Archive for December, 2009

Vaccines and Autism: Why the Controversy?

by Tania Houspian, PharmD 2011


VaccineThere is a tried and true medical procedure that is minimally invasive and takes a few seconds to perform. This procedure will help prevent dozens of diseases and aide in making the entire population healthier. The more people that undergo the procedure, the better it is for the health of the entire population. Like any procedure though, it has its risks. Do the benefits outweigh the risks? Would you choose to undergo this procedure?

That’s a question you always have to ask yourself when choosing to undergo any medical procedure. The risks and benefits need to be weighed.  More importantly the true risks and true benefits need to be weighed. Grandma thinks that her blood pressure medicine gives her gas but, as her children and grandchildren can confirm, Grandma had some serious gas long before she began taking blood pressure medication. Just because two things happen at the same time does not mean that one caused the other.  Correlation does not equal causation.

So what was the procedure we referred to above?

Procedure: Vaccinating Children

Benefit: Vaccines are the single best public health measure ever implemented in our society. They have been proven to prevent many diseases that, in the past, were the leading causes of death in young children.  Think Polio, for example.

Risk: Autism?

One in four Americans believes that vaccines cause autism. When anything becomes that engrained in the minds of a society, it warrants deeper examination. There are two main theories that aided in forming this widespread notion.

Theory #1:

Andrew WakefieldThe first mention of vaccines being a possible cause of autism was in 1998 by British gastroenterologist, Andrew Wakefield. Wakefield, along with 12 others, published a paper in which they put forward the theory that the measles virus in the measles, mumps, and rubella vaccine (commonly called the MMR vaccine) caused a “leaky gut.” They concluded that the leaky gut allowed toxic substances into the bloodstream that eventually ended up in the brain. In the paper they recommend separating the three (measles, mumps, and rubella) into separate vaccines. Wakefield called a press conference to let everyone know about his discovery and consequently triggered a panic in Great Britain.

Since then, Wakefield has not exactly been what we would call a respected member of the medical community. Ten of the co-authors on that paper retracted their involvement and have said they do not agree with the conclusions that Wakefield drew in his paper. The General Medical Council is also investigating Wakefield for scientific misconduct, specifically falsifying data.  Oh yeah, and Wakefield also forgot to mention that he was working on introducing a new measles vaccines to the market to compete with the MMR vaccine. Can you say conflict of interest? Hidden motives aside, Wakefield’s research methods have been accused of not only being flawed but also unethical.

Taking into account the fact that Wakefield has been publicly discredited and his paper deemed invalid, you would think this theory regarding the connection between vaccines and autism would have fallen by the wayside…and it hasn’t.  This is because it’s not that simple.  Many people believed Wakefield was on to something even if the science did not match his conclusions. Due to the number of vaccines children receive in the first three years of life (14 vaccines to be exact) many parents felt that there could be a connection.  Once the idea of a risk like this has been introduced, it’s difficult to get the idea out of people’s minds. Simply said, it’s always easier to scare people than to un-scare them.

Theory #2:

MercuryIn 1999 the US government published a report revealing three childhood vaccines (diphtheria, tetanus, acellular pertussis [a combo called DTaP]; Haemophilus influenzae type b (Hib); and hepatitis B) contained higher levels of mercury than previously thought. Thimerosal is the preservative used in these three vaccines and contains 49.6% ethylmercury by weight. An obscure medical journal took this finding and ran with it, publishing an article (without any scientific validity) saying that autism was a form of mercury poisoning.  This, of course, caused a huge uproar in the United States and propaganda like the image and chart included below (again, without scientific support; note the lack of references for the chart’s information).  In response, the Center for Disease Control reviewed numerous studies all finding that there is NO LINK between autism, vaccines, and mercury. Even though the CDC’s findings showed no connection between mercury and autism, the government still requested vaccine manufacturers to remove the mercury component from all childhood vaccines.  Since 2001, no childhood vaccines have contained mercury.  So let’s say the initial theory published by the obscure medical journal linking mercury and autism was correct (even though all the scientific evidence pointed the other way), then autism rates should have dropped dramatically after mercury was removed from all vaccines in 2001…and parents everywhere would be able to breath a sigh of relief. Well, it turns out that the exact opposite has happened. Autism rates have continued to rise since 2001. This simple fact should be enough to put the mercury-autism theory to rest yet many groups out there continue to vilify vaccines and anyone who dares step up to defend them.

Mercury – Autism Propaganda

Mercury Poisoning

Then why the controversy?

