Exercise Archives - OrthoSport Hawaii PT & Aquatic Rehabilitation

Meet Our Staff – Medical Fitness Trainer Mariah!

Every month or so, we hope to highlight one of our amazing employees. The folks who work at OrthoSport Hawaii come from many different backgrounds, have a wealth of experience and knowledge to share, and love staying active while helping others improve their health and fitness. To schedule an appointment or get more information please call (808) 373.1114.

Aloha! My name is Mariah. I used to work briefly at the downtown location a couple years ago & I’m beyond grateful to be back working at OrthoSport at the Niu Valley location! I’m a certified personal trainer and corrective exercise specialist. I was born and raised on the west side of the island. I played collegiate soccer at Graceland University, where I studied Psychology and Corrective Exercise & Performance Enhancement.

Following my college years, I continued my soccer career, playing competitive soccer with semi-pro team Kansas City Courage. I have 10+ years experience of coaching soccer and training athletes – to be a more effective coach & trainer, I’m currently working on obtaining my Certification in Strength & Conditioning. I’ve also had some experience in the outpatient physical therapy setting as both a physical therapy aide/exercise specialist and Personal Trainer. When not in the work setting or on the soccer field, I love to surf, hike, workout, read books on my hammock, and cook! It feels great to be back at OrthoSport!

Why You Should Spend Time in Nature

We live in one of the most beautiful and unique ecosystems on the planet. How often do you get out into nature? Are you a regular hiker, swimmer, snorkeler, gardener, or surfer? Do you run trails, mountain bike, or birdwatch? Even in Hawai’i it’s easy to get stuck in a rut. You commute to work on packed highways, spend most daylight hours indoors at work or school, and drive home often in the dark. Then you watch some TV and off to bed to repeat again the next day. Weekends can fill with household chores, childcare, errands, and social obligations. It’s no wonder so many people are disconnected from the natural world, and struggle with insomnia, anxiety, obesity, headaches, and so on.

Why make the effort? We’re so busy, why find time for nature? According to the American Psychological Association exposure to nature has been linked to many benefits including improved attention, lower stress, better mood, reduced risk of psychiatric disorders, and interestingly–improved empathy and cooperation.

There is also increasing amounts of research correlating many physical health benefits with at least 120 minutes per week spent in green areas (forests, trails, urban parks) and blue areas (rivers, ocean, beaches.) A study published in Nature describes decreased risk of cardiovascular disease, obesity, asthma hospitalizations, diabetes, and more.

Children who spend time in nature also benefit significantly. Increased physical activity outdoors improves Vitamen D absorption to build strong bones, may decrease risk of childhood obesity, can reduce stress, and improve sleep. A study in Pediatrics found positive associations with activities such as spending time in residential or school greenspace, nature walks, gardening, and wilderness experiences.

Lucky we live Hawai’i – we can get ourselves and our families outdoors year-round with great weather and a variety of natural environments to explore. Here are a few ways to get 120 minutes a week in the natural world:

Walk through urban parks, such as Kapiolani or Ala Moana. Make note of the weather, (is it windy, humid, cloudy?) birds and other wildlife, trees and plants. Apps such as Seek and Merlin can help you identifity plants and birds.
Grab your phone or camera and find some natural beauty to photograph. Focus on crashing waves, plumeria flowers, coconut palms, lava rock — whatever sparks your interest.
If you have any outdoor space of your own, plant something. Take the time to really care about a tomato plant or Hawaiian chili pepper and it may reward you with a tasty snack.
Have breakfast, lunch, or dinner outdoors at the beach or in a park.
Start a nature journal. This is a great way to learn about the plants, animals, and ecosystems in your area.
Exercise outdoors. Take a surfing lesson, join an outdoor boot camp workout, try Yoga on stand-up paddleboards, or ask your personal trainer to work with you outside.
Join a nature conservation group and volunteer to watch over monk seals, weed invasive species, or help protect and plant coral.
Take a whale watching or manta ray snorkeling tour. Make sure the tour group is ethical, doesn’t harrass the marine life, and has a spotless safety record.
Sign up for your first trail run. Yes it’s okay to walk!
Learn a new outdoor sport like canoe paddling, pickle ball, or scuba diving.

