Archive for January, 2010

What on earth is Iliotibial Band Friction Syndrome?

by G. John Mullen, DPT 2011

IT Band SyndromeWho doesn’t want to be in great shape?  Ask around and you’ll be hard pressed to find an individual that is actively trying to be out of shape.  So what is it that we, as a society, do when we decide to get in shape? We go running.  Running is the most popular and simplest form of exercise. The most popular and simplest form of exercise is running.  Running is great cardiovascular exercise, however many injuries stem from running and often arise from doing too much too early.  One of the most common injuries is iliotibial band friction syndrome (ITBFS).  This injury can linger for long periods of time without quick and proper treatment but if assessed and treated soon, the effects can be mitigated.

Stat Fact: Health club memberships typically increase 12% in the month of January (4).

What is ITBFS?

IT Band Friction SyndromeThe iliotibial band is a fibrous band that runs on the outside of your leg from your hip to your knee.  It is generally firm, but as it is irritated it may become extremely tough and sensitive.  Irritation of the iliotibial band can be due to poor biomechanics, anatomical flaws or muscle weakness.  Many of the biomechanical flaws stem from muscle weakness, but the anatomical flaws are a bit trickier.  The main anatomical flaw is flat feet, which causes your knee to internally rotate with each step, subsequently stretching your IT band.  While stretching is typically good, when done repeatedly it can break down the tissue and inflammation and tightness can occur.  The most common biomechanical flaw is too much hip adduction (bringing your thigh bones close to one another) and internal rotation (rotation of the knee inward) of the thigh bone (femur).  This motion is controlled by the gluteus maximus (the upper fibers to be exact…also the sexiest muscle in the body) and if this muscle is weak it can cause repeated stretching of the muscle leading to problems similar to those seen with anatomical flaws.  These are the main causes of ITBFS, but many other anatomical issues may cause ITBFS (leg length discrepancy, bowed legs, previous injury, improper footwear, etc.).  However, simple muscle strengthening is not the solution, especially if you already have ITBFS. Read the rest of this entry →


01 2010

Creatine is Going To Pump You Up?

by Tania Houspian, PharmD 2011

Arnold the Body BuilderYou can picture it now: Your New Year’s resolution to get in shape finally realized. You’re on the beach in your Speedo with your muscles glistening in the sun. Ok, maybe that’s not exactly what you are imagining the finished product to look like. Perhaps your New Year’s resolution was geared more towards building bigger muscles and getting in better shape rather than becoming the next World’s Strongest Man (skin bronzer, shaving, and Speedos may not be your style).  Nonetheless, you do want to become more muscular.  If so then creatine is the one supplement all your Google searches for “build more muscle” will undoubtedly produce.  Creatine is possibly the most widely used and talked about dietary supplement in the world of bodybuilding.   It’s definitely something a lot of people come into pharmacies and nutrition stores looking for. The question, of course, is “Does it work?”

Before we answer that question here’s another one: What is creatine?

Creatine is not, I repeat, is NOT a steroid. Creatine is a protein your body (specifically your liver) makes. You also get creatine from foods like meat and fish. The creatine that is made by your liver or that is absorbed from food is then stored in muscles. An average 70kg (154 lbs) person has about 120g of creatine stored in their muscles and metabolizes about 2g of creatine each day (which is easily replenished from your diet or liver).  Creatine PhysiologyIn the muscles, creatine acts as a battery charger.  In this case the battery is your body’s energy stores called ATP.  When muscles use up ATP to perform an action it is converted into ADP. Creatine is able to convert ADP back into ATP, which can once again be used by your muscles to perform actions.  This is a quick and easy way for the body to create more energy (twice as fast as the bodies normal way of deriving ATP from glucose).  Sounds great, right?  The downside is that the creatine is depleted pretty quickly and the body has to go back to breaking down glucose to make more ATP.  So when an athlete takes creatine, their hope is that it will help their muscles maintain the ATP levels for a longer period of time subsequently allowing them to train longer before becoming fatigued.