So why is it that, even though all the scientific evidence seems to point away from the connection between vaccines and autism, people still believe vaccines cause autism? Personal experience and temporal associations. One of the main driving forces amongst groups who believe vaccines cause autism are parents with children who have autism, which they begin to notice during the same period of time their children are receiving their 14 recommended vaccinations. Many parents first start to notice signs of autism when their children have developmental delays in speech. The MMR vaccine (which, by the way, never contained thimerosal) is given around 12-15 months of age, which coincides with the age most children begin to speak. So it seems that the most likely explanation is coincidence not causation. There are also many children who exhibit signs of autism prior to any vaccinations, further discrediting the link between vaccinations and autism.

What Now?

No one can belittle how difficult it must be for the parents of autistic children to witness their children’s developmental challenges. These parents need an explanation and, with so many people pointing the finger at vaccines, it’s a tempting to jump on the bandwagon. This approach, however, is not helping anyone. The focus of autism research has been and will continue to be on genetic causes of the disease.  This is the research that needs to be supported and perpetuated in order for real answers to be found and for meaningful interventions to be developed.

UK Measles CasesPeople seem to have become comfortable with how safe vaccines have made our society and forgotten that the illnesses they prevent can kill their children. These viruses continue to exist throughout the world and, without vaccination, we remain vulnerable to the epidemics they can cause. When Wakefield published his paper in 1998, parents in Great Britain stopped vaccinating their kids. The rate of vaccination dropped to 80% by 2003.  That same year, over 1,000 measles cases were reported in Great Britain. Similarly, in the United States there have been outbreaks of measles, pertussis, and Haemophilus influenzae Type B…all diseases that are preventable through vaccination.

References:

Fombonne,E. Thimerosal disappears but Autism Remains. Arch Gen Psychiatry. 2008 Jan;65(1)15-6

Gross L (2009) A Broken Trust: Lessons from the Vaccine–Autism Wars. PLoS Biol 7(5): e1000114. doi:10.1371/journal.pbio.1000114

Immunize.org, http://immunize.org. December 22,2009.

Miller L, Reynolds J. Autism and vaccination- the current evidence. J Spec Pediatric Nursing. 2009 Jul; 14(3): 166-72.

Thimerosal In Vaccines Questions and Answers. http://www.fda.gov/BiologicsBloodVaccines/Vaccines/QuestionsaboutVaccines/UCM070430#q5. December 26,2009.

29

12 2009

Save the Tatas: New Breast Cancer Screening Protocol

by Sarah Gilman-Short, MD 2010

Save the TatasWriting this article has been an interesting journey. A few weeks ago I turned on the radio to hear some pundit screaming, “this is just the first step with this health care reform – first they’re taking away our mammograms, then they’re going to start rationing everything![1]” I wanted to call in, but instead I prepared myself to shoot off a fiery retort extolling the new guidelines and explaining the importance of evidence-based medicine, public health, and risk-benefit analyses. However, after looking at all sides of the issue, I see that things are much more complicated than I had previously thought and my position is much less clear (who’s fair and balanced now, Fox News?).

So now, with the utmost humility and effort, I bring you a primer on the complicated relationship between doctors and numbers, using the recent change in the recommended guidelines for breast cancer screening as an example. And there may be a little rant about health care reform for good measure, but I’ll try to tone down the politics as best I can.

Personally, I’ve always distrusted numbers; they’re shifty and unfriendly creatures. In the third grade, I literally shook with fear before every timed arithmetic test. However, medical school has forced me to confront my numerophobia, and, although I still do not like the little buggers, I have come to deeply respect their utility in my profession. I see myself as an artist and humanist foremost, and I fully believe in the power of individualized care drawing heavily on a strong relationship between the doctor and patient. However, if doctors didn’t care about hard evidence and science, we’d still be running around “blood letting” everyone with a fever.  This is one of the biggest challenges of medicine – we have to merge the evidence we’ve been given (which can be somewhat dodgy itself) with our own intuition and first-hand experience in order to make the right decision for the unique patient in front of us. Sometimes the numbers are right and sometimes they’re wrong, but usually those evil numbers win.[2]

USPSTFThis brings me to the new breast cancer guidelines. If you haven’t yet experienced the treat of being hollered at by a media pundit (and I do recommend it; quite exhilarating during your morning commute) I’ll give you a quick explanation. The United States Preventive Services Task Force (USPSTF[3]) is an independent board of “experts in health prevention and primary care” who have taken on the formidable task of pooling all the evidence from multiple clinical trials regarding a particular subject. They mix all the studies together in a huge pot, add some eye of newt and rat’s tail, mutter a few incantations, and then poof[4]…an evidence rating is set, a guideline is published, and all the primary care physicians in the country collectively gasp together, recognizing that they’ve been doing everything totally wrong their whole career. This happens, oh, about once every few months, and has included everything from abdominal aortic aneurysm screening to youth violence counseling.[5]

