1. Would you say that you’re an optimist?
Optimism: Mindset has a profound influence on your body. Positive outlook not only impacts medical conditions like heart disease and cancer but also is important for optimal musculoskeletal health. Ailments become less disabling, pain levels are reduced and healing accelerated. With a little practice anyone and everyone can improve their mood. Positive results will be felt not only by your, but also those around you.
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2. Do you have
a family history of knee or hip arthritis?
Family
History hip/knee arthritis: We know that there are genetic determinates of
certain forms of arthritis. This is not only true of rheumatoid conditions
like rheumatoid arthritis and lupus but also even the common “wear and
tear” type osteoarthritis, especially in the hands, hips and knees. Check
your family tree. Some of us need to focus more on prevention, at earlier
ages than others.
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3. Do you have a
family history of back problems?
Family History low back pain:
Back pain is some common in our modern society that it’s hard to say what
exactly is the exact cause in any given case but we do know that genetics
play a role. Other important causes include past injury, posture, being
overweight or obese, smoking, sedentary work, heavy manual labor and
pregnancy. Higher levels of fitness protect against back pain and back
attacks.
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4. Do you
snore?
Snoring: Both quantity and quality of sleep count when it
comes to sleep’s restorative abilities. Sleep associated with snoring is
low quality sleep. When normal sleep patterns are interrupted (which
happens often in cases of snoring and conditions like sleep apnea), there
is a higher incidents of certain musculoskeletal pain syndromes like
fibromyalgia. Also proper sleep is important in weight control, mood, and
recovery from workouts and sport. Healthy sleep cycles can also be
interrupted by a wide variety of musculoskeletal ailments. Power naps can
also be restorative.
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5. Do you wear out your shoes
unevenly, one shoe versus the other?
Shoe wear: Your pattern of
shoe wear is almost as unique as your fingerprint and relates not only to
your gait pattern but also possible issues with spine and leg alignment,
leg lengths (i.e. one leg longer or shorter than the other), lower
extremity weakness and foot and ankle biomechanics such as pronation (flat
foot) and supination (high arch)- all of which can easily be screened for.
Check both your shoes and activity related sneaker wear patterns
especially if you have had recurrent overuse type injuries.
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6. Do you ever
limp?
Limp: Pain is natures signal that something is wrong and a
limp is your body’s way trying to lessen the load on an injured body part.
Different injuries often have their own unique type of limp and with many
chronic mild conditions, individuals may even be unaware that they are
actually limping. If there is any doubt, ask you friends. They will know.
Once you are limping, it is very easy to throw things out of wack and
cause other problems with your frame in addition to the one that got you
limping in the in the first place.
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7a&b. Women, have you ever
been pregnant? Did you have any significant musculoskeletal problems (such
as knee pain, back pain, sciatica) during or after
pregnancy?
Pregnancy: Pregnancy takes a major toll on your body.
The combination of weight grain, postural changes, and hormone surges
resulting in laxity (loosening and weakening) of ligaments and joints can
cause a variety of problems with almost every part of your frame
especially lower back, hip, knees and feet. Pinched nerves are common like
carpal tunnel (possibly related to fluid retention and swelling) and
sciatica (from low back issues or fetal positioning). Tendonitis also
occurs often. Much of that can be prevented. Many obstetricians tell
expecting mothers that all will be fine after pregnancy but I believe this
is not the case. Pregnancy leaves your frame vulnerable and each
additional pregnancy makes things a little worse. The good news is that
much of this is preventable with exercise and proper nutrition. Exercise
is important before, during and after pregnancy. The big challenge is
finding the time and energy once baby arrives, especially if you are
heading back to the work place. I believe that if men got pregnant, there
would be comprehensive rehab type programs to get them back in shape as if
they were athletes recovering from a major sports injury. Not so for women
at this point in time.
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8. How stressed-out are
you?
Stress management: Stress can be hazardous to your health.
It can negatively impact numerous systems from the cardiovascular (heart
disease and stroke) to the endocrine and immune systems. Stress can be
particularly damaging to your musculoskeletal system or frame. This
includes higher incidents of neck and lower back problems as well as other
chronic pain disorders. Stress can amplify pain signals. Stress also can
impact healing of a variety of tissues with negative consequences in terms
of injury recovery and surgery related complications. Problems can occur
from sudden acute exposure to stress or the more common chronic (even low
grade) accumulation of, or exposure to, stress. We all have stresses of
sorts and learning to manage and diffuse it is the key to a avoiding its
wrath in terms of your health.
