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As a lifelong athlete, the transition between team sports in high school and college to individual fitness has been challenging. In an effort to push myself and up my fitness level I signed up for a sprint triathlon 2 summers ago. A 1/2 mile swim, 14 mile bike, and 3.1 mile run lay ahead of me. Although participating as an individual, for the first time since I had stepped off the basketball court the drive to compete and make myself better took over. Are you thinking of signing up for a triathlon but unsure how or where to begin?Here is my guide to some of the more common questions regarding triathlon training and injury prevention.

Do I have to be a good biker, runner, and Swimmer to do a triathlon?

You do not have to be a good biker, runner, and swimmer to do a triathlon. The most important part of a successful triathlon is safety.  Know your race course prior to the race and the rules. Stay well hydrated and practice proper nutrition.

In terms of the swim, is there a current in the water you will be swimming in and which direction will it go? 

A beginner triathlete should stay at the back and out wide of the swim pack since the start can be crowded and physical.  During the swim there are kayaks and boards in the water to grab onto should the triathlete run into trouble.

In terms of biking, are there any sharp turns, uneven surfaces or high traffic areas during your bike? 

Make sure you check out your bike before the race.  Make sure there is nothing in the tires that can cause a flat, and that they are properly inflated, and check the brake pads for wear and in proper position.The run is the safest which is why it is last.  You can always walk as needed. There are different lengths of triathlons so you do not have to be good at all the disciplines. Start off with a sprint distance and build up.  Make sure you are training each event properly and ensure you practice your transitions, especially the bike to run.

How far in advance should I start training?

That is dependent upon the length of the race you are training for and how in shape/active you are prior to beginning your training.  If you know the mechanics of the swim, bike, and run, are in fairly good shape and want to do a sprint race, give yourself a minimum of 2 months.  If you need to learn technique, are fairly inactive at baseline, or are planning for a longer race (ie full Ironman or half Ironman), more time is required. I would estimate anywhere from 6 months minimum to 1 year, also depending on race goals and weekly hours available for training.

Besides the obvious biking, running, and swimming are there a few exercises (weights) that I should be doing to avoid injury?

YES!!!  Cross training is very important.  Thinking about the demands of each event, anterior musculature gets very tight.  For example, pecs and anterior shoulder in the swim & bike, hip & neck flexors on the bike, and hip flexors, calves, quads with the run, just to name a few.  Quad, hip flexor, calf, pec, and neck stretching is very important, It is also a good idea to invest in a foam roller. In terms of strengthen exercises core stability is important:  planks (front & side), rotations with weighted medicine ball, etc.  For lower extremity I like a variation of squats and lunges, as well as resisted side stepping as to not neglect the gluteus medius which is really needed for stability during the events.

For upper body pushing activity for chest (push up, chest press), follow by pulling (rows, lat pulldowns, pull up).  I also like to add in scapular stability (ie external rotation & middle/lower trap T/Y exercises) This is widely neglected and can result in shoulder impingement symptoms during the swim and is needed for upper body support during the bike. Not all of these exercises & stretches need to be done in one session.  I would recommend one session of cross training per week, then incorporating the stretches and a couple of the exercises into each workout (ie, after a bike workout, stretch out the hips, quads and pecs, do a few sets of pushups and planks:  DONE!)

What equipment will I need to invest in?

A bike, helmet and all the bike support equipment.  You may want bike gloves as well. It is also important to learn how to fix a flat tire and keep spare inner tubes, tire levers, and a CO2 cartridge in a saddle bag under your seat. You should also have a good tire pump at home. For the swim, if it is open water you will want a wetsuit and goggles.  The wetsuit will keep you warm in cold water and provide buoyancy. Body glide helps to get your wetsuit on and prevents chaffing of the skin.
The run is easy:  running sneakers!

Any motivational training tips?

Have fun with your training, it can be a lot.  Have a good training plan to follow so you feel organized, but don’t get down if you miss a session or it doesn’t go as planned.  Also, remember to add in rest and active recovery days.  If your body is struggling, it is saying it needs a break and listen to it.  Your training will be better off for it.  The next session you will come back feeling stronger and more energized! Happy training and good luck!

With each triathlon I have participated in, I learn something new about myself and my training. Below is a picture of my dad and I after completing my first sprint triathlon. The following year I crushed by time by 13 minutes!