The concept of an “evidence rating,” although somewhat boring, merits discussion. Theoretically, the strength of evidence behind every decision that doctors make can be distilled down to by the USPSTF to a single letter. There are tons of really good studies that unequivocally say that Breast Cancer Screeningcigarette smoking is very bad for your health;[6] therefore, counseling patients to stop smoking is grade A, or strongly recommended. Grade B means that there is “at least fair” evidence to support the service.  Grade C means that the USPSTF makes no recommendation for or against the service and D means that the service is either ineffective or actually hurts patients (thus the USPSTF recommends against it). There is one more distinction – called “I Statement” – which means that there is insufficient evidence to make any kind of decision whatsoever. In theory, the letter is determined by a weighing the risks of a particular service against the strength of evidence for the benefits of the service. Telling your patients to stop smoking is not risky and it can have a huge benefit for people; hence Grade A[7].

So what happened with breast cancer screening? The smart USPSTF people set the sights of their mystical computer programs on breast cancer screening. And they came up with the following results:

1. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years (Grade B Recommendation).

2. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms (Grade C Recommendation).

3. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older (I Statement).

4. The USPSTF recommends against teaching breast self-examination (Grade D Recommendation).

5. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older (Grade I Statement).

6. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer (Grade I Statement)[8].

Now let’s try it in English. If the USPSTF were a normal person standing in front of you, it would say: “If you’re a woman between 50 and 75 years old, there’s pretty good evidence that you should get a mammogram every two years. Even though there seems to be a significant amount of evidence, I don’t really know if it’s a good idea to get a mammogram if you’re between 40 and 49 years old, so I’m going to leave that up to you and your doctor. And there definitely isn’t enough evidence at all to say if you should have one after age 75. As for your self-breast exams, they’re either totally ineffectual or harmful, so you probably shouldn’t do them. There isn’t enough evidence to prove if your doctor’s clinical breast exam is useful. Lastly, there isn’t enough evidence to prove that special studies like digital mammograms or MRIs of the breast help more than they hurt people.”

Teresa Heinz KerryI don’t know about you, but if the USPSTF were my doctor, I would be writing some really angry Yelp reviews. The USPSTF doesn’t know anything about me, doesn’t care about me and all of this talk about evidence and proof doesn’t mean anything to my or Teresa Heinz’s[9] tatas. At the same time, the USPSTF is not sexist or intrinsically evil. The USPSTF, with all its unfriendliness, doesn’t care about money. It only cares about large-scale risks and benefits – which, in the case of breast cancer, involve unnecessary biopsies, further imaging, and psychological stress weighed against the possibility of a life-saving early intervention. I think that, even though you have to do 556 mammograms to diagnose 1 case of invasive breast cancer in women 40-49 years old, it’s still worth it[10]. Conveniently, the American College of Obstetricians and Gynecologists as well as the American Cancer Society[11] agree with me.

This brings us back to the struggle between the individual and the public good, which has been at the root of the health care debate. In this case, I chose to ignore evidence (albeit wishy-washy) and to potentially ignore economics to come out in favor of the one woman out of 556 who benefits from getting a mammogram between the ages of 40-49.  Wouldn’t you?  At the same time, I’m not completely satisfied with this decision. As I said before, the USPSTF doesn’t take cost into consideration, and I think that cost-effectiveness should always be taken into account when deciding whether or not to perform a test. Despite the way we’ve historically practiced medicine in this country, our money and resources are not infinite. BruneiIt feels ugly to merge economics with medicine, but the truth is that we, as a nation, have become very good at providing incredibly expensive health care of questionable quality to the “haves” while neglecting the “have not’s,” bankrupting the American people along the way.  America’s pathetic rankings on the full spectrum of health indicators reflect this discrepancy (for example, we rank 33rd in the world for infant mortality…behind Brunei, Cyprus, and New Caledonia.  We’ve included a lovely picture of Brunei for those considering relocation).[12] We all might have to make some individual sacrifices to provide the greatest good for our society as a whole. We’re working on it, but we still have a long way to go.[13]

References


[1] I can’t find the particular pundit now, but here’s a good example of what people have been saying in the same vein.

[2] For a fabulous, in-depth discussion about this, please check out this article.

[3] Say that phrase three times fast.  About the U.S. Preventive Services Task Force

[4] The real and much less interesting version involves a series of ugly calculations that I shudder to think of.

[5] U.S Preventive Services Task Force Recommendations

[6] It really is! Seriously, don’t do it!!!

[7] It also helps to repeat the message. So this is meant for you. Don’t do it.