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9a. What is your body mass
index?
9b. Are you significantly overweight or underweight?
9c. Do
you find it harder than 5 years ago to maintain your ideal weight?
9d.
Can you pinch an inch?
Body Weight: Being both overweight and
underweight can have negative consequences for your frame.
If you are overweight you place undo strains on your musculoskeletal system. Forces across your joints, muscles, ligaments, and tendons are amplified. The result is back pain and higher incidents of arthritis especially in the knees, hips, and foot/ankle area. Being overweight not only causes osteoarthritis but also results in more rapid acceleration of wear process once it is present. For every extra pound you carry your knees and hips think you have 5 and that adds up quickly. If you are 10 lbs overweight, your knees think it is 50. Imagine carrying around a 50 lb dumbbell all day. You’ll get the idea pretty quickly. The opposite can work in your favor and that is why even small amounts of weight loss can be helpful. Lose 5 and your knees sense a 25 lb reduction. They start to feel better. Being overweight also affects non-weightbearing joints such as the shoulder- there is a higher incidents of rotator cuff tears in those who are obese.
We are seeing the damage to joints (i.e. arthritis) in overweight people at younger and younger ages. 30 years old with 80 year-old knees, on the brink of a knee replacement. Speaking of knee replacements ( or any orthopaedic surgical procedure) there is a higher incidence of surgical complications (wound healing, medical and more) when you are overweight.
So in terms of your musculoskeletal health, there are many great reasons to start shedding those extra pounds and for all of us to pay much better attention to prevention when it comes to our children.
If you are underweight the main musculoskeletal problem usually occurs
with females. Anyone (male or female) who is not taking in enough calories
(especially higher quality calories) will have problems with athletic and
fitness related performance and recovery and will probably lose or start
breaking down that ever so important muscle tissue. Injury rates will
rise. Females who are underweight and underfed get additional serious
frame problems. Once body fat drops to a certain level, hormonal
imbalances occur resulting in the “female athlete triad”. This all too
common syndrome consists of disordered eating, amenorrhea (abnormal or
missed menstrual cycle), and osteoporosis (weak bones). This is especially
common in female endurance athletes like distance runners and also
gymnasts and ballerinas. Inadequate calcium intake is another factor. The
result is higher incidence of bone stress reactions and stress fractures
that can be recurrent and disabling.
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10. Have you ever
smoked?
Smoking: You don’t have to be the Surgeon General to
know that smoking is hazardous to your health. Traditionally we think of
smoke related damage to heart disease, stroke and numerous cancers.
Clearly smoking kills but it is also pretty devastating to your
musculoskeletal system or frame. Smokers have a higher incident of low
back pain and problems including herniated and degenerative discs in their
spine. Also smokers who undergo spinal fusion surgery have a significantly
higher failure rate. The bones and fusion just don’t heal and that is a
big problem with no easy solution. Smoking also interferes with fracture
healing and slows down the process leading to longer healing times
(“delayed union”). Smoking also increases the risk of a fracture
“non-union” in which the broken bone does not heal at all. The healing
process is shutdown completely. Smoking also disrupts the microcirculation
that is vital to numerous musculoskeletal tissues and as a result there
can be problems not only with your spinal discs (which rely on
microcirculation) but also problems with major tendons like the shoulder’s
rotator cuff (tendon degeneration, inflammation and tears). Smoking also
affects wound healing and increases the risk of complications in those
undergoing orthopaedic and other surgical procedures.
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11. Do you consume more than
two glasses of wine (or other alcoholic beverages) a day?
Wine:
A glass a wine a day can be good for your health. This is part of the
“French Paradox” in which the French enjoy longevity despite a higher
incidence of smoking and intake of high fat food. Wine is given the credit
for counter acting those other evils. Wine is rich in anti-oxidants, which
are good for your overall health and your frame. It can also help with
relaxation and stress reduction. When it comes to alcoholic beverages,
more is not better and alcohol can be a poison with many negative health
consequences. Also if there is an issue with alcoholism or other
dependency, you will do better getting your anti-oxidants
elsewhere.
