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Low Back Pain? Make PT Your First Stop… The Sooner the Better

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Low back pain?  You’re not alone. Low Back Pain (LBP) is common, costly, and debilitating.  “Epidemic” is a word commonly used by experts. Lifetime prevalence of low back pain (LBP) is about 70%.  LBP alone accounts for 2.5% to 3% of all physician visits annually in the United States. It is the most common reason to see a primary care provider in the US second only to the common cold.  Healthcare costs for LBP in the US were ~ $86 BILLION in 2005, a 65% increase from 1997 estimates, and they continue to rise. Yet despite increasing resources, recurrence is common (24% – 33% likelihood), and back pain numbers continue to grow, with chronic low back pain the fastest growing segment, estimated to be ~ 10% of cases.  Costs from lost work productivity due to LBP in the United States exceed a staggering $7 billion dollars annually. Money spent on lumbar fusions for low back pain in the US annually is roughly equal to what the US government spends on foreign aid annually — ~ $20 billion (compared to cancer research for prostate, breast and lung cancer combined, $1.9 billion).  The United States had dramatic increasing trends in MRIs, opioid prescriptions, epidural steroids and fusions from 1994 – 2004, and yet, we do not see improved outcomes in chronic low back pain. 44 million medication prescriptions were written for LBP in 2000, of which hundreds of thousands of people experienced life-threatening adverse events and deaths.  In one large study of over 2,000 patients with LBP, the most common initial treatments were opioids (~ 40%) and muscle relaxants (~40%). Despite the noted increasing medical expenditures dedicated to its management with these interventions, the prevalence of chronic, disabling LBP continues to increase. The majority of patients with LBP initially access healthcare through a primary care provider.  Given the volume of patients with LBP managed in primary care, decisions in this setting have substantial implications for process of care and overall healthcare cost.  Research shows that there are wide variations in primary care practice for decisions such as prescribing medication, ordering imaging, and referral to specialists. Physical Therapy Clinical Practice Guidelines that synthesize the latest clinical research for LBP recommend an active approach to physical therapy care with the focus on exercise interventions and other strategies to help patients maintain and improve their overall activity levels.  Despite this recommended approach and the fact that various interventions within the scope of practice of physical therapists (eg, exercise, spinal manipulation / manual therapy, education) are recommended as effective, unfortunately, many physicians mostly recommend delaying referral to physical therapists for at least 4 weeks following initial primary care consultation.  This “wait and see” approach is based on the belief that most patients with LBP will recover rapidly, and intervening quickly would not be cost-effective. However, more and more, the evidence is indicating that this belief and approach to managing LBP is failing patients and burdening the healthcare system.  Despite current medical management guidelines to the contrary, the current approach has yielded high rates of initial use of imaging, nonsteroidal anti-inflammatory drugs, and opioid medications in the initial management of patients with LBP.  There is not evidence that clinical outcomes are improving with these interventions; in fact, rates of chronicity related to an episode of LBP are increasing.  A majority of “wait and see” patients go on to experience persistent and/or recurrent symptoms, and up to one-third report moderate to severe pain 1 year following the initial primary care encounter.  Contrary to current medical practice guidelines, early use of imaging and opioids are common, as referenced above, and are associated with higher rates of prolonged disability, invasive procedures (injections and surgery), greater cost and poor quality of life. What’s the missing link to successful recovery from LBP?  Evidence points more and more to Physical Therapy-guided active recovery.  We see improved outcomes, lower costs and reduced risk of invasive procedures like injections and surgery when compared to delaying care, opioids, and early imaging.  Yet primary care referral rates were as low as 7% in a very large study of 32,000 people with low back pain. In a study across more than 400,000 low back pain patients, the evidence showed: Significant DECREASE in likelihood of surgery when people receive PT in the acute (1 – 30 days) and sub acute phase (31 – 90 days) Significant DECREASE in risk for injections in those who received PT in acute or subacute phase vs. chronic (91 – 365 days) Significant DECREASE in frequent (11 or more) office visits for LBP who received PT in acute or subacute phase Overall, patients who received PT within the first 30 days had fewer episodes of doctor visits, epidural injections, and surgeries in the year compared to those who received PT after 90 days (chronic phase). And yet… Mean time to initiate PT in this very large study was 86 days. Physical therapy evidence-based interventions, and clinical reasoning to match the right patient to the right treatment at the right time by a physical therapist earlier in the course of care, can prove more cost-effective by promoting recovery and reducing the need for more invasive and costly interventions. The good news is, this trend is improving as the research becomes clearer and is broadly shared across the medical system, and evidence-based guidelines are more and more integrated into medical practices.  So we’re headed in the right direction for best practices. At Elevate, we treat people experiencing low back pain A LOT, and in our model of 1:1 care with our highly experienced Doctor of Physical Therapy and our Evidence-Based Approach, we have great success.  If you’re having back pain, don’t delay any longer.  The sooner you receive proper care, the better.  And don’t despair if your pain is longer standing.  We also treat many people coping with chronic low back pain very successfully as well. No physician referral or prescription is necessary. California is a Direct Access state allowing you to go directly to Physical