Aside from increasing the amount of work your muscles can perform before becoming fatigued, there are other theories about how creatine helps build more muscle:

  1. Creatine pulls water into muscle cells via osmosis (remember osmosis from high school chemistry?), helping keep muscle cells hydrated and making your muscles appear rounder and fuller…possibly the origin of the common gym phrase, “Getting swoll”

  2. By delaying the muscles’ use of glucose to generate ATP, creatine also helps delay the creation of lactic acid (a byproduct of glucose use). Lactic acid is what makes your muscles burn and causes you to feel sore the morning after a tough workout (yes, lactic acid is to blame for the “I was just hit by a big rig” sensation).

So far we have discussed theories about creatine’s ability to improve muscle building.  What we really want to know is if any of them have been proven.  The answer is yes and no. Given the popularity of creatine as a workout supplement there have been hundreds of studies done to examine its efficacy and safety. The studies reviewed asked participants to consume 20 Bench Press Strength Traininggrams of creatine supplements a day for five days (called creatine loading). Then the subjects were asked to consume 5 grams of creatine per day for 21 days. Theoretically, this would increase the stores of creatine in their muscles. The participants were then asked to perform various exercises and their results were compared to their pre-supplementation results. The studies show that creatine does help increase body mass and it does help increase endurance in short-duration, high-intensity exercises (they specifically looked at number of bench press reps, leg press reps, and vertical jump height). However, creatine did not help the men in long endurance exercises such as running a 12 mile race (creatine actually hurt test subjects in long endurance exercises, possibly because they were carrying around excess body mass).  Creatine also did not decrease the amount of post-workout soreness reported by the subjects. The amount of soreness felt was the same before using creatine and after the supplementation period.

The Verdict: Creatine is not a wonder supplement.  You can’t take it, go to sleep, and wake up with bulging muscles.  It is, however, something you can take if you are serious about working out as it may help you increase your stamina and strength with specific workouts.

Now to the most important information: Is it safe and are there any side affects?

Initially, there were reports of creatine causing dehydration, cramping, and kidney & liver damage.  Athletes taking creatine were subsequently warned to not work out on hot days and to be cautious of any cramping the experienced.  That sounds pretty ridiculous to us: if you’ve ever worked out hard you know that cramping is Football Trainingbound to happen from time to time.  To test out these claims more studies were done. The main study on this subject was performed on 14 football players who were told to consume creatine for 8 weeks.  They chose football players as the athletes to use as guinea pigs…I mean test subjects…because football is considered a high-intensity, short-duration exercise (which is exactly the kind of activity creatine is supposed to aid in).  During the 8-week time period the athletes’ kidney function, liver function, and over health were closely monitored. Their results regarding creatine efficacy paralleled those of other previous studies showing that body mass increased and the athletes’ abilities to perform high-intensity, short-duration exercises did improve.  As far as toxicity goes, no signs of kidney or liver damage were seen in any of the patients.  In addition, none of the football players became dehydrated or had more cramping than they did at baseline.

Before we go waving our “Creatine is Safe” flag, a few things should be pointed out.  First, the studies were done on healthy, young males.  People who have liver or kidney problems to begin with should not further challenge their organs unless they are Waterunder the close supervision of a health professional.  Studies have not been done with people who have kidney or liver problems so it is hard to say how it may affect them.  Second, all these studies were short term (8 weeks was the longest one performed) so no one really knows the long-term effects of taking creatine.  Many of the problems initially reported with creatine supplementation could have been due to impurities in the creatine supplement people were purchasing thus it’s always important to buy supplements made by a well known and trusted company (i.e. don’t order it off the web from some no name company just because shipping is free).  In addition, be sure to consume plenty of water when using creatine.  Remember that creatine pulls water into your muscles (and out of your body’s circulation).  You need to make sure that you are replacing this displaced water while using creatine to prevent dehydration.

