Injury Prevention 101

I heard on TV the other day that more and more people are getting injured while doing exercise. As someone who has been injured from exercise, and who deals with clients who have suffered exercise induced injuries, I believe this is one of the most important issues in the health and wellness field. So what are the causes of these injuries? Basically, people get injured when doing exercise for three reasons: 1) They perform the exercise with bad form. 2) They attempt to do something they are not sufficiently prepared for either in terms of coordination or intensity. 3) The have an accident due to a dangerous environment or faulty equipment.
Leaving aside the third reason, let’s analyze the first two reasons, which are by far the most common causes.
1. BAD FORM. What constitutes bad form? As a Yogilates instructor, I constantly stress proper alignment, control of momentum, limited range of motion, and performing the exercises with a minimum of unnecessary tension. Any deviation in these qualitative factors can lead to bad form and thus to injury. Above all, a participant must learn alignment principles when they are lying down, sitting, and standing. The neutral, parallel positioning of the feet, knees, hips, ribcage, spine, shoulders, neck, and head have to be shown and practiced in static positions and then gradually introduced into movement. This is why modern Pilates training which includes “functional awareness exercises” is so vital and important. It would be difficult, if not impossible, for someone to know how to hold themselves in proper alignment while performing an exercise if they had not first practiced simple articulations of the body parts to see how the movement affects their alignment. Cues such as “pull your ribs in”, “draw your shoulder blades down”, “keep your pelvis in neutral”, are common in Pilates training, but would be difficult for a non-Pilates exerciser to grasp while in the middle of doing a conventional exercise against resistance. A certain amount of body awareness training is essential to insure that a person first knows what proper alignment is and then how to maintain it. Emphasis on this when training should be paramount if someone wants to avoid injury.
Other factors that constitute bad form include giving into momentum where it throws the body off its center. One cannot move without generating momentum, but it can be controlled through stabilization and by initiating the movement from the center. Again, this is part of Pilates training, but as a concept it can be practiced in any exercise or movement. Suffice it to say that if you are jerking or swinging wildly in your movement, your risk of injury skyrockets.
Other key factors I mentioned earlier that relate to injury prevention is to limit one’s range of motion(ROM). Recently, I have seen a lot of people doing an exercise that some call “Bulgarian Lunges”, which is a lunge with the back leg and foot up on a bench or step. This creates an excessive ROM for the hip flexor of the back leg and very often can lead to injury in that hip. There is a better way to accomplish the same ends without risking the strain on the back leg hip flexor. Focus on keeping your hips level and inline with your back, and simply ease up the muscles in the back leg to place more focus on using the front leg. This is what we do in the Pilates studio when we do Step Ups on the Wunda Chair. By not letting the client tilt forward at the waist, we keep the weight centered over the front leg and get more work for those muscles.
Lastly, holding unnecessary tension anywhere in the body while exercising can lead to a strain. Always take a “sigh” exhale before beginning an exercise and try to let go of any unnecessary tension in the body. Try to get to know your tension spots, the places you usually grip, like the neck or shoulders, or buttocks or feet. If you can relax before and breathe with your movements, you will more likely be working with your body, rather than against it.
2) NOT SUFFICIENTLY PREPARED. It sounds so common sense, but you would be surprised how often this is the reason why people get injured. It is the classic weekend warrior syndrome – doesn’t exercise all week, then goes out and plays hard on the weekend and gets injured. To be truly effective, and to reduce the risk of injury, training needs to be consistent, progressive, and balanced. Someone who hasn’t run in months (or years) can’t suddenly go out and run like they used too just because they decide they are going to do it. Just like it would be silly to try to lift something too heavy for you, the same is true with trying to do an aerobic activity at an intensity level (speed) or duration that you are not used to. Same thing applies with flexibility exercises. Someone who hasn’t done any stretching for years and then goes into a power yoga class is setting themselves up for a strained, even a pulled muscle. For most people who are deconditioned and want to start exercising it is recommended to start with simple, functional strength, balance, and flexibility exercises. Simple exercises that are fully doable are better than complex movements even if your eventual goal is to play a sport that involves plyometric and/or coordinated movements. To better prepare for sports, one would be best served by doing body-weight exercises that teach not only strength, but work on stability and engaging of supportive core muscles, such as push-ups, free squats, supported lunges, and general calisthenics. Most people as they get older get better at pacing themselves and can perform well at moderate aerobic activity for extended durations. Unfortunately, our joints and tendons can become stiffer as we age, and support muscles can become weaker so while we may not feel pain during the workout, we often experience pain afterwards that gradually increases with each consecutive workout. The best ways to prevent this is 1) Always do a thorough warm-up before exercising which should include some gentle dynamic movements like leg and arm swings, brisk walking, short/light repetitions of planned exercises, etc. 2) Set a reasonable goal for each workout. You have to start from where you are. Anything that is new, or you haven’t done in a long while, needs to be approached carefully and performed at moderate intensity and duration so that the body can gradually get used to it.