WORKOUT ON YOUR TRAVELS

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Excited about your Summer vacation but worried about losing your fitness gains?  Here are some great exercises you can take on the road. All you need is a mini loop band and a resistance band. No matter how full your bag is or how little space you have to move, there’s no excuse !     ❇️Banded Pull Aparts: This is a great exercise to strengthen your upper back and increase shoulder mobility. Grab the band with an overhand grip with palms facing the ground. Your hands should be approximately shoulder width apart, go wider or narrower depending on the tension of your band. Your arms should be parallel with the floor with  elbows fully extended. Pull the hands apart squeezing your upper back musculature and bringing your shoulder blades together. The band should make contact with your sternum. ❇️Banded Bicep curls: Stand with one foot on your resistance band holding handles or ends next to your sides with palms facing forward.  Slowly curl hands up to shoulders, squeezing biceps and keeping elbows next to your sides. Slowly release arms back down to starting position• ❇️Banded Step-outs This is a great exercise for your glute medius. Place mini loop band around your legs just above your knees. Place your feet shoulder width apart, keep a slight bend in your knees and your chest up. Push hips back as though you were about to begin a squat motion. Step to the side with the right foot. Your stance should be well outside of shoulder-width. Pause, then step back into the start position. Repeat for the desired number of reps and then repeat on the left side• ❇️Squat Progression: A common form flaw with squats is the caving in (valgus) of the knees. This is often caused by weak glutes and abductors. The mini band is a great tool to correct this flaw in technique. The tension of the band increases bodily awareness, creating a mind-muscle connection in those areas. Performing banded squats for reps allows you to strengthen the proper squat form. Progress from a squat to a squat- jump, to a lateral or  an “In n’ Out” squat jump to increase the intensity.