The Final Verdict: If you are serious about working out and are looking for a supplement to provide you with additional stamina to help you strength train for longer periods of time then creatine may be the way to go.  Some things to keep in mind when shopping around:

  1. Most of the studies used creatine monohydrate powder as their creatine source (there are more expensive formulations with fancy names but this formulation seemed to work well in the studies).

  2. No consistent standards were set for the loading phase of creatine use but 20 grams per day (split into 4-5 grams doses throughout the day) for 5 days seemed to be the most common approach. Note, however, that consuming that much creatine is going to upset your stomach.

  3. It was recommended that the average person who wants to gain body mass should supplement with 2-5 grams of creatine per day when working out.

  4. Make sure you’re buying high quality creatine from a reputable manufacturer at a reasonable price.

Now go hit the gym mister.

Body Building


Bemben M, Lamont H. Creatine Supplementation and Exercise Performance Recent Findings. Sports Med 2005; 35 (2): 107-125

Cancela P, Ohanian C, Cuitiño E, et al., Creatine supplementation does not affect clinical health markers in football players. 2008 Sports Med 42: 731-735 .

Dalbo V, Roberts M, Stout J, et al. Putting to rest the myth of creatine dehydration and supplementation leading to muscle cramps. Br J Sports Med 2008 42: 567-573

Herda T, Beck T, Ryan E, et al. Effects of Creatine Monohydrated and Polyethylene Glycosylated Creatine Supplementation on Muscular Strength, Endurance, and Power Output. 2008. The Journal of Strength and Conditioning Research.

Lopez R, Douglas C, McDermott B, et al. Does Creatine Supplementation Hinder Exercise Heat Tolerance or Hydration Status? A Systematic Review with Meta-Analyses. 2009; Journal of Athletic Training. 44(2), 215-223.


01 2010

Meatless: The Ins and Outs of Vegetarian Eating

by Leah Frankel, MS, RD

VegetablesHave you ever looked at your recently-turned-vegetarian friend and wondered what the heck they are thinking? With more and more people now considering themselves vegetarians it makes us wonder, “How do they do it?”  You’re probably wondering why someone would ever want to give up meat. Additionally, aren’t vegetarians missing some key life-sustaining nutrients.  We are omnivores for a reason.  We’ll learn about the different varieties of vegetarians, why people chose a vegetarian lifestyle and what nutrients vegetarians need to be sure they include in their meals to have a well-rounded diet.

Types of Vegetarians

By definition, a vegetarian is someone who doesn’t consume meat, poultry or fish.  The spectrum of vegetarians is vast and we’re here to help you decipher the differences. Even within each classification of vegetarian, there are variations depending on the individual’s needs or reasons for becoming a vegetarian.

Pescatarian: A pescatarian is someone who eliminates all poultry and meat but consumes fish and seafood. This has become increasingly popular due to health advantages of fish consumption or as a first step in becoming a vegetarian.

Delicious SaladSemi-Vegetarian: Someone that follows a semi-vegetarian diet follows a vegetarian diet the majority of the time but occasionally eats meat, fish or poultry.

Lacto-ovo Vegetarian: People who follow a lacto-ovo vegetarian diet avoid meat, poultry and fish; however they do eat dairy (lacto) and eggs (ovo). In addition, some people are either lacto vegetarians (consuming dairy, but not eggs) or ovo vegetarians (consuming eggs, but not dairy).

Vegan: A vegan is a person that, in addition to not consuming meat, poultry or fish, does not eat any foods that are of animal origin including eggs, dairy, gelatin and honey. In addition, many vegans refrain from wearing leather or other products made from animals, as well as products that are tested on animals.

Reasons to “Go Veggie”

Religious reasons: A variety of religions promote vegetarian or vegan diets including Buddhism, Jainism, Taoism, Hinduism, and Seventh day Adventists. Each religion encourages a vegetarian diet for a variety of reasons including health benefits (in the case of the Seventh day Adventists) and respect for living creatures (as seen with Buddhism).