So, let’s all take some time to be sensible in our workouts. Never sacrifice good form for more intensity. Be gradual in your planning and be consistent in your schedule. Here’s hoping that the exercising you choose, and the way you do it, makes you healthier and injury free for the long term.

Weight Loss vs Fat Loss

I want to follow up on my article above regarding losing body fat and add some more information about weight loss. Many articles have been written lately (including the most recent Pilates Style magazine) about how exercise isn't very effective for those who mainly need to lose weight. The research on this subject is not very convincing as it doesn't really use a comprehensive exercise program, but nevertheless, common sense is all you need to agree that exercise compares poorly to diet when it comes to adding or losing weight. For example, to burn 3,500 calories, which is equivalent to 1 pound of fat, a 120lb person would need to run at 8mph (7.5min/mile) pace for 4.78 hours. To consume 3,500 calories, all you have to do is drink a Grande Skim Chai Tea and Blueberry Scone five days in a row. No comparison! Cutting back on high-calorie food is a lot easier to do than running for hours. If you only walk, you'd have to walk at 3mph for nearly 20 hours to burn 3,500K! So, let me be clear - exercise doesn't trump diet when it comes to weight loss. That being said, if done properly, the best way to lose weight is a combination of both diet and exercise, and it is proven to be the only effective and healthy way to keep weight off for good. My article on fat burning includes sensible diet guidelines, but the main point is that to really burn fat to look leaner, you have to charge your metabolism through specific exercise, as detailed above.
As always, your thoughts and comments are welcome.

THE REAL SKINNY BEHIND LOSING THE FAT

Everyone wants to know the best way to reduce body fat. The truth, however, is that it isn’t just about diet or exercise. There are some scientific facts about the body that many people fail to take into account when they approach the issue of losing body fat through training and or diet; and those facts have to do with your metabolism.

The simplest way to understand how your metabolism works is to think of it as the energy your body needs just to be alive. Basically, you can think of your body like an engine that needs fuel to power it just to stay on. However, unlike a car engine, which can be shut off, your body’s engine never shuts off until you die. Even when you are asleep, you are still burning fuel to power the ongoing systems of your body, which includes your respiratory and cardiovascular system, digestion, body temperature, and cellular functions and rebuilding. One thing to remember is that your body rebuilds itself constantly from the inside. Even after we become adults and stop growing, our body still replaces worn out cells with brand new ones. Physiologists call the caloric (fuel) needs of a body at rest the “basal metabolic rate” or BMR. Common sense tells you that the bigger a body you have, the more calories it will burn at rest to keep it functioning. But, your metabolism is also related to how much muscle you have as opposed to fat, since a muscle cell is used more for everyday functions, it will also use more calories at rest. So body composition (body fat vs lean body mass) is also a determinant of what your BMR is.