HOW TO COMBAT BLOATING

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Bloating can often cause pain, discomfort and a “stuffed” feeling, while making your stomach look bigger.It involves excessive amounts of solids, liquids or gas in your digestive system.  Sometimes bloating can indicate a serious medical condition, but is more frequently  caused by the diet and some foods or ingredients you are intolerant to.   Don’t Eat Too Much at a Time Being overly full after a meal can feel like being bloated, but the problem is that you simply ate too much. If you’re eating big meals and tend to feel uncomfortable afterward, then try smaller portions. Add another daily meal if necessary. Chewing your food better reduces the amount of air you swallow with the food. It also makes you eat slower, which is linked to reduced food intake and smaller portions.   Avoid Swallowing Air and Gases There are two sources of gas in the digestive system. One is gas produced by the bacteria in the gut. The other is air or gas that is swallowed when you eat or drink. The biggest offender here is carbonated beverages like soda or fizzy drinks.  Chewing gum, drinking through a straw and eating while talking or while in a hurry can also lead to increased amounts of swallowed air.   Rule Out Food Allergies and Intolerances to Common Foods Food sensitivities and intolerances are fairly common. Consumption of food you are intolerant to can cause excess gas production, bloating and other symptoms. Some common foods and ingredients to consider: Lactose: Lactose intolerance is associated with many digestive symptoms, including bloating. Lactose is the main carbohydrate in milk. Fructose: Fructose intolerance can lead to bloating. Eggs: Gas and bloating are common symptoms of egg allergy. Wheat and gluten: Many people are intolerant to gluten, a protein in wheat, spelt, barley and some other grains. This can lead to various adverse effects on digestion, including bloating. Both lactose and fructose are a part of a larger group of indigestible carbs or fiber known as FODMAPs. FODMAP intolerance is one of the most common causes of bloating and abdominal pain. *If you strongly suspect that you have a food allergy or intolerance, see a doctor.   Avoid Swallowing Air and Gases There are two sources of gas in the digestive system. One is gas produced by the bacteria in the gut. The other is air or gas that is swallowed when you eat or drink. The biggest offender here is carbonated beverages like soda or fizzy drinks. Chewing gum, drinking through a straw and eating while talking or while in a hurry can also lead to increased amounts of swallowed air.     Try a Low-FODMAP Diet FODMAP stands for fermentable oligo-, di-, mono-saccharides and polyols. These are the scientific terms used to classify groups of carbs that are known to trigger digestive symptoms like bloating, gas and stomach pain.   Studies have shown that indigestible carbohydrates called FODMAPs can drastically exacerbate symptoms in people with Irritable bowel syndrome (IBS). A low-FODMAP diet has been shown to lead to major reductions in symptoms such as bloating  in IBS patients. If you have problems with bloating, with or without other digestive symptoms, a low-FODMAP diet could be a solution.   Here are some common high-FODMAP foods:   Wheat Onions Garlic Broccoli Cabbage Cauliflower Artichokes Beans Apples Pears Watermelon This diet can be difficult to follow if you’re used to eating many of these foods, but may be worth a try  if you have bloating or other digestive problems.   Be Careful With Sugar Alcohols Sugar alcohols are commonly found in sugar-free foods and chewing gums. These sweeteners are generally considered to be safe alternatives to sugar. However, they may cause digestive problems in high amounts. The bacteria in your large intestine digest them and produce gas. Sugar alcohols are actually FODMAPs as well, so they are excluded on a low-FODMAP diet. Try avoiding sugar alcohols like xylitol, sorbitol and mannitol. The sugar alcohol erythritol may be better tolerated than the others, but it can also cause digestive issues in large doses.   Peppermint Oil May Help Bloating may also be caused by a change in function of the muscles in the digestive tract. Drugs called antispasmodics, which can help reduce muscle spasms, are sometimes prescribed for this. Peppermint oil is a natural substance that is believed to function in a similar way. It has been shown to reduce various symptoms in IBS patients, including bloating. Peppermint oil is available in supplement form.     Drink More Water It might sound counterintuitive to drink more water when feeling bloated, drinking water can actually help relieve the condition . Drinking plenty of water helps to naturally flush our systems of excess water and sodium that we might retain. If drinking enough water is a challenge for you, try eating foods with high water content, like watermelon, tomatoes, grapefruit, and cucumber. Coconut water contains potassium, similar to a banana, and electrolytes that maintain regular fluid levels in the body, all helping to alleviate the symptoms of bloating.   If your symptoms of bloating persist for more than a few days then it’s important to contact your healthcare provider to rule out the possibility of a medical condition.

