorbs best when digested with other food.

Important to note

This is meant to make readers aware of this supplement and it’s potential effects. Those currently on medication for any diseases should consult with their physician regarding supplementation to avoid any crucial interactions or adverse effects.

There are many other claims surrounding CoQ10 such as lowering blood sugar, improving testosterone levels, decreasing muscle damage, etc. however there is either limited evidence or very limited effects. The less-common desired effects of CoQ10 supplementation should certainly be discussed with your physician as many can benefit on a case-by-case basis. For example, while it may not help manage blood sugar in those with diabetes, it can help the function of multiple systems that can be affected in those with diabetes.

Thank you for taking the time to read my post. Please like and share if you enjoyed. Feel free to reach me with any questions, other article ideas, or comments at Jonathan.Gayed.PT(at)gmail.com and @DrGayedDPT.

Coenzyme Q10: should you take it? was originally published in Rise Rehabilitation and Fitness on Medium, where people are continuing the conversation by highlighting and responding to this story.