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Fitness Question: Neck Surgery, now what?

Neck Pain

I just got operated for a herniated disc between the 6th and 7th vertebra along the back of the neck. A part has been removed. I had a nerve failure in my left arm because the nerve was compressed by the herniation. Now I have one problem; I walked 2 or 3 times a week for 1 hour but according to the doctor that is not very good for my neck because I have osteoarthritis between my 5th and 6th cervical vertebrae (strongly narrowed intervertebral space with slight disc herniation) and the other cervical vertebrae have small disc protrusions)

My question now is whether it is wise to buy a cross trainer and to maintain my fitness level that way. I mainly did fat burning and endurance.

I am 50 years old and still want to be active and have no overweight bmi = 21

Christine

 

 

Mark Chen, Physiotherapist:

 

Hi Christine,

I think it is certainly a good idea to keep the condition up to date via a cross trainer. I would certainly also put the advice of the GP to the test.
The idea that osteoarthritis should be a reason to be careful is very old-fashioned. To get an idea of what I mean, take a look at the next image.

 

Recent scientific research has tested the causal relationship between abnormal findings and pain by allowing people to take an MRI scan without any symptoms.
These studies show that there are a huge percentage of deviations that in these cases are totally unpaired with pain.
For example, for a disc “bulging” as you describe, 87% !!!
For degenerative changes of the discus, such as dehydration/desiccation, as many as 96%!!! of the older population.
This group, again, does not experience any pain.

This should be a reassurance. The findings in your neck are normal, and not necessarily responsible for any pain.
Of course, from my position I can, not determine whether there is actually a connection!

My advice would be to find a sporty physiotherapist who can help with this process. The neck must be tested slowly to see what is and is not possible!

In this way you will probably be surprised at what is possible. The idea to reduce a basic activity such as walking at such a young age (provided there is a good reason) does not seem sensible to me.

I hope this helps!

Mark Chen

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Fitness Question: Shoulder pain

“I suffer from a bursitis in my shoulder. Now I have heard that an injection does not always work. Can I benefit from physiotherapy?”

-Astrid

Mark Chen, Physiotherapist

How annoying that you have bursitis: They can, especially in the shoulder, be very persistent.

Injections are an often used treatment for bursitis and other inflammatory issues. The results are variable, but generally very good. With such an injection, corticosteroids are injected into the joint, with the intention of reaching the bursa, or whichever structure is the problem. A good placement of the injection is, therefore, very important.

The cortisone that is used is a variant of a hormone that the body itself makes to combat inflammation. When cortisone is administered from the outside, the immune system is suppressed and the body temporarily stops with production. In the short term, so with a single injection, that is generally not a problem. But the use of cortisone in the long term can have adverse effects, such as atrophy (decrease) of muscle tissue, decrease in bone quality and susceptibility to infections.

Physiotherapy

If you opt for treatment by a physiotherapist, you will probably look at the underlying cause. When the bursitis in your shoulder is not caused by a trauma, there is often a reason to find in the mechanics of the shoulder, posture or behavior. You can identify and solve these types of causes together with a therapist. In many cases, an injection is not required.

I myself always advise people to take a close look at the immune system. Are there ways, for example in your diet, to support the body in its own abilities to heal? When the shoulder is relieved, the body is well hydrated and provided with sufficient building materials, then you are often perfectly able to solve an inflammation by yourself.

Of course, one does not have to exclude the other. The physical therapist can inform you if and when it is wise to choose an injection.

 

Hope this helps!

 

-Mark Chen

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Fitness Question: Exercising with worn joints?

I have lost cartilage in my knee and a little bit in the hips, can I still do spinning? I’ve been doing it for years.

-Diny

Mark Chen, physiotherapist

The advantage of spinning is that it is not a weight-bearing activity (except the standing parts , of course). That makes it a ‘safer’ option than, for example, running, in which your knees and hips have to endure huge impact for miles. So if you look at it purely from a mechanical perspective, no problem at all.

You indicate that you have been doing spinning for years.

