Fast Track Fitness and Physical Therapy

Dieting plateaus are the enemy of anyone trying to lose weight.  These plateaus are extremely frustrating.  You are suffering through the torture of a restricted calorie diet and yet you're seeing no results on the scale.  Your body has stopped losing weight.  Why is this happening and what can you do?

Dieting plateaus occur because the body is extremely efficient and determinedly focused on staying alive.  If you are the average person, then you burn approximately 2000 calories per day.  If you go on a 1200 calorie diet, you're creating an 800 calorie, per day, deficit.  Since 1 pound of fat is equivalent to approximately 4000 calories, this means you should be losing 1 pound of fat every five days.  In a perfect world, this scenario would continue indefinitely until you reach your target weight.  The body, however, sees things differently.  The body perceives your restricted calories as a lack of adequate nutrition.  The body does not realize that you are on a voluntary diet and that food is readily available.  Instead the body thinks that food must be in shortage and that you must be in danger of starvation. To cope with this potential danger, the body will act to slow the metabolism down as quickly as possible.  The body's goal will be to get the metabolism down to 1200 calories to meet the new 1200 calorie intake.  When this occurs, your weight-loss days are over.

So how can I avoid a dieting plateau?  One way to help avoid a dieting plateau is to incorporate a "free day" into your dieting plan.  Once a week, feel free to eat whatever you want in whatever quantity you want without feeling guilty.  This will provide a tremendous amount of calories for your body.  The body will then be tricked into thinking that the shortage of nutrition is over.  When free day is employed on a regular basis (only once a week), it should decrease the likelihood of your body putting the brakes on your metabolism.  It is also important to note that research has shown that you will lose more weight when you incorporate a free day into your diet on a regular basis.

Another strategy that will help the avoidance of a dieting plateau is the consumption of six small meals per day.  If you only eat one or two meals per day, your blood sugar will be low for the majority of the day.  When this happens, your body, figures that it is experiencing a food shortage.  Despite the fact that you're providing the body with adequate nutrition once or twice per day, the majority of the day is spent in a low blood sugar state.  This will encourage the body to slow the metabolism. When you consume six meals per day, the body is constantly receiving food which helps to keep the blood sugar more level.  The body then feels more confident that food is readily available and recognizes no immediate danger or reason to slow the metabolism.

Exercise provides yet another strategy to keep your body from going into a metabolic slowdown.  When you engage your body in weightlifting activities, the body is encouraged to maintain or add additional muscle to the body.  1 pound of muscle burns approximately 35 calories per day, at rest.  It is a highly metabolically active tissue.  More muscle in your body equals more calories burned.  This equates to a faster metabolism and consequently more fat lost.

Cardiovascular exercise will plain and simply burn calories.  If your body has slowed its metabolism down to the 1200 calorie mark, but you burn 600 extra calories with cardiovascular exercise then you have effectively pushed your daily metabolic expenditure to 1800 calories.  This means that approximately every six exercise sessions you'll keep your body burning close to 1 pound of fat.

Losing weight is strictly a numbers game.  It is simply calories in versus calories out.  The goal is to keep the calorie gap between intake and expenditure as wide as possible.  As long you keep this gap wide you will experience continued dieting success.  Allow the gap to close and you'll experience a plateau.  Heed the advice of this article and you should successfully avoid dieting plateaus.

If you ask people what the best exercise for weight loss is, most would answer some type of cardiovascular exercise.  This is, however, not necessarily true.  In fact, excessive amounts of cardiovascular exercise may be highly counterproductive to weight loss.

The body is a highly efficient machine.  It is excellent at conserving energy and will optimize the body for whatever circumstances that it regularly encounters.  If you were to compare the human body to a car, it would be the highest performance, most fuel efficient vehicle on the road.  The body will adapt to any situation.  If it is short on food, it will slow it's metabolism down.  If it is not being fed certain nutrients, it will trigger hunger for foods that contain the nutrients it needs.  If it is being physically challenged, it will adapt the musculoskeletal system to a more effective configuration for that particular activity.

