New York Times & Houston Chronicle, Nov. 2015

 

Obesity rises despite efforts to fight it

shutterstock_189084083-288x300Despite years of efforts to reduce obesity in the United States, including a major push by first lady Michelle Obama, federal health officials reported Thursday that the share of Americans who are obese had not declined in recent years but instead edged up slightly.

About 38 percent of U.S. adults were obese in 2013 and 2014, up from 35 percent in 2011 and 2012. Researchers said the increase was small enough that it was not statistically significant. But to many in public health, it was surprising and disheartening.

“Very Disappointing”

 

“The trend is very unfortunate and very disappointing,” said Marion Nestle, a professor in the department of nutrition, food studies, and public health at New York University. “Everybody was hoping that the decline in soda and sugar consumption, that we’d start seeing a leveling off of adult obesity.” And compared with a decade ago, the increase was significant: In 2003 and 2004, about 32 percent of adults were obese, said the report’s lead author, Cynthia Ogden.

Health experts had hoped that gradual improvements in the U.S. diet in recent years would have moved the needle on obesity. Consumption of full-calorie soda has dropped by a quarter since the late 1990s, and there is evidence that calorie intake has dropped for adults and children. Obesity began rising in the 1980s, but the rate flattened in 2000s, and declines among young children in some cities had lifted expectations that the epidemic might be easing. Obesity among young people was unchanged in 2013 and 2014 from the previous period, the report found. Seventeen percent of Americans aged 2 to 19 were obese, the same as in 2003 and 2004. Experts pointed out that far more work has been done to fight obesity in children, including changes in school lunches and the removal of sugar-sweetened beverages from some school systems. The figures are from the National Health and Nutrition Examination Survey, the gold standard for federal health data, released every two years. For smaller slices of the U.S. population – for example, women or blacks – researchers used four years of data, from 2011 through 2014, for the most reliable results.

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Cultural Gaps

 

Some of the most striking numbers were among minorities. About 57 percent of Black women were obese from 2011 to 2014, the highest rate were Hispanic women, at 46 percent, and Hispanic men, at 39 percent. About 36 percent of White women were obese, and 34 percent of White men. The prevalence of obesity among Asians was the lowest, who had a combined rate of 12%.

 

Dr. Walter Willett, the chairman of the nutrition department at the Harvard School of Public Health, cautioned that the modest improvements nationwide were extremely unevenly spread, with the most of them happening among more educated Americans. A paper he helped write, published this month in Health Affairs, found that Americans’ diets had improved in quality from 1999 to 2012, – with a reduction in trans fats, small increases in fiber, and less soda consumption – but that most of these advances were not happening among lower-income, less educated Americans. “In general, there’s been a big gap” between rich and poor, Willett said. “When we take the U.S. average, we are hiding a lot of detail.” There were a few other surprises. Men had more or less caught up with women in obesity prevalence in recent years, but the new numbers showed that women had edged ahead again, Orden said. About 38 percent of adult women were obese from 2011 to 2014, the report found, compared with 34 percent of men.
Middle-aged Americans were hardest hit. Adults aged 40 to 59 had the highest rate of obesity, 40 percent, followed by people 60 and over, 37 percent of whom were obese. About 32 percent of 20- to 39- year olds were obese. Kelly D. Brownell, the dean of Sanford School of Public Policy at Duke University, said the new figures were a reminder that many risks, such as prevalence of and inexpensiveness of junk food, had not gone away, and a sign that policymakers needed to redouble their efforts to, for example, impose a tax on soda. “the emergency flag has gone up,” he said. “We are not doing nearly enough”

Pilates continues to receive attention in the field of rehabilitation – with good reason. Recent research supports Pilates as an appropriate intervention for common orthopedic injuries.

Pilates-integrated Physical Therapy is traditional Physical Therapy incorporating equipment. Pilates equipment helps physical therapists manipulate gravity and supply assistance to movement that might normally be too fatiguing to execute. It is also combined principles of breathing, core strengthening, alignment, integration, and spine articulation that involve body and mind.

