Active Care

Muscle Cramping

Short of an emergency phone call, there’s few worse ways to be awakened in the middle of the night than a muscle cramp.  When it happens, someone usually offers the sage advice of eating bananas and drinking water.  But are you really dehydrated and electrolyte deficient in the middle of the night?  We owe this perception to early observations of miners and athletes working under hot and sweaty conditions, leading experts to believe that heat, poor hydration and electrolyte loss explained the incapacitating cramps often seen in athletes during and after exercise.  However, while this belief is still common, it is largely supported by only anecdotal evidence and lacks scientific basis.

To get to the bottom of the cramping question, researchers looked at hydration and electrolyte status before and after long and arduous events like Ironman distance triathlons or ultra running events to determine possible differences between those that experienced cramps and those that did not.  Surprisingly, there wasn’t any difference in electrolyte or hydration levels between crampers and non-crampers, indicating that some other trigger was to blame for muscle cramping.

So what’s to blame?  Well, after listening to athletes complain about muscle cramps after intensive training and racing, researchers stumbled upon a different reason to possibly explain painful muscle cramps – muscle fatigue.

A study published in the British Journal of Sports Medicine that followed a group of over long distance triathletes found that those athletes that either pushed themselves harder in the beginning portion of the race or competed at a pace that exceeded their “usual” pace were more likely to experience muscle cramps than those that competed at a more typical pace.  A similar study in the same journal also correlated recent injury and a history of cramping with increased risk of the problem.  Additionally, in a study of ultra-runners, those athletes that didn’t adequately rest or weren’t fully prepared for the race were again more likely to cramp during or after a long event.

These studies suggest that any factor that leads to greater fatigue increases the risk of muscle cramping as in all the above studies the groups did not differ in hydration or electrolyte levels when the muscle cramps were experienced.

More fuel for this alternate theory for muscle cramping is that the painful cramps typically only occur in muscles that are working such as the hamstrings of cyclists or calf muscles of swimmers.  If systemic dehydration or electrolyte deficiency were to blame, any muscle in the body would be equally likely to cramp.

Researchers have also observed that muscles that are on the verge of cramping display a greater baseline level of nerve activity than normal muscle.  The researchers hypothesized that the nerves responsible for inhibiting muscle cramps in working muscles are short-circuited after exhaustive exercise and stop performing their function, leading to muscle cramps.  The oft-used cure for cramping, muscle stretching, re-establishes normal function of the nerve – at least temporarily – and is often successful in relieving the cramp.

Of course, these studies can only infer the mechanism behind cramping, as direct observation of cause and effect is not yet scientifically possible – thus these results should be interpreted with caution as they simply have strongly correlated fatigue with cramping.  Maintaining hydration and electrolyte balance, especially during long distance events, is still important for performance and safety.  Just don’t expect that extra bottle of water to protect you from muscle cramps.

Exercise is the Medicine

Chances are if you work, go to school or are around kids there’s always someone sniffling, sneezing or coughing.  Of course, all you’re trying to do is avoid getting the cold, flu or stomach virus your self.  But is hand sanitizing, incessant hand washing and kicking open doors like an ER doctor really the only way to avoid the sniffles?

Well other than being an older age, married male – interestingly the other demographic factors that predict less susceptibility to upper respiratory illness – near daily physical activity significantly lessens the chance of those nagging cold symptoms.  Active Care founder and physical therapist Lisa Giannone has coined the phrase ‘Exercise is the best medicine’; who knew that it applied to upper respiratory illness as well as orthopedic health.

It would be an understatement to say exercise is an important piece of health and well-being.  After all, exercise has been definitively linked to cardiovascular health, disease risk and mental health.  So we know that exercise makes us live longer and feel better, but does it help avoid the non-life threatening illnesses, like the good old common cold?  After all, sickness absence has a major affect on economics and society and preventing long-term absences is in the best interest of every business and organization.

It’s well known that many adults in the United States (and world) don’t meet the physical activity requirements that experts say are needed to realize the health, fitness and well being benefits associated with physical activity.  Unfortunately for those that don’t, a clear relationship exists between the amount of physical inactivity and all cause mortality.

Well add increased cold immunity to the list of exercise benefits as researchers from Appalachian State University reported in the British Journal of Sports Medicine that those that exercised 5 times a week for 20 minutes or more suffered through 40 percent less sick days than those that exercised 1 day or less per week.  What’s more the cold symptoms that the exercisers did experience were of lower severity and didn’t last as long.

The experts are still debating the reasons behind this reduced risk but there are many good guesses.  Among the most likely is a bout of aerobic exercise causes a short-term increase in the recirculation of cells tasked for immune system defense. Additionally, stress hormones, which are potential suppressors of immunity, are not elevated during moderate aerobic exercise.  Although the immune system returns to pre-exercise levels within a few hours after exercise, each sweaty workout session may improve the immunity against the viruses and bacteria that cause illness.

Upper respiratory infections are caused by a variety of different pathogens, making full coverage preventative vaccines a near impossibility.  For those that want to make it through the long months of winter without a cough, runny nose or sore throat, exercise may be the best vaccine.