Not sure you are strong enough or fit enough to increase your time and activity outdoors? We’re here to help! We have free lectures and screenings for improving running form and fitness for court sports like pickle ball. We offer free 1 hour fitness assessments and orientations to our medical gym services. Our massage therapists are experts at helping you release tension and muscle aches. Our physical therapists are available to chat with you during a free consultation. If you’re having pain, balance issues, or signifcant weakness, health insurance may cover your treatment.

OrthoSport Hat on Kayak Don’t let stress, fitness, or health issues keep you from your goals. Call 808.373.1114 for information on medical gym and massage therapy services in our Downtown and Niu Valley clinics. Call 808.373.3555 for information on physical therapy services in our Downtown, Niu Valley, and Kaka’ako locations.

A hui hou!

References:

https://www.apa.org/monitor/2020/04/nurtured-nature

https://www.nature.com/articles/s41598-019-44097-3

https://publications.aap.org/pediatrics/article/148/4/e2020049155/181269/Nature-and-Children-s-Health-A-Systematic-Review?autologincheck=redirected

Meet Our Staff – Personal Trainer Vincent!

I’ve been a trainer for the last 8 years. My passion for fitness and training stems from playing sports from a young age. The ability to train and work on ourselves through sport or physical training day to day, always improve, and overall feel better mentally is something I feel that should never be taken for granted. After years of playing sports and not having an outlet to train, I found CrossFit and it revamped my love of training. It really showed me how I can take control of my health physically and mentally.

Vincent Through CrossFit I learned about powerlifting, bodybuilding, gymnastics, Olympic weightlifting, calisthenics, speed and agility, endurance, HIIT training, and mobility. All the strength and knowledge I gained from training I wanted to share and have others experience the same as well. My goal is to help others take control of their lives by training and realize their bodies true potential or just to help maintain normal function and independence.

Eat (Right) and Be Merry!

Today’s article was written by our Medical Fitness Director, Thomas Fasulo. Enjoy!

“OMG I am about to go into an absolute food coma from that garden salad!”… said no one ever.

However, food comas, sugar crashes, the unbuttoning of the top button, and groan-walking your way over to collapse on the sofa are all phrases and visions commonly associated with the after-effects of bingeing unhealthy foods.

Turns out the connection between junk food and mood is actually stronger than we once thought. New studies have revealed that the connection between diet and emotions comes from a close tie between your brain and your gastrointestinal (GI) tract. This is often referred to as our “second brain” which can help regulate our mood and emotions based on what we eat and how that food is processed.(1)

How does the second brain work? Well, the GI tract is a complex system of organs covered in hundreds of microorganisms, known as the “gut microbiome.” The gut microbiome can influence the production of neurotransmitters; chemical substances that carry messages from the GI tract to the brain. Eating nutrient-dense foods that promote the growth of “good bacteria” in our gut can increase the production of neurotransmitters. In contrast, eating junk food can cause inflammation that decreases the production of neurotransmitters, which can affect your mood.(1)

The emotions we are experiencing often influence what we eat. As stress levels go up, we tend to turn to junk foods that are high in fat, sugar, and heavily processed for comfort. These “comfort foods” tend to be empty calories, meaning they provide little to no essential nutrients, but a large amount of energy. Empty calories are the main culprits of food comas and sugar crashes. These foods are quickly broken down in the digestive tract leading to rapid spikes in blood sugar and insulin levels. They may give a fleeting burst of energy but often lead to mid-day slumps that leave you feeling tired, sluggish, and desperately craving more food and caffeine. Patterns of sugar crashes can contribute to mood swings, irritability, and the feeling of “hanger.” This “second brain” will help dictate whether we plod through our day doing the bare minimum due to fatigue and mental fog, or if we feel spry, chipper, and full of energy.

Let’s break down what a healthy and unhealthy cycle can look like when food, exercise, and sleep are taken in either direction.