Pilates can be modified to create positive movement experience for special populations that cannot be overheated or fatigued such as Multiple Sclerosis and Parkinson’s. The ability t modify a functional activity- like sit-to-stand, reaching, rotating, and walking within the Pilates environment is key to a successful movement experience. The ability to grade difficulty using springs, levers, and gravity require the education of a Physical Therapist. This provides a continuum that can help patients reach their ultimate rehabilitation goal – the successful restoration of function.

Pilates training for Physical Therapists necessitates skill levels that far exceed the normal memorization of a cookbook Pilates repertoire. It requires critical reasoning to identify objectives, match patients’ goals, design an intervention, and create modifications to facilitate a positive movement experience, as well as adjust the program daily to progress the patient towards function.

Clinically, Physical Therapists have noticed a range of successful outcomes with patients suffering a variety of ailments- from Parkinson’s Disease to chronic low back pain- with the help of Pilates

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Footwork using jump board, on heels. Used with permission. This image is available on (www.topicsingeriatricrehabilitation.com)

Osteoporosis and reduction and/or prevention of worsening symptoms are imperative to those practitioners and trainers who assist the elderly in rehabilitation or training in order to improve their quality of life. Physical therapist, health care practitioners, exercise physiologists, kinesiologists, and trainers alike should know what osteoporosis/osteopenia are, as well as indications and contraindications of exercise for this population. Over the years, numerous studies have been conducted on exercise and its effects on bone density. Studies looking at Pilates and its effects on osteoporosis have also been published. Overall, the benefits have been quite favorable. Articles have shown prevention of continued bone loss, as well as improved quality of life and perceived physical function. Studies specifically have been conducted on Pilates in comparison with other exercise interventions and the overall effect and results have also been favorable. Extensive research on Pilates and which exercises are most beneficial for use with this population have also been completed. These articles, as well as numerous others, certainly indicate the benefits of exercise and the utilization of exercises in the Pilates repertoire for promoting good bone health.

The purpose of this case study was to demonstrate that Pilates exercise intervention can help reduce the effects of osteoporosis and reduce the progression of osteopenia in a 52-year-old man.

Mr H. was a 52-year-old man who had a diagnosis of osteoporosis/osteopenia since the age of 34 years. His medical history included bilateral total hip replacements because of his poor bone density, a rotator cuff repair, and a torn Achilles tendon. His orthopedic history had been quite extensive. In 1998 after magnetic resonance imaging was performed, it was revealed that he had avascular necrosis in both hips. He was immediately prescribed a series of medications to increase his blood circulation. This intervention was not successful, and his symptoms actually worsened.

Toward the end of 1999, he was limping badly and having to utilize a cane. It was at this time he decided to interview doctors in Louisiana, Dallas, and New York areas and finally settled on a doctor in New York who was both an MD/orthopedic surgeon and a biomechanical engineer. He had invented a new type of hip replacement with a different point of view regarding “weight bearing.” He was also the only doctor who had at the time performed a bilateral replacement at the same time.

Surgery was performed in February 2000. Three years later, his MD noted that his bone density was significantly worse. He was given Fosamax (alendronate) and testosterone. In 2008, he was not very active and was still having back issues and mobility challenges. He came to Core for gait training and overall conditioning. Working with our team, he discovered Pilates!! By 2013, he could no longer be prescribed Fosamax because 10 years was the limit. Once he was taken off the Fosamax, his bone density testing got much worse and fell into the osteoporosis range. His preliminary results as of December 2013 were as follows: bone mineral density (BMD), 0.815; T-score, −2.5; z-score, −2.2; diagnosis, osteoporosis. In 2014, Mr H. was instructed to start a specific Pilates repertoire focusing on exercises designed and executed for a client with osteoporosis. He was retested in 2014, and his results were significantly improved: BMD, 0.893; T-score, −1.8; z-score, −1.4; diagnosis, osteopenia.