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12a. Do you have
breakfast?
12b. Is it a healthful breakfast?
Breakfast: The
old adage “eat like a king at breakfast, a prince at lunch, and a pauper
at dinner” is great advice for your frame. Breakfast is the most important
meal of the day and seems to set the pace for not only how you will feel
and perform, but also how much you will overeat later in the day. Those
who eat a high calorie, high quality breakfast (especially with protein)
seem to better maintain their ideal body weight and suffer less fatigue
later on in the day. Food consumed later in the evening, especially near
bedtime, seems to be more easily converted to fat.
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13. What’s your daily
consumption of fruits and vegetables?
Fruits and Veggies: The
new USDA recommendations are great for your frame. You should accumulate a
total of 9 servings combined of fruits and vegetables each and every day.
This includes 4 servings (2 cups) fruits & 5 servings (2 _ cups) of
vegetables. This is power fuel for your frame. The premium pump. Better
than any supplement could ever provide. Unfortunately most of us don’t
even get close to these recommendations, so start keeping count. Eat a
rainbow and chew in Technicolor!
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14. How often to you eat oily,
cold-water fish, such as salmon or sardines?
Fish: Fresh fish is
part of the Mediterranean Diet secret to great health and longevity- rich
in Omega 3 fatty acids which are not only good for your heart but also
your joints, possibly serving as a lubricant. Omega 3’s help those with
arthritis and even tendonitis.
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15. When you eat on the run,
where do you go?
Fast Food: Not all “Fast Foods” are bad. In
fact, ethnic restaurants such as Indian, Thai, Japanese and Greek have
menu items and ingredients (like olive oil and certain spices) that are
great for your frame, helping your tendons, bones and joints.
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16a. Do you take an antioxidant supplement
that includes vitamins A, C, E and beta-carotene?
16b. Do you take a
daily multivitamin?
Vitamins and Supplements: In today’s fast
paced, always on the run society, most of us do not get adequate amounts
of necessary vitamins, minerals and anti-oxidants each and everyday.
Nothing is better absorbed and better utilized by your body than the
vitamins, minerals and anti-oxidants present in your foods. Having said
that, I believe that the vast majority of us would do well to assure
adequate daily intake of these essential compounds via sensible
supplementation. Your body, especially your frame, will appreciate it and
knows what to do with any excess. What it can’t do is make up for
deficiencies.
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17. Do you routinely need to
take Advil, Aleve, Motrin, or prescription drugs for muscle, joint, or
back discomfort?
Meds: The regular use of anti-inflammatory
and/or pain medications (even those found over- the- counter) should be an
alert that something is not right with your Frame and should be checked by
a professional. Also recent research suggests that NSAID medications may
not be your musculoskeletal systems’ best friend and may actually hamper
the normal repair and remodeling process needed for tendon, bone and joint
injuries. For example, NSAID’s can slow down your body’s repair or healing
of common fractures. Also, recent cardiovascular related issues with
NSAID’s (i.e. Vioxx and Bextra taken off the market) should remind
everyone to carefully weigh the potential risks and rewards of taking any
of these medications on a regular or continuous basis. Talk to your doctor
and definitely stay tuned for more on this issue. Also, always explore the
most natural and safe ways to deal with musculoskeletal issues, as
outlined in detail in FrameWork - Your 7 Step Program for Healthy Muscles,
Bones and Joints.
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18. Combining food and
supplements, do you routinely consume 1,200 milligrams of calcium every
day?
Calcium: Adequate calcium is essential for a healthy
musculoskeletal system. This is especially true for bone health.
Inadequate calcium intake results in weak fragile bones (i.e.
osteoporosis) which are more prone to fracture. Osteoporosis is a major
health issue and its incidence is on the rise. Both men and women are
affected although women are much more susceptible. Prevention is the key
especially in young females and includes a lifetime of adequate calcium
intake combined with regular exercise, especially weight bearing exercise
(weight training is ideal). Unfortunately, most of us are not meeting
daily calcium requirements so a deficit will build up. Prevention is so
important because once osteoporosis occurs, it is very difficult to
reverse.
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19. Do you routinely drink
sodas?