Derrick wakes up after a night of restless sleep and is running late for work. He decides to put some extra sugar in his coffee and grabs a cinnamon roll on his way out the door. Forty-five minutes later he is sitting at his desk feeling exhausted and ready to go home although his day has barely started. Eating that cinnamon roll and the extra sugar has inhibited the growth of “good” bacteria in his gut which negatively affects neurotransmitter production. This essentially slows down the messaging of important chemicals (i.e. GABA, serotonin, norepinephrine, dopamine, acetylcholine, melatonin) from his gut to his brain. He decides on a second cup of coffee with more sugar to perk him up and for a while it does, as his blood glucose levels spike, but it’s short-lived and followed by a second wave of crashing as his blood glucose levels plummet.

His meetings are non-productive, he is testy with his co-workers, and he’s feeling generally down on himself. Given that he has been so unproductive all morning, he has a time crunch to get his work done and decides to grab pizza and fries for a fast and easy lunch. He was supposed to go to the gym with his friend after work, but cancels because he has no energy and is feeling moody and despondent. Around 2:30 he feels himself nodding off at his desk so he grabs a soda and hopes the caffeine will get him through the day.

He barely finishes his work then heads home and collapses on the couch to watch TV. He is feeling stressed, run-down, and the last thing on his mind is cooking dinner. He orders some takeout for dinner and later that night treats himself to a piece of chocolate cake to feel a little bit of happiness in what was otherwise a rather unpleasant day. Before he goes to bed, he looks in the mirror and gets down on himself as he notices the muscle definition he had throughout his 20’s is fading quickly and being replaced by fat. He stays up scrolling through his phone aimlessly and reminiscing on easier times. His sleep is interrupted by the caffeine coursing through his system, thoughts of his negative self-image, and his body trying to digest his late meal versus helping put him to sleep. He wakes up feeling restless from a poor night’s sleep — and the cycle continues.

Next door, Eric wakes up feeling refreshed and happy. He has ample time before work and decides to do a quick yoga routine before making himself a breakfast smoothie with spinach, blueberries, protein powder, and avocado. Eating these healthy foods is promoting the growth of “good” bacteria in his gut, which positively affects neurotransmitter production ensuring clear communication of important chemicals from his gut to his brain.

At work, he is all smiles as he feels energized and invigorated. His co-workers and clients feel his confidence radiating and admire his positive energy. For lunch, he has a modest portion of brown rice, garlic chicken, mixed sautéed veggies topped with plain greek yogurt, and hot sauce. His messaging center is firing properly and all those good chemicals are received loud and clear. His blood glucose levels remain steady and he doesn’t feel any spikes or crashes. After finishing work early, he goes to his gym where he does 45 minutes of resistance exercise and cardio.

At home, he listens to music while cleaning his house and meal preps for the following day before having a spinach and salmon salad with lemon vinaigrette for dinner. He winds down the night with some breathing exercises and a cool shower. He admires his reflection in the mirror as he sees a healthier and happier version of himself. He falls asleep easily and has a quality eight hours before waking up — and the cycle continues.

It’s important to note that in these two examples, neither person is suffering from any sort of apparent mental health issues. If you mix in anxiety, depression, or any other similar diagnosis, the symptoms are more likely to be amplified in the first example and reduced in the second. In both examples, food played a large role in stress management, endorphin release, self-esteem, and energy. When these physiological responses are working in our favor, they can give us the boost we need to take on the emotional and spiritual challenges which may be less in our control. Similar to mental health, our nutritional and exercise journey has to be an individual one, and there is no one-size-fits-all solution.

You may need to explore different techniques such as nutritional journaling, to help identify and fine-tune dietary patterns. You can schedule a preliminary session with OrthoSport Hawaii’s registered dietitian to work alongside your PT, trainer, or massage therapist and ensure you are on the right track. Together, we can keep you moving in the right direction. While some aspects of your life may feel out of your control, taking small progressive steps towards a healthier lifestyle will empower you to tackle whatever life throws your way.

Call 808.373.1114 for more information on OrthoSport Hawaii’s medical fitness solutions for a healthier and happier you.

(1) https://www.hopkinsmedicine.org/health/wellness-and-prevention/the-brain-gut-connection

Caution! Home Exercise Fail Ahead!

A recent analysis of consumer injury data shockingly discovered that at-home workout injuries increased 48% from 2019 to 2020. Some of the increase is due to more people working out at home during the pandemic when gyms and group exercise classes were put on hold. However, roughly 30% of all at-home exercise injuries occurred in people aged 60 or over. The equipment most likely to cause injuries were treadmills and exercise bikes.