HEAD & NECK INJURIES

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Recently, the topic of head injuries, including concussions, has rapidly come to the forefront of sports medicine. The prevalence of head and neck injuries in all sports has led to an increased awareness and education on concussions; what they are, how they occur, and how they’re diagnosed. However, risk factors related to demographics and optimal treatment approach to a diagnosed concussion is still evolving. The “boom” of the concussion topic begs the question: why are there so many concussions? Are our bodies prone to head injury? Is there something we can do to decrease risk for a head injury? Recent studies have shown that women take longer to recover from a TBI (traumatic brain injury), report more symptoms and receive more concussions than men in similar sports, possibly due to neuroanatomical differences, weaker neck muscles and hormonal changes. Hormones and the physiology of women’s necks and upper bodies are two possible reasons why women experience concussions differently than men.1 Specifically in the sport of soccer, concussions are recorded to occur just as frequently as they occur in football and ice hockey, with the risk being higher in goalkeepers, females, and youth.2 Head-to-head contact is the most common mechanism for concussion diagnosis in soccer, while heading the ball is not a common cause. Many head-to-head contact injuries occur accidentally, or unintentionally, but there is less understanding of how intentional head impacts (i.e. heading in soccer) can also cause brain injury and affect cognitive function. Although concussions have been the “hot topic” in recent years, all head injuries are not diagnosed as concussions. In soccer, intentional head impacts (i.e. heading the ball) have been shown to worsen cognitive function, specifically associated with frequent ball heading, rather than unintentional head impacts due to collisions.3 Furthermore, another study revealed that kids between the ages of 9 and 11 who experienced at least one “subconcussive” impact associated with heading the soccer ball showed decreased cognitive test scores. These changes in cognition showed variation in gender, suggesting girls had memory changes, whereas boys had processing changes.4 Another study has shown that heading soccer balls is more damaging to the female brain than the male brain. These findings suggest that gender-specific guidelines for soccer heading may be required. Researchers suggest that females are more at risk for brain injury associated with heading a soccer ball due to differences in neck strength, sex hormones or genetics.5 Not only does heading in soccer cause head injury, but it can also lead to neck injuries associated with the cervical spine. These potential injuries include muscle strains, ligamentous sprains, compressive disc injuries and joint injuries. With all this risk for injury associated with heading the soccer ball, what should be done about it? Some researchers, after analyzing the data of their respective studies, have considered the question of whether or not heading should be allowed, but realized that that would be unrealistic. They have also posed rules and heading restrictions that are gender-based and age-based. Research is providing evidence that neck muscle development and protective headgear may play a role in the prevention of head injuries, specifically concussions.2 Additional research has found that cervical spine biomechanics is a modifiable risk factor in reducing sports-related concussions. This being said, preventative treatment of head injuries can be geared towards improving cervical spine biomechanics and postural education.6 Furthermore, a combination of cervical and vestibular physiotherapy has decreased the medical clearance time to return to sport in youth and young adults with persistent symptoms of dizziness, neck pain and/or headaches following a sport-related concussion.7 Therefore, the employment of both cervical and vestibular exercises to accelerate recovery and return to sport is important. Historically, treating a concussion has been quite passive, physicians and sports medicine staff relying heavily on pure rest to allow for the brain to heal and recover from the traumatic and potentially damaging event. Progressive research and evidence are now suggesting that an active approach to all types of head injury recovery is the most appropriate for returning an athlete to normal activities of daily living and his/her sport. This includes a multi-modal approach of collaboration among health care professionals who are able to apply their respective areas of expertise to a patient-centered recovery.8 Please contact us at Elevate to set up an appointment for an active approach to your PT treatment plan following a head or neck injury.   References:   Covassin, T., Swanik, C.B., & Sachs, M.L. (2003). Sex differences and the incidence of concussions among collegiate athletes. J Athl Training, 38(3), 238-244. Al-Kashmiri, A., & Delaney, J. S. (2006). Head and neck injuries in football (soccer). Trauma, 8(3), 189–195. https://doi.org/10.1177/1460408606071144. Stewart, W.F., Kim, N, Ifrah, C, Sliwinski, M, Zimmerman, M.E., Kim, M, Lipton, R.B., Lipton, M.L. Heading frequency is more strongly related to cognitive performance than unintentional head impacts in amateur soccer players. Frontiers in Neurology, 2018; 9 DOI: 10.3389/fneur.2018.00240 Lopez-Roman, LR, Diaz-Rodriguez, YI. Are subconcussive impacts harmless in youth soccer players?: 1965 Board #226 May 31 3. Medicine & Science in Sports & Exercise. 50. 475. 10.1249/01.mss.0000536644.03929.cd. Rubin, TG, Catenaccio, E, Fleysher, R, Hunter, LE, Lubin, N, Stewart, WF, Kim, M, Lipton, RB, Lipton, ML. MRI-defined white matter microstructural alteration associated with soccer heading is more extensive in women than men. Radiology 2018 289:2, 478-486. Streifer, M, Brown, AM, Porfido, T, Anderson, EZ, Buckman, J, Esopenko, C. The potential role of the cervical spine in sports-related concussion: clinical perspectives and considerations for risk reduction. J Orthop Sports Phys Ther. 2019 Jan 15:1-22. doi: 10.2519/jospt.2019.8582. Schneider, KJ, Meeuwisse, WH, Nettel-Aguirre, A, Barlow, K, Boyd, L, Kang, J, et al. Cervicovestibular rehabilitation in sport-related concussion: a randomised controlled trial. Br J Sports Med. (2014) 48:1294–8. 10.1136/bjsports-2013-093267. Ries E. (2017 March). Beyond rest: physical therapists and concussion management. PT in Motion, 18-27.

