Movement Matters

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You’ve heard it before, “exercise is good for you.” It probably started with your PE teacher in grade school and now it’s your doctor reminding you at your annual physical exam. It seems that a new study touting the benefits of exercise is reported on the nightly news almost every week. We all know that exercise is good for losing weight and getting stronger, but what you might not realize is that beyond the physical changes you see, by committing to a regular exercise routine, you’ll have a positive impact on your mind, body and soul. So why is it that according to the Centers for Disease Control and Prevention, 25 percent of the U.S. population doesn’t participate in any physical activity?

Mind:
When faced with a busy schedule and too many meetings on your calendar, exercise often takes a backseat. If you’re not sleeping well and wake up exhausted, the last thing you want to do is lace up your running shoes and head out for a sweat session. However, the next time you’re fading midday, consider skipping your visit to the local coffee truck and hit the gym instead.

According to a 2011 study of more that 3000 people, those who get at least 150 minutes of exercise a week sleep significantly better and feel more alert during the day than those who do not.1

In that same year, a study of older adults revealed that regular aerobic exercise increases the volume of the hippocampus, the area of the brain related to memory, and can help improve memory function. While its effect on the mind is continually being studied, findings strongly suggest that exercise promotes improved brain function.2

Body:
You’ve probably known that aerobic exercise is essential for heart health as long as you can remember. Starting an exercise program is often the first piece of advice given to individuals at risk of developing cardiac disease. People who exercise regularly tend to develop less heart disease their sedentary colleagues. If they do develop a form of heart disease, it happens later in life and is generally not as severe.3

Exercise also promotes bone health, an important consideration as we age. While studies are ongoing, one released earlier this year showed moderate intensity aerobic exercise may have a protective effect on bone and cartilage by regulating elements in the body involved in increasing our bone mass density.4

A strong heart and strong bones are important, but exercise can help the body in other ways. Emerging research suggests that moderate amounts of exercise may have a positive effect on chronic pain by changing an individual’s perception of and response to their pain.5 Movement continues to be the most conservative, most inexpensive, and likely the most effective treatment for lower back pain, a condition that affects 80% of us during our lives.

Soul:
Have you ever started a workout in a bad mood and ended it feeling even worse? Not likely. Do you alleviate stress with a tough session? You might be on to something. There is a strong link between between exercise and mood. In general, active people are less depressed than sedentary people. A 2007 study concluded that exercise was generally comparable to antidepressants for patients with major depressive disorder.6 A hot topic of research in the mental health field, scientists are extremely interested in learning how to prescribe exercise as treatment for a variety of conditions including stress, anxiety, and depression.

The more digitally connected we are, the less real contact we tend to have with friends and family. There’s an app for everything, but not one that promotes in-person interaction with our true social circles. Exercise has a positive effect on our relationships and can even lead to developing new friendships. Finding a common exercise interest increases motivation, fosters healthy competition and can create strong social bonds with friends and family.

The benefits of exercise are vast and the scientific support of movement continues to grow. Who wouldn’t want to look better, feel better and be better? If you’re a regular exerciser, keep it up! The changes you’re making are huge. If exercise hasn’t been your thing, find something you enjoy, commit to your health and get moving. Your mind, body and soul will thank you.

  1. Loprinzi, Paul and Bradley Cardinal. “Association between objectively-measured physical activity and sleep, NHANES 2005–2006.” Mental Health and Physical Activity2, (2011) 65–69.
  2. Ericksona, KI, et al. “Exercise training increases size of hippocampus and improves memory.” PNAS 108.7, (2011) 3017-3022.
  3. Myers, J. “Exercise and Cardiovascular Health.” Circulation.107(2003) e2-e5
  4. Alghadir, JH, et al. “Correlation between bone mineral density and serum trace elements in response to supervised aerobic training in older adults.” Clin Interv Aging.11 (2016) 265-73.
  5. Jones, MD, et al. “Aerobic training increases pain tolerance in healthy individuals.” Med Sci Sports Exerc8(2014) 1640-7.
  6. Blumenthal, JA, et al. “Exercise and pharmacotherapy in the treatment of major depressive disorder.” Psychosom Med. 7 (2007) 587-96.

 

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How to stay motivated to exercise during the foggy days of a San Francisco summer

Come December, almost every fitness magazine or blog features an article about how to stay motivated to workout during the winter months. The Internet is full of fitness tips for winter, while retailers push the latest in coldweather gear.