In our OrthoSport Hawaii clinics, we’ve seen an increase in patients coming to therapy for orthopedic injuries and pain syndromes. There are a few predominant pandemic-related themes:

Someone who used to exercise pre-pandemic, completely stopped working out. Their gym, yoga studio, pool, etc. was closed. They may have spent a great deal of time at home, watching NetFlix. Now they are suffering from deconditioning, poor posture, weight gain, and so on. This has led to insidious neck, back, shoulder, knee, wrist, or foot pain.

Someone who used to exercise pre-pandemic suddenly getting back to their previous exercise routines. They are launching themselves with great gusto into Zumba, tennis, running, basketball, bodybuilding, jujutsu, etc. Due to poor conditioning, decreased strength and/or flexibility they are injuring themselves pretty quickly.

In addition we’ve seen a great number of office workers with pain from working in less than ergonomic conditions, especially those working from home on laptops or with poor home office setups.

Did you pick up a new sport during the lockdowns? We’ve been seeing more newbie surfers, joggers, cyclists, and others in more socially distant sports. Along with new sports have come new injuries. With fewer family and social engagements to attend, some folks have found themselves engaging in novel activities at a much greater frequency than they would have normally.

All of these factors have created a boom in new patients visiting our clinics. This is great for business but not so great for the public, so let’s see if we can help. If you haven’t read our series on returning to fitness activities, start with Returning to Exercise After a Layoff.

Why are there more injuries in people over 60?

– Older bodies, regardless of fitness level, require longer warm-ups and cool-downs than they did in their younger years. As we age, connective tissue naturally loses its elasticity. If you have wrinkles on the outside, similar processes are occurring on the inside, you just can’t see them. Less elasticity means tissue is more likely to tear.

– Our maximum heart rate lowers as we age. This is not related to cardiovascular fitness. A 60 year old can be much fitter than a 30 year old, but no matter what, their 60 year old heart simply can’t beat as fast. That’s why having a strong heart is so important as we get older. A stronger heart doesn’t need to beat so fast as it can pump more blood with each beat. A simple formula for estimating your maximum heart rate is 220-your age. Therefore a 30 year old’s heart can beat all out at 190 bpm. A 60 year old’s can only reach 160 bpm. This affects how much work the body can perform.

– Many in-home workout programs, online fitness classes, etc are designed by and geared for a younger audience. The exercises may not be as appropriate for someone with stiffer joints, old injuries, asthma, or other medical conditions.

Why are there more injuries with home gym equipment?

– The treadmills, ellipticals and exercise bikes found at your local gym are probably heavy-duty, high quality machines designed to be used for hours and hours every day. For home use, consumers usually purchase something less expensive and therefore of a lower quality. This may be perfectly fine but could potentially have more defects or breakdowns of the equipment.

– Many people use exercise equipment incorrectly. They may set the treadmill speed too fast, or place it in a location that could cause injury, such as next to a wall. Weight benches may need to be assembled and one missing piece could spell disaster when barbells and plates are added. If you are putting your road bike on a trainer, be careful as you can fall off that thing!

– Home exercisers often use their home equipment inconsistently. Without a plan or program it’s easy to slack off and lose focus. Just because you were able to lift 50 lbs over your head three weeks ago doesn’t mean you can do that again today.

So if the gym is closed or open for too few hours, if it’s too crowded or your favorite classes are cancelled what can you do? Working out at home is a great option for many but it may be wise to consult with a fitness expert when deciding on equipment, exercise programming, pacing, and goal setting.

How OrthoSport Hawaii Can Help

We offer a free, no obligation, one-hour fitness orientation to help you understand what you will need to reach your fitness goals. These sessions are offered in our Downtown and Niu Valley locations. Once we’ve established where you are and where you want to go, we offer in-person and online personal training as well as online group exercise classes.

We can also consult with you online about equipment setup, exercise progressions and planning, home safety, etc to get you ready for your home workouts. Call for information on pricing for this consulting service.