Boxing for Patients with Neurological Conditions

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An Elevate PT is shown here working with a patient with Parkinson’s Disease utilizing boxing as sensorimotor agility therapy. Movement is one of the most important things you can do if you are living with a neurologic condition. One of the most common neurologic condition today is Parkinson’s Disease which can affect one’s functional mobility including flexibility, speed, agility, and balance to navigate in a variety of environments.   New research suggests that intense exercise can improve brain function in patients with neurological disorders. Boxing is a fun and novel way to address speed, agility, dual tasking coordination, quick changes in direction, and balance to navigate tight spaces in patients with neurological conditions.  It does this by requiring patients to make postural adjustments and balance corrections, perform fast arm and foot motions, and coordinate timing and sequencing in different directions and planes of movement. Elevate PT Dr. Jasmine Burton, PT, DPT is shown here working with a patient with Parkinson’s Disease utilizing boxing as sensorimotor agility therapy. Laurie A King, Fay B Horak; Delaying Mobility Disability in People With Parkinson Disease Using a Sensorimotor Agility Exercise Program, Physical Therapy, Volume 89, Issue 4, 1 April 2009, Pages 384–393, https://doi.org/10.2522/ptj.20080214

Elevate’s *MINUTE FIT* Fall Challenge!

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How much can you handle in 60 seconds?! Our *MINUTE FIT* Challenge for Fall is all about pushing yourself to the limit in 12 different intervals💪🏻 With a little recovery time between each one, we’re sure you’ll be able to surprise yourself with what you’re capable of! Here’s a sneak peek of what to expect – which one would you try first?!