[8] USPSTF Breast Cancer Screening Recommendations

[9] Teresa Heinz’s take on the new breast cancer screening recommendations

[10] American College of Obstetricians & Gynecologists’ Screening Recommendations for Cervical Cancer

[11] American Cancer Society Responds to Changes to USPSTF Mammography Guidelines

[12] Population Reference Bureau, World Infant Mortality Rates, 2008

[13] The New York Times on the Senate Health Care Reform Bill

Other Articles by Sarah Gilman-Short:

Swine-Flu-Palooza!: Demystifying the H1N1 Virus

28

12 2009

Preventing Low Back Pain: $86 Billion Worth of It

by G. John Mullen, DPT 2011

Low Back Pain

Imagine you are working at a desk job for 20 years (or writing an article once a week) and out of left field your low back begins to hurt.  Now imagine you’re trying to impress an individual of the opposite sex by picking up a box of their weights and body building trophies and all of a sudden your low back is killing you.  Next imagine you’re playing a pick up game of basketball, you have your Chris Sabo rec specs on,  and as you’re running down the court you twist to grab a pass and your low back starts to hurt. All of the above are common ways of injuring your low back.

Stat Fact: $86 billion is spent annually on the treatment of low back pain.

There are many structures located in your lower back that can cause low back pain including bony vertebrae, intervertebral discs, ligaments, muscles, nerves, and your spinal cord.  Any one of these could be causing a variety of problems (very scientific, we know).  We will talk about some of the most common problems and a few ways to help strengthen and protect your spine.  The three scenarios described above are the most common back injuries, but there are many more ways to injure your low back (obviously).  It is important to note that if you already have back problems it’s probably a good idea to talk to your doctor or an exercise specialist about it because if the exercises below are done in an improperly things can get worse rather than better.  Now let’s tackle the most common causes of low back pain.

Herniated Disc1. Herniated Nucleus Pulposis (bulging disc) is a disease that occurs when the jelly-like center (the nucleus pulposis) of the shock absorbing disc located in between each vertebrae ruptures through the tough, fibrous outer portion (the annulus fibrosis) of the disk.  One way to think of this is similar to a jelly doughnut: the nucleus pulposis is the jelly, the dough is the annulus fibrosis, and the bulging disc is the delicious, jelly exploding through the wall of the doughnut. This bulging can put extra pressure on the spinal cord and lead to tingling or numbness in your legs.  Some treatment options include: epidural injection, physical therapy or surgery.  Surgery is always a last resort, so we’ll go over a few stabilizing exercises that would be used in the physical therapy clinic to prevent the need for surgery.

2. Degenerative Disc Disease is a decrease in the volume of the intervertebral disc.  The nucleus pulposis and annulus fibrosis break down over time and cause a narrowing of the canal through Spinal Cord Problemswhich your spinal nerves pass and the space between each vertebrae.  This may irritate your joints as the vertebrae sit closer together and possibly rub on one another.  This condition occurs for a variety of reasons:

  • Age-related changes

  • Lifestyle

  • Genetics

  • Smoking

  • Poor Nutrition

As stated, lifestyle is one modifiable variable in the mix.  Poor posture is frequently one of the causes.  It is important to think of your spine as the game Jenga.  All of your muscles and ligaments are your Jenga pieces and as you begin to slouch (the popular choice for poor posture), you are removing key supporting pieces causing your spine to lean and eventually fall.  This is what we call degenerative disc disease.

Stat Fact: There is a high prevalence of dehydrated discs (i.e. breaking down of the intervertebral discs) seen as early as the third decade of life in both men and women.

Back Muscle Strain3. Muscle Strain is another common lower back injury and can be caused by a several of different accidents, the most common being improper lifting.  Proper lifting technique is as follows:

  • Bend with your knees and keep your back straight from your butt to your neck

  • Bring the object close to your body

  • Come straight up while pushing through your legs

Untitled2The most important treatment for an acute muscle injury is rest.  The amount of rest depends on the severity of the injury.  Depending on the severity of the injury, the rest period can be anywhere from 2 weeks to 3 months!  While resting your muscles, it is also vital to improve your flexibility.  When a muscle becomes injured, its natural reaction is to tighten up (which we call “muscle guarding”) ultimately leading to other injuries and impeding the healing process.  Regular, targeted stretching can prevent this further damage during the healing process.

Stat Fact: Roughly 1/3 of all workplace injuries occur while lifting.

Now for the fun part: preventing and treating your back pain with exercises.  Once again, if you currently have back pain it is recommended to see a health professional before completing these exercises.  These exercises are few examples of many options available for back strengthening.

Beginner:

Abdominal Bracing

Abdominal BracingAbdominal Bracing is used to find a safe and supportive position for your lower back.  The exercise involves pulling in your stomach by tightening your abdominal muscles (trust me everyone has them in there…somewhere) but not flattening your back to the floor.  This exercise should be completed in three sets of 10 repetitions, holding for 10 second each repition.