Having pain or dealing with an old injury? Our PTs can consult with you in-clinic, or online to see if physical therapy may be the first step prior to a home exercise program. Our 30-minute, no-charge consultations are scheduled same-day by calling 808.373.3555.

Suffering the effects of overdoing it? Our massage therapists are ready to schedule 30, 60, and 90-minute appointments in our Downtown and Niu Valley clinics.

Not sure where to start? Call our Medical Fitness Center at 808.373.1114 for information on the appropriate services to meet your needs.

Remember the key to success is planning, consistency, progression and feedback. Our medical fitness experts are ready to share their knowledge and experience with you. Call today!

Meet Our Staff – Personal Trainer Cassidy!

Years of experience: I started my journey into health and fitness back in 2017, when I got my first certification through the NASM. Shortly after I started my career as a trainer, I decided I wanted to learn more about how to enhance athletic ability, prevent injury, and create pain-free movement for my clients. I was certified as a core-conditioning and biomechanics specialist in 2020 and I am currently pursuing the physical therapy assistant program at KCC. My goal is to help people move more efficiently and stay as independently functional as long as possible.

Specialization: Functional training, athletic performance, and core-conditioning. I love the passion, drive, and motivation an athlete brings to the table; however, I also enjoy working with clients of any age or skill level.

Interesting fact: I love 80’s rock band films, professional basketball, and spicy ahi

Hobbies, interests: I enjoy lifting weights, surfing, and listening to music

What got you interested in your field/passions? The men in my family are all coaches; my dad, brother, and grandpa. I grew up going to football and basketball games and fell in love with sports at a very young age. My brother is now a trainer and strength and conditioning coach. I’ve always looked up to him, so of course, I followed in his footsteps and became a coach too. The human body is amazing and is capable of so much more than you think!

Overuse Injuries in Sports – Don’t Ignore Them!

biceps curl With COVID restrictions easing, people are returning to their favorite sports with enthusiasm and sometimes wild abandon. The tennis players are competing with the pickle ball players for access to courts. Surfing breaks are crowded, hiking trails and national parks are packed with people. There are lines of cars waiting for parking at many gyms, sports fields, and beach parks.

Have you returned to your favorite athletic activities? It may be tempting to dive back into canoe paddling 3 or 4 times per week, or to sign up for yoga, barre, and zumba classes all at once. If you haven’t been paddling, hiking, or zumba’ing all year you may be setting yourself up for overuse injuries. Your muscles, bones, tendons, and ligaments are no longer adapted to those sports. In another article I talked about things to consider when returning to your workouts. We also discussed ways to prepare the body for a return to sport. Now we will look at some specific overuse injuries to be aware of so that you don’t end up sidelined, injured, or worse.

Tennis, Golfer’s, Pitcher’s Elbow – these injuries are well known and related to those sports specifically, however you can get lateral or medial elbow epicondylitis from a variety of repetitive activities. Anything that involves gripping and twisting the forearm, if done in excess, can lead to pain and weakness that will stop your arm from functioning. If you have pain in the inner or outer elbow that just won’t go away, get in to see your PT for a full evaluation. boy pitching

Surfer’s Myelopathy – this scary injury causes paralysis below the waist due to prolonged positioning in an extended spine (back bent) position. Although very rare, surfers and sometimes gymnasts or yoga students will get this injury that blocks blood flow to the spinal cord. If you feel back pain while doing these activities, stop immediately and seek medical attention. This form of paralysis is often but not always curable. prone surfer

Runner’s Knee – another very common complaint is knee pain while running. There are many things that can cause knee pain including weakness, poor running form, osteoarthritis, running too fast or too long, progressing too quickly, and so on. Also known as patellofemoral pain syndrome, runner’s knee can stop you from running entirely. If you feel pain around the kneecap, grinding, clicking or popping while running, have a PT evaluate your knee before the pain becomes disabling. runner in a race jumping volleyball player

Jumper’s Knee – the knee absorbs impact in many jumping sports such as basketball, skateboarding, and volleyball. Patellar tendonitis (or tendonopathy) involves pain and inflammation in the patellar tendon which attaches your kneecap to your shin bone. If you feel pain just below the kneecap with bending/straightening the knee, jumping, jogging, or walking it’s best to figure out the cause before you tear the tendon completely.