Elevate’s “Office Fit” Spine Mobility Tips

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We’ve got your back!  Sitting for hours on end hunched over a desk and a computer is not what the spine is naturally built for, nor is any part of our bodies for that matter.  It’s not that sitting is so bad, it’s the lack of MOVEMENT due to the excessive sitting that’s the problem!  The result is stiffness in joints, tightness and weakness of muscles, and eventual long-term adaptation over time leading to pain and overuse injuries.  What can you do?  Start to incorporate mobility and activation breaks to reverse the sitting postures, lengthen what’s getting tight, and activate & strengthen what’s getting weak.  Here are some of Elevate’s favorite “Office Fit” movement and spine mobility tips from the PT team.  And look for more “Office Fit” tips coming next week too! Take movement breaks hourly.  Set a timer!  Stand up.  Walk to the water cooler.  Do a ‘walk and talk’ for a phone call or a meeting with a colleague. And try these: ❇Thoracic spine extension over the back of your chair. ❇Thoracic spine extension / shoulder stretch at your desk. ❇Thoracic spine rotation with neck rotation. ❇Standing cervical retraction (make a double chin!) with shoulder flexion. ❇Thoracic side bend + rotation in child’s pose and (deeper version) in quadruped. ❇Lumbar Rotation in supine. Pick a few and try several reps of each throughout your day! Work in a pain free motion. Which is your favorite? If you’re having spine pain, come in for an evaluation and we will customize a plan for your specific issue!

Concussions 101: What You Should Know – A Four-Part Series

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Concussions have become a highly discussed and debated topic. Because of our increased awareness, the diagnosis of concussion has increased dramatically at all levels of athletics and in the general population. However, many athletes, parents, and even clinicians lack a good understanding of the underlying condition, the several types of concussion, and the appropriate ways to properly evaluate and manage the condition. WHAT IS A CONCUSSION? A concussion is a functional injury of the brain that results in altered metabolic activity within the brain. This alteration involves changes in chemical activity, increased energy demand, and decreased blood flow within the brain. Simply put, the combination of increased energy demand and decreased blood flow results in an “energy crisis” that impairs optimal function and leads to the symptoms of a concussion. Many of these changes occur within the first 24 hours of the injury, but some of these changes can persist for multiple weeks! Contrary to widespread belief, a concussion does not involve any structural damage to the brain or surrounding structures of the head and neck. Other injuries to the head and neck may occur in conjunction with a concussion but are not required to be diagnosed with a concussion, which is diagnosed based on the individual’s signs and symptoms. Therefore, if a concussion is suspected it is imperative to be evaluated by a medical professional that can guide appropriate care and rule out the possibility of a structural injury that may require diagnostic imaging. However, if a head or neck injury is not suspected, then diagnostic imaging is not indicated, and diagnosis is based on a thorough clinical examination. WHAT CAUSES A CONCUSSION? Concussions can occur through a variety of mechanisms. Although most common in impact sports, they can also occur in non-impact sports and in incidents such as motor vehicle accidents. Typically, a concussion occurs when an impact is made with the head, or the head and neck undergo a violent acceleration or deceleration motion. These motions can place stresses on the structures within the brain that result in injury and responds with altered metabolic activity. It is important to remember that a concussion does not always require a violent motion or loss of consciousness. Even seemingly innocent injuries can lead to a concussion! Furthermore, signs and symptoms do not always present immediately, so it is important to be aware of and monitor for the signs and symptoms and seek medical care if suspected. WHAT ARE THE SIGNS AND SYMPTOMS OF A CONCUSSION? Typical signs and symptoms of a concussion can vary between individuals. The most common symptom of a concussion is a headache, but other common symptoms may include: Additionally, symptom presentation and recovery can vary drastically between individuals and may be based on age, gender, activity level, and history of prior injury, among other factors. For instance, symptoms may be exaggerated in younger individuals due to an immature neurologic system. On average, professional athletes become asymptomatic in 1-2 days, collegiate athletes in 2-7 days, and high school athletes in 1-2 weeks! And, while most people recover in less than 2 weeks, approximately 20% of individuals take more than 3 weeks to recover! This is referred to as post-concussion syndrome and can lead to persistent symptoms that not only impact return to athletic activities but can impair mental performance and cause persistent pain. In these scenarios it is especially important to seek medical advice from a qualified medical provider that can accurately identify the type of concussion, contributing factors, and appropriate management options. WHAT TO DO… Now that you are more informed about the potential causative factors and signs and symptoms related to concussion, it is important to recognize when a concussion might be present and be evaluated by a medical professional if it is suspected. If sustained at a school-related sporting event this may be performed by the Athletic Trainer, but, if one is not present, a physician that specializes in concussion is a great option. They can decide if further testing is warranted and refer to Physical Therapy! As we will soon see in the next segment in this four-part series, a concussion is not as simple as we once thought, and Physical Therapy can be a fantastic treatment option to promote return to function.