Health reasons: There are a number of health benefits associated with following a vegetarian diet including:

  • Lower rates of obesity

  • Decreased risk of chronic diseases including type 2 diabetes, heart disease, high blood pressure and certain types of cancer

  • Longer lifespan

  • Reduced risk of food-borne diseases

  • Nutrient intakes that are closer to current nutrition recommendations

Ethical reasons: Some people choose to eliminate meat from their diet due to the treatment that animals receive, including how they are raised, transportation to slaughter houses, processes uDon't Eat Puppiessed to slaughter animals and believing that animals have rights, similar to those of people.

Environmental reasons: There are a number of benefits for following a vegetarian diet in terms of protecting the environment including: preserving water resources, preventing water pollution, preserving the earth’s ecosystems, and reducing the consumption of the earth’s resources.

Getting Your Vitamins from A to Zinc

In order to plan a well-rounded vegetarian diet there are a few nutrients that vegetarians and vegans need to be cognizant of and be sure to incorporate into their diet:

Protein: Most people assume it will be difficult to meet their protein requirements as a vegetarian, however most American’s consume twice as much protein as they need; most vegetarians are able to meet their protein requirements with a little planning. Daily requirements for protein depend on gender and body weight.  Symptoms of protein deficiency include edema (swelling, usually on the extremities), weight loss, thinning or loss of hair, general weakness, slowness in healing of wounds and bruises, headache, and difficulty sleeping. Vegetarian sources of protein include: beans, lentils, tofu, chickpeas, dairy (for lacto- or lacto-ovo vegetarian) and eggs (for ovo- or lacto-ovo vegetarian).

Silk SoymilkVitamin B12: Vitamin B12 is only naturally found in foods derived from animals. A lacto-ovo vegetarian likely will have an adequate intake but a vegan may not. Options for meeting your vitamin B12 requirements include taking a B12 supplement (pill form), eating foods fortified with vitamin B12, or receiving regular vitamin B12 injections from your physician (usually monthly).  Symptoms of vitamin B12 deficiency include anemia (particularly one subtype called megaloblastic anemia), fatigue, weakness, constipation, loss of appetite, weight loss, numbness or tingling in hands and feet, depression, confusion, and dementia.  Daily requirements for vitamin B12 vary by age and gender.  egetarian sources of vitamin B12: fortified cereals, nutritional yeast, soymilk, and soy products.

Iron: There are two types of iron: heme iron and non-heme iron. Heme iron is the iron found in hemoglobin (which carries oxygen in a red blood cell). Pistachios This form of iron is only found in animal products and is more readily absorbed than non-heme iron. However, non-heme iron’s absorption is improved when consumed with vitamin C (so be sure to include vitamin C in your iron-enriched meal).  Daily iron requirements vary by age and gender.  Symptoms of iron deficiency include anemia, fatigue, pale skin, weakness, shortness of breath, headache, dizziness, cold hands/feet, and brittle nails.  Vegetarian sources of non-heme iron: pistachios, cashews, chickpeas, sesame seeds, dried fruits, and spinach.

Calcium: Since vegans and ovo-vegetarians don’t consume dairy, it’s important to ensure adequate calcium intake. Symptoms of calcium deficiency include twitching, seizures, and tetany (extreme stiffness and rigidity in your muscles).  Vegetarian sources of calcium: kale, collard greens, broccoli, legumes, figs, almonds, tofu, and fortified soymilk.

FlaxseedOmega-3 Fatty Acids: The primary source of omega-3 fatty acids is fish, so unless you’re a pescatarian it can be difficult to have an adequate intake. Vegetarian sources of omega-3 fatty acids do not contain the active form of the nutrient that your body needs so supplements with flax seed oil may be necessary. Daily omega-3 fatty acid requirements vary by age.  Symptoms of omega-3 fatty acid deficiency include fatigue, dry/itchy skin, brittle hair, weak nails, constipation, depression, and poor concentration.  Vegetarian sources: soy, walnuts, canola oil, flaxseeds and pumpkin seeds.