Whiplash – this neck injury is often seen in car accidents where the head and neck is forcefully whipped back and forth or to the side. This can also occur in contact sports such as football, soccer, and wrestling. Not as well known is the fact that severe whiplash can coincide with concussions when the brain is also whipped back and forth inside the skull, causing brain injuries. Seek medical attention immediately if you suspect a neck or brain injury. Any loss of consciousness, slurred speech, foggy thinking, severe neck pain, or visual disturbances can indicate a medical emergency.

Swimmer’s Shoulder – this impingement of the shoulder joint is caused by too much compression to rotator cuff tendons and other soft tissue in the front of the shoulder. This condition affects not only swimmers but is commonly seen in office workers who spend hours in front of a computer, using phones, and tablets. It can eventually lead to full tears of the rotator cuff or biceps tendon and should not be ignored. Swimmer with elbow high

Bowler’s Thumb – okay this is not a common or well-known injury unless you bowl frequently as one might for competition. It’s characterized by numbness and weakness in the thumb due to compression and friction to the ulnar nerve where the thumb inserts into the hole of the ball. The point here is that any activity taken to excess can lead to overuse injuries which may stop you from participating in your favorite sport.

Seriously, this list of overuse sports injuries could go on and on. The key take away is to realize that pain is a signal. Your body is telling you something’s not right and if you continue to ignore it, you’ll most likely end up with a serious injury.

What You Can Do

At the first sign of pain, stop to evaluate what might be the cause.

Did you jump off your skateboard and land in a weird position? Did you try hiking Kokohead stairs after a year layoff? Did you sign up for mixed martial arts classes despite having not exercised in decades? Did you increase your running frequency, duration, or speed without gradually building up? If you aren’t sure, you may need some professional help from a coach or personal trainer with a background in exercise science.

Ice is your friend! For most painful conditions ice can decrease inflammation and swelling. Massage a chunk of ice on the area for 3 minutes or until the skin is numb to the touch. Old yogurt cups filled with water make a nice sized chunk of ice. Hold the ice in a towel to collect the drips. If you can’t tolerate ice, consider gentle massage of the tissue in the direction towards the heart.

Rest until the pain goes away. If you’re taking pain medication, that doesn’t count! If after 2-3 days you still have pain it may be time to get the injury examined. You can start with your primary care physician or an MD at an urgent care clinic. If your health insurance allows direct access to physical therapy, you can call your favorite PT clinic and set up an appointment for an evaluation. You can pay for PT services out of pocket if you wish. At OrthoSport Hawaii, we also offer same-day free consults to help you decide if the injury needs medical attention, without the need to schedule a full one hour evaluation. We can also consult with you over the phone or via our Telehealth portal.

Don’t allow overuse injuries to ruin your fun as you get back into the swing of sports, fitness, and recreation. We’re here to help you get fit or recover from over-doing it. Call 808.373.3555 for more information on our services. See you out there!

Sports Are Back! Are You Ready? Read This First…

Thanks to the pandemic lockdowns, restrictions, stress, and lifestyle disruption, many of us have fallen off the wagon in terms of our fitness and sports activities. Golf courses were closed, tennis courts locked, and beach access was limited. Sports and paddling clubs couldn’t meet, trails were off limits, and of course, gyms and fitness studios could offer only remote online services. Some of us persevered and we saw a jump in outdoor walking, cycling, skateboarding, surfing, and swimming. Outdoor, socially distanced yoga and boot camp classes offered limited exercise options to the fortunate few.

On the other hand, we also saw an increase in alcohol consumption, fast food munching, and Netflix binge watching. These activities helped us cope with the fear and uncertainty of 2020. Some were obviously healthier than others. How did you manage in 2020? At this point, there is no need for regret or self blame. Tiger King may not have helped you stay fit but provided some much needed distraction from negative news and dire warnings. And thankfully, it was a limited series!

But hey it’s 2021! Although we must stay vigilant with mask wearing, hand washing, and physical distancing, we now have a much better understanding of this virus. The vaccine is providing hope for a better year with less risk of disease or death. So if you gained the “COVID 19” (pounds!) and want to lose weight, now is the time to get off the couch, turn off the TV, and get back in action.