San Francisco is a city with little variability in our temperatures, making these articles virtually irrelevant to our fitness buffs. Yet, we do have one weather phenomenon that can be a buzz kill for outdoor recreationalists. While the rest of the country enjoys warm summer days, we often host an unwelcome guest named Karl the Fog. Karl is active on social media, with his very own Twitter, Facebook and Instagram accounts. Don’t get me wrong, some people welcome Karl and appreciate the cooling blanket he provides. It is easy enough to escape his presence with a quick trip inland. Plus, it’s pretty amazing to see his fingers of fog creep across the skyline, hiding the sun and its warmth in a matter of minutes. Others, myself included, are easily affected and develop feelings of fatigue and sluggishness. We may need a little push to get outside for exercise. On my first day of graduate school at UCSF almost 15 years ago, a professor told us to be sure to escape the city on weekends to avoid developing SAD—Seasonal Affective Disorder, a type of depression that often occurs during winter conditions…or, in our beloved city, during the summer when the sun doesn’t shine. I still get a burst of energy when I wake up to a clear, sunny morning. On those perfect days, I can’t wait to get outside and don’t want to waste a rare, beautiful day. Those kinds of San Francisco days make even the foggiest worth it.

So how can you stay motivated to exercise during the foggy days of a San Francisco summer?

      • Appreciate the cool- While the fog may be lingering in your neighborhood, just a few miles in any given direction the temps may be soaring, making a morning workout intolerable. Last weekend I was visiting my hometown and got out for a fairly early run…in 85 degree heat (and loved every minute of it). Yet, friends in hotter climates complain of having to workout at 5:00 am to avoid the heat, or worse, they have to stay in an air-conditioned gym for their daily dose of exercise.
      • Wait it out- Depending on the day, it may actually burn off. But, as soon as you see a glimpse of clear sky, head on out. You never know when Karl will return. It may be a matter of a couple of hours, or might stay clear the rest of the day.
      • Or don’t…There’s a strong chance that he’s here to stay for the day. Embrace the cool climate and know that you’ll have a sunny day soon enough. According to a 2011 study of 229 students conducted at sunny Santa Clara University (1), exercising outdoors was more enjoyable and resulted in less tension and stress, compared to indoor exercise.
      • Try a different neighborhood- In a city known for its microclimates, you can almost always find a sunny spot in San Francisco. Venture to a different neighborhood for some exploration and, fingers crossed, maybe a little sun. Some of the sunniest neighborhood in San Francisco include the Mission, Noe Valley, DogPatch and Potrero Hill.
      • Appreciate your surroundings- The outdoors take on an entirely different look and feel under the cover of fog. Views you have seen a million times, suddenly become new, taking on a different type of beauty. Have you ever seen The Presidio under cover of fog? Or heard the foghorn sounding under the Golden Gate Bridge? The trails in Glen Canyon become beautifully mysterious when shrouded in fog.
      • Take it indoors- There are a ton of great indoor fitness options, if you just can’t drag yourself outside to face the fog. Some of my favorites are TRX, yoga, Pilates, and circuit training workouts in the gym or at home.
      • Grab a friend or play some music- Can’t get out the door? Grab your iPod or call a friend. Both have been linked to increased motivation for exercise. In fact, a 2013 article in Scientific American (2) reports, “Music distracts people from pain and fatigue, elevates mood, increases endurance, reduces perceived effort and may even promote metabolic efficiency. When listening to music, people run farther, bike longer and swim faster than usual—often without realizing it.”

Tips for exercising on foggy days:

      • Don’t overdress- While wet, foggy weather isn’t always cold weather. You’ll learn your lesson if you head out with too many clothes into the often warm, humid air. Your best bet is to dress just like you do for any SF day—layer, layer, layer (preferably in a sweat wicking fabric).
      • Don’t forget the sun protection- Sunscreen and sunglasses are a must on even the foggiest of days. According to dermatologists, 87% of the sun’s rays penetrate through clouds, fog and mist. While these can block sunlight, they don’t effectively block harmful UV rays.
      • Warm up appropriately- Depending on the temps, you may need more of a warm up on a foggy day. I recommend a dynamic warmup and light start to your workout.

Ahh…the sun just came out—time to hit the trails! See you soon, Karl.

 

References:
1. Plante, TG, et al. Exercising with an iPod, Friend, or Neither: Which is Better for Psychological Benefits? Am J Health Behav.™ 2011;35(2):199-208.
2. Jabr, Ferris. “Let’s Get Physical: The Psychology of Effective Workout Music”. March 20, 2013. http://www.scientificamerican.com/article/psychology-workout-music/.