Could it be that the amount of years and intensity have contributed to the amount of wear?
Ultimately, spinning is  a very one-dimensional and repetitive form of sport. Do you clearly have more issues immediately after spinning, or the morning after? In that case you can question how beneficial spinning is for your body.

I am personally in favor of variety, not only because I like to do different things myself but also not to stress my body too much in one way. I also recommend this to the majority of my clients. Ask yourself the above questions and if spinning does indeed cause issues to you, then consider reducing or varying with a different sport.

 

Mark Chen

Physiotherapist / Personal Trainer / Nutritionist

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Fitness Question: Hardcore boot-camp training bad for me?

“Do you train your muscles better if you first ensure that you are experiencing fatigue and then go all out? We do this at my Bootcamp class: first, we have to feel fatigue in a squat and then we sprint at full effort. I find this very heavy. Is it really better?

-Maartje

Bootcamp Training

Mark Chen, Physiotherapist

‘Better’ is a difficult word, because that depends entirely on the goal you want to achieve. Still, I can be quite clear about creating fatigue in preparation for an explosive effort. Don’t, unless there is a very good reason for it.

Fatigue in a muscle involves a number of physiological changes in the circulatory system around the muscles. Simply put, it negatively affects the control of the muscle and therefore it will function less efficiently. You’ve probably felt that already!

Muscles with fatigue also lose their ability to contract and relax properly. If you demand an explosive action in that state, the performance you can deliver will always be below your actual capacity. I can even go one step further and say that at such moments, strains and tears occur most often. Take a look at football matches and the number of cramps and injuries that occur in the later stages of the match. It’s a very obvious percentage.

Creating fatigue in the muscle system can certainly have positive aspects, but should usually be kept until the end of a Bootcamp class. Ask yourself if your trainer has a good reasoning for this way of training. It is difficult for me to estimate how far your athletic ability reaches! If he can not explain it in a way that is sensible, I would be very careful with this combination. Listen to your own body and play the long game, don’t risk an injury.

 

 

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“Knee Pain, what to do?” – Readers Question

knee pain fixed

“I have osteoarthritis in my knee but am a fanatical athlete. Running I have to give up, but otherwise, I do everything from strength training to spinning, and daily cycling to lubricate the knee. Lunges are too stressful just like certain yoga exercises. Doctors advised me to do a procedure. But I am not ready for that yet,  although the pain comes back more regularly. I am 53 and my weight is fine. Do you have any more tips to improve my knee condition?”

– Caroline

 

Mark Chen, Physiotherapist:

A number of factors are important in the discomfort caused by osteoarthritis. Of course, the way of stressing the knee is very important and also the amount of rest that the joint gets to recover. Running is an activity that generates enormous impact on the knees. It is therefore not very surprising that you get a lot of problems with that particular choice of sport.

Strength training is indeed a good way to relieve the joint. You describe that lunges are too stressful, does the same apply to squats? If so, are you sure that the technique is correct? A large part of the load on the knees can be reduced by making these kinds of exercises more hip-dominant versus knee-dominant. If you use the hips more, the knees will taxed less. A good trainer can advise you and adjust if necessary.

Another option is so-called ‘open chain’ exercises. Thanks to machines, these exercises can train the muscles without having to carry the whole body weight. A disadvantage is that this way of moving often does not match how you use the knees in daily life (rising from a chair, climbing stairs). We call these exercises “non-functional” but that doesn’t mean they are not valuable.

Nutrition is also important. There is more and more research that shows that a balanced diet has a big effect on the discomfort that arthrosis brings with it. Consume a balanced diet and try to supplement with a multivitamin and possibly glucosamine. In the field of glucosamine, scientific studies are contradictory, but I have seen that a good quality glucosamine supplement can definitely add value.

A final option is an injection with Fermathron (hyaluronic acid). This is a kind of gel that can be injected and acts as a pad. It can both reduce pain and increase mobility and lasts for up to six months

If you’d like some extra help with your knee, make an appointment here!