Eating Before Exercising?

If you’re looking for answers on whether to eat before or after exercise to promote weight loss, research on the topic may leave you more confused.  That’s because a commonly cited article seemingly recommended fasting before exercise, leading to a rash of other articles and blogs using the research as evidence that exercising before eating increases fat burning.

Unfortunately for those wanting to figure out the answer to fueling question the study, published in the Journal of Applied Physiology, was looking at whether or not people who are eating 50 percent of their calories in fat should exercise before eating.  If you’re on such a diet, then it would appear that exercising in a fasted state does offer some benefit, but how many of those who want to lose weight through exercise actually fall into that category? Most people concerned about nutrition, fueling and performance are not eating half of their calories in fat and are not eating more calories per day than their bodies require.

The study muddied the nutritional waters because what we eat contributes to what we burn as fuel during exercise, making the results inapplicable to the general population, as few nutritionists would advocate switching to a high fat, high calorie diet to aid burn more fat during exercise.

For those with a more standard diet, a 2011 study in the International Journal of Sport Nutrition and Exercise Metabolism found that fasting before undergoing moderate exercise did not improve fat metabolism.  The conclusion of this study? Eat a light meal before exercising.

What’s more not eating before exercise may cause dizziness or lack of energy, both of which can lead to a sub-par workout and probably will not aid in weight loss.  Fainting on the treadmill at the gym won’t help you achieve a smaller waistline but will lead to smaller wallet after you fork over the ER co-pay.  Of course for many, eating too much or too heavy of a meal before exercise leads to stomach discomfort or worse.  For those individuals, small amounts of an energy drink may be the best alternative.  If you’ve just had a big meal and want to follow-up your steak and potatoes with a good workout, experts recommend giving it 3 to 4 hours to digest.

The bottom line of this research suggests that eating a light, carbohydrate-based meal before exercise may give you the energy for a good workout, ultimately furthering your weight loss goals.

CrossFit or CrossFad?

The fitness community has a well-established love affair with the latest and trendiest exercise programs. Remember Tae-Bo and Billy Blanks? Jazzercise and Jane Fonda? Spin and Johnny G? Yet despite the hype, these fitness programs and their famous, chiseled originators eventually faded into anonymity.

However, despite our short attention span with exercise programs, CrossFit believers proclaim it’s no flash in the pan, but an effective and efficient exercise practice that benefits from a unique blend of high intensity exercise, Olympic style lifting and gymnastics-related exercise. While CrossFit continues to enjoy immense popularity and has legions of devoted followers, it has been the center of an intense debate between those who believe in the success of CrossFit’s pace and intensity and the vocal critics that believe the program puts its practitioners at high risk of serious injury.

Those that believe in the effectiveness of CrossFit focus on research that highlights the benefit of high-intensity training for athlete and non-athlete alike. CrossFit style high intensity interval training has been shown to have many benefits, including improvement in both aerobic and muscular fitness. This point of view is supported by a recent article in the Journal of Strength and Conditioning Research that found high intensity power training programs such as CrossFit improved body composition and aerobic fitness in subjects of both genders and all fitness levels.

However, there are those that believe that this high intensity workout comes with a not insignificant degree of risk. In fact, the same 2013 study above that supported CrossFit’s effectiveness also noted an injury rate of 16% among the participants in the 10-week study. This seemingly small side note ignited a storm of backlash against the study and many of those that warn of CrossFit’s risk. While it’s difficult to truly assess CrossFit’s injury rate, supporters say it’s no greater than other popular activities such as running, gymnastics and triathlon.

However, to cover up the risk of injury in any activity or sport, including CrossFit, is to disregard the obvious. The same high-intensity exercise program that gives CrossFit practitioners an effective means to lose weight and gain fitness comes with a higher risk of injury than lower intensity exercise. Any workout that is repeatedly done at full intensity carries the same risk, especially those that involve technique dependent exercises like Olympic lifting. Going to the track for full-speed sprint training multiple times a week would carry a similar degree of increased injury risk.

Like any other activity, conscientious CrossFit practitioners should emphasize technique over speed and ensure that the riskiest moves be carefully learned before applying intensity. Those that are new to CrossFit should start progressively, especially if just starting an exercise program, to avoid the overuse injuries common to high intensity activity.

Remember, you can’t have it both ways; it’s not possible to be both the hardest workout on the planet and the safest.

Practice Makes Running (More) Perfect

We may be all born to run, but are we all born to run well, fleet of foot and without injury?  Running is an immensely popular fitness activity and for good reason.  It offers efficient exercise and it can usually be done anywhere or anytime, with only the most basic of equipment.  But this simplicity may lead many to believe that running doesn’t require the preparation that is part and parcel of other sports or activities.  After all, one wouldn’t pick up a tennis racket and presume to play in Wimbledon, yet many runners begin training for half-marathons, marathons and ultras without specifically training the running “skills” that help avoid injury and improve efficiency.