Will following a vegetarian diet make you healthier? Not necessarily. As people often forget, vegetarian diets can include plenty of unhealthy foods including french fries, donuts, pizza and ice cream. However, most vegetarians consume more fruits and vegetables, and eat less unhealthy fats (trans and unsaturated) than their meat-eating counterparts. Not ready to completely change your diet? Try going veggie once a week and discover fun new vegetarian dishes!


01 2010

Pain in the Neck: Fixing the Problem at its Root

Massage on Demand

by G. John Mullen, DPT 2011

Neck PainNeck pain: We’ve all had suffered through it at least once in our lives as it is one of most common areas of the body to cause pain.  However, it may be hard to diagnose the primary cause of your neck pain.  Let’s pretend you sit at a desk for 40 hours a week for work/school, and then come home and sit at a desk watching Hulu for a few more hours. Just a hunch, but I think the excessive sitting may be causing some of your neck pain.  Sitting this long is not natural for once nomadic humans.  In addition to sitting for these long hours, most people make it worse by maintaining poor posture while sitting (which is not entirely your fault…humans were not designed to sit for the long durations that our modern lifestyles require).  Despite our societal evolution, our anatomy has not adapted.  As a result, we must actively adapt our bodies to the new societal demands.  Lucky for us, we can make these changes to help improve and possibly prevent most unnecessary neck pain.

Stat Fact: It is estimated that 70% of all muscle injuries that occur without a known accident are sprains or strains.

Neck Anatomy:

The cervical spine is composed of many muscles that are contorted, stretched and shortened with poor posture.  These muscular changes can cause pain in various areas of the spine and in other body parts (shoulders, middle back, etc.).  With sustained poor posture, tiny muscles in the back of your head (suboccipital muscles) tighten or shorten.  Unfortunately, the body compensates by shortening, stretching or elongating the muscles in the front of your neck (your deep neck flexors).

Ways to tell if this is causing your pain…

If you are having neck pain and you think it’s from your poor posture, here are some telltale signs your neck pain is due to your posture:

  • Persistent neck or shoulder blade aching

  • Symptoms worsen with sustained poor posture

  • Muscle imbalances (weak deep neck flexors and weak rhomboids)

Some simple tests you can do to test yourself:

1. Deep neck flexor test:

To perform this test lie down on your back and lift your head off the ground by tucking your chin in tight, as if you’re making a double chin (some people have to try harder to achieve this).  While holding your head 1 inch off the ground, keep your chin tucked as long as humanly possible (shaking and the urge to urinate may be present if one has extreme muscle weakness).  If you unable to hold your neck folds for approximately 30 seconds then you have weak deep neck flexors.

Stat Fact: Patients with neck symptoms (pain, for example) produced 15% less pressure than patients without neck symptoms in the deep neck flexor test.  The bottom line: people with neck pain are usually weak in their deep neck flexors.

2. Neck Rotation Test:

Another simple test to be done at home is a neck rotation test.  Rotate your neck to each side slowly and if your symptoms or pain increases as you rotate more, then your neck pain is probably caused by posture problems.

What to do next?

You have a few of the neck symptoms described above and your neck muscles aren’t as strong as Žydrūnas Savickas…don’t be discouraged there is hope for you!  First and foremost, correcting your posture is the number one cure for this ailment.  I know holding good posture is hard, but so is eating 66 hot dogs in 12 minutes and that didn’t stop Joey Chestnut did it?  A few tips for holding proper posture while at a computer or sitting down:

  • Keep your feet on the floor!  You’re not a six year old kid in elementary school.  Put both feet on the floor and keep them there!

  • Keep your back against the chair, especially your upper back.  If your back is not against the chair there is a high chance you are leaning forward.

  • Keep your chin tucked.  You’re not finishing a 100 meter sprint against Usain Bolt.  Keep that chin tucked.

  • Keep your shoulder blades close, don’t round that back!  I know many people dreamed of being a Teenage Mutant Ninja Turtle growing up, but we hope you’ve outgrown that fantasy.  No need to round out your back as an adult.