For more information on training tips and injury prevention visit us at www.premierptny.com

Charissa Morrisroe, DPT

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An injury can take you out of the game of life.  When you are injured your priority becomes finding the quickest way to recover. Physical therapy is essential to healing your injury. But what role does food, diet and nutrition play?

Nutrition to Heal Your Injury

The inflammatory process is what initially happens when you are injured. Inflammation causes pain, swelling and redness. We have been taught (mostly through big pharma) that inflammation is bad- hence aggressive use of non-steroidal anti-inflammatory drugs prescribed daily. The inflammatory process should actually be called the HEALING process, as this is what is occurring on a cellular level.

The standard American diet is known to cause a pro-inflammatory state—not what you want when you are healing. A pro-inflammatory diet creates an unfavorable environment for tissue to heal. A diet high in processed foods, sugar and an imbalance of omega-6 to omega-3 fatty acids contribute to inflammation. Some of the foods and items that cause inflammation are:

• Refined sugar & artificial sweeteners
• High fructose corn syrup
• Hydrogenated oils and damages fats
• Processed meats (lunch, smoked)
• Commercial meat and dairy
• Farmed fish
• Processed Omega-6 oils (corn, soy, canola)
• Food additives (MSG, nitrates, nitrites)

Proper nutrition will keep the healing process moving. Poor dietary choices can lead to deficiencies in essential vitamins and minerals. Below are a few major players in the healing process that you should be aware of as you’re filling your plate with nutritious foods. Consider the following foods and/or supplements to help moderate inflammation and promote tissue healing:

Foods Rich in Vitamin C

Vitamin C plays an important role in collagen formation and is a powerful antioxidant. Foods rich in vitamin C are guava, red bell pepper, broccoli, green bell peppers, strawberries, grapefruit, kohlrabi, papaya, Brussels sprouts, kiwi, mango, oranges.

Foods/Supplements Rich in Omega-3 Fats

Omega-3 fats have been shown to decrease inflammation in patients with rheumatoid arthritis, improving pain and joint stiffness. Avoid farm raised fish as they have a high omega-6 content which can increase inflammation. Wild caught, cold water fish are high in omega-3 fatty acids. Other omega-3 rich foods are flax, chia, hemp, walnuts, leafy greens and fish oil.

You can supplement with omega-3 fatty acids daily. Here is the omega-3 we use in our practice.

 

 

Foods Rich in Vitamin A

Vitamin A modulates the inflammatory process and helps strengthen collagen cross-links. Some foods high in vitamin A are carrots, pumpkin, sweet potato, spinach, collards, kale, watercress, beets, winter squash, tomatoes, dried apricots, mango.

Foods Rich in Copper

Copper works with vitamin A to strengthen connective tissue. Foods with copper include: mushrooms, green leafy vegetables, barley, soybeans, tempeh, sunflower seeds, navy beans, garbanzo beans, cashews, molasses, beef liver, oysters, lobster, crab, chocolate, cocoa powder.

Protein and Amino Acids
Protein is needed to rebuild muscle, tissue and heal. Increased protein is recommended during times of tissue repair (post-surgical, physical therapy, strength building) from the normal 0.8 grams/kilogram to ~1.5 grams/kilogram. At a minimum 1 gram of protein per pound of body weight is needed. Branched chain amino acids (valine, leucine, isoleucine) are especially helpful to decrease inflammation, assist in muscle repair, prevent oxidative stress and minimize recovery time. Chose high quality, organic sources of protein such as meat, poultry, fish, eggs and dairy. Supplementing with a protein shake is another strategy for obtaining the necessary protein and branched chain amino acids required for healing.

Here is the vanilla protein shake we use in our practice. This shake is dairy and gluten free and has all three branched chain amino acids necessary to assist the healing process. It can be used to supplement you protein needs, as a post-work out shake or as a meal replacement for those decreasing energy needs with the hope of loosing weight.

 

 

 

Other Tips

Keep a food journal trying to correlate the foods you eat with an increase in symptoms of pain or inflammation.

See if you notice any correlation. When is your pain better or worse? Do particular foods make a difference?

Many people find when they remove inflammatory foods or foods they react to, they have less joint pain.

