Weight Loss Tips: What worked for me

In lieu of this weekend's seminar I wanted to give you a weight loss tip that has worked for me in the past. Two years ago I worked with a personal trainer three times per week. My goal was to tone up and lose weight. That I did, but not without hardwork, sacrifice, and commitment.

My personal trainer wanted me to keep a food journal. I laughed at him. He said he was so serious and he handed me a notebook and a calorie counting book that was small enough that I could carry it everywhere I went. It was perfect for me because it had every restaurant/cafe you could ever imagine (i.e I loved that it had two of my favorite places; Starbucks and Houlihan's) so I never had to wonder how many calories I was consuming.

During our initial assessment, he figured out how many calories I should consume in order to lose weight and wrote that number on the inside of the notebook. He also instructed me that I shouldn't eat after 6pm. You can imagine how wide my eyes got when he said that!! Every week I had to hand in my book to my personal trainer like homework. This also helped me stick with the journal because he would really get on my case if I didn't stick to the plan. The trick to the food journal is to write down the calories down BEFORE you eat them. Oh boy, was this a reality check! I remember when I was about to eat a cookie and I wrote down the calories in my food journal. I immediately crossed it out and decided against eating that cookie! I then chose a snack with a more reasonable calorie count.

I worked out with him three days per week for 45 minutes of resistance training and 15 minutes of stretching at the end of the session. I did 30-45 minutes of cardiovascular training (I most did elliptical, upright bicycle, recumbent bicycle with rowing) 3-4 times per week. I logged all of my workouts because it helped me organize my week and see what I had accomplished. It felt really good to write down my exercise in my workout journal.

In the end, I ended up losing 13.5 lbs and became toned and flexible again! It was such a great feeling and I was extremely proud of myself.

My weight loss tips:
1. Buy a notebook and start a food journal.
2. Purchase a calorie counting book or log on to a website that works best for YOU.
3. Write down the calories before you ingest them. Then decide if you want to still ingest them.
4. Start eating early aka eat breakfast and then don't eat late (after 6pm or 7pm).
5. Buy a notebook or use the food journal notebook and start a workout journal.
6. Find a person who you see weekly that you must hand your food journal over to in order to keep you on track.
7. Don't cheat because you're only cheating yourself!
8. Perform resistance training 3x/wk for 45-60 min.
9. Schedule 10-15 minutes at the end of your workout to stretch the muscles you just worked.
10. Perform cardiovascular training 3-4x/wk for 30-45 minutes.
11. Believe in yourself and don't give up!

Video Gaming and Back Pain

'Tis the season or 'tis always the season for video games!

After the holidays, I have had a handful of patients with increased back pain. They complain of tightness in their lower back, hamstrings (the back of the thighs), and hip flexors (the front of the thighs). I ask them, "What have you been doing differently?" Their answer is usually, "Well nothing really strenuous. I have just been sitting around playing video games for hours at a time." And there you have it! That's where their back pain is coming from. Due to the fact, that the cord to the controller is very short, you must sit on the floor in front of the tv. This puts the body in a position of poor posture and if sustained for periods of >10 minutes will cause tightness of the muscles and joints of the shoulders, back, knees, and hips.

Video games, just like being on the computer, can be time consuming and somewhat addicting. According to the Bureau of Labor Statistics, information received from the American Time Use Survey revealed, in 2008 "individuals ages 15 to 19 read for an average of 0.2 hour (10 minutes)per weekend day while spending 1.0 hour playing games or using a computer for leisure".
Amazing how times have changed. What did we do before video games and computers? I remember playing manhunt outside with my friends all day only to come inside to eat dinner. Unfortunately, life for most kids isn't like that anymore.


Playing video or computer games is setting our young population up for poor posture, which will eventually lead to injury in their future. Here are some suggestions on how to prevent back pain and other injuries in your future.

1. First, limit your playing time. Make a point NOT to sit in front of the tv playing video games for hours. It is not good for your posture, your eyes, your nutrition, or your well-being.

2. Second, get a "video rocker" also known as a "gaming chair". These are somewhat ergonomically correct (well anything is better than sitting on the floor in indian style, right?) chair that is made specifically for gaming on the floor. However, you must still be aware of your posture while sitting in this chair also. Trying not to slouch forward. Tuck your chin back and pinch your shoulder blades together.

3. Third, stretch your muscles after you have been sitting for a while. My suggestions are to stretch your hamstrings (at the back of your thighs), lower back muscles, and pectoralis (chest) muscles for at least 30 seconds for 3 sets each.

4. Last, but not least, consult with a professional on your posture and how to improve it. A physical therapist or physician will be able to look at your posture and advise you whether your posture requires improvement and specific techniques on how to improve it.

If you can't seem to pull yourself away from the tv then try to break your gaming up by using a Wii or Wii Fit. These video games will keep your muscles active and you burn calories while you play. Remember, the Wii is a very dynamic game and it is very similar to a gym work out or playing a recreational sport. Warming up for 5-10 minutes beforehand and stretching will help prevent injury. You don't want to end up in Wii-hab. =)

Happy Gaming!!