Soda: Sodas are pure sugar. Naked calories that add up
quickly contributing to obesity. Sodas are also bad for your bones. Most
who drink soda do so at the expense of healthier calcium rich beverages
like milk (especially children and teens). Sodas also have a double-
whammy in that the phosphorus in many sodas blocks the absorption of any
other calcium that is taken in. Most of us don’t get enough calcium, and
the little we do, is blocked from entering the body where it’s needed.
Also, the insulin surges that occur from the sugar blast result in higher
levels of inflammation in the body (not good for your frame) and higher
risk of both obesity and diabetes (neither of which is good for your
frame).
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20. How much water do you take
in a day?
Water: Water is essential for virtually every
physiologic process in your body yet most of us go around with our tanks
not adequately filled. Athletes and those who exercise regularly are
particularly prone to dehydration related issues. So “camel- up”. To learn
more about the importance of water checkout “Running On Empty”.
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21. How much do you sleep each
night?
Sleep: Too much or too little sleep can be harmful to
you. Between 6-8 hours per night of quality sleep (frequent wake-ups
and/or snoring don’t really count) is ideal. With less you can have issues
related to chronic fatigue as well as problems with agility (both mental
and physical), and coordination. Too much increases your risk of heart
problems and like too much sedentary behavior can result in muscle and
bone loss. Even proper weight control is linked to catching the right
amount of ZZZ’s.
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22. What is your morning
resting heart rate (MRHR)?
MRHR: It is a good idea to both know
and regularly monitor your MRHR especially if you are involved in vigorous
exercise or athletic training. MRHR can serve as a fairly sensitive
barometer of “overtraining” syndromes with resultant decrease performance
and increased injury rates.
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23. Have you ever taken
steroids, growth hormone, or supplements such as androstenedione and DHEA
(dehydroepiandrosterone)?
Steroids: Even if it does allow you to
hit more home runs or look better at the beach, anabolic steroids and
other illegal performance enhancing substances should not be taken. These
are potentially dangerous medications with a myriad of long and short term
health consequences-some reversible, some not. There is no safe way to
take anabolic steroids, even with medical “supervision”. In addition to
numerous medical problems (liver, heart, endocrine, skin, psychological)
these substances can be damaging to your frame or musculoskeletal system.
Muscles get stronger but tendons weaker – a bad combination in terms of
increased incidents of rupture of major muscle/tendon groups (usually
requiring major surgery). Also, there can be instances of joint surface
damage and collapse related to a condition called avascular (AVN)
especially in the hip joint. These compounds are especially dangerous in
children whose skeletons are still growing resulting in premature closure
of growth plate and stunted growth. In the past, this has been a
predominantly male problem (except for some female pro bodybuilders), but
recently more and more young girls have turned to steroids for that “beach
body” as well as to enhance athletic performance. Sure your “friends” may
say they are safe and have “gotten away” with Russian roulette. If you
really care about your body, Just Say No. There are no shortcuts to a
lifetime of great health and durability.
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24. For how many hours at a
stretch do you sit at a desk?
Sitting: You would think that
being sedentary and sitting around doing nothing all day long would
prevent your frame from getting into trouble but just the opposite is
true. Thomas Cureton, an exercise physiologist was so correct when he said
“the human body is the only machine that breaks down when not used”.
Sitting places tremendous stress on the lower back and spine and can cause
many other joints to “stiffen” up. Also working at computer (especially if
not perfectly positioned from an ergonomic standpoint) can wreak havoc on
you neck and upper extremities with cumulative trauma disorder such
tendonitis, and carpal tunnel syndrome. So make sure your workstation is
properly setup and take frequent breaks to stretch and move about. Also,
if your job is sedentary you had better find time during the day to get in
your daily dose of required exercise.
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25. Are your joints
hypermobile?
Loose-jointed: Being loose jointed or hypermobile
can help you in a variety of sports and activities such as ballet,
gymnastics, ice-skating , yoga and martial arts but it also increases your
risk of numerous bone and joint injuries such as ligament tears, muscle
strains and joint subluxations and dislocations. If you are loose jointed
you should spend less time stretching those loose areas and instead focus
on strength training to add to better muscle support and control of those
vulnerable areas.
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26. How often do you work
out?
Workout: Exercise is a medicine and like any medicine
requires an optimal dose. If it is too little or intermittent it will not
protect your health and your frame. Too much and it can be damaging
resulting in breakdown (more on that later). Also it needs to be a
lifetime habit. Medications have a “half –life” which means that over
time, the effects of that medication will predictably leave your body.