In regards to long-duration cardiovascular exercise (exercise being performed for greater than 45 minutes at a time), the body is being given a stimulus to become more efficient at endurance activity.  The body knows that it is not efficient to carry extra weight during an endurance activity so it looks to make the body lighter.  After all, which would you rather do, run with a 50 pound backpack or without?  So where does the body look to reduce weight?  It looks to the muscle on the body.  The body only needs enough muscle to perform the endurance activity is being asked to perform.  Any extra muscle is considered excess weight.  After all, muscle is 80% water.  Water is a very heavy, dense substance.  The body considers this extra weight to be inefficient and, therefore, it causes the muscle to atrophy or shrink.

In addition to being heavy, muscle is a highly metabolically active tissue.  1 pound of muscle burns 35 calories a day, at rest.  Because the body is already burning a lot of calories in order to perform the endurance activity the body views this extra expenditure of calories (to maintain an unnecessary tissue) as inefficient.  This is another reason that the body is stimulated to reduce muscle mass on an individual that is training the body with long-duration endurance activity.

Unfortunately, the loss of muscle is bad news for weight loss.  Muscle is highly metabolically active `tissue.  Muscle speeds up your metabolism.  The more muscle you have on your body the more calories you burn – every day.  This helps you lose weight.

But don't I burn a considerable amount of calories when I perform cardiovascular or endurance activities?  The answer is yes.  During a one-hour bout of running, at a moderate pace, you'll burn approximately 600 calories per hour.  This will definitely help with losing weight.  For most of us, however, pounding out an hour on the treadmill, elliptical machine, or bicycle on a regular basis is highly unlikely to occur indefinitely.  We might be motivated to do so for a few months but beyond that the torturous, repetitive boredom will take over and most people quit their exercise program. Now we have a problem.  Because we lost muscle mass performing our long-duration endurance activities our metabolism is no longer as high as it was prior to engaging in exercise.  Plus, we're no longer burning calories with our endurance exercise.  This means we're in prime position to regain any lost weight and possibly end up in a worse predicament than when we started.

So what should I do?  You need to do 20 minutes, three days a week, of moderate intensity cardiovascular exercise in order for your heart to receive a cardiovascular training affect (for your heart to get healthy).  You should also engage in weight training three days per week in order to encourage the maintenance, or growth of muscle tissue to maximize your metabolism.  Save the long-distance endurance activities for runners and cyclists who perform these activities out of love.  Don't choose endurance activities for long-term weight loss/maintenance strategies.

That's right; you can eat candy and still lose all the weight you like.  In fact, your entire diet can be candy and junk food and you will still be successful dropping pounds.  How can this be true?  It is true because your body does not care where  calories come from when losing weight.  Your body simply cares about how many calories are entering the system.

Weight loss is simple math.  It is calories in versus calories out.  If you consume more calories than you expend (the average female burns 1800 to 2000 calories per day, versus the average male that burns 2200 to 2400 calories per day), then you will gain weight.  If you consume fewer calories than you expend, then you will loose weight.  The body could care less about the source of the calories.  In fact, the only difference between somebody eating a 1200 calorie candy diet and another person eating a 1200 calorie vegetable and fruit diet is that the person eating candy will feel horrible while the person eating the fruit and vegetables will feel great.  From a weight loss standpoint, however, there will be absolutely no difference between the two groups.  The body simply considers food as energy.  When you digest food, the body converts the food energy into a utilizable human  energy source.  If the food source that you ingest  contains 100 calories, then the body has 100 calories.  It does not matter what type of food provided the calories.

A good analogy would involve purchase transactions.  If you go to the store to purchase an item, you can use cash, credit, or a check to pay for your purchase.  The store could care less what source of payment you utilize.  All three payment forms will eventually be converted into a standard monetary value.  A $1000 check will deposit no differently than $1000 in cash.