Looking for more advice on healing, nutrition and weight loss?

Contact us at www.premierptny.com for more information.

In good health,

Joe Tatta, DPT

References

Cruzat et al. Amino acid supplementation and impact on immune function in the context of exercise. J of International Society of Sports Nutrition. 2014, 11:61.

Seaman DR. The diet-induced proinflammatory state: a cause of chronic pain and other degenerative diseases? J Manipulative Physiol Ther. 2002 Mar-Apr;25(3):168-79.

Vasquez A, Musculoskeletal Pain: Expanded Clinical Strategies. Gig Harbor, WA; The Institute for Functional Medicine 2002.

 

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Physical Therapy – it’s more than just for “Broken Bones”

What is Physical Therapy? The definition of who Physical Therapists are and what they do is often a broad and not well understood concept, and it changes based on personal experience. You may think: “where I would go after I sprained my ankle playing basketball”, or “the person who helped my Grandmother walk in the hospital after her knee replacement”. Like these two very different experiences, Physical Therapy covers a vast number of settings with a variety of different treatment techniques throughout the world.

The American Physical Therapy Association (APTA) defines PT’s as “highly educated, licensed health care professionals who… [use a variety of] treatment techniques to promote the ability to move, reduce pain, restore function and prevent disability.” ¹ This definition, however inclusive, still leaves a lot of questions when really trying to explain all the ways PT can be utilized. This post is an inside look at some of the unique and less commonly known ways that PT can be utilized to PROMOTE your personal health and wellness, as well as PREVENT pain or unnecessary doctor’s visits.

THE GYM

You don’t have to be in pain to benefit from PT services; maybe that random clicking in your shoulder isn’t as harmless as you think? We have all made that New Year’s resolution that we will go to the gym more, or maybe to try a new running regime. Or maybe you’re trying to start back into an old program after an injury? In any case, PT’s are a great addition to the team to help you reach those goals. PT’s are extensively educated on the physiology of exercise, the risks/benefits of different exercises, as well as proper running and weight lifting form. Unlike other exercise professionals, PT’s also have the exclusive knowledge of how each muscle responds to injury, and can evaluate and correct dysfunction and/or imbalance. What better way to start your healthy lifestyle off right, than with the skilled professional who can determine how you’re moving, and more importantly how you SHOULD be moving.

DESK JOBS

As it turns out, our bodies weren’t made to sit using a computer for 8+ hours per day, and your body may already have started to tell you that. That occasional episode of neck pain when you wake, or that achiness in your low back when you are sitting too long, may actually be more harmful than you think. Recent studies have demonstrated that within 10 minutes of sitting at a computer, your posture already begins to deteriorate³. So before you start to suffer from chronic neck and back pain, headaches, carpal tunnel syndrome, or any of the other various overuse injuries, you should talk to the experts in postural education. PT’s have a special skill set in which they can spot dysfunction before it causes pain, and have the knowledge to correct it. Let us help ensure that you have a safe and pain-free work day!

HEADACHES

Headaches are one of the most common types of “pain” that people experience. Like most causes of pain, headaches can have numerous causes, such as nerves, blood vessels or muscles and joints, and the first line of treatment is commonly medications². While some types of headaches do require medication or a physician’s visit, a large percentage are muscular or joint related. Many of the muscles and joints surrounding the head, neck, and shoulders can get tight, stiff, and irritable with poor postures and overuse. Each of these muscles and joints has specific areas of the head, face and jaw that they can refer pain to, which is commonly interpreted as a headache. Luckily, studies have shown that physical therapy is an effective way to decrease the frequency of these headaches, and to a lesser degree the duration and intensity².

DIZZINESS

Almost everyone has experienced dizziness upon standing up too fast. However, for many people these symptoms can continue for more than a few seconds, lasting hours or even days. There are many possible causes of dizziness and imbalance, such as vestibular/inner ear dysfunction, blood vessel compression and more commonly, dizziness stemming from underlying cervical dysfunction. With cervical-based dizziness, the joints, muscles and ligaments are the cause of dizziness along with other possible symptoms, and often these symptoms will increase with neck movements⁵. Physical Therapists are trained to evaluate all the different types of dizziness to determine where your symptoms are coming from, and the necessary treatment to get you back to your life.