Fruit: Nature’s Answer to Your Snack Cravings

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By Kyle Blix, CPT, Cert. Ace Fitness Nutrition Specialist Are you working hard in the gym but not seeing the changes you’re going for with your weight or body composition? It may very well be your diet–and more specifically, your snacks. Perhaps the greatest contributor to seeing results in with any exercise program is the diet. A week of hard lifting and strenuous cardio can be seriously undercut by poor food decisions. This is because food plays such a critical role in rebuilding the cells of the human body. As a personal trainer and nutrition counselor, I stress the importance of eating real, whole, unprocessed foods as much as possible, because they’re proven to be the most nutritionally dense and thus keep the body healthy and lean.(1) When strategizing for proper nutrition, one of the most helpful questions to ask first is:  What are the foods that you know, without a doubt, are holding you back? And more specifically, what are the snack foods that you’re eating in-between and after your meals? Often times people will get into a whole food diet only to go off the rails when it comes to their snack habits, which in turn can sabotage their progress of sculpting a lean physique. Here,  we turn to nature for the solution–fruit.  When used as a snack replacement, fruit is one of the easiest ways to keep your body healthy and lean without sacrificing flavor and satisfaction. Fruits are nature’s ultimate snack hack. To better understand just how fruit interacts with our bodies, we must address fructose. Simply put, fructose is fruit sugar. It’s a monosaccharide, the simplest form of carbohydrate, and thus it digests very easily.(²)  Fructose is also found in processed foods as well, more commonly under the name high fructose corn syrup (HFCS). It’s a cheap way to sweeten processed foods and is found in a variety of products. However, there’s a big difference between HFCS and natural fructose from fruit.  The negative effects of high fructose in the diet are known to cause metabolic issues, such as obesity, high blood pressure and type 2 diabetes. But the naturally occurring fructose in fruit is completely different. Unlike HFCS, fructose does not cause a rapid rise and subsequent drop in blood glucose levels, giving it a fairly low glycemic load. Glycemic load is the measure of how a carbohydrate impacts your blood glucose levels.(³)  Fruit has a fairly low glycemic load and contains a good amount fiber and water, which, when consumed together, help to mitigate the effects of fructose on blood sugar. For this reason, most fruits take a while to digest and hit the liver-insulin system slowly.(4)  This is beneficial because consuming foods with a low glycemic load reduce the chance of health problems like diabetes, hypertension, obesity and heart disease. Compare eating two apples, with a total of 38g of fructose sugar, to a can of Coke containing 39g of HFCS or cane sugar. One is going to keep you satisfied and fuller, and the other is going to cause a huge spike and crash. They both have completely different effects on the body. The nutrient density of fruits cannot be ignored. They’re rich in fiber, vitamins, minerals, as well as a plethora of phytonutrients and antioxidants. Plus they’re incredibly filling, and delicious. Fruits have been shown in multiple studies to reduce the risk for type 2 diabetes, heart-disease and as well as different types of cancer. In one particular study, research found that the risk of heart disease is reduced by 7% for each daily portion of fruit.(5) Fiber especially has many benefits. The soluble fiber found in fruits has been shown in several studies to reduce cholesterol levels as well as slow down the absorption of carbohydrates.(6)  This benefit carries over into weight loss as well, as fiber plays a critical role in increasing satiety, which in turn leads to consuming fewer calories. On the caloric front, fruits come with more good news! They’re relatively low in calories, which means you can consume a variety of fruits before coming anywhere close to what the average bag of chips would cost you, for example. The average apple comes in at 95 calories, a banana 100 calories, an orange 45 calories and a carton of strawberries at 145 calories. When you habitually eat fruit, you’ll be less inclined to turn to snacks that are devoid of nutritional value. To drive it home, the most useful way to work fruits into your diet is to use them as a complete snack replacement.  Fruits are nature’s ultimate snack-hack. Take any and all sweet snacks that you would normally eat after a lunch or dinner and simply replace them with a variety of fruits. For example, you could pack two bananas and a Tupperware of berries to take with you to work. Or toss them in a smoothie along with a plant-based protein powder for a meal replacement. They’re portable, tasty, and most importantly, incredibly nutrient-dense. You could even start with eating only fruit for breakfast and you would already be on your way to a much healthier day than if you picked a sugary cereal or a bagel. Armed with this knowledge, try incorporating more fruit into your diet combined with your exercise program to see those results you’re hoping for and realize the multitude of health benefits from fruit!   References: 1: Slavin, Joanne L., and Beate Lloyd. “Health Benefits of Fruits and Vegetables.” Advances in Nutrition 3.4 (2012): 506–516. PMC. Web. 16 Mar. 2018. 2: The Britannica – https://www.britannica.com/science/monosaccharide 3:Eleazu, Chinedum Ogbonnaya. “The Concept of Low Glycemic Index and Glycemic Load Foods as Panacea for Type 2 Diabetes Mellitus; Prospects, Challenges and Solutions.” African Health Sciences 16.2 (2016): 468–479. PMC. Web. 16 Mar. 2018. 4:Tappy L, Lê KA. Metabolic effects of fructose and the worldwide increase in obesity. Physiol Rev. 2010 Jan;90(1):23-46. doi: 10.1152/physrev.00019.2009. Review. PubMed PMID: 20086073. 5: Luc Dauchet, Philippe Amouyel, Serge Hercberg, Jean Dallongeville; Fruit and Vegetable Consumption and Risk of Coronary