In a previous article, we talked about how to return to exercise after a layoff. If you still feel uncertain, it’s understandable! That’s why we created our SPORT READY program to help you return to your favorite fitness and sports activities. So how does it work?

Step 1. Think about what you want to achieve. Have you missed golfing or tennis for an entire year? Have you gotten injured trying to follow an online yoga class? Are your neck, shoulders, and back stiff and sore from hours in front of a computer, working from home? Are you lacking motivation to run or paddle with no races on the horizon?

Step 2. Call our Medical Fitness Center to set up a free, no obligation 60 minute fitness assessment with one of our Medical Fitness trainers. We offer sessions in downtown Honolulu and in Niu Valley. Want to return to golfing, paddling, or tennis? A custom strength and cardio program could give you the boost you need. Not sure if you need new running shoes? Our RunFit assessment corrects your gait, posture, and form to prevent injury and improve performance.

Step 3. At your fitness assessment, our trainer will help you determine if an injury could benefit from physical therapy – usually covered by health insurance. Or, our 1:1 personal training, massage therapy, and nutrition services may qualify for your FSA funds.

Step 4. Plan a course of action — Physical therapy to address low back pain during your golf swing. Personal training to improve your trunk range of motion during paddling. Cardio and plyometrics to get you back on the soccer field. Nutritional counseling to improve diet for fat loss. By the end of your fitness assessment you will have a good idea what you need to work on next.

So what’s stopping you? Whether it’s pain, weight gain, motivation, or simply feeling too out of breath up the stairs, we are here to help. Make 2021 the year you achieved your health and fitness goals, no matter what craziness is continuing in the world. Take charge and call 808.373.1114 to schedule your free SPORT READY assessment today!

Evidence-Based Practice in Medicine Part 3: Evaluate the Evidence

In our last installment we looked at the validity of medical claims based on the source of the claim, whether there is cited research, whether the research was published in a peer-reviewed journal, and whether the authors had any conflicts of interest. Let’s assume you are researching the effectiveness of drinking beet juice to improve your running. A friend shares a link to an article on Facebook. The article quotes and references some research studies one of which was published in the peer-reviewed journal Applied Physiology, Nutrition, and Metabolism . You search for and find the original research article on pubmed.gov. So far you are doing good, the article’s author referenced a research study to back up their claims, the research was published in a peer-reviewed journal, and you can read the abstract online. Now, how do you know if this study is any good? You need to determine what type of study was done and how much evidence that type of study imparts to the research question posed.

Levels of evidence (sometimes called hierarchy of evidence) are assigned to studies based on the methodological design quality, validity, and applicability to patient care. Here’s a chart describing the basic types:

You should always search for studies with the highest level of evidence, i.e. meta-analyses or systemic reviews that analyze many, many randomized, controlled trials (RCTs) to look for consistent results across large numbers of subjects and conditions. A randomized, controlled trial (RCT) is, according to Wikipedia: “a type of scientific (often medical) experiment that aims to reduce certain sources of bias when testing the effectiveness of new treatments; this is accomplished by randomly allocating subjects to two or more groups, treating them differently, and then comparing them with respect to a measured response. One group—the experimental group—receives the intervention being assessed, while the other—usually called the control group—receives an alternative treatment, such as a placebo or no intervention. “

Level 1 evidence would be the “gold standard” upon which we can make some good medical conclusions regarding our research question. Level 2 evidence is also very persuasive in our decisions to implement new medical treatments based on research findings. Level 3 and below may provide useful information on trends and indications for future research. Our beet juice study appears to be level 3 – placebo controlled, but not randomized because there were only 14 subjects who performed with both beet juice and without beet juice (i.e. a crossover study.) Therefore, you may not want to rush out and buy a huge jug of beet juice to chug before your runs just yet – but the research is intriguing.

They key words you want to look for when reading about scientific research in the mainstream media or on social media are the words “meta-analysis of randomized controlled trials.” This means that a number of RCTs have been pooled together and analyzed to provide Level 1 evidence. Lower levels of evidence may be good starting points for new directions in research. For example, if a coach writes an article about how she has noticed her runners performing better with beet juice supplements that may qualify as an expert’s opinion (Level VII.) It could be an accurate description of her experiences but may also be biased by the coach’s desire to sell beet root supplements. She may want to help athletes avoid the temptation of illegal sports-enhancing drugs or she may just want to improve her notoriety in the running community. A RCT on the use of beet juice designed to avoid these biases would help us see if beets really do have a physiological effect on running.