SURGERY and SCAR TISSUE

Every time a surgeon cuts, a scar is formed. These scars are similar to an iceberg, where the scar may look small on the surface, but actually extends throughout the entire incision to where the surgery was performed. When scar tissue is formed, the body produces it in a disorganized way and the tissue may adhere to nearby structures, restricting motion⁴. This can leave you feeling very stiff, and can even create pain in surrounding structures due to the scar tissue. Seeking Physical Therapy to help mobilize these scars and restore motion is an important part of recovery from any surgery, whether you had Cardiac surgery or a knee replacement.

Physical Therapy doesn’t have to be the last resort when you’ve grown fed up with pain. New York State has direct access to PT services, meaning that you can see a PT without going to your doctor first. So, give us a call today, and let your new Physical Therapist be part of your health care team, promoting correct and pain-free movement with your daily activities, and preventing serious injury later on. And if it’s too late and you’ve already experienced an injury, let us get you back to your life and work to prevent future injuries!

Contact us at www.premierptny.com to learn more and schedule an appointment with a physical therapist.

Lauren Carleton, DPT

1. American Physical Therapy Associated Website: http://www.apta.org/AboutPTs/
2. Chaibi A and Russell MB. Manual therapies for primary chronic headaches: a systematic review of randomized controlled trials. The Journal of Headache and Pain. 2014; 15(67).
3. Falla D, Jull G, Russell T, Vicenzino B and Hodges P. Effect of Neck Exercise on Sitting Posture in Patients with Chronic Neck Pain. Physical Therapy, April 2007; 87(4) 408-417
4. Hardy MA. The Biology of Scar Formation. Physical Therapy. 1989; 69(12): 1014-1024.
5. Yacovino DA and Hain TC. Clinical Characteristics of Cervicogenic Related Dizziness and Vertigo. Semin Neurol. 2013; 33:244-255.

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As physical therapist we see a lot of patients who live with chronic stress and as a result have pain. When you are in pain the hormone cortisol rises. The outcome of this is hormonal imbalances, weight- gain and…you guessed it, more pain. I had the opportunity to interview New York Times Best Selling author Dr. Sara Gottfried on the effects cortisol and what to do about it.

Joe Tatta, DPT: Dr. Gottfried, adrenal fatigue and cortisol imbalances are slowly gaining attention. Patients are beginning to ask, “should I test my cortisol?” We have lots of patients that are stressed, fatigued, painful and struggling with weight. What’s the best way to have your cortisol tested?”

Dr. Gottfried: As usual, the answer is: It depends. Cortisol is known as the “stress hormone” because stress triggers cortisol secretion from the adrenal glands. While normal amounts are key to stable blood sugar, blood pressure, and immune function, too much can poke holes in your gut and make you fat loss resistant.

In my new book, The Hormone Reset Diet, I created for you a cortisol reset that lasts only 3 days. It’s the fourth reset (out of a total of seven) designed to help you lose weight, fight fatigue and feel great fast. (If you want to order the book and get 7 awesome bonuses, including more details on my favorite health tests, click here.)

JT: Cortisol can be difficult to test and different physicians recommend different tests. Which test do you use with your patients?

Dr. G: I suggest a baseline lab test. When it comes to cortisol testing, here are the options:

1. A cortisol test is done to measure the level of the hormone cortisol in the blood, which may indicate problems with the adrenal glands or pituitary gland. Ideally, perform the test around 8:00 a.m., and aim for the optimal range for adults of 10-15 mcg/dL. Perform this test with your health professional, or less ideally, order from a direct-to-consumer lab.[1] The advantage of blood testing is that it’s the universal language of conventional health professionals; the disadvantage is that it’s a 10-second snap shot of your stress level while the blooddraw needle is in your vein, and if you have a needle phobia, the measurement may be falsely elevated.
2. There’s a diurnal pattern to your cortisol levels, which means you must be systematic about measuring your level at the same time over the next few months to years. Diurnal refers to a 24-hour period. Similar to how a flower opens its bloom in morning and closes in the evening, your cortisol rises after arising and should be at its lowest before bedtime. Measure your cortisol at four points during the day (also known as a four-point cortisol, usually before breakfast, lunch, dinner, and bedtime) to assess your cortisol slope. You can measure your cortisol in saliva at a number of direct-to-consumer labs.[2] The advantage to saliva is convenience, but the disadvantage is that most people vary a fair amount in their salivary cortisol level. Still, you can spot trends over time and I’ve found 4-point tests to be the most helpful of all the tests in my medical practice. Even though salivary cortisol is not readily accepted by mainstream medicine, there are thousands of studies demonstrating its utility clinically.[3]
3. I like measuring the urinary metabolites of sex hormones because they give you a sense of the wear-and-tear from catabolic hormones like cortisol versus the growth-and-repair from anabolic hormones like DHEA and testosterone. My favorite is the “Complete Hormones” test, available from Genova.[4] Usually, this is a first morning urine (again, disadvantage is that it’s a quick snapshot) or a 24-hour collection (inconvenient, and averaged over your diurnal cycle, but can provide important assessment of your cortisol load in one day).
4. I like the test from Accu-metrics[5] to measure the last 90 days of cortisol load, in your hair. This may predict cardiovascular risk, and it’s a reliable measure of your allostatic load – or your ability to roll with the punches (I’m always moderately stressed, according to the test. Go figure!).

JT: Do women struggle more with cortisol function than men do?

Dr. G: We are learning more every day but women’s hormonal patterns are more complex. I can tell you my personal story related to stress and cortisol. When I was in my thirties, I worked at a local Health Maintenance Organization (HMO) as a mom to two young kids, and a wife to a green rock star who travelled frequently. As if this weren’t stressful enough, I struggled with low energy, belly fat, a nonexistent libido, and a less-than-sunny attitude. As you might imagine, this was a truly miserable experience, and my entire family suffered.

I was too young to feel like crap. Antidepressants didn’t seem like the right solution. I didn’t want to dampen my personality with drugs. I just wanted to feel more alive and charged.

I was lucky. Because of my medical training, I knew what to do. I formed a hypothesis: my hormones were off balance. In med school, I was taught that measuring hormone levels is a waste of time and money, because hormone levels vary too much. But when I thought about how we track hormones such as estrogen, progesterone, thyroid, and testosterone when women are trying to conceive or are in the early months of pregnancy, I wondered why those numbers would be important indications of a woman’s health in one situation but not another? Wouldn’t my hormone levels be as reliable an indicator of my health after my pregnancies as before them?

So I drew some blood and tested my blood-serum levels of thyroid, sex hormones including estrogen and progesterone, and cortisol, the main stress hormone. And I discovered what millions of other women face: my hormones were seriously off kilter. My blood cortisol was three times what it should have been! I was a frazzled new mom, harried wife, and busy doctor, with significant imbalances in my estrogen, progesterone, thyroid, and cortisol levels.

I fixed it in four weeks, but that’s a conversation for another time. The takeaway here is that I wouldn’t have known that cortisol was the main culprit if I didn’t measure it. You should measure your level too.

JT: If chronic stress or chronic pain is a problem and hormonal imbalances are suspected what should a patient do?

Dr. G: One of the most important aspects of your health is adrenal function. Your adrenals are the tiny little endocrine glands on top of your kidneys that secrete several stress hormones, including cortisol and DHEA.

If you suspect hormonal imbalance test your cortisol, using one of the four methods I’ve described. What you measure improves. Your adrenals may just be the most important aspect of your hormonal balance and overall vitality.

To learn more on how to reset your hormones, check out Dr. Sara Gottfried’s new book, The Hormone Reset Diet.

References

[1] Direct to consumer blood labs include https://www.mymedlab.com/, http://www.wellnessfx.com/, plus many others.

[2] Direct to consumer saliva tests are available from http://www.zrtlab.com/ or order through your health professional at http://www.diagnostechs.com/.

[3] Here are just a handful of studies showing the benefit of salivary cortisol:

http://www.ncbi.nlm.nih.gov/pubmed/20233956

http://www.ncbi.nlm.nih.gov/pubmed/19602555

http://www.ncbi.nlm.nih.gov/pubmed/16377094

http://www.ncbi.nlm.nih.gov/pubmed/8902896

[4] Genova tests can be ordered by health professionals. See https://www.gdx.net/product/complete-hormones-test-urine for more information.

[5] http://www.accu-metrics.com/cardiac-risk.php

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