Exercise physiologists William McCardle and Frank Katch came up with a simple formula that you can use to estimate your BMR once you have your Body Fat % measured. It is:

BMR (men and women) = 370 + (21.6 X lean mass in kg)

Example:
You are female
You weigh 120 lbs. (54.5 kilos)
Your body fat percentage is 20% (24 lbs. fat, 96 lbs. lean)
Your lean mass is 96 lbs. (43.6 kilos)
Your BMR = 370 + (21.6 X 43.6) = 1312 calories

REMEMBER, that is the calories needed just to maintain yourself if you were lying in a bed ALL day. This is not your maintenance amount of calories if you do any activity at all, including just sitting at a desk. To find out what your maintenance level of calories would be, you have to factor in your activity level. Below is a chart to help gauge this number which is your Total Daily Energy Expenditure needs (TDEE):

Activity Multiplier
Sedentary = BMR X 1.2 (little or no exercise, desk job)
Lightly active = BMR X 1.375 (light exercise/sports 1-3 days/wk)
Mod. active = BMR X 1.55 (moderate exercise/sports 3-5 days/wk)
Very active = BMR X 1.725 (hard exercise/sports 6-7 days/wk)
Extr. Active = BMR X 1.9 (hard daily exercise/sports & physical job or 2X day training, i.e marathon, contest etc.)

Example:

Your BMR is 1312

Your activity level is moderately active (work out 3-4 times per week)

Your activity factor is 1.55

Your TDEE = 1.55 X 1312 = 2033 calories

According to exercise physiologists McArdle and Katch, the average maintenance level for women in the United States is 2000-2100 calories per day and the average for men is 2700-2900 per day. These are only averages; caloric expenditure can vary widely and is much higher for athletes or extremely active individuals. Some triathletes and ultra-endurance athletes may require as many as 6000 calories per day or more just to maintain their weight! Calorie requirements may also vary among otherwise identical individuals due to differences in inherited metabolic rates.

Calculating your TDEE is very useful for planning any weight loss program. Basically, you would want to create a slight caloric deficit (15-20% of TDEE) in order to lose body weight, but you have to be careful that you also maintain a lifestyle that helps you lose fat and not muscle, or you could wind up with deceptive results (more about this later).

Most of us don’t know our exact body fat % or our TDEE. However, if your weight hasn’t changed in several years, you can still figure out some important information that you can use to reduce your body fat. If your weight has been consistent, than you are in a homeostasis (metabolic balance) in that your body is maintaining a fairly steady weight. Most of us will over eat some days and under eat on others. Even with these variations in our caloric intake, our bodies will adjust metabolically to settle back to what it feels is our regular weight. The formulas above make it look like all you have to do is establish a negative caloric balance from your usual TDEE and voilà, the fat will burn off. The truth is that is a little more complicated than that, especially at first. This is one reason it is so hard to lose weight just through exercise. In terms of establishing a negative caloric balance, you can burn 250Kal on the elliptical (around 30 minutes) and cut out 250Kal from your diet daily and you still might not lose a whole pound each week, even though formula wise, 7 x 500 = 3,500K which equals one pound of fat. The reason is your body is going to fight going down to a weight it is not used to. I have found that you actually have to hit specific targets in terms of exercise and diet and maintain them for several weeks, before the body accepts the change permanently and resets itself with a new metabolism matched to your new weight.