The Top Five Reasons Why You Should Get To Know Your PT

A few years ago I hosted a get together with a bunch of friends. At some point in the evening, after everyone had figured out how we were connected, someone remarked, “It’s a good thing you’re a PT. You wouldn’t have any friends otherwise.” As I looked around the room at my guests, two were physical therapy colleagues, while the rest were former patients turned friends. While I understand that some PT’s prefer not to develop personal relationships with current patients, I truly believe in the importance of developing a long-term professional relationship with one.

If it’s not a good fit, find one you trust and with whom you can connect. If they turn into a good friend, even better!

Here are The Top Five Reasons Why You Should Get To Know Your PT:

We’ll be spending quality time together.
During the course of your treatment, you’ll be seeing us regularly. I am fortunate to spend 45 minutes with patients, often once, maybe twice a week. Compare that to the amount of time you spend with your doctor during a scheduled appointment, or even how often you see your best friend in any given week. Several years ago, I attended the wedding of a patient-turned-friend after knowing her only a few weeks because, as she told me, “The only person I spend more time with during the week is my fiancé.”

You can confide in us.
Because we will be spending time together working on improving your health, there may be certain things that come up during our time together. Human are complex creatures. There are many factors that can contribute to health, some of which may not be that easy to bring up. As healthcare providers, we are bound by law and ethics to maintain your privacy, and need to know about factors that may be affecting your healing. During any given week I talk to people about such potentially uncomfortable topics as depression, intimacy, problems in relationships, and other sensitive things. We talk about frustrations with treatment and health concerns seemingly unrelated to their physical therapy treatments. Often, the things we discuss are vital to my success as a PT though occasionally I need to refer out to someone better equipped to handle the issue. You need to feel comfortable enough with your PT to be able to discuss the uncomfortable.

We can help ease your fears.
Perhaps you’ve just received a new diagnosis that is troubling, even scary. Sometimes the medical jargon associated with an MRI report or after a doctor visit can be overwhelming. Chances are, we’ve worked with other patients with similar problems and can help explain things in ways you’ll understand. It is not a normal week if I don’t have a friend or family member reach out with questions about a particular diagnosis. The discussion this weekend was about Jason Day at The US Open, his struggles with vertigo, and how PT can help…did you know that?

We can let you know when it’s time to get serious about your health.
There is a reason your back hurts. Ignoring it isn’t the answer and it is likely a symptom of a larger problem. The good news is, you’re willing to invest a little time and energy, and maybe a few little changes to your daily routine, we can make a huge impact. Sometimes a friend or PT who knows you well is the best person to impress upon you the importance of taking your health seriously. You only get one body in this life, treat it well.

We can help you navigate the confusing world of medicine AND fitness.
There is so much misinformation and conflicting advice floating around out there. Who can help you differentiate fact from fiction? A PT with a good clinical experience who has continued to grow professionally and is able to critically evaluate research is good person to have on your team. Well-meaning but incorrect advice is commonly dispensed from people who don’t have the same training and expertise as PT’s who work in musculoskeletal medicine every single day.

We really do care.
My colleagues and I talk about this all of the time. It is not uncommon for us to say to a patient, “I was thinking about you on my walk to work.” I often develop new treatment plans in the most unlikely of places. This is why my showers are sometimes a little longer than necessary. We PT’s are generally so invested in our patients that we take it to heart when someone doesn’t seem to value or appreciate our care. This is also the reason we are exhausted at the end of the week. Don’t expect your PT/friend to want to get together for Happy Hour on a Friday evening!

Welcome to the TPSF Team-Michelle Cotter, PT, DPT

Dear Friends,

I’d like to take a moment introduce myself as I am so grateful to be the newest member of the TherapydiaSF family. My name is Michelle Cotter and I’m a physical therapist. While I specialize in pediatrics, I love treating adults as well. 

My passion for helping people heal began as a youngster when I volunteered in the athletic training room at my high school while rehabilitating my own injuries.  It was further strengthened when I spent the summer of my junior year in high school helping my mom recover from heart surgery. I received my Doctorate in Physical Therapy from Samuel Merritt University in Oakland, California and completed my final internship at Lucile Packard Children’s Hospital, where I learned the intricacies of proving excellent patient care to children and their families. My experience working on the UC Davis Athletic Training team, as well as over 5 years of clinical experience, has helped me develop expertise in identifying movement dysfunction and choosing the best treatment methods for a variety of injuries for all ages. 