Ditto for exercise. All it takes is a few weeks off the wagon and you
begin to lose all the health and musculoskeletal benefits. So stick to it!
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27. Does your workout include
the following- Balanced aerobic, strengthening, and
stretching?
Balanced workouts: One of the biggest missing
elements for most individual’s workout regime is balance. The three
pillars of a great balanced workout include cardiovascular, strength and
flexibility. Most of us favor one or two at the expense of others. No
matter what your fitness or health goals are, find a way to regularly
include all three critical elements.
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28. Do you run to get in shape?
Or get in shape to run?
Run: Running is a terrific
cardiovascular or aerobic exercise but it can be very strenuous and also
create high forces across your skeleton, especially your joints. If you
are overweight, the high forces are even magnified. To avoid injury or
breakdown, get in shape and shed some unnecessary pounds first and then
incorporate running. If you have arthritis in your hips, knees, ankles or
feet consider a lower impact alternative. If your lower extremity joints
are healthy, it’s hard to beat running as an exercise.
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29. For a given sport or
activity (bicycling, Rollerblading), do you wear the full protective gear
suggested?
Gear: So many injuries (including many serious and
life threatening ones) are preventable when proper safety gear is used.
Yet, far too many children and adults do not use the appropriate safety
gear for their sports or activities. You wouldn’t see Lance Armstrong
without his bike helmet or Terrell Owens without his helmet and pads. Nuff
said. To learn more about safety gear and be even more convinced of its
importance check “Gear Up”.
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30. Do you stop an activity
when you feel pain?
Pain: Pain is an important warning signs
that never should be ignored. “No pain, No Gain” is no longer a sensible
mantra and certainly has left a trail of walking wounded. Learning to
listen to your body and better understand its language and signals is
important in maintaining lifetime durability. With experience you will
also learn the difference between “the burn” or other forms of mild
discomfort that are safe to work through in exercise and sport, and those
ouches that are problematic and of concern.
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31. If you’re a runner, how
many miles do you log in a week?
Miles logged: The likelihood
that a runner will sustain an injury (especially overuse related)
increases dramatically when the runner’s weekly mileage goes over 25-30
miles. This is especially true if there was a sudden increase in the
mileage. The body is less able to adapt. The volume of activity/
likelihood of injury equation also holds true for other sports and/or
activities. For example, aerobic dance instructors who teach more than 3
classes per week have higher injury rates as do pitchers who throw more
than a certain number of pitches a week (that number varies also by the
pitcher’s age) and so on with many other activities. Obviously we all have
a break point and the key is to learn to listen to your body and design
workouts that build you up, not break you down.
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32. Do you regularly play
soccer, rugby, or basketball, or do you powerlift?
Sports:
Certain sports, if done regularly, are associated with much higher
incidence of arthritis (especially knee) down the line. Surprisingly,
soccer and powerlifting are worse for your knees (in the long run) than
football (unless of course you’ve had that one major “blowout” injury-
which does tend to happen more often in football). Contrary to popular
belief, running does not seem to cause wear and tear arthritis in the
knees. If however you do already have knee arthritis, running and other
high impact activities will accelerate the arthritic wear.
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33a. Have you had to see a
doctor in the past 3 years for any bone, joint, or spine problems?
33b.
Have you ever had an orthopaedic injury severe enough to result in one of
the following? Kept you out of sports or exercise for a month? Required
crutches for 2 or more weeks? Required surgery?
Injuries: Prior orthopaedic (bone and joint) problems are often
predictive of future ones. Even if you have fully “recovered” and are
without current symptoms, there may be some underlying weakness or damage
that could rear its head in the future. This is especially true if you
have had multiple or recurrent problems, more serious injuries or surgery
i.e. orthopaedic. You probably have “weak links” or points of
vulnerability in your frame. Seek them out and try to toughen them or if
necessary learn to safely work around. In the FrameWork book, an entire
section is devoted to exercise programs that deal with the top 20
Orthopaedic (bone and joint) ailments and their workout fix. By smartly
adjusting your workout, you can usually continue your path to lifelong
fitness.
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34. Have you ever dislocated or
separated your shoulder?