Table Top

Table TopAs you may have guessed, this exercise involves making your legs look like a table top.  Lie on your back and begin by bracing your abdominals as mentioned above.  Next, lift both legs up creating a 90 degree angle at your hips and knees.  Perform this exercise three times for 1 minute each time.  Technique tip: Don’t arch your back!

Intermediate:

Dead Bug

Dead BugDead Bug is an uncoordinated individual’s nightmare because it involves alternating arms and legs.  Don’t worry, practice makes perfect.  To start, implement the abdominal bracing from above and bend your knees and hips to 90 degrees.  Now, extend one leg at approximately a 45 degree angle and raise the opposite arm overhead (see the picture to get a better idea of this position).  Hold this position for one minute.  After a minute, return to the starting position, pulling your hip/knee toward your chest and returning your arm back to your side.  Repeat the same leg extension and arm flexion on the other side.  You should feel this exercise in your things and abdominals.  Perform this for 3 sets of 1 minute on each side per set.

Quadraped

QuadripedPosition yourself on your hands and knees and begin with your abdominal bracing.  Your hands should be under your shoulders and your knees under your hips.  Once this position is obtained, use a mirror or a partner to help gauge if your back is straight and flat.  Start by raising one arm at a time and alternate these movements.  When you are comfortable with this movement, advance the exercise by including your legs.  Extend the leg on the opposite side of your body from the arm you are extending.  Once your arm and opposite leg are extended, hold for 5 seconds.  After 5 seconds, return to the resting position.  Do not lift your arms or legs above your trunk during the exercise as this will excessively arch your back.  Perform 3 sets of this exercise with 10 repetitions on each side per set.

Advanced:

Plank

The plank is one of our favorite exercises!  Start by lying on your stomach and then lifting your body up, resting on your forearms and knees (beginner) or feet (advanced).   Your body should form a straight line from your ankles to your hips to your ears.  Hold this position for 30 seconds maintaining your abdominal bracing the entire time.  Repeat this 30-second hold 3 times, resting for a minute between each plank.

Beginner                                                           Advanced

Beginner Plank

Advanced Plank

The back is one of the most commonly injured parts of the body, most of which are preventable with proper mechanics and muscle strength.  With the help of your health professional and a little personal motivation and commitment, you can prevent low back injury and help us save some of that $86 billion we’re spending every year!

whey-protein-1

References:

Mair S, Seaber A, Glisson R, et al. The role of fatigue in susceptibility to acute muscle strain injury. Am J Sports Med 1996,24:137-43.

Martin BL, Deyo, RA, et al. JAMA. 2008; 299;656.

23

12 2009

Holiday Health: A Holiday Eating Survival Guide

by Leah Frankel, MS, RD

Holiday FeastWith a plethora of special occasions and excuses to indulge, the holiday season can wreak havoc on your diet unless you’re prepared to tackle those festive buffets and eggnog-filled nights. Preventing holiday weight gain and maintaining your normal healthy diet is definitely possible with a little planning.  First, don’t accept the mentality that you can indulge now and start your diet and exercise regimen when New Years comes around.  You’ll be fighting an uphill battle with even more calories to burn!  Food is meant to be savored, just not in excess!  Enjoy the tips below that outline how to navigate your way through the holiday season as well as some ideas for healthy variations of your traditional holiday favorites!

Tips for Holiday Health:

Have a plan before attending a holiday gathering. Adjust your diet and workout schedule, if necessary, the day of the party to compensate for the food you’ll be eating later that night. If you know you’ll be at a party tonight, skip the desserts at work during the day.

RunningMaintain your exercise schedule, or modify it to fit your situation. If you’re not going to be home for your usual workout, bring running shoes with you to enjoy exercise outside with family and friends.  A game of catch or tennis before dinner is a great way to spend time with family and stay fit.  You can also research gyms in the area where you’ll be staying and make exercising a family activity.  Remember that working out can help reduce stress, regulate your appetite and maintain your weight.

Eat a snack before hitting up the holiday party. If you go to a party or holiday dinner hungry you’ll be more likely to overeat and will have more difficulty resisting the tempting high calorie and high fat treats. A good pre-party snack should include a glass of water, some protein and high fiber carbs, such as an apple with peanut butter or whole grain crackers and cheese.

Use small plates. This is a good tip for all year, not just during the holidays. Studies show that people who switch to smaller plates or bowls consume fewer calories. Grab an appetizer plate instead of a large entrée plate to prevent overindulging.