Over the past 3 years, I have also been treating infants and children, assisting in their gross motor development, so that they are able to play and participate in age-appropriate activities with their peers. I have had particular success in developing effective rehabilitation programs for children with developmental delay, positional plagiocephaly and a variety of sports-related injuries.

My goal as a physical therapist is to provide an individualized framework for healing based on current research and patient education.  I aim to facilitate the recovery and prevention of injuries for each patient, no matter what age, so that they may achieve their mobility goals.

I love educating patients about how their body moves and teaching them strategies to change dysfunctional movement patterns. I emphasize educating patients and families on their specific condition and how they will take an active role in the recovery process for optimal health and function. This approach to an interactive plan motivates me to be the best physical therapist I can be. I get great satisfaction in building collaborative partnerships focused on the achievement of life-long health and wellness with my patients

I am very excited for the opportunity to work in such a collaborative and interactive environment that promotes long-term health and wellness and I look forward to meeting each of you! Please feel free to contact me if you would like more information.

Sincerely,

Michelle Cotter, PT, DPT
Doctor of Physical Therapy

The Educated Therapist

Let’s face it. Most physical therapists aren’t winning any sales and marketing awards. Most of us have don’t have a business background and typically enter this profession based on a love of health, exercise and helping others. In school, we don’t really have time to cover anything beyond examination and treatment of our soon-to-be patients. We graduate, enter the world of health and wellness as practitioners of physical therapy, and soon realize the competition is fierce. In San Francisco, a city with something for everyone, there are individuals providing health and wellness services that seem in direct competition with everything we offer. There are personal trainers, massage therapists, Muscle Activation Therapists, Sports Therapists, Neurokinetic Therapists, Core Activation Therapists, and more. Have you ever stopped to consider who is best trained to help you heal? While these practitioners may indeed be skilled at the services they offer, based on our level of education and training, physical therapists are in a league of our own.

The other day, I had a pleasant conversation with a gentleman who was interested in learning more about the field of physical therapy. A seemingly intelligent man, he’d also had personal experience as a recent physical therapy patient. At some point in our conversation, he stopped me and asked, “Do you have to have some sort of certificate to be a physical therapist?” My jaw dropped.  It was then and there I realized how physical therapists have done such a terrible job of informing the public of what we do, what we can offer, and why we should be considered the practitioners of choice for musculoskeletal health.

So here’s what you should know: physical therapists go to school for 7-8 years. This includes 4 years of undergraduate education, heavily based in science (physics, chemistry, microbiology, exercise physiology, etc.), and 3-4 years of graduate-level education. Students graduating from physical therapy programs in the United States today earn a Doctor of Physical Therapy. The first Doctorate program in Physical Therapy was started in 1993 at Creighton University in Nebraska and, as of 2015, all accredited and developing physical therapist programs are DPT programs. Often part of a medical school, PT programs teach physical therapy examination and treatment, as well as courses in Anatomy, Neuroanatomy, Pathology, Pharmacology, Radiology and Differential Diagnosis (how I determine if a symptom may be something more serious—and outside of my scope of practice—than run-of-the-mill back pain). In fact, when I attended UCSF in the early 2000’s, the physical therapy students were the only students who performed full cadaveric dissections. Other programs used the cadavers we spent our first foggy summer in San Francisco dissecting. It was also the start of our collaboration with the first year medical students, where we 2nd year PT students helped teach the medical students musculoskeletal anatomy. Most recently, residencies and fellowships after graduation have grown in popularity to provide advanced training for physical therapy school graduates.

Beyond our formal education, physical therapists are licensed by the state in which we practice and are held to a high level of professional conduct that includes requirements for continuing education every year. Most courses are held on the weekends and many physical therapists travel great distances to take courses of interest. This year alone, PT’s from TherapydiaSF will take courses in San Francisco, San Diego, Montana, and Las Vegas. Some physical therapists also opt to enhance their degree and training by completing board certification in different areas of practice, including Orthopaedics, Pediatrics, Women’s Health, Neurology and 4 other areas of specialty practice.

The next time someone suggests physical therapy, please consider our extensive training and education and know that we have the education, expertise and dedication to help you work, play and move without pain.

 

 

Navigating Nutrition Part One: Processed Food

“Avoid processed foods” is common nutrition advice given out these days. It is a well-intentioned, sound suggestion that seems easy enough to follow…assuming you know what the term “processed foods” means. As it turns out, there is no easy definition of “processed foods”. Most foods we eat are processed in some form or another unless you’re eating it straight out of the ground.