Shoulder: The shoulder is a complex
joint and many injuries (even old ones) leave it vulnernable. Shoulder
dislocations and even partial dislocations (subluxation) are often
recurrent and can result in problems with the labrum (cartilage type
stabling rim within the shoulder socket), rotator cuff, and surrounding
nerves. Shoulder separations (“AC joint” injury) can result in painful
arthritis and/or rotator cuff problems.
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35. Do you have joint
swelling?
Swelling: Joint swelling is never normal and always
should be evaluated. It can be related to injury or arthritis as well as
mores systemic medical problems including infection.
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36a. Have you lost mobility
(range of motion) in any joint? For example, can you fully straighten
(extend) and fully bend (flex)? Compare right to left.
36b. Do you have
stiffness in any joints for any of the following? Do you
have stiffness in any joints for any of the following? Upon awakening
(i.e., until showering or moving about 15–20 minutes)? After sitting still
more than 30 minutes? For no apparent reason?
ROM/Stiffness:
Every joint in your body has a normal range of motion (ROM) which is
usually symmetric and equal right to left. Even your spine (neck and low
back) and jaw have a normal range of what should be available. Joints are
measured in flexion (bending), extension (straightening) and some have
rotation. Motion loss is never normal and may be due to arthritis, injury,
surgery, scar tissue or other less common problems A feeling of tightness
or stiffness can be an early sign of problems such as arthritis. If a
joint is not moving right, get it checked.
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37. Do your knees creak or make
noise going up or down stairs?
Noisy joints: Many individuals
experience sounds from their joints. Sometimes tendons will go snap,
crackle, pop and some will experience a crunching or grinding sensation
especially around patella or kneecap on stairs. It is never a bad idea to
get noisy joints checked. Kneecap noise is usually due to some arthritis
type wear or softening on the joint surface but not always. If there are
absolutely no symptoms, then things can just be monitored but if it hurts
or limits you, make an appointment with a sports medicine specialist.
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38. Do you have trouble
actually ascending or descending stairs?
Stairs: Difficulty
going up or down stairs can be related to joint problems like arthritis or
issues with leg weakness especially the important quadriceps muscle on the
front of your thigh. As we age, muscle loss occurs and it usually is
gradual and unnoticed. Problems with stairs, or getting out of a deep
chair may be the first indication. No matter what the underlying reason,
this is an important issue that should be evaluated. In many instances,
simple strengthening exercises will greatly improve your
function.
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39. Does high barometric
pressure (i.e., damp, rainy weather) make your joints
ache?
Barometer: Your joints are mini-barometers. This is
especially true if you have arthritis, synovitis (irritated joint lining)
or inflammation in a given joint. It (the joint) then can sense changes in
barometric pressure. So, it is not an old wive’s tale that some
individuals can predict whether (especially high barometric conditions
like rain). If you don’t need the weatherman because of bum knee or other
joint, get it checked.
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40. Have you ever had an
episode of lower back or neck pain or spasm?
Low Back Pain: An
epidemic in our country, low back pain sidelines 80% of the population at
some point in their lives. The #1 predictor of low back problems is
previous low back episode. It tends to be recurrent. Getting over the
episode (which most of us do pretty easily) is not enough. Take it as a
warning shot to learn more about your lower back and get into a preventive
low back program that focuses on preventive exercises, weight control and
things like proper posture (including sitting) and lifting
technique.
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41a. Do you have pain while
lying on either shoulder at night in bed?
41b. Do you have difficulty
falling asleep at night or awaken during the night because of any joint or
muscle discomfort?
41c. Do you awaken at night with your hands or
fingers “asleep”?
Night Pain: Nighttime can be uncomfortable for
those with a variety of musculoskeletal ailments. Pain or discomfort alone
is an issue but the secondary problem is disruption of important sleep
cycles necessary for repair and renewal of your body. For reasons that are
not entirely clear, problem muscles, bones and joints can hurt more at
night. This may be due to circadian rhythms affecting certain hormones or
perhaps the day-to-day distractions (which block pain signals as you go
about your daily routines), are gone. All is quiet, and the pain signals
are front and center, amplified. This phenomenon is common with arthritis.