One of the exercise targets that absolutely must be met is to increase your cardiovascular endurance to where you can do 45 minutes to an hour of steady aerobic exercise. Studies have shown that for the first 45 minutes of aerobic activity, your body will derive most of it’s energy from the carbohydrates floating in your bloodstream and in your muscle cells. Only a small percentage of your energy needs come from fat during this time since fat is harder to break down and it doesn’t have the need for using it as fuel yet. After you go past 45 minutes however, the metabolism will kick into burning fat mode, using it as its primary source of energy to support your aerobic exercise. So, someone who does 30 minutes of cardio every day may still be frustrated from not seeing fat loss results because they never reach the 45-minute threshold. I actually don’t recommend anyone to do 7 days a week of cardio, nor do I think you have to. Five days a week of exercise is plenty to reach the 3,500K goal, especially if you add some weight training into your fitness program. Which is exactly what you want to do if you want to lose body fat, because increasing muscle tissue has been proven to increase the metabolism. Twice a week should be enough for the strength training to have a noticeable effect. However, there is an interesting phenomenon with the two different forms of exercise; strength training has been associated with an increase in appetite, while moderate aerobic training hasn’t. So, you should do both kinds for best results. For most people, they should build up to doing 4 – 5 days of cardio training, with 2 workouts lasting over 45 minutes long. On the other 2 days of cardio, you could try doing shorter “interval training” workouts, which have been shown to help people lose weight faster than plain steady pace aerobics [please see following article on Interval Training Plan].

In terms of diet, of course you have to cut some calories if you want to lose weight, but again, you need to be really careful how much and when you do this or you can really sabotage your system. A lot of people find breakfast the easiest meal to skip. This is a big mistake. You don’t have to eat breakfast right away in the morning, but you should try to eat within 2 hours of getting up. That means you could even go for a 45 minute run after you wake up (drink at least 8oz water before), and then come home, shower, and then eat and you would still be within the guidelines. What is not good, is skipping breakfast and not eating anything until 4 hours later. By that time your metabolism will have reset itself into starvation mode, which is a low calorie BMR, and even small amounts of calories will be more than your body will be ready to burn so it will be more likely to be stored as fat. It really isn’t the calories that will hurt your goal, it is the lowering of your metabolism over time that is the sabotage that skipping breakfast will cause. Skipping any meal will hurt your metabolism because it get’s partially turned on by regular timing of your meals. Now, if one day you are really sedentary, you might be able to eat breakfast, and lie down and just read for hours on just a cup of tea. So, activity does play a key part in the timing and quantity of food you would want to consume. If you are having a normal active day, the four-hour rule is a pretty good one to be conscious of, meaning you should eat something every four hours, even if it is just a snack, in order to keep the metabolism charged.

The quality of the foods you eat is also vitally important to your health and to maintaining a healthy weight. The worst in terms of foods that hurt your metabolism are sugary ones, also known as simple carbohydrates. Breakfast again is the meal where people are the most neglectful of this. It never fails that most of the people who buy the glazed donut or super sized caramel mocha latte are overweight. Eating sugary foods for breakfast are the worst thing you can do to your energy system. They take the metabolism, by way of your glucose levels, on a roller coaster ride. Riding up for a few short minutes, then crashing down for hours afterwards. The best thing to have in the morning is protein, a little fat, and some complex carbohydrates. In terms of actual food, that could be 3- 4 egg whites and some whole-wheat toast with Smart Balance spread. You could eat an orange as well, or later as a snack before lunch. There is enough fiber in the orange pulp to help offset the sugar in the juice. But, just a glass of juice or a fruit based smoothie in the morning is not the best idea for a fat-loss lifestyle.

The end of the day is also a time to be mindful of eating. Generally, your metabolism slows down the later in the day it gets. Therefore, eating big meals really late at night is a lifestyle habit you should try to break. If you work at night, plan on eating an early dinner right before work, and then eating only lightly afterwards, like vegetables or salad. When we are tired at the end of a long day, our willpower is also tired. That means that fattening comfort foods and desserts start looking better the later the hour gets. Be conscious of this and just avoid the temptation by not having them around you and hitting the hay sooner rather than later.

Lack of sleep is a stressor, and like stress in general, it has a negative effect on the metabolism. Studies have shown that living under stress causes the body to release extra amounts of cortisol, which is a hormone that causes the body hold onto fat. More than that, studies on sleep deprivation show that being tired causes your body to lose its sense of “satiation”. Normally, after you’ve eaten, the body releases a chemical that tells the brain it is full, and this makes you no longer crave food. If you are sleep deprived, this chemical isn’t released so you never feel satiated. This explains why late night binging is so common in people with eating disorders.