The degree of processing is what most people are talking about when they use this term, and even then, there is no set list of things to avoid, and some processed items are better than others. Generally speaking, this refers to anything that comes in a package, but doesn’t usually apply to things such as milk or whole beans in a can. Confused yet? Who can blame you?

So why is this advice out there? One reason is that it can be very easy to overeat packaged goods. A box of cookies can disappear in an instant, and no time was taken to prepare them. Another reason for this advice is the number of unfamiliar ingredients used in our “food” these days. For example, maltodextrin, soy lecithin, and artificial flavors are all common ingredients found on nutrition labels. Do you have any idea what they are? This isn’t some big exposé, I’m just pointing out that you might not know what you are putting in your body. Lastly, processed foods tend to have a lot of sodium or sugar added in, which isn’t good for us.

It might not feasible to go “package-free”, so here are some rules of thumb to simplify things:

  • Only choose foods with 5 ingredients or less.
  • Make sure you know what each ingredient is, and how it’s made (knowing that something is made “from corn” or “from soy” doesn’t tell you how it’s made).
  • Check the nutrition label for the amount of sodium (look for items with 150mg or less per serving).
  • Choose items with no added sugar. That means NONE of the following ingredients: sugar, corn syrup, fructose, high-fructose corn syrup, agave nectar, honey, brown rice syrup, dextrose, maltose, sucrose, molasses.

Do your best to buy whole foods and do the processing yourself, but when you need to buy things in a package, be sure to check the labels!

The Holidays: A Time of Love, Laughter and Overeating

You know the scene, you swear you’re going to have just one drink at a holiday party, and the next thing you know you’ve lost count and have a killer headache the next morning. Or maybe you show up to the party thinking there will be dinner only to find out they are only serving apps, so you start taking down every bacon-wrapped scallop in sight. Or perhaps your Aunt Margaret swears you’ve lost too much weight and starts handing you a snack every time you walk by. Or hey, maybe it’s just the holidays and you only get this food once a year, so you cram as much as you can onto that plate…and then make a second trip. The holiday season is packed full of healthy eating obstacles (some more fun than others!). If you want to stay healthy through the holidays without adding “lose holiday weight gain” to your New Year’s resolution list, it takes a bit of planning and mindfulness, and we’ll tackle some of the big ones here.

Booze

Without a doubt, the biggest contributor to holiday weight gain is all the extra alcohol consumed throughout the season. We see friends and family we haven’t seen in a while, and every occasion seems like a real good reason to celebrate. Not to mention in addition to the beer, wine, and regular cocktails, eggnog, hot toddy’s, and mulled wine make their way onto the menu this time of year, and hey, it’s been a while since you’ve had one! Here are some tips to keep holding the reins on your alcohol intake:

  • Give yourself a weekly allotment for alcohol and plan it out. If you have several events in one week, decide ahead of time where you would like to spend your “booze dollars”. If you find yourself having trouble sticking to it, you might need to make some events alcohol-free.
  • Keep track – a serving of wine is 5 ounces, which is less than half of most wine glasses. If you fill it up to the top, that’s two drinks. If someone comes around and tops off your glass, count it as another drink. We frequently have the equivalent of 6 drinks in one night, thinking we only had two.
  • Watch the higher calorie drinks – eggnog, cider, and most mixed drinks have a lot of extra calories in addition to the alcohol. If you need to have one for the season, keep it to just one.

Hors d’oeuvres

These tasty little morsels seem so innocent, but do a lot of damage. Typically crowd-pleasing fare, these items tend to be mini-calorie bombs, and if you show up hungry one after another will slide right down, adding up to more than a meal’s worth of calories…before you even get to dinner. So what can you do?

  • If you know the party will be appetizers only, make sure you eat a small healthy meal before you go. This will take the edge off any alcohol you have, and prevent you from stalking the waiters circulating the apps.
  • Only try 1-3 appetizers, and only if they look worth it – the point is for you to get a small taste of an amazing dish, not to substitute for a meal.
  • If it’s a dinner party, try having a small snack with protein beforehand so you can hold out until dinnertime.

Buffets

Buffets are a popular, convenient way to serve dinner, and are generally a healthy-eating nightmare, especially if it’s a potluck. It’s as though someone thought of every food you were trying to avoid and put it all on one table. You’re sure to see at least a few of these this holiday season.