I hope that helps,

 

Mark Chen

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Starting with Fitness (In Phnom Penh)

“I would like to start working on my fitness. I am 58 years old and have stopped drinking (white wine) for a year and unfortunately gained weight. I smoke, my height is 1 meter 64 and now I’m at 78 kilograms. I always weighed around 70 kilograms. I have never done anything to work on my fitness in the last twenty years. I do not feel comfortable with that and I am now considering sports, but I would like some advice on this.

Of course, I can go to a Fitness gym but I feel a lot of resistance; a gym with often many young people who are focused on their muscles and hard music.

Ideally, I would like my muscles to become more supple and my posture and condition to improve. I notice that after walking for fifteen minutes I am already heaving, my posture is probably not good either, because I often get pain between my shoulder blades.

I hope you can give me some tips. Thanks in advance.”

– Joki

Mark Chen, physiotherapist

I would first off offer to adjust your vision with regard to a fitness gym. I understand very well that it can be overwhelming to enter a gym for the first time, but I think that once you feel at home, a lot of the prejudices will fade away.

I’ve also had that experience when I was 16 when I went to the gym for the first time.  There I was, with my ‘mini-weights’, standing there between the ‘big boys’. I remember it to be very uncomfortable and I felt judged. But soon, people started talked to me, I got tips and I started to feel more and more at ease. And of course, my fitness increased!

A few years later it was the other way around, and it was me that put new members at ease, as an instructor but also as a member. A beautiful thing, right? Fitness remains, in my opinion, one of the fastest and most effective ways to work on your health. And crossing that first speedbump may be difficult, but it is definitely worth it in the end. Don’t let limiting beliefs hold you back.

 

Personal trainer

If necessary, hiring a personal trainer is a good option. This will facilitate the entire process and create a tailor-made fitness program, where your postural problems can be tackled at the same time.

Yoga
In addition, there are plenty of other sports to be fit and flexible. For example, yoga is an option that immediately comes to mind. A wonderful form of exercise that is focused on all aspects of Fitness: stability, posture, and flexibility in the entire body.

It is also a sport that can be well adapted to the individual, making it accessible to everyone. I also suspect that the chance of having hard music and muscular men is a lot smaller.

Hiking
Last but not least, do not underestimate the effect of walking on your level of fitness. You indicate that you start heaving after fifteen minutes. Maybe it is an option to start walking fifteen minutes a day? If after a few days you might notice that you are no longer panting, you can, for example, extend it by five minutes every week. Before you know it you walk for half an hour without stopping. Once a start has been made and progress becomes more visible, the motivation to continue will automatically follow.

It is literally a matter of taking the first step. Good luck, and I hope you find a sport that suits you.

 

I hope that helps!

 

Mark

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Fitness Question: “Spinning bad for my Knee?”

I have arthrosis in my knee and a little bit in the hips, can I still do spinning? I’ve been doing it for years.

– Din

Mark Chen, Physiotherapist

The advantage of spinning is that it is not a weight-bearing activity (except the standing parts, of course). That makes it a ‘safer’ option than, for example, running, where your knees and hips have to endure huge impact for miles. So if you look at it purely from a mechanical-stressn perspective, it should be no problem at all.

You indicate that you have been doing spinning for years. Could it be that the number of years and intensity have contributed to the current condition of the knee? Ultimately, it is, of course, a one-sided and repetitive form of sport. For example, do you clearly have more pain immediately after spinning, or the morning after? In that case, you should question how good spinning is for your body.

I am personally a fan of variety, not only because I like to do different things but also not to burden my body too much with one element. I also recommend this to the majority of my clients. Ask yourself the above questions and if spinning does indeed cause problems for you, then consider reducing or varying with a different sport.

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Injury? Here are the estimated recovery times

When you have an injury, there’s only one thing on your mind: Getting better.
An injury is not just a literal pain, it’s also keeping you back from reaching your fitness goals. And if you’re anything like me, the exercise-restricted version of you is not exactly a pleasure to be around.

Take a look at the expected recovery times here so that you have something to plan your recovery around.