IMG_0011.MOVDry-Needling-Acupuncture-2

Alternative forms of medicine are offered in our clinic to improve your overall quality of life.  Cupping is a term applied to technique that uses small plastic cups as suction devices that are placed on the skin.  At our clinic, the suction is created by a hand held pump.  Once the suction has occurred, the cups can be gently moved across the skin causing the skin and superficial muscular layer to be lightly drawn up into the cup.  This is a particularly relaxing and relieving sensation to most patients.  Generally, cupping is combined with dry needling in one treatment, but can be used alone as well.  Cupping is used to relax tight muscles, anxiety, fatigue, migraines and even cellulite.  Like dry needling, cupping follows the five meridian lines on the back; toxins can be released and blockages cleared.

Dry needling is an effective technique that uses a very fine acupuncture needle to “deactivate” painful or knotted areas in your muscles.  the procedure may elicit a ‘twitch” response” or it may not; either way an immediate and long lasting relaxation of the tense muscle follows.  The needles are used as extensions of the practitioner’s hands, reaching deep into the muscle belly.  the technique can result in amazing pain relief, often immediate, that may never have been thought possible.

We are excited to announce we offer both services at Jennifer Klein Physical Therapy!

 

 

According to the National Fibromyalgia Association, Fibromyalgia Syndrome (FMS) is an increasingly recognized chronic pain illness characterized by widespread musculoskeletal aches, pain and stiffness, soft tissue tenderness, general fatigue and sleep disturbances. While the cause of FMS is still unknown, the disease affects between 6-12 million in the U.S. alone. It is most common in women between 25-50 years of age. Symptoms of FMS can include headaches, sensitivity to temperature, restless leg syndrome, irritable bowel syndrome, tingling or numbness sensations, painful menstrual periods, and cognitive memory problems.

Many who suffer from FMS tend to believe that exercise will increase the pain they are already experiencing. However, current research suggests that low impact aerobic exercise, such as Pilates, can be done without increasing pain. For some, it can actually increase their pain threshold. However, gradual progression, ideally supervised by a Physical Therapist, is key. It is suggested to begin with exercising 3-5 minutes 3 times a week then progressing to 30 minutes 4 times a week.

Pilates emphasizes the connection of the mind and body, being a huge benefit to those with FMS. The client’s ability to participate in an exercise program from which there is no exacerbation of symptoms can greatly improve their sense of well being. Pilates also allows for the improvement in articular mobility of the spine in a very gentle and supported environment. Clients with FMS will improve best with personalized programs, which can be accomplished with Pilates. The focus should be on gentle stretching exercises and focus on deep, core stabilization work for both pelvic and scapula stabilization.

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Chronic pain huts, not just physically, but also emotionally. But there is hope. Customized, specific interventions, as well as overall lifestyle approaches, can make an enormous difference in the quality of life of people with pain. Since chronic pain affects various aspects of a person’s life –physical, mental, emotional, and social- therapists at Jennifer Klein Physical Therapy aim to reprogram both the physical and mental realms, which, in turn, affect the emotional and social. A variety of causes can contribute to chronic pain, including old injuries, habitual patterns, and even emotional trauma. But it tends to involve a shift in muscle groups and brain response which propagates pain. Pain then leads to doctor visits, and often, a measure of fear, which sends people into a “fight-or-flight” stress response. “Those suffering from pain are in a constant mode of fight response” says Jennifer Klein, DPT. “The brain doesn’t know the difference between a tense and relaxed muscle. Through intervention, they learn to feel the difference, and eventually they can actually physically relax their muscles”.

With chronic pain, the input and the output system of pain response in the brain gets mixed up and generates a pain signal when there shouldn’t be one. Retraining may include joint mobilization, which, studies have shown interrupts the pain pattern and helps the brain stop producing pain signals when it’s not necessary. A technique therapists may use is neuromuscular education, which retrains the brain to reconnect with specific muscle control. Many patients with lower back pain, for instance, adopt habitual positions or movements, which contribute to their pain. It’s not their fault!

The brain has shut down the use of the stability muscle, and it goes to the stress muscles. Rather than employing deep abdominal and gluteal muscles, the brain substitutes other muscle groups, which weren’t intended to carry the load, so they become overworked and cause pain. Placing dry needles into muscular trigger points can also help relax muscles and interrupt the pain signal. But as Jennifer points out, a technique like dry needling “isn’t going to be enough”. Patients must learn how they can actively reduce pain through changes in perception and lifestyle. “We’re trying to teach the person to abolish pain themselves versus relying on physical therapy,” she says.