From a weight loss standpoint, when you are dieting, you should be less concerned with the food you are eating and more concerned about the sheer number of calories.  It is all just simple math; calories in versus calories out. It would be irresponsible of me, however, not to point out that from a nutritional standpoint your body will be far healthier and happier if you're consuming healthier food choices and a diet that is nutritionally sound.

Don't believe all the hype.  The types of food you eat will make little to no difference in your dieting outcomes.  There are no magic bullets.  Simply watch your calories, consume nutritious foods and you'll be as successful as anyone on any specialized diet or nutritional program.

A lot of people think that fat is an unhealthy substance that should be avoided in the diet.  Nothing, however, could be farther from the truth.  In fact, if you completely avoid fat in your diet, you will die.  For example, did you know that every cell in your body has a fatty membrane that surrounds it?  If your body is not supplied with regular fat intake, your cells will be unable to replicate properly. This will eventually lead to your demise.

Having established that fat is an important component of your diet, it is important to note that there are good fats and bad fats.  In general, a good fat is any fat that is a liquid at room temperature.  These fats are considered unsaturated fats.  On the other hand, a bad fat is any fat that is solid at room temperature.  These fats are considered saturated fats.  It is easy to understand why your body preferres fats in liquid form.  Imagine a liquid fat versus a solid fat floating around in your arteries.  Which do you think is more likely to clog things up?

Interestingly enough, there is no caloric difference between a saturated fat and an unsaturated fat.  All fats contain 9 calories per gram.  From the standpoint of your weight loss or weight gain, there is no difference between saturated and unsaturated fats.  If you are cooking with an excessive amount of unsaturated fats such as olive oil/vegetable, your food will still be calorie laden.  Just because unsaturated fats are less likely to clog your arteries does not mean that the excess calories will not be deposited in your fat stores.  Remember that fat should only comprise 30% of your daily caloric intake for a healthy diet.

The take-home message is to make sure that you include fats as an important part of your dietary plan.  Simply make sure that your fats are unsaturated, and limited to a maximum 30% of your diet. Also, be aware of fat's high calorie content.

If I chronically crack my back, will this lead to arthritis? There are no current studies demonstrating that chronic cracking of a joint will lead to arthritis.  There are, however, studies that show that chronic cracking of a joint will lead to inflammation in the joint and weakness in the muscles surrounding that joint.

Does my spine go back into alignment with my spine pops?  When your back is cracked it has no direct relationship to the alignment of your spine.  When your spine pops, it is simply a release of gas from the joints.  It is not your bones realigning.  Think about what happens when you crack your knuckles.  Prior to cracking your knuckles, move your fingers around.  Do any of your fingers appear out of alignment?  Certainly not.  If they were, you would be most likely heading for the hospital.  Despite the fact that your knuckles are clearly in alignment, you can still crack them.  That's because you're simply releasing gas from the joint when you distract or separate the joints.  Try to pop your knuckles again within 20 minutes of your initial cracking and you'll find that you're unable to produce any noise.  This is because the gas has not had adequate time to assimilate back into the joint fluid where it can be released again.  The same phenomenon occurs in your back.  Cracking your back has little to do with the alignment of your spine.

Will cracking my back make my problems disappear?  In some cases, cracking your back can indeed significantly reduce your symptoms.  The reason for this is that you can cause muscles to relax that may be in spasm or causing compression on sensitive tissues.  At other times, however, cracking your back will lead to increased pain.  It all depends on what tissues are damaged.  Cracking your back requires all the tissues around the joint to be maximally stretched.  If some of these tissues are injured, then you can count on your pain being increased after having your spine manipulated.  It is important to remember that the spine is made up of the same exact tissues as the rest of your body.  If you sprained your ankle, is there anything that you think could be done to magically make your ankle instantly return to normal?  Of course not.  By the same token you should not expect any particular treatment for your spine to instantly alleviate your symptoms.  Spraining your back is no different than spraining your ankle.  Tissues are damaged and must be given a chance to heal.  Any treatment you receive to your back, or any other body part, has the same goal.  Treatments are designed to remove barriers that may be impeding your body from healing itself.  It is the body that must do the healing not the practitioner.  Until your body heals itself your problems will remain.