Ice vs. Heat

This is probably the most commonly asked question that I hear in the clinic. Should I use ice or heat on my injury and for how long?

When an injury or trauma occurs such as a muscle strain (tear), a direct blow, fracture, etc. inflammation occurs due to rupture of tiny blood vessels surrounding the injury site. The increased volume of blood around the site causes pain, swelling, and bruising of the injured body part. Here are some FAQs regarding when and when not to use ice/heat for an injury.

ACUTE (NEW) INJURY:

Question: Should I use ice or heat?
Answer: Ice. Ice causes your blood vessels to constrict (narrow) in order to draw blood and inflammation away from the site of injury, which decreases pain and swelling. When using an ice pack be sure to place one layer of protection in between your skin and the ice pack (i.e. pillowcase). There are other forms of ice available for use instead of the traditional ice pack. These include ice cup or ice bath. The ice cup can be made by filling up a medium sized Dixie cup with water and freezing it. When ready to use you can rip the top half of the cup off so that the ice is exposed. Then, apply ice to injury site and massage the area by making small circles with moderate pressure for 6 minutes. The ice cup penetrates deeper than the traditional ice pack and is great for quick on-the-go application. The ice bath is very effective, however most are unable to tolerate placing their extremity in a bucket of ice water. First, you fill the bath or a bucket of water with ice and then place your affected extremity into the water for 4-6 minutes.

Question: How many minutes should I keep the ice on my injury?
Answer: You should use ice for 10-20 minutes max. If ice is used for more than 20 minutes it actually does the opposite of what we want it to do. It causes the blood vessels to dilate (widen) allowing increased blood to enter the area of injury. You can use this schedule when icing: 20 minutes on, 1 hour off and repeat 4-8 times per day. Also, make sure to periodically check your skin for ice burns.

Question: How many days should I use ice on my injury?
Answer: The inflammatory phase of healing last 2-4 days, therefore ice should be used up to 4 days following injury.

RECOVERY FROM INJURY:

Question: When I am recovering from an injury, when can I begin to use heat?
Answer: Heat may be applied to injury after day 4. Heat is excellent to use before exercise and/or stretching in order to increase blood flow and relax the muscle.

Question: How many minutes should I put heat on my injury for?
Answer: 10 minutes of heat will suffice prior to exercise. If you want to use it to relax your muscles you may also submerge your body or injury site in a nice, warm, relaxing bath for 20 minutes, twice a day. The water temperature should be between 92 to 96 degrees Fahrenheit.

Attention Holiday Shoppers!

With all the hustle and bustle of holiday shopping we tend to forget about the "little" things such posture, proper lifting techniques, etc.

Here are some tips to keep in mind in order to prevent injury:

1. Proper footwear: If you know you will be out all day shopping make sure you have shoes that are comfortable. Try to avoid heels if possible, however if you MUST wear heels then make sure they are 1-2 inches or less and are made of a material that has some give to it, such as rubber. If you are wearing boots or shoes with no support in them you can buy an arch support at your local pharmacy and place it inside the shoe for added support (if possible, take the insole out of your shoe and then put the arch supports in).

2. Carrying bags: When carrying bags, pocket book, baby, etc. make sure that you even the weight out on each shoulder. Do not carry all of the weight on one side of your body. This will directly affect your posture and may cause serious injury to your back.

3. Lifting: When lifting always remember to "activate your core" first by drawing in your belly button towards your spine before you perform the lift. Remember to bend at the knees and hold the object as close to your body as possible. If you are taking presents/bags out of your shopping cart and/or trunk first activate your core, move the object as close as you can to the edge of the cart/trunk, then lift object as close to your body as possible. Do not pull the bags/presents out of the car by tugging and rotating your spine. This may cause a serious injury to the back and prevent you from completing the rest of your shopping!

4. Wrapping: When wrapping presents have your gifts and wrapping supplies placed directly in front of you. Sit at your dining room table, stand at a high counter, or tall kneel at the side of your bed (that's if the bed isn't positioned too high). Remember to always "activate your core" and keep it activated. Sitting on the floor will place your body in a compromised position which you might regret later.

These helpful tips will help save you some unwanted post-holiday discomfort. I hope you find these helpful and I hope you remember them this holiday season and in the future.

HAPPY HOLIDAYS!

Tendinitis vs. Tendinosis

There is a common misconception regarding the term we commonly hear called "tendinitis" and a term we don't hear as often called"tendinosis". However, the latter is far more common than most of us think.

Tendinitis is an inflammation of the tendon. Tendinosis is degeneration within the tendon caused by repetitive microtrauma, decreased blood supply to the tendon, or the natural aging process.

When a tendon is repetitively stressed or "overused" microtears form on the tendon in turn igniting an inflammatory process, which is called tendinitis. The inflammation can usually last anywhere from 7-10 days. It can be decreased if treated promptly with rest and anti-inflammatory agents such as ice and anti-inflammatory medications (NSAIDS, OTC Ibuprophen such as Advil, Motrin, etc.).