FeastAssess all the food options and choose which foods you really want to eat. While you might really love chocolate chip cookies, remember that your Aunt Molly’s pecan pie only comes once a year.  Think through which foods you really want and choose a combination of small portion of your “treats” mixed with healthy foods like fresh fruits or vegetables.

Stay away from the buffet table. Once you’ve filled your plate, moving away from the table can prevent overeating. Remember that the holidays are about spending time with family and friends, so enjoy their company instead of eyeing the food table. If your hands feel empty once you’ve finished your food, keep them busy with a low- or no-calorie beverage.

Bring your own dish so you can guarantee a healthy option. Most hosts would love help with the cooking.  Ask them what they’re preparing and suggest some dishes you could prepare. Check out the suggestions below for some healthy culinary ideas.

EggnogBeware of calorie-laden drinks. Alcoholic drinks can pack more calories than a burger and fries at McDonald’s and drinks during the holidays are no exception (see our previous article, Know thy Liquor: What’s in a Drink).  Eggnog, hot cocoa and cider all contain excess calories.  Try to stick with your low-calorie choices such as wine, light beer or mixed drinks made with low- or no-calorie mixers. Also, try to drink a glass of water between alcoholic beverages.  It helps prevent hangovers (see The Hangover: Make it go Away!) and keeps your waistline the way you want it.

Pay attention to what you’re eating. Food is meant to be enjoyed so slow down and savor the foods you’ve chosen. Take small bites and chew your food thoroughly to prevent overeating and to truly appreciate your food. Your host has spent hours slaving away in the kitchen.  Why not slow down and savor all that hard work?  Also, beware of mindless eating which can happen if you settle down on the couch with your hand in the chip bowl.

Beware of snacking. Mindless snacking while cooking or socializing can add hundreds of excess calories that you don’t ever realize you’re consuming. Eat a nutritious snack or chew gum while cooking to prevent yourself from snacking mindlessly.

If you’re full don’t be afraid to say no to seconds.  While family members or friends may push you to eat more, remember that it’s your decision what you eat.  You’ll feel better afterwards if you say no to seconds when you’re full, than if you keep eating.Fitness Class

If you overeat don’t beat yourself up. Just because you ate too much at one meal doesn’t mean you should give up your health-conscious ways and stop eating healthily. Make sure your next meal is lighter and then return to your usual eating pattern. Remember that one meal alone won’t make you gain weight.  It takes 3500 excess calories to gain a pound.  Lastly, a nice long workout later that day or the next can help burn those excess calories you consumed during your holiday splurge.

Begin a tradition of hitting the mall on Black Friday, going on a family bike ride, or playing a game of touch football the morning after a holiday meal. This will force you to get in some exercise the next day while enjoying time with family.

Don’t turn the day after a holiday meal into round 2 of holiday eating. With your fridge filled with leftovers it can be difficult not to indulge in these foods the next day. Try supplementing the leftovers with healthier items, like fruits and vegetables, so that you can enjoy your favorites again without the extra calories.

Transforming Holiday Classics into Healthy Well-Balanced Dishes:

Sweet Potato CasseroleInstead of Mashed Potatoes: Choose mashed sweet potatoes which contain more nutrients including fiber, vitamin C, potassium, and vitamin A. If you want to make traditional mashed potatoes, consider replacing milk and butter with broth. Adding cauliflower to mashed potatoes provides extra fiber and nutrients and will be equally filling with fewer calories.

Instead of Dark Meat Turkey with Gravy: Choose white meat and skip the skin. Turkey is a great source of lean protein if you choose the right parts. If you want to drizzle a small amount of gravy on top, try refrigerating the gravy beforehand and skimming the fat off the top to cut calories and fat in your savory topping.

Whole Wheat StuffingInstead of Corn Bread Stuffing: Try making your stuffing with whole wheat bread and add healthy additions like nuts, fruits, and vegetables. The added fiber in the bread, fruit, and vegetables will keep you full with fewer calories and less fat.

Instead of Pumpkin Pie: Serve pumpkin pie filling with cool whip.  Cutting out the crust will save calories and fat, and pumpkin is a good source in beta-carotene. You can also substitute low fat evaporated milk or light cream into your pumpkin pie recipe.

Instead of Green Bean Casserole: Modify the recipe by choosing a low fat cream of mushroom soup or using light butter. You could also serve green beans as a cold salad with nuts, onions and light Italian dressing.  Green beans are a great source of many nutrients including vitamin C, vitamin K, vitamin A and potassium and can be an excellent healthy addition to a holiday feast if prepared correctly.

Instead of Cranberry Sauce: Cranberry sauce from a can is very high in sugar and not nearly as nutritious as whole fresh cranberries. Cranberries are an excellent source of vitamin C and cooking cranberry dishes from scratch is a healthier way to enjoy the fruit. Trying cooking your own cranberry sauce, adding dried cranberries to a salad, or baking cranberry muffins.

