Tuesday, December 5, 2017

7-Minute Workout based on HIIT to do anywhere

Back in 2013, the NY Times wrote up a 7-Minute Workout and it proved to be quite popular.  The basic premise is that the workout uses HIIT to achieve maximum results in a short amount of time.  HIIT stands for High Intensity Interval Training and has been researched a reasonable amount in recent years.  The NY Times article was inspired by an article with the title "High-Intensity Circuit Training Using Body Weight: Maximum Results With Minimal Investment" from the Amer. College of Sports Medicine's Health and Fitness Journal.  My personal trainer suggested I give it a try during a training session about a year after I completed physical therapy for knee rehab.  After that I found a free app that makes it easy to do the workout, especially when I am traveling.  All that's needed is a little space, a towel, and an appropriate chair.


When I first started doing the 7-Minute Workout, I was in decent shape but I wasn't ready for 30 seconds for some of the exercises.  I did what I could, and then took a longer rest until it was time for the next exercise.  I felt it was more important to maintain good form than worry about the number of reps.  For instance, I started with about 8 pushups at a slow pace.  Once I got into better shape, I started doing 10-15 pushups in the 30 seconds.  When I'm in good shape, I can do 20 pushups.

Possible progression from easy to harder:
  1. Very slow, stopping before 30 sec up if needed, complete rest for 10 sec
  2. Slow and steady, continue for 30 sec, complete rest for 10 sec
  3. Normal pace for 30 sec, simpler versions for a few exercises, complete rest for 10 sec
  4. Normal pace for 30 sec, good form for all exercises, complete rest for 10 sec
  5. Normal pace for 30 sec, good form for all exercises, active rest for 10 sec
This video demonstrates the entire 7-Minute Workout.  She gives good explanations.  In this case, active rest is used instead of complete rest.  She does exercises that rely on upper body strength the easier way.  For instance pushups or the plank from her elbows.

Friday, November 24, 2017

Bone density and hyperthyroidism

An additional factor for some women, and men, to consider when thinking about bone density are thyroid hormones.  People with hyperthyroidism are at higher risk of low bone density.  People taking medication for hypothyroidism who are not being monitored often enough can end up taking too much synthetic hormone that causes them to have too much in their system.  That's a reason to check thyroid labs at least every six months, as well as pay attention to common symptoms for hyperthyroidism and hypothyroidism.

Thyroid Disease, Osteoporosis and Calcium

The good news is that once thyroid hormones are back in normal range and stable, it's possible to build up stronger bones to get back to a normal level for a given age.

A good source of information about thyroid imbalance is the latest edition of a book first published in 1999.  The Thyroid Solution by Dr. Ridha Arem, covers diagnosis and treatment for hypothyroidism and hyperthyroidism in great detail.  The third edition was published in 2017.

I was diagnosed with an over active thyroid aka hyperthyroidism in October 2016.  In my case, the source was Grave's Disease.  It took almost a year to get the correct dose for medication.  After the initial treatment, the maintenance dose is quite low.  Most of the symptoms went away within six months, but it took another few months to feel completely back to normal.

Wednesday, October 11, 2017

Five years after rupturing an ACL, still a successful coper

Hearing from other people in the midst of knee rehab recently made me think back to my knee rehab process.  My knee injury resulted in a complete ACL rupture (not a skiing accident).  Using KOOS (max 100, Knee Injury and Osteoarthritis Outcome Score) was useful for tracking the healing process.  After five years I have a different appreciation for milestones during the first year.  During rehab it was not clear how long the process would take and whether or not I would have to change my approach to skiing.  I decided to take the treatment approach based on physical therapy and improving fitness only, as opposed to scheduling ACL reconstruction surgery.
  • Month 1: crutches (injury was during 2-week international trip) and rest - June 2012
  • Month 2: formal PT, mostly no impact exercises while giving MCL strain time to heal completely, MRI confirmation that ACL completely ruptured
  • Month 3: started weekly personal training, fully functional for daily living, KOOS 86-88 (Mild or Moderate for Running, Jumping, Twisting/pivoting because avoiding those actions), second and final appointment with orthopedic surgeon
  • Month 4: continue personal training, back to indoor rock climbing, avoiding jumping and running (never liked running for exercise)
  • Month 5: final PT session included agility exercises, KOOS around 90
  • Month 6: ready for easy skiing, KOOS at 94 (Moderate for Twisting/Pivoting) 
  • Month 7: skiing at speed on small hill (Massanutten) - Jan 2013
  • Month 8: started lessons with a very experienced instructor (three Silver Clinics at Massanutten with Walter, PSIA Level 3), decided not to bother getting a brace
  • Month 9: 3-hour private lesson at Bridger (Ric Blevins, PSIA Level 3, worked with Ric the season before), skiing at Bridger and Big Sky included a few bump runs steeper than the year before
  • Month 10: skiing harder ungroomed terrain at Alta than the previous year, KOOS about 96 - Apr 2013
I had a relatively easy time making an educated decision about which treatment made sense for my ACL injury. I had an MRI and was evaluated by a orthopedic specialist about a month after injury. The collateral damage was a minor MCL strain and a small hole in the part of the meniscus that could heal fully without medical intervention. By the first time I met with the surgeon I had researched the most common treatment options was ready to discuss the options. Even though I was over 50, my orthopedic surgeon was willing to do surgery if I was interested.  At three months my surgeon supported my decision to stay a coper.  I was very careful the first six months and gave my body almost a year before considering the healing process complete. I made use of Chinese medicine (acupuncture, herbal Yunnan BaiYao) from the start.