If my hip is out of place, will this cause back pain?  I hear many patients state that they have been told that their back pain is related to their hips being out of joint.  This is most likely never the case.  If your hip was dislocated, you would be in 10/10 pain and on your way to the emergency room.  Dislocating a hip requires a tremendous amount of force and results in a tremendous amount of pain.  You would be unable to walk and the hip would need to be manipulated into place immediately by a physician.  The reason your back pain decreases following a manipulation (popping) of the hip is that your hips are connected to your pelvis which in turn connects to your spine.  When your hips receive a strong pull, the force will also be directed to your spine.  This will cause the spine to stretch which produces a similar effect to manipulating or cracking the spine (see above for an explanation of what occurs during a spinal manipulation).

As additional evidence, patients that are diagnosed with hip related back pain are given this diagnosis based on the fact that one leg is shorter than the other.  The leg length diagnosis is given based on external observation (i.e. simply looking at leg lengths visually). This is highly inaccurate.  The only way to truly discern a leg length discrepancy is through x-rays.  The next best method would be to utilize a tape measure on bony prominences between the pelvis and ankle.  Many people are born with differences between their leg lengths.  If a person is born with one leg longer than the other, no amount of manipulation will cause this to change.  This is a good way to make a false diagnosis.  Obviously if one leg is physically shorter than the other one this is perfectly normal for that particular individual and in no way indicates abnormal pathology of any part of the body.

As mentioned in previous blogs, the reason the joints in your back crack is because you have increased the amount of space between the bones causing gas bubbles to be released from the joint so that they pop.  When the bones are pulled apart, you are stretching all the tissues that connect the two bones.  These tissues would include the joint capsule, ligaments (ligaments connect bone to bone), muscle, and the outer portion of the disc.  If any of these tissues are injured from the primary insult, they will likely be irritated when they undergo a spinal manipulation (a spinal manipulation is a rapid stretch of the spine necessary to produce cracking).  A good analogy would be; if you sprained your ankle, stretching out important ligaments, and then had someone pull on your ankle in order to make it crack, how do you think it would feel? I think we would both be surprised if you did not have a significant increase in pain following an aggressive stretch of a sprained ankle.  This is exactly what you're doing when you undergo a manipulation of your spine when the supporting structures are injured.  The spine is not a magical entity.  It is made up of the same tissues that you would find in any other part of your body (such as the ankle).  With most injuries, there is nothing you can do to magically make the pain disappear instantly.  The body simply needs time to heal itself. Don't pursue the wrong treatment for your body. A quick fix will often cause you increased grief.

In my last blog I explained what actually happens when your back cracks.  Now you may be saying to yourself, if all that happens when I crack my back is that gas bubbles are popping in the joint, then why do I feel better? The answer is not related to the release of gas bubbles popping but is instead related to the stretching apart of the joint.  When two bones are pulled away from each other, the tissues connecting the bones (joint capsule) are stretched.  These tissues have receptors in them that respond to stretch.  These receptors send signals to the spinal cord and brain to provide information regarding the position and condition of the joint.  If, however, the receptors are stretched maximally (which is necessary to produce popping in a joint) they will trigger a reflex to inhibit the muscles surrounding the joint.  This reflex is designed to protect the body.  If the body is receiving a stimulus that it perceives as excessive, the muscles are encouraged to relax in order to prevent catastrophic tearing and ripping.  To summarize, when you crack a joint it causes relaxation of the muscles adjacent to that particular joint.  This makes you feel better. If you're experiencing muscle spasms, cracking your back and causing muscular relaxation will certainly reduce pain.  Also, wherever a muscle crosses a joint (most of the muscles of the back cross numerous joints.) It will cause compression at that joint.  This compression can lead to pain at the joint, nerve or disk. Once again, if the muscles are made to relax, this will alleviate the problem.