No research study methodology is perfect. That’s why research is published, so it can be carefully reviewed by experts and the general public for any flaws, mistakes, or biases that could impact the author’s conclusions. When flaws are identified, new research studies aim to fix those problems and glean further information on the question. Thus, the scientific method is an iterative process where we gradually gather more and more information on a subject to clarify our understanding and produce better and better medical treatments. Yes, sometimes we get it wrong. It’s always important to challenge established conventions when new evidence comes to light. But it’s equally important to understand that new and unusual claims demand a high degree of scrutiny. Learn as much as you can about science and its methods, and you will be able to make better, more informed decisions on your own.

If you don’t have the time or interest to become adept at evaluating research, you may want to search out expert opinions you can trust. How do you know if an “expert” is trustworthy? How can you avoid getting scammed by disreputable fakes? That will be the topic of the next installment in this series.

If you’d like to experience the difference evidence-based, hour-long, physical therapy sessions can make resolving your pain or healing from injury, call OrthoSport Hawaii at 808.373.3555 for more information on scheduling a free online or in-person consult.

Returning to Exercise after a Layoff – What You Need to Know

There will always be times when you must take a break from your exercise routine. For many, the closure of gyms and cancellation of exercise classes during the COVID-19 pandemic has meant little ability to exercise in their normal routine. Some of you may have started walking or cycling outdoors recently and are interested in continuing and building on that. Here are some tips to gradually return to or start an exercise program – post Stay At Home orders.

As always, if you have any injuries or health conditions, are new to exercise, or haven’t seen your primary healthcare provider in recent years, a quick check-up and go-ahead from a medical professional is always a good idea. Many people ignore this step, but it’s extremely important. I’ve seen runners collapsed in cardiac arrest, joggers overcome by heat exhaustion nearly unconscious, and cyclists or swimmers blacking out during their workout. These people all thought they were healthy but were in very real danger of losing their lives.
START SLOWLY, START SLOWLY, START SLOWLY! You won’t be at the same fitness and ability level anymore. It doesn’t matter what you used to do; your body is different now. What does start slowly mean? If you normally spent an hour exercising (even in a class) cut that time in half. Don’t push yourself to your limit. In weightlifting, decrease your resistance and reps by half and work yourself back up gradually. For endurance exercise, decrease your distance and intensity adding only 10% each workout. During a fitness class, slack off for the second half of the hour or even step out to rest and stretch.
Overuse injuries are your enemy. Avoid them! Your tendons and ligaments are no longer adapted to the forces you used to put on them. Whether it’s playing tennis or getting back to martial arts, your connective tissue needs a couple of weeks to re-build and return to its previous level of elasticity and load tolerance. Now is not the time to snap your achilles.
Respect the messages from your body. If you feel overly fatigued or sick, don’t exercise or cut your workout short. Especially during the pandemic, pay attention to feelings of fever, cough, and unusual shortness of breath.
Now may be a good time to seek instruction or coaching in your favorite sport or activity. Certified trainers and sports physical therapists can help you improve your weightlifting form, analyze your running gait, and teach you how to stretch correctly.
If you wear a mask while exercising, rest if you feel light-headed. Don’t forget to stay hydrated. Signs of overheating include headache, dizziness, nausea, faintness, cramps, or palpitations.
If you notice an ache or pain that doesn’t go away with rest for a day or two, seek medical attention from your MD or Physical Therapist. Treating an injury in the earliest stages results in the best outcomes and less time required for full healing.

At OrthoSport Hawaii, we offer a variety of services to help you return to your favorite sport or start a new exercise program. Our certified personal trainers and PTs are available to help you avoid or recover from injury and optimize your performance. Check out our RunFit running analysis program and our SportFit package for athletes looking to stay active in their favorite sport into their older years. For information on our personal training, physical therapy, and massage therapy services, call 808.373.3555.

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