Get Strong to Run!

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This week, we are sharing our favorite exercises for Getting Strong to Run! Inspired by our Elevate PT’s preparation for the LA Marathon this month, she is going to show some necessary strengthening exercises that are crucial to running injury-free. PHASE 1: Glute Activation Prior to a run, activating your glutes is so important in order to help stabilize the pelvis during your jog, and to reduce the load on your knees and lower legs. Isometric holds are important to allow higher focus on recruiting the correct muscles, and improving neuromuscular activation at the brain. Here are our 4 favorite glute exercises: 1. Side plank with Clam Hold 2. Single Leg Bridge Holds 3. Banded Squat Holds 4. Standing fire hydrants holds PHASE 2: Core Strength Having a strong core, especially with rotational strength, is so important for runners because it helps power and propel your run while also protecting your spine. A stable trunk is the starting point for *safe and efficient movement* and will also help protect your lower extremity kinetic chain while you run! Here are 3 of our favorites: 1. Banded Dying Bugs 2. Isometric Lunge with Diagonal Chop 3. Plank on medicine ball with Diagonal Mountain Climbers   PHASE 3: Leg Strength “Is strength training really necessary?” Research shows that adding strength training twice a week for 12 weeks improves speed by 8% and VO2max by 10% on average for endurance runners! Since running is a “single leg ballistic activity,” we really focus on single limb support strengthening. The split squat progression you see in the video works the calf as it’s progressed to the toe and then into a hop. Aside from glutes, calf strengthening is often a missed strength exercise, and an area of weakness that leads to injury in runners. Our top 4 exercises for Leg Day? 1. Banded Hex Bar Dead Lifts 2. Split squat, progressed to toe, progressed to ballistic hop 3. SL squat with a row 4. Crab Walks and Monster Walks