90% of the public will experience back pain at some point in their lives.  Of those 90%, many believe that this pain is due to the back being out of alignment.  People often think that the back can be cracked, put back into proper alignment and that the pain will then go away.  This is not what actually happens.

Most people consider the spine to be a great mystery.  Knowledge, regarding the spine, is based on chiropractic propaganda instead of fact-based research. In the next few blogs I will explain and unravel some of the more common misconceptions regarding the spine.

What happens when you "crack/pop" your back?

 When the spine pops, or when the back is cracked, gas bubbles are being released from inside the joints.  The cracking noise is not the bones sliding back into alignment as most people believe but is instead gas bubbles popping.  When you manipulate the spine, or any other joint in your body, all you're doing is simply pulling one bone away from another bone.  This increases the volume of space between the two bones.  Because there can be no void of space inside the body, something must rush to fill this new space.  What rushes in to fill the space is gas that is dissolved within the fluid inside the joint.  Under normal circumstances, the fluid within your joints is under pressure.  This pressure causes gas in the joints to convert to a liquid form.  A good analogy of this is the bubbles in soft drinks.  With soft drinks, carbon dioxide gas is injected into the beverage under pressure.  Because the gas is under pressure it converts to a liquid form.  This is why when you look at a 2 L bottle of soda, before it's opened, you see very few gas bubbles.  Once you take the cap off the soft drink, you decrease the pressure, and increase the volume of space.  Consequently, bubbles escape from the soda.  Cracking or popping your back is no different than opening a bottle of soda.  You're just decreasing pressure so that the bubbles form and pop.

50% of the population have one, or more, bulging disks in their spine.  None of them have any pain.  Why is it then that people panic when they are told that they have a bulging disk?  The simple answer is a lack of understanding regarding the spine and especially the disk.  Here are the simple truths regarding disks.

Disk Facts

• 50% of the population, without pain in their spines, have bulging discs.
• MRI findings are frequently inaccurate.  The MRI often fails to give an accurate picture of the spine.  Many time disks are shown to be bulging that do not indeed bulge at all (and vice versa).
• Research has only been able to generate disk injuries when the spine is in a flexed position (i.e. bent forward).  In other words, if you can keep your back in an erect position you can avoid disk injuries.
• The best way to injure the disk is to bend forward and twist your back at the same time.
• There is more pressure on your spine in a seated position than in a standing position.
• The biggest risk factors for a disk injury are: sitting, bending forward, bouncing/vibrating(driving), and twisting.
• There are really only two types of disk injury.  One injury involves the disk bulging out in a particular place on the disk (think of a worn-out tire where the rubber has gotten thin.  In the thin area a bubble will show up).  The second way to injure a disk is for the disk to actually tear.  This is like ripping a piece of paper.  When this happens the fluid inside the disk leaks out.  This fluid is highly irritating to the adjacent nerves and can cause significant pain.
• Rotating the spine (think of looking back behind you) causes the pressures inside the disk to increase by a factor of four.  Rotating the spine also causes the disk to lose 50% of its integrity or strength.  This is why rotating the spine places you at high risk for disk injury.
• Never stretch your back in the morning.  When resting at night, your disks swell up with fluid.  When the disks swell, they separate the adjacent bones that they connect.  This means that the outer part of the disks (that connects the bones together) are stretched maximally taunt.  If you stretch in the morning, you will over stretch the disks.
• 90% of the fluid in the disk will be squeezed out after the first hour of getting out of bed.  The first hour of the day is the easiest time to provoke a disk injury because the disk is swollen and stretched tight.