Shoulders are different. Individuals with rotator cuff problems don’t
tolerate lying on the involved side. Possibly due to pressure related
circulatory issues (micro-circulation) within the shoulder’s rotator cuff
itself. Hands that go numb in the night can be from nerve problems like
carpal tunnel or cubital tunnel syndrome. Nighttime is not always great
for individuals with low back and neck problems, fibromyalgia and
“restless leg syndrome”. Sleep should be a time of comfort and rest. If it
is not, talk to your doctor. Also consider a different mattress.
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42. Is one leg longer than the
other?
Leg Lengths: If one leg is shorter or longer than the
other you may be more prone to orthopaedic issues involving the lower
back, hip, knee, lower leg, ankle and foot. This is especially true if you
are involved in high performance, lower body predominant activities like
running and cycling. The difference in leg length may come from actual
differences in the length of the legs themselves or from spinal issues
like scoliosis (curvature) or sacroiliac (SI) dysfunction. Sometimes it’s
a combination. Old fractures of the hip, femur or tibia can result in a
longer or shorter leg as can surgeries like hip replacement. A removable
heel lift will usually correct things when needed. Many of us have a
slight leg length discrepancy that is well tolerated and does not need any
treatment.
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43. Are your foot arches too
high or too low?
Arch: Very few of us have golden arches. Arches
can be high or low. A low arch or flat foot is pronated (pronation) and a
high arch or cavus foot is supinated (supination). Your arch is an
important part of the shock absorption system for your lower body, pelvis
and spine. Both high arches and low arches can get you into trouble with a
variety or orthopedic conditions especially in the foot, ankle and knee. A
high arch foot is actually a worse shock absorber than a low pronated
foot. Heel pain and spurs, planter fasciitis, Achilles and/or ankle
tendonitis and stress fractures all can occur. Proper shoe and/or sneaker
selection is essential and shoe inserts are often helpful. These can be
inexpensive “over the counter” or more expensive custom fitted
orthotics.
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44. Ankle Mobility- Have you lost some
motion or mobility in your ankles?
Ankle ROM: Loss of even a
little ankle mobility can throw off your entire gait leading to other
problems. Motion loss can follow a simple sprain or can be related to more
serious conditions like arthritis. If you’ve had ankle sprains, fractures,
or have ankle pain, check for motion loss. Often you can re-gain lost
motion with some simple exercises or physical therapy.
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45. How’s your Knee and Leg
Alignment?
Knee/Leg Alignment: Few of us have perfectly straight
legs. Most of us are slightly knocked-knee (valgus) although there are
many bow-legged (varus) individuals. A little of either is not bad but the
more you have, the more likely you are to wear your knee joint out
unevenly and develop arthritis on the inner (medial) or outer (lateral)
side of your knee. It’s like a car with a wheel alignment problem, the
tires wear prematurely and unevenly. If you are very knocked-knee you are
7 x’s more likely to develop arthritis, and if you are very bow-legged,
you are 5x’s more likely to develop arthritis than someone with normal
alignment. Much of it is genetics although knee injuries themselves can
create these deformities.
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46. How’s your Kneecap
Alignment?
Kneecap Alignment. Your patellofemoral joint (where
the kneecap or patella glides over the end of the femur bone in the
trochlea groove) is not an inherently stable joint like a deep ball and
socket i.e. hip joint. It tends to slip and slide in the groove especially
in some individuals with “malalignment”. The rotation of your hip, shape
of your leg and looseness of the joint itself are all factors. Those with
kneecap alignment issues are more likely to have patellar pain syndrome
(sometimes called chondromalacia) and even problems with patellar
subluxation and dislocation as well as patellofemoral arthritis. There are
excellent exercises and rehab programs that help with these conditions.
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47. How’s your
balance?
The Stork: Balance is so important to maintain a
healthy frame. It not only prevents injuries and falls but also improves
sports performance. Balance can always be improved with a little work.
Some great activities to build super balance and coordination include
martial arts, Tai Chi, Qi Gong, ballet and yoga.
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48. Can you hold “The Horse”?
And how long?
The Horse: A basic martial arts position that is a
cornerstone for so many other movements. It builds your important
quadriceps muscle (front thigh) and can also be used as a position for
meditation. I once had a martial arts instructor who would meditate in the
horse position, and could spend an entire hour holding that
position!
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49. How’s your Lower-Leg
Strength (Hop Test)
Hopping: The ability to hop repetitively and
evenly (right to left