  • Take a tour of the buffet before you get in line. See what’s available and decide ahead of time what you want to put on your plate.
  • Only fill up one dinner plate, and only go through the line once. No, you cannot start stacking the food vertically to get more to fit.
  • Try only small portions of the heavier items and fill most of your plate with the healthier options.

Family

This section could take up its own blog post, or even its own book, and could probably be co-authored by a psychotherapist, but we don’t have room for that here, so we’ll only cover the basics!

  • Stress – is there a lot of tension at your holiday gatherings? Meditation and therapy are more productive solutions, but in the interest of time, try this quick fix: instead of eating to drown your sorrows or avoid talking to someone, bring a large plate of pre-cut veggies to share as hors devours. When you’re feeling frustrated, grab a small plateful of veggies – the crunch will help get your aggravation out and keep your mouth full so you don’t have to talk!
  • The pushers – the ones pushing high-calorie although made-with-love food. Quick fix: small portions, big fanfare. “This is so delicious! You’re such a fantastic cook! No, I can’t fit anymore, I’m so full. It’s so good, but I also want to save room for XYZ too, I wouldn’t want to miss that!”
  • Look for healthier recipes of old favorite foods. If your family resists, stick to a serving the size of a ping-pong ball. The first 3 bites are where you get all the taste and flavor, after that your taste buds become accustomed to the food and you spend the rest of the time trying to “chase the taste”.
  • Bring your own healthy dish so you know there is something there you can fill your plate with.

The holidays should be a jubilant time of year, where you enjoy the company of friends and loved ones. Although everyone has different ways of celebrating during the holiday season, we hit on some common pitfalls here that frequently trip people up. There are certainly challenges we didn’t cover here. If you need a little help figuring out how to enjoy the holidays without damaging your waistline, head on down to see your friendly neighborhood Registered Dietitian. You can get your own customized plan that still allows you to have fun! Happy Holidays!  Bethany is seeing clients at TherapydiaSF, located on Maiden Lane in downtown San Francisco.

Fit as a…fiddle?

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Body image has been a hot topic over the past several years. Recently, many companies have run advertising campaigns to promote healthy body types in reaction to the extremely thin models who have been so prevalent in the media.

The recent video of dancer Misty Copeland has had a huge impact on the dance world and has made us think about the concept of an ideal dancer’s body.  I remember not too long ago, when “athletic body type” was considered a euphemism for “thick” or “heavyset.”  I hope you agree that while Misty is certainly athletic, she is neither thick nor heavyset.

Beyond the notion of an ideal body type, I’ve recently been thinking about the concept of fitness. I blame this partly on recently reading The Sports Gene by David Epstein, and also having just returned from a continuing education class filled with practitioners who each work with a different clientele, including college athletes, golfers, yoga practitioners, and the general population, some more active than others.   As I thought about the baseball pitchers, cyclists, runners, and CrossFit participants with whom we each work, I could easily identify ways they are fit, but I also thought of areas where they may be deficient.  I began to wonder about fitness.

When someone is decribed as “fit”, what does that really mean?  Does it mean the same thing to everyone?  There are different dictionary definitions of fitness, some of which brought a smile to my face:

1. The condition of being physically fit and healthy (I’m going to need a little more here…).

2.  Good health or physical condition, especially as the result of exercise and proper nutrition (ok, we may be getting somewhere…).

3.  The capacity of an organism to survive and transmit its genotype to reproductive offspring as compared to competing organisms (well….I bet you know plenty of people who have the capacity to transmit their genotype to reproductive offspring who you would not call fit).

So, we’re back to the drawing board with defining fitness.

Is a body builder with bulging biceps and massive quads more fit than a marathon runner?

Is Tiger Woods more fit than Serena Williams or Michael Phelps?

What does it mean to be fit?  Ah…what I would do to take a camera out onto the streets of San Francisco and ask people this question (stay tuned…).

As we think about each of the athletes and their respective sports, it quickly becomes clear that fitness is hard to define and describe.  While the bodybuilder might have larger muscles that allow him to lift heavy weights, the marathon runner would certainly show greater cardiovascular endurance across those 26.2 miles.  Tiger Woods and Serena Williams both demonstrate amazing muscular development and precise hand-eye coordination, but if he had to run around the golf course like she does the tennis court, could Tiger keep up with Serena?  Michael loves the game of golf and, like Tiger, has an amazingly strong core, yet I wouldn’t want either one of them representing the other’s sport in competition.