However, if the tendon is continuously placed under stress for an extended period of time the condition can no longer be called tendinitis and is now termed tendinosis. The reason for the name change of the condition is due to the physiological changes of the tendon. Due to increased stress, the tendon becomes ischemic meaning there is decreased blood supply to the tendon. If the tendon is ischemic for an extended period of time the collagen (that all tendons are made up of) begins to die. Once the collagen dies there is no longer a presence of inflammatory cells. If there are no inflammatory cells that means there can be no inflammation (aka tendinITIS) and therefore, NO PAIN. I am sure no pain sounds great to all of you, but this is very bad. If there is a lack of pain there is no way for your body to tell you if and when the tendon has been overly stressed again. Hence, there is a very high chance that the tendon will rupture or tear completely as in when an individual tears their Achilles' tendon.

Collagen can regenerate if the proper treatment is rendered. If the tendinitis has become tendinosis it is much harder and it takes longer, but it can still be done. So if you think you have tendinitis, please do not wait for the pain to go away because with the proper treatment it will not turn into tendinosis. It doesn't hurt to get it checked out, right?

What is the best cardiovascular exercise to do if you have knee pain?

Choosing the right cardiovascular machine that prevents further damage to your joints is so important and will save you pain in the long run. The best cardiovascular exercises for your knees are the ones that put the least amount of stress on your joints. Two of these exercises include the stationary bicycle (recumbent or upright) and swimming. The exercise bike is a great way to burn calories and to build strength in your leg muscles without putting excessive stress on your lower extremity joints. When you set up your bike you want to make sure that when seated your knees are slightly bent. Also, when you extend your leg at the fullest rotation your knee should still have a slight bend in it. You also want to make sure your knees are not bent too much (greater than 90 degrees). Hint: When your knee is bent at the proper angle you should still be able to see your toes. Excessive bending in the knee will increase the stress on the patella (knee cap) located in the front of your knee. Swimming is also another great way to burn calories and increase muscle strength throughout your whole body without putting excessive stress on the your joints. If you suffer from bad knees and a bad back, swimming is a great exercise. You can burn up to 450-900 calories per hour. Sounds good to me! I have found a website where you can figure out caloric expenditure during various exercises based on your body weight. Go to http://www.nutristrategy.com/activitylist3.htm.

Some helpful advice:

1. If you have back pain as well as knee pain the recumbent stationary bicycle may be a better fit for you.

2. If you have shoulder pain and you want to swim try using the breaststroke. The breaststroke does not require rotation of your shoulders which can cause excess shoulder pain. If the breaststroke still causes pain then stick to the stationary bicycle for the cardiovascular portion of your workout and do you weight training in the pool.

Pain in the foot...

I am just getting over a bad bout of plantar fasciitis. For those of you who are unfamiliar with this painful and ruthless foot condition, it is an inflammation of the fibrous band of tissue that runs along the bottom of the foot from your heel to the ball of your foot. When inflamed it can become extremely (did I say extremely?) painful causing one to limp or have to use an assistive device, like a cane or crutches, to walk. So, I have been limping around on the ball of my foot (sometimes with straight cane in hand) due to plantar fasciitis. I am positive that many of you are wondering “How did a physical therapist let herself get to this point?” Well, I am as guilty as many of you and I ignored my pain. I thought ‘Oh, it’s not so bad…it will go away tomorrow. I can deal with the pain.’ Well, it did go away…and then it came back with a vengeance! So, for the past 8-10 days I have had to treat myself like a patient and even become a temporary patient of Dr. Yoo’s. After 8 days of consistent treatment I am finally step on my heel with minimal pain and today (day 12) I have hardly any pain! I cannot explain how amazing it feels to be able to finally step on my foot without wincing in pain.

Prevention is the solution! The human body is a kinetic chain; everything is connected! Over time, poor mechanics of one part of the body will affect another part of the body somewhere up or down the chain. Shoes, shoes, and more shoes! I cannot stress enough how important footwear is when it comes to preventing injury. I own great shoes that are wonderful for my feet and I own shoes that even though they may look good they are terrible for my feet. When I wear my great shoes, my foot doesn’t bother me at all, however when I don’t I suffer tremendously. I understand that footwear can be pricey, but it is even pricier down the road for treatment of injuries caused by poor footwear. If you have proper footwear it may prevent you from having to purchase orthotics. Some individuals may even do well with over-the-counter arch supports (i.e. Dr. Scholl’s, Spenco). These can be purchased at your local pharmacy, Road Runners (on Route 4 West in Paramus), and/or On Track (Englewood, NJ). However, some individuals depending on the severity of the condition or foot positioning may need to be fitted for orthotics by an orthotist in order to permanently correct the problem.

I hope this blog has helped save you from some unwarranted pain. I will continue to treat my condition until my foot feels 100% better and I will take preventative measures so this does NOT happen again.