22

12 2009

Winter Training: Preparing for the Slopes

Killer Skiing

by G. John Mullen, DPT 2011

With Thanksgiving behind us and winter weather in full effect, snow has already begun to cap the mountains across America.  With a layer of white powder on the ground, everyone is counting the days until they can escape from work, school or writing anonymous cynical comments on message boards and hit the slopes.  Whether you snowboard, sled, cross-country ski or bare foot ski, with the rush of mountain adrenaline comes the risk for injury.  We’re here to help you train those hard-to-reach, unused muscles for the slopes so that you are prepared for anything the mountain can throw at you.

Stat Fact: Lower extremity injuries were the most common injury in the Utah slopes from 2001-2006 for both snowboarding (~27%) and skiing (~50%).

Little HerculesWhether you’ve looking for exercises to prevent future knee injuries, strengthen your legs for the slopes, or help make that knee pain from that 1960 football injury (quit living in the past) go away, you can utilize the exercises below to strengthen weak muscles and lengthen tight muscles. We’ll discuss some plyometrics and exercises you can use to mimic skiing or snowboarding. Even if you’re as big as Richard Sandrack (see Lil Hercules at left) your bulging biceps and six-pack abs won’t prevent lower extremity injuries…training those targeted muscles will.

STRENGTHENING:

There are hundreds of exercises that can be used to train for the slopes.  We are going to talk about the main muscle groups that will prevent injuries and go over our favorite exercises to strengthen these muscle groups.  Unless you’re like hip hop video girl Vida Guerrera, you, like most Americans, may already experience knee or hip pain (or at least feel a little weak when it comes to these joints), due to weak gluteal muscles,.  As stated, there are hundreds of exercises to strengthen these muscles…so we’ve boiled it down to some key moves to get you started:

Overview of Strengthening:

When you first begin these exercises, start with the beginner exercises in your training of  those gluteal muscles.  At the beginning start with 3 sets of 20 repetitions and after two weeks add weight and try 3 sets of 10 repetitions.  After two more weeks add more weight and go 5 sets of 5 repetitions.  After this progressive process, advance to the intermediate exercises and repeat the same amount of repetitions and sets.

Beginner:

1. Clams:

ClamsLie on your side and bend you knees to 90 degrees and your hips at 30 degree with your legs one on top of the other.  Now just lift your top leg open like a clam, brilliant!

Stat Fact: By increasing the amount that your hips are flexed during this exercise (by bringing your knees towards your chest thus changing the angle from 30 degrees to 60 degrees) you change the gluteal muscle you are working, from gluteus medius to gluteus maximus.

2. Bridges:

BridgesLie on your back with your heels on the ground, but your toes in the air (lifting your toes makes sure you don’t use your calves and helps you to better isolate those gluteal muscles!).  Next, lift your lower back and butt off the ground by pushing through your heels.  At this point only your upper back and feet should be on the ground.  Note: a band can be used just above your knees to keep your legs from coming together, but is not necessary.  However, keep your knees apart!

After you’ve mastered double leg bridges, you can advance to single leg bridges or double leg bridges with weights on your hips.

3. Side-lying Leg Raise:

Leg RaiseLie on one side with one leg on top of the other, keep both legs straight and raise your top leg towards the ceiling.  Make sure your leg doesn’t creep forward.  To do so, keep it aligned with your hip or back (you should form a straight line from your shoulder to your hip to your knee to your ankle).

Stat Fact: If done properly, with your leg in correct alignment, this exercise requires the most gluteus medius activation of the exercises without weight.

Intermediate:

Lunges:

We’re not talking about your run-of-the-mill forward lunges.  We need to use exercises that are as close to skiing as possible, thus the use of multi-directional lunges.

Transverse Lunge1. Transverse Lunge:

Start with your hands on your hips and both feet facing forward like your feet are facing 12 on a clock.  Now, with one leg take a large step towards 2 o’clock.  Make sure your back foot rises on its toes and you don’t allow your front leg’s knee to come in front of your toes!

2. Lateral Lunge:

Once again, start with your hands on your hips and both feet facing forward like your feet are facing 12 on a clock.  With one leg take a large step towards 3 o’clock.  Lateral LungeMake sure your back foot rises on its toes and you don’t allow your front leg’s knee to come in front of your toes!

To advance the lunges, you can hold weights (or anything that will add extra weight) in your hands or if you’re at a gym you can put a bar on your back.

Advanced:

1. Single Leg Squat:

Single Leg SquatStand on one leg and slowly lower yourself bending at your hip, knee and ankle until you can touch the floor with your middle finger without reaching your shoulder.  Remember to stick your butt out as you come down and try not to let your knee come in front of your toes.  To advance this exercise, you can hold weights in either hand.