Sprain/ Tear:

Grade I: 0-2 Weeks
Grade II: 2-12 Weeks
Grade III: 3-24 Weeks

Ligament Sprain / Tear:

Grade I: 0-3 Days
Grade II: 3-24 Weeks
Grade III: 5-52 Weeks

Tendon:

Tendonitis: 3-7 Weeks
Tendinosis: 12-28 Weeks
Laceration: 5-28 Weeks

Bone Contusion/Fracture:

5-12 Weeks

Cartilage Irritation/Damage:

12-100 Weeks

Ligament Graft:

12-100 Weeks

 

All of these are depending on health and level of activity of the individual, alongside with illness beliefs, perception, nutrition, sleep and stress levels. Therefore these are to be used as a guideline and always is the help of a professional recommended for an efficient rehabilitation process.

Source: Dr. Caleb Burgess DPT, OCS, CSCS

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Do this before you start running

If you’ve read the previous articles on running, you now know that your bodies’ own shock absorbers are of crucial importance.

Whenever I work with clients that want to either get into or- improve their running performance, I test them on multiple abilities.
One of those is their ability to jump. or actually, to land. 

By practicing and optimizing your jumping mechanics, you create can learn how to use your ankles, knees, and hips to decelerate impact. It teaches the central nervous system how to make all the different muscles and joints to work together in an efficient way.

These are the conditions for a healthy jump and landing.

  • Knees track the first 2 toes during the jump and the landing
  • There is a smooth transition between ankle, knee and hip flexion during the land
  • There is a smooth transition between ankle, knee and hip extension during the jump
  • No noticeable impact may be heard during the landing “or Ninja-style landing”
  • Has to be performed barefoot

This is how to test it for yourself, though I strongly advise getting a set of trained eyes to accompany you for a good assessment.

  • Put your phone on camera mode and select the “Slow-Motion” option.
  • Make the jump at least three times while taking separate videos for it.
  • Rate the technique on the points above. Sound usually doesn’t transfer well to slow-mo videos so you’ll have to rate that yourself.

Here’s a video of my athletes doing box jumps in slow-mo, what do you think?

 

Also, if you want to read more, Click here to find some shocking facts about running

 

 

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Readers Question: A muscle tear, now what?

“Can you be treated for a muscle tear by a physiotherapist? What relieves the pain and how long does the recovery take?”

-Wilma

 

Mark Chen, physiotherapist:

 

I would like to start with the following: everyone can use physiotherapy!

That said, the answer to your question depends on a number of factors. The location of the tear and the size, for example, are very decisive for the duration of the recovery. Someone who walks a lot in his daily life will need more recovery time for a tear in his calf muscle than someone who is sitting behind a desk.

Recovery

The recovery of soft tissue proceeds in phases. There is a fixed time for the recovery. This cannot be accelerated but it can be optimized and certainly also be delayed. Give your body the time and opportunity to do its job.

The first phase of recovery is called the inflammatory phase. Think of an ankle that becomes thick and stiff when you have rolled it. Thickness, redness, heat, pain and stiffness characterize this phase, in which the body tries to create a safe environment for recovery.
This phase often takes three to five days.

In the phases that follow, the ‘proliferative phase’ and the ‘organization phase’, a new network of tissue is created. This can be compared with a wound on the skin. It must first be bridged. If there is a scab the body can repair the skin underneath. Then the crust falls off and you see new tissue.

That’s how it works with muscles too. As soon as the crack is bridged, the new tissue has to be stressed and adapted to the demands. The muscle will be ‘repaired’ again within three to five weeks, but the time to make the tissue completely stressable can take several months to a year!

Support
I advise people to support the affected muscle with medical tape in the period that it can be less stressed. If the requirements you place on the tissue do not go beyond the general daily life, then, most likely you do not need physical therapy.

If you are an athlete or do a heavy job, that is a different story. It can make a huge difference if you hire a therapist or trainer to help you build your load capacity. My experience is that most clients become stronger than they were before.

Do not underestimate the capacity of your body, it is amazing if treated properly! Drink enough, rest enough and success with your recovery!

 

Best,

 

Mark