Next is a routine of stretches we recommend doing in the shower on a daily basis.  All of these stretches should be done twice for 30-45 seconds each.

1. Armpit Sniffer:

The arm pit sniffer is a favorite of ours for numerous reasons.  While standing, look down towards your armpit as if you were checking to see if that Old Spice has kicked in.  If done correctly, you should feel a slight pull on the neck of the opposite side.  This is stretching the levator scapulae, a muscle that is commonly tight with poor posture.   The picture shows the person pulling their head toward their armpit, but if this muscle is really tight, just looking in the direction will provide a proper stretch.

2. Corner Stretch:

Pectoralis StretchThis stretch is used to stretch the pectoralis muscles that are often tight due to extended periods of time sitting or at a computer.  To complete this stretch, find a doorway and put the inside of your bent arm on the surface of the wall at shoulder height.  To feel the stretch turn your body away from the arm, and you should feel the stretch in chest (amazing ponytail as seen in the photo is optional).

3. Scalene Stretch:

To complete this stretch, hold on to something for support because you will be tipping your head backwards and towards the opposite shoulder.  Tip your head slightly back and to the side, the picture shows the person pulling his head back, this should only be done if you do not feel a stretch in the front of your neck with the initial movement.

4. Upper Trapezius stretch:

This is the simplest of all the stretches.  Without rotating your neck, tip your head, as f you were trying to touch your ear to your shoulder.  If you do not feel a stretch on the  opposite side you can use overpressure with your hand to elicit the desired stretching sensation.


Strengthening exercises should be performed with high repetitions to help build endurance.  We recommend 5 sets of 10 repetitions, 3 times a week for best results.  These exercises may seem simple, but if used properly they can alleviate your nagging neck pain.

1. Chin Tucks:

Similar to the deep neck flexor test done earlier, lie on your back and tuck your chin, lifting your head 1 inch off the ground.  Make sure you hold the double chins in your neck.  Hold for 30 seconds (or as long as you are able to if you cannot hold for 30 seconds) each set and complete 5 sets 3 times each week.  And, yes, this exercise falls into a category of exercises know as “Not sexy but very effective!”

2. Scapular squeezes:

Begin this exercise sitting down and, just as the name suggests, and squeeze your shoulder blades together.  By pinching your shoulder blades together, your chest will stick out slightly.  Make sure not to lift your shoulders towards your ears while holding this position!  Hold this position for 30 seconds each repetition and complete 5 repetitions per day 3 times a week.

3. Upper Cuts:

Upper Cut Exercise

Begin with your knees bent 15 degrees and as you start the upper cut movement, punch towards your opposite shoulder (your bicep should come towards your mouth) and push through your legs.  You can make the exercise more difficult holding a weight in your hand while punching as seen in the photo.  This exercise is used to strengthen the serratus anterior.

Stat Fact: Neck musculature is estimated to contribute 80% to the stability of the cervical spine.

These are some of the exercises and stretches that can be used to help people minimize neck pain.  Next time you’re sitting at your desk, think twice about leaning forward to read the computer screen.  If your neck pain persist or worsens after doing these exercises for a few weeks, talk to your medical doctor about additional treatment options.

Your Future Muscular Neck


Deyo RA, Weinstein JN. Low back pain. N Engl J Med 2001;344:363–70.

Chiu TT, Law EY, Chiu TH. Performance of the craniocervical flexion test in subjects with and without chronic neck pain. J Orthop Sports Phys Ther. 2005 Sep;35(9):567-71

Ekstrom et al, Surface Electromyographic Analysis of Exercises for the Trapezius and Serratus Anterior Muscles, J Orthop Sports Phys Ther 2003;33:247–258.

Childs J, Cleland J, Elliott J, Deydre T, Wainner R, Whitman J, et al. Neck Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Orthopaedic Section of the American Physical Therapy Association. J Orthop Sports Phys Ther. 2008;38(9):A1-A34.


01 2010

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