So, in conclusion, to lose fat properly means to look at where you are in terms of current weight, activity level, diet, and lifestyle and making sure you pay attention to each aspect. Everyone is different in terms of what is best for his or her individual situation. However, there are common rules about the body that anyone can use to help lose fat and look leaner. To summarize, here are the steps you can take to get better control over your metabolism and body fat:

A. If possible, find out what your body fat % is right now. Many health clubs offer this free as a part of your membership, or you can ask a trainer to measure it for you. I personally prefer the Lange Skinfold Caliper measure. After that, use the formulas provided above to

figure your Lean Body Mass(LBM) and then calculate your BMR = 370 +(21.6 X LBMkg)

Then you multiply your BMR times your activity factor (see above) to find your TDEE, which is the number of calories you need to consume to stay the weight you are now. This is a good number to know just for your own information, and can help guide you if you start to measure your caloric intake for a weight loss program.

B. If you don’t know your BF%, you can still begin a sensible program to reduce your by following the specific exercise, diet, and lifestyle rules summarized here:

EXERCISE RULES:

1. Do aerobic exercise 4 – 5 days a week, start with one of those days being a longer workout of at least 45 minutes within your training heart rate, and then try to increase to two long cardio days each week. The other two days of cardio should be shorter in length (25-30min) with one being an interval speed workout if running, or interval incline workout if walking.

2. Do resistance training (strength) at least twice a week. The easiest plan would be to do a full-body routine each day, starting with large muscle groups (legs, back, chest) and then smaller muscle groups (shoulder, biceps, triceps). Hit your large muscle groups with two exercises each, doing one warm-up set and two progressive sets, meaning a little heavier each time. Hit your smaller muscles with at least one exercise each, two sets each. You also want to do abdominal exercises and stretching, which you can accomplish in a Pilates class!

DIET RULES:

1. Creating a negative caloric balance between what you consume and what you expend is of course essential to losing weight. However, if you weren’t exercising at all before, you will be creating a negative caloric balance just from that. Try just reducing your portions slightly (200K a day) and keeping healthy snacks like fruit, nuts, and non-fat yogurt around if you need an energy boost.

2. Make breakfast a conscious choice each day. Remember, you can exercise before breakfast as long as you can do that and still get to eating within two hours of when you wake up. Also, you will support your metabolism better if you choose lean protein as the main ingredient in your breakfast choice.

3. Stay away from sugary foods.

4. Don’t skip meals entirely. If you have a sedentary day of rest, you could eat lightly(small portions), but don’t let too much time go by with an empty stomach.

LIFESTYLE RULES:

1. Try to eat dinner earlier rather than later. The later it gets, the slower your metabolism is.

2. Learn how to cope with stress so you minimize its effect on your metabolism. Luckily, exercise is one way to combat stress, both physical and mental. Nevertheless, you may want to investigate meditation and lifestyle coaching to help you deal with persistent stress and its negative health effects.

3. Be patient. Remember that body fat is pretty stubborn stuff. You will probably start to lose it where you have it least (face, neck, back) and from your main problem areas last. There is no such thing as spot reduction, meaning you can do exercises for the back of your arms all you want, but that only works the muscles, possibly building them bigger if you do too much, and won’t touch the fat that covers them. Body fat, no matter where it is stored, is used for energy; it can’t be changed from fat to muscle. So, the best way to burn it is to up your metabolism, as described above.

4. Be consistent and enjoy yourself. Find friends to work out with, or even a pet dog. You can use music to motivate yourself as well. Keep the faith, you will succeed if you just stick to it.

For more on nutrition, please see my Seven Lifestyle Eating Principles under the Nutrition section in the Exercise and Tutorials tab on my website.