2. Single Leg Deadlift:

This exercise is similar to the single leg squat.  Single Leg DeadliftTo begin bend your knee slightly (~10 degrees).  Now bend at your hip and bring your chest towards the floor, reaching with your hand to touch the ground.  To advance the exercise, you can add dumbbell weights in each hand.

Stat Fact: Single leg squats and single leg deadlifts have been shown to have the highest gluteus maximus activation of any non-weighted exercise…buns of steel, here we come!

STRETCHING:

It is hard to predict what muscles will be tight on each individual, but if we were to grab 10 people off the Red Line subway in Los Angeles and test their muscle flexibility I would bet a liter of cola that 9 of those people have tight hamstrings, piriformis (a muscle in your butt… that’s all you need to know), calves and hip flexors.  What do you say we try and loosen those bad boys up.

Overview of Stretching:

As you move through the stretches outlined below, remember to stretch both legs, completing each stretch twice for 30 seconds or more.  It is hard to overstretch these tight muscles, so the more you do the better.

Hamstring Stretch:

Hamstring StretchLie on your back, grab the back of your thigh of one leg and begin to pull that leg towards the ceiling.  If done correctly, you should feel a stretch in the back of your leg and possibly in your calf.

Stat Fact: It is estimated that 80% of persons suffering from low back pain have tight hamstrings.

Piriformis Stretch:

Piriformis StretchOnce again, lie on your back but this time bend one leg over the other.  Now push your bent leg towards the ground, without lifting your back off the ground.  If done properly, you should feel a stretch in your butt.   You have now officially located your piriformis muscle.

Calf Stretch:

Calf StretchBeing by standing facing a wall with one leg in front of the other. with the leg to be stretched extended behind you.  With your hands on the wall at the level of your head lean forward.  You should feel a stretch in your calf.  The more you lean forward, the more stretch you will feel.  Repeat these same steps on the other side as well.

Hip Flexor Stretch:

Hip Flexor StretchPlace one knee on the ground and lunge forward with the other leg, keeping your back straight.  If done correctly, you should feel a stretch in the front of your leg around your hip on the kneeling leg.  As you push forward with your pelvis, you should feel the stretching increase in this area.

Plyometrics:

Plyometrics are activities that enable a muscle to reach maximal force in the shortest possible time.  These exercises are meant to be explosive, but need to done carefully and under proper conditions (outlined below):

  • Good landing surface (grass field, suspended floor, rubber mats)

  • Plenty of space

  • Proper footwear (no flip flops)

  • Supervision, it is highly advised to do plyometrics with a training professional (personal trainer, physical therapist)if you are new to the exercises

Since this is a high intensity exercise we will start with one basic exercise as well as some strategies for plyometric training.  First, it is important to complete a proper low intensity warm-up.  Begin with skipping, marching, or jogging. The total amount of time you spend on these activities needs to be strictly monitored.  It is recommended that beginners do a maximum of 80 contacts.  80 contacts simply means each foot should only hit the ground 80 times including the skipping and jogging warm-up.  Anyone doing plyometrics should also include the appropriate amount of rest between exercises (at least a minute per exercise).  Below are a few examples of beginner plyometric exercises that mimic skiing and snowboarding.  We highly recommend doing these beginner exercises with an exercise professional (at least when you’re first starting off…the only thing worse that hurting yourself on the slopes is hurting yourself while training for the slopes).

Forward/Lateral/Diagonal Jumps:

Just as they sound, these jumps are performed with both feet together and you jump either straight forward, to your side or diagonally.  To begin start by jumping, landing and then jumping again.  As you progress you can begin performing multiple jumps in a row.

Now that you know what strengthening, stretching and plyometric exercises to perform, make sure you always warm-up first (at least fifteen minutes of cardiovascular work to get your heart rate elevated and muscles warm).  Perform these stretches exercises every day and the strengthening/plyometrics no more than three times a week.  When you hit the slopes tell Shaun White hello for us.

Shaun White

References:

Distefano, L., Blackburn, J., Marshall, S., Padua, D. Gluteal Muscle Activation During Common Therapeutic Exercises. Journal of Orthopaedic and Sports Physical Therapy.  2009 Jul; 39 (7): 532-540.

Torjussen J, Bahr R. Injuries among competitive snowboarders at the national elite level. Am J Sports Med. 2005 Mar;33(3):370-7.

Wasden CC, McIntosh SE, Keith DS, McCowan C. An analysis of skiing and snowboarding injuries on Utah slopes. J Trauma. 2009 Nov;67(5):1022-6.

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