Of course, a lot of attention has been devoted to the role running shoes have in the prevention of injury.  Yet despite all the advances in running shoe technology over the past 30 years the rate of injury among runners remains quite high.  Even barefoot running, once eagerly embraced by many as the answer to injury woes, hasn’t delivered on its early hype.  The barefoot backlash has been highlighted by a group of disgruntled runners recently settling a multi-million dollar lawsuit against the running shoe company Vibram over marketing claims that its once popular sock-like 5-finger shoe prevented running injury.

Now with the confirmation that no one shoe type prevents injury, what should the stylishly appointed runner wear on their feet? Well just like a golfer can choose a club to suit a particular shot, so to can the runner choose a shoe to match a run; a lightweight shoe for speed/track workouts, a maximalist (highly cushioned) shoe for recovery or long runs, and a regular running shoe for any run in between.

So what are these essential running skills that every runner should practice?  First, as the impact of running sends a force of 3 to 5 times bodyweight through the joints with every step, the muscles of the legs, hips and back should be strengthened to help absorb some of that impact.  Research suggests that the muscles of the outer hip and quad are of particular importance.

Although the characteristics of a runner’s stride are like snowflakes, no one stride is the same, a unifying factor seems to stand out in terms of injury prevention.  That seemingly critical factor is stride rate or the number of strides a runner takes per minute.  Regardless of what part of the runner’s foot that strikes the ground first, where the foot lands in relation to the runner’s body seems to be more important.  A high stride rate correlates with a shorter stride length and less chance that the runner “overstrides”.  Overstriding or excessive stride length causes the leg to act like a brake and increases the impact force each time the foot strikes the ground.

In fact, a just-published review article in the journal Sports Health concluded, “An increased stride rate (reduced stride length) appears to reduce the magnitude of several key biomechanical factors associated with running injuries.”

While making this change takes time and focused effort, research suggests that making the investment in changing stride rate is more important than concentrating on forefoot, midfoot or heel striking.  Making those changes may help reduce the risk of injury more than buying into the latest running shoe fad.

It’s That Time of Year

It’s that time of year that we resolve to start fresh and eat better, workout more, play less iPhone Candy Crush and generally remake everything.  Unfortunately, too often those resolutions don’t make it past Groundhog Day.  Research shows that about 45% of Americans make New Year’s resolutions but only about 8% actually achieve them.

But that same research indicates those that make resolutions realize more success than those who don’t, so make that list.

Yet how do you make sure those good intentions make it to summer and beyond? In a recent Reuters article on the topic, American Council on Exercise researcher Jennifer Ratliff suggests borrowing from the business world and adopting the S.M.A.R.T. goal-setting approach (smart, measurable, attainable, relevant, time-bound).  For example, if you haven’t been exercising don’t set the goal of working out five days a week.  Start with two or three days and build on the enjoyment and satisfaction of working out.

Unfortunately another stumbling block for New Year’s resolutions is injury.  Many well-intentioned resolvers make the mistake of doing too much, too soon or start an exercise program that is too advanced.  Overuse injuries such as kneecap pain or rotator cuff tendinitis are often the result of quick changes in the volume or intensity of exercise.  For instance, resolving to run a marathon and beginning a training program without any preparation often results in a knee or lower leg overuse injury.  Other common scenarios, starting Cross Fit without a solid base of general strengthening; resolving to get more flexible by going to five yoga classes a week; starting a soccer league with players 20-years your junior.

So how do you resolve to get fitter and improve health without ending up on the examination table of your local orthopedic surgeon or physical therapist?

  • Start slow-research shows that the majority of the general health benefits of a fitness program can be achieved with light exercise such as walking.  One to two hours a week (depending on the type of exercise) of cardiovascular exercise and one 15-30 minute session a week of strength training.
  • Be a beginner-don’t try to pick up an exercise/training program where you left off a month/year/decade ago.  Bones, ligaments and tendons are just like muscles and get stronger in response to regular exercise.  The converse is true as well so prepare these structures for more advanced exercise by sticking with a basic, beginner program for several months before trying more advanced exercise (plyometrics, Olympic lifting, marathon training).
  • Aim low-when starting from scratch, trying to adhere to a 7-day a week exercise program at best invites burnout and at worst welcomes injury.  Exercise is addicting but the habit needs to be nurtured a bit before trying to make radical changes in activity.
  • Don’t “work through the pain”-small problems can end up being big problems if they are ignored or “patched-up” for too long.  Make modifications in volume, intensity or type of activity if pain or soreness starts to become consistent (e.g. if the knee hurts after a run switch to the bike).
  • Cross-train-integrating different types of activities keeps exercise interesting and minimizes the chance of injury.

The best part about starting to exercise?  Those who are the least active get the biggest gain from starting to exercise.  Those poor slobs that have been working out everyday realize very little additional health gain by exercising any more.  Of course those that regularly exercise have banked a great deal of health related gains already as a Physical Activity Guidelines report suggests, “It has been estimated that people who are active for approximately 7 hours a week have a 40 percent lower risk of dying early than those who are active less than 30 minutes a week.”

That’s good motivation to get out and exercise.