“The longer somebody has been in pain, the more the body becomes adept at generating pain signals when there is no actual tissue damage.”

The first step in fighting chronic pain involves understanding the input/output process of pain, exemplified by a nail injury. “There is a lot fear and anxiety associated with the pain,” Jennifer says. “In some cases patients have been told they have a bulging disc or a degenerative spine. It becomes a life sentence for them. They think they never have a way out, that they may never be normal.” But most of the time, that’s simply not the case. “There’s great hope in pain management, but it’s the perspective shift,” she says. “When people have so much constant pain, they stop moving and doing anything. When they do any kind of exercises that are not fearful, exercises they enjoy doing, breaking it down in a way that’s not threatening. We work toward small goals.” Oftentimes, people have lived with pain for so long, it becomes a part of their identity.

Sometimes there isn’t even physical evidence of any injury or debilitation; the longer the pain persists, the better the brain gets at producing pain signals- out of habit- even through the pain-producing stimulus may no longer exist. As a result, much of the therapists’ work involves stress management, because, like so many other diseases, stress directly impacts chronic pain. “When you get stressed out, you tense up more, which contributes to setting off pain signals in the brain,” Jennifer says. Though this may sound difficult, it’s like anything else; it becomes a way of life. Jennifer says sometimes it’s as easy as takin five minutes a day to turn off all electronics and focus on breathing exercises or progressive muscle relaxation, in which a person tenses a muscle and relaxes it, to relearn how to relax the muscle groups. The key involves interpreting pain sugnals so the brain can reorganize its information and stop sending the body into fight-or-flight response. Through strategic, progressive interventions and education, therapists work with patients to better manage their pain, and allow them to return to the activities they love.

What is Diastasis Recti?

Diastasis Recti is commonly referred to as the separation of Abdominis muscles due to excessive intra-abdominal pressure. It is the widening of the gap between the outermost abdominal muscles; and the split occurs at the Linea Alba, the mid-line collagen structures of connective tissue at the front of the abdomen. This split of the Linea Alba compromises ALL of the abdominal muscles due to the lack of support and tension needed from this connective tissue. Although anyone can develop Diastasis Recti, it is extremely common in pregnant women, especially towards the later stages of pregnancy. 100% of women have some level of diastasis of the rectus abdominis in the third trimester, and for many women this gap remains untreated and unchanged at 1 year postpartum. When pressure is increased inside the abdomen, the muscles begin to separate and weaken the connective tissue in the mid line. This leaves the front of the abdomen unsupported and will cause a bulging of the stomach.

How to test for Diastasis Recti

Lie flat on your back with your knees bent and your feet flat on the floor. Place your fingers, palm down, just above your belly button and lift your head a neck very slightly off of the floor. Press down with your fingertips and feel for the abdominal muscles. Repeat this test in two other places: directly over the belly button and a couple of inches below. The goal when contracting the muscles is to feel slight tension in the midline, as well as have a gap of 1-2 fingers or less. If the gap is much larger than 1-2 fingers, and/or you feel no tension, that is known as Diastasis Recti. Stay posted on a video link on how to test.

 

What exercises help Diastasis Recti?

Treatment for Diastasis Recti should focus on re-aligning, re-connecting, and strengthening the entire core musculature. Weakness of the pelvic floor and core all contribute to developing Diastasis Recti, and should all be treated as a unit. The purpose of the exercises should be to correct alignment and re-engage an entire system of muscles and fascia. You must learn to engage your transverse abdominis and pelvic floor muscles correctly, as well as strengthen the muscles in order to lessen the separation gap and pull the abdominal muscles closer together. This is where Pilates is applicable with a Physical Therapist trained in core and pelvic floor strengthening! Additional bonus is to find a physical therapist who is also certified in Pilates.

Stay posted for a video on Pilates mat exercises and Pilates reformer exercises!