What I’ve learned since rupturing an ACL is that there are a lot of factors to consider when deciding on treatment. Initially I thought that the level of collateral damage (meniscus, bone fracture, other ligament damage) were the most important. After reading about ACL treatment options, recent research results, and learning more about copers who ski, including skiing with several older advanced skiers who are ACL-deficient, I think the following is only the start of a list of other significant factors.
  • Health care system of the patient’s country
  • Age of patient
  • Personality of patient related to fear of further injury
  • Personality of patient related to ongoing fitness exercises
  • Type of physical activities and sports the patient enjoyed at the time of injury
The medical approaches for how to treat ACL-deficient patients continue to evolve.  The knee is complicated.  Everyone's situation is different. Regardless of what can be learned online about copers and ACLr surgery patients, it's ultimately a very personal decision that should be made in consultation with experienced medical professionals.

Importance of hips when you want to dance on the slopes

After doing ski conditioning for a while and exploring ideas online and with my personal trainer, a few exercises stand out as part of almost any routine.  Most people know that lunges and squats are useful.  One objective is to work on the glutes, which turns out to be how to have stronger hips.  Bridge exercises are a good way to strengthen hamstrings, which are important for supporting knees.  For core strength, a plank with good form is a fundamental exercise.

For this set of seven ski conditioning exercises related to hip strength, resistance bands are used to increase the difficulty.

September 2017 Denver Post - includes 4 min video of seven exercises

If someone tells you that strong quads are the basis for good skiing, show them what an orthopedic surgeon at the well known Steadman Clinic in Vail, CO has to say.

“We’re finding more and more that we think strengthening of the hip muscles is as important as anything,” said Dr. Tom Hackett, an orthopedic surgeon at the Steadman Clinic in Vail who has worked with hundreds of U.S. Ski Team athletes. “I watch people in the gym getting ready for the ski season — all they’re working on is their quads. That’s obviously important, too, but we really have found that the control over your leg that prevents knee injuries is coming from the hip. So more and more, we’re really trying to encourage our patients to work on strengthening the hips.”

Sunday, October 1, 2017

Balance is key and easy to improve

My first blog post was about balance exercises.  Three years later, I'm still more likely to do something related to 1-leg balance every day than any other type of exercise.  A few minutes a day makes a difference after a month or two or three.  That's what I learned doing knee rehab for about four months.  Consistency matters.  Can do something to improve balance anywhere, anytime:   indoors, outdoors, waiting in line, watching TV, in the bathroom.

A very basic introduction to a few balance exercises (6 minute video)

A balance routine that doesn't take long, which can be easy or hard (5 minute video)

Easy balance exercises that give a clear view of good form (9 minute video)

Saturday, September 23, 2017

Strong adductor muscles are good for skiing and mountain biking

Recently I did a little downhill mountain biking for the very first time.  It was a 1-day workshop for women at Massanutten in northern VA, which added lift-served mountain biking a few years ago.  Turns out that in a bike park, you spend pretty much the entire time on the bike going downhill while standing on the pedals.  What little uphill there is does not require sitting on the seat, which is kept low so that it's out of the way.  Learned a lot from the two instructors that worked with the group of ten women, which included a few novices.

The muscle that didn't appreciate the extra work was the adductor muscle that goes to just above my  knee that is missing an ACL.  When I did the knee rehab, working on adductors and abductors went together with hamstring exercises.  Those muscles are also important for downhill skiing.  While my MCL was healing after the knee injury, it was obvious whether or not it was too soon for these exercises because there would be pain.  I would wait another week before trying again.  In my case, it took about three months for complete healing.

Adductor exercises are easy to do at home.  Take a look at the videos for an introduction.  When I was doing formal physical therapy, I learned how to do all of them at some point.

Using a soft ball to strengthen adductors

Two knee exercises using a resistance band

Eccentric exercise for adductors

Inner thigh exercises to strengthen adductor and groin muscles

Wednesday, August 24, 2016

Focus on eccentric exercise to build leg strength for skiing

Regardless of how you exercise, it helps to understand what "eccentric" means when it comes to muscle movement.  The opposite type is "concentric."  Doing squats or lunges is not as effective if you don't know which direction is an eccentric exercise.

Here is what I found in a Backcounty.com article:

"Think of concentric strength as “positive” strength. This is the strength you use to stand up from the bottom of a squat, or hike up a steep hill. Eccentric strength is “negative” strength. You use eccentric strength to lower yourself into the bottom of the squat, and hike down a steep hill. Eccentric strength absorbs force.

My observation at the fitness center is that some people tend to think that going faster is better when they are using fitness machines.  Meaning to the point that they ignore the speed warning provided by the machine.  They also tend to do relatively heavy weight that they cannot handle slowly.  For ski conditioning, a weight that can be handled slowly for 10-15 reps is more helpful in the long run.