Disk Myths

• You can slip a disk.  This is simply not true.  The disk is not a separate structure that lies in between the bones.  The outer layers of the disk actually connect adjacent bones of your spine together.  The disk, because it is a connector of the bones, would have to be sheared in two in order for the bones of the spine to slide horizontally away from each other.  This would result in a catastrophic, paralyzing accident.
• Chiropractic manipulation can fix the disk.  The fact is no treatment can fix the disk.  Once you have developed a bulge in the disk it is there to stay.  The disk bulge can decrease in size as inflammation reduces and scarring takes place but the injured site will always remain a weak point in the disk.
• I will always have back pain because of my disk injury.  50% of the population have bulging disk without any pain.  A bulging disk is not a desirable commodity but at the same time it is not something that should cause you great distress.  Also, remember that 90% of back pain, regardless of the tissue involved, will resolve within one year.
• I will need surgery to repair my disk injury.  You can lead a normal life without surgery to repair your disk.  In fact, long-term studies have shown that people that avoid surgery to repair a disk experience less pain over time.
• I need a significant accident in order to produce a disk injury.  Unfortunately, a disk can be injured by an activity as simple as bending over to pick up a pencil off the floor.  This should encourage you to execute good body mechanics at all times and not just during heavy lifting tasks.

Everyone would readily agree that physical jobs such as mover, construction worker, and auto mechanic would be considered physically demanding jobs.  Most, however, would not rank office work as being physically difficult.  The truth is that office work can be highly physically demanding due to static body positions being held for long periods of time.  The key to avoiding serious problems from office work is to adopt good posture and make sure that your work and ergonomics are as ideal as possible.  It is also important to change positions and tasks frequently.  You may need to spend time planning out your day.  Intersperse different activities throughout your day in order to avoid long periods of static tasks.  The below suggestions to improve posture and ergonomics will help you to avoid problems and maximize productivity.

Chair Ergonomics

• Your feet should sit flat on the floor.
• The base of your chair (the part of the chair in which you are sitting) should be angled slightly downward.  This will place your knees at a level below that of your hips.  The chair base should not be tilted to such a degree that you feel like you're sliding forward.
• The armrests of the chair should be adjusted a half an inch higher than the resting position of your forearms when your elbows are bent at 90°.
• The seat back should be adjusted forward to support your spine.
• Your head position should center your ear lobes in the direct center of your shoulders.  This position can be difficult to maintain as computer work will cause people to have a tendency to move their heads forward towards the monitor screen.  It may be beneficial to tape the word "posture" on the top of your computer monitor to remind you to keep your head out of the forward position.

Desk Ergonomics

• Position your monitor so that your eyes are level with the top third of the screen.
• Position your mouse and keyboard at a level where your wrists can maintain a neutral position.  The neutral position for your wrists is perfectly straight.  Imagine placing a ruler from the tip of your finger up to your elbow.  Your finger and arm should make contact with the ruler along its entire length. If it does, your wrist is in the neutral position.
• Position your keyboard and mouse close to your body so that you can avoid reaching forward.  This will allow your shoulders to remain in a better postural position.  You never want your shoulders to be rolled forward.
• Position all frequently utilized items as close to your body as possible.  This will help you to avoid awkward reaching postures.
• When reading a document and simultaneously working on the computer, keep the document being read as close to the computer monitor as possible.  This will help you to avoid frequent neck rotation.  Remember that repetitive motions lead to injury.  Think of what happens when you take a piece of metal and then bend it back and forth repeatedly.  It breaks.

General Office Tips

Employ as many of these suggestions as possible and you will be well on what your way to minimizing your likelihood of attaining a work-related injury.

• Change tasks as often as possible.  Plan your day to interject differing physical demands.  Run errands, file, take bathroom breaks, etc. to break up long periods of computer activity.
• Intermittently stop and review your postural position and make necessary corrections for the better.  Frequently stop and take 3 deep breaths, focusing on relaxing muscles and letting all the tension go out of your body.  Breathing deeply will cause your nervous system to relax and will greatly reduce tension that is being stored up in your body.
• Stretch the muscles in your neck and upper back at least once every hour.  Stretching does not need to take longer than 30 seconds.
• Stand whenever possible.  Look for opportunities, such as phone calls, to change positions.
• Never cradle the phone between your ear and shoulder while trying to work.  If you need to frequently speak on the phone for work, get a head set.