This is an important topic to me both personally and in my work with athletes of all ages, skill levels, shapes and sizes.  To me, there is no one definition of fitness.  I believe that fitness is a balanced combination of strength, stability, balance, flexibility, and endurance…and maybe even mindfulness.  What the general population thinks of as an ideal of fitness may actually be a person who excels in the sport in which they train, but has severe and potentially harmful imbalances in some of the categories mentioned above.  The fittest people with whom I work are those who enjoy a variety of exercise and sporting activities.  These are the folks who are rarely in our studio for treatment, except for the occasional tune up after having changed their routine. Often, the people who appear most physically fit are those who are plagued with injuries related to imbalances in overall fitness.

I’ve learned that there is no one ideal body type just as there may be different ideas of fitness.  I encourage my clients to be successful in their rehab and develop and improve their fitness by recommending a three key steps:

1. Move well and move often.

2. Find something you enjoy doing.

3. Mix up your routine—your body will thank you for it.

So, what does fitness mean to you?

And, in case you were wondering where “Fit as a fiddle” came from…

When should I see a physical therapist?

Many of the patients I treat are extremely active, though few make their living playing sports professionally. They are passionate about their lifestyle and sport of choice, and take their health very seriously.  With many sports and hobbies, aches and pains are likely to occur.  Athletes quickly get used to sore muscles and minor injuries, often considephysical-therapy-san-francisco1ring these a normal part of an active lifestyle.

But should these be treated more seriously?

Many of the patients with whom I work initially ignored what seemed to them to be minor injuries, yet have since become more frequent or more intense.

At what point should you visit a physical therapist?

Read more for quick tips to decide if what you’re feeling needs a closer look.

1. Immediately after a specific injury.

A number of recent studies have shown support for early physical therapy for lower back pain.  The studies show that physical therapy within 2-4 weeks of a lower back injury leads to a decreased risk of surgery and injections, fewer doctor visits, faster recovery, and fewer incidents of chronic pain.

Clinically, I have seen even earlier physical therapy provide excellent results. I am a strong advocate of patients developing a relationship with a physical therapist as a practitioner on their medical team (see post).  I also believe that patients should have email access to their physical therapists in order to communicate updates and ask general questions.  Often, a patient will email or call our office within the first few days of an injury and we will schedule them that day.  Earlier this year, I worked with a triathlete who developed intense back pain after a weekend race.  We saw her the next day and within a week she reported an 80% decrease in her symptoms. The following week she reported a 95% improvement and was able to race again exactly one month later. The sooner we can see a patient post-injury, the faster their recovery from the painful, acute stage.  This allows us to move to more advanced stages of physical therapy earlier, in order to address the root cause of their injury.

2. If an old injury has reappeared or never disappeared!

As I was getting ready to graduate one of my runners from physical therapy the other day, she asked, “but…how will I know if I need to come back?”  It was a great question, yet one without a definitive answer.  Runners, especially, are subject to occasional minor aches and pains.  At what point should they take these more seriously and seek help?

In general, you should reconnect with your physical therapist when:

You feel pain during an activity that gets worse as you continue the activity.  This is a sign that something is not right.

Your pain changes the way you perform the activity.  If you are running down the street with foot pain and you have to limp so it doesn’t hurt as much, go home and call your PT.  Remember, the faster the painful symptoms are addressed, the more likely the root cause will be identified and other related injuries are less likely to occur.

You feel pain during three consecutive workouts or activities Often pain will be present at the start of an activity, but will disappear within a few minutes.  Does that mean it should be ignored?  No.  If you are consistently feeling the same or similar symptoms, even if they go away during the activity, schedule an appointment.  Pain is a sign of tissue fatigue or too much stress on a particular part of the body, likely related to an underlying movement dysfunction.  In English?  You’re likely not moving as well as you could, an area of your body is doing more than its fair share of the work, and it needs some help.

3. For an annual check up.

Physical therapists can be, and should be, the medical practitioners of choice for a musculoskeletal wellness/fitness screen, an assessment with a physical therapist to identify risk factors for developing a particular injury.  Much like we visit the dentist on a regular basis, we believe that everyone should schedule an annual preventative visit to their physical therapist to identify and address areas of dysfunction (that tight neck you’ve been complaining about, poor posture, or the shoulder that occasionally hurts in your bootcamp class).  Left undetected, these will likely get worse over time.  We would much rather see you once a year to revise your exercise program and keep you healthy, than have you wind up in our office as our newest patient!

Remember, you shouldn’t try to tough it out or wait until an injury becomes more severe before visiting your physical therapist.  You will wind up suffering needlessly and make our jobs even harder!

If you’re still not sure you should come in for an assessment, feel free to email us:  hello@therapydiasf.com.

In your email, please provide the following:

-where is the location of pain?

-how did the injury occur?

-how long have you had the pain?

-what makes it hurt?

-what makes it feel better?

We will review the information and advise you on the best option for your injury.  This may include advice for self-management, the need to schedule a physical therapy assessment, or a physician contact, if necessary.

When should I see a physical therapist?

Many of the patients I treat are extremely active, though few make their living playing sports professionally. They are passionate about their lifestyle and sport of choice, and take their health very seriously.  With many sports and hobbies, aches and pains are likely to occur.  Athletes quickly get used to sore muscles and minor injuries, often considephysical-therapy-san-francisco1ring these a normal part of an active lifestyle.

But should these be treated more seriously?

Many of the patients with whom I work initially ignored what seemed to them to be minor injuries, yet have since become more frequent or more intense.

At what point should you visit a physical therapist?

Read more for quick tips to decide if what you’re feeling needs a closer look.

1. Immediately after a specific injury.

A number of recent studies have shown support for early physical therapy for lower back pain.  The studies show that physical therapy within 2-4 weeks of a lower back injury leads to a decreased risk of surgery and injections, fewer doctor visits, faster recovery, and fewer incidents of chronic pain.

Clinically, I have seen even earlier physical therapy provide excellent results. I am a strong advocate of patients developing a relationship with a physical therapist as a practitioner on their medical team (see post).  I also believe that patients should have email access to their physical therapists in order to communicate updates and ask general questions.  Often, a patient will email or call our office within the first few days of an injury and we will schedule them that day.  Earlier this year, I worked with a triathlete who developed intense back pain after a weekend race.  We saw her the next day and within a week she reported an 80% decrease in her symptoms. The following week she reported a 95% improvement and was able to race again exactly one month later. The sooner we can see a patient post-injury, the faster their recovery from the painful, acute stage.  This allows us to move to more advanced stages of physical therapy earlier, in order to address the root cause of their injury.

2. If an old injury has reappeared or never disappeared!

As I was getting ready to graduate one of my runners from physical therapy the other day, she asked, “but…how will I know if I need to come back?”  It was a great question, yet one without a definitive answer.  Runners, especially, are subject to occasional minor aches and pains.  At what point should they take these more seriously and seek help?

In general, you should reconnect with your physical therapist when:

You feel pain during an activity that gets worse as you continue the activity.  This is a sign that something is not right.

Your pain changes the way you perform the activity.  If you are running down the street with foot pain and you have to limp to avoid it, go home and call your PT.  Remember, the faster the painful symptoms are addressed, the more likely the root cause will be identified and other related injuries are less likely to occur.

You feel pain during three consecutive workouts or activities Often pain will be present at the start of an activity, but will disappear within a few minutes.  Does that mean it should be ignored?  No.  If you are consistently feeling the same or similar symptoms, even if they go away during the activity, schedule an appointment.  Pain is a sign of tissue fatigue or too much stress on a particular part of the body, likely related to an underlying movement dysfunction.  In English?  You’re likely not moving as well as you could, an area of your body is doing more than its fair share of the work, and it needs some help.

3. For an annual check up.

Physical therapists can be, and should be, the medical practitioners of choice for a musculoskeletal wellness/fitness screen, an assessment with a physical therapist to identify risk factors for developing a particular injury.  Much like we visit the dentist on a regular basis, we believe that everyone should schedule an annual preventative visit to their physical therapist to identify and address areas of dysfunction (that tight neck you’ve been complaining about, poor posture, or the shoulder that occasionally hurts in your bootcamp class).  Left undetected, these will likely get worse over time.  We would much rather see you once a year to revise your exercise program and keep you healthy, than have you wind up in our office as our newest patient!

Remember, you shouldn’t try to tough it out or wait until an injury becomes more severe before visiting your physical therapist.  You will wind up suffering needlessly and make our jobs even harder!

If you’re still not sure you should come in for an assessment, feel free to email us:  hello@therapydiasf.com.

In your email, please provide the following:

-where is the location of pain?

-how did the injury occur?

-how long has have you had the pain?

-what makes it hurt?

-what makes it feel better?

We will review the information and advise you on the best option for your injury.  This may include advice for self-management, the need to schedule a physical therapy assessment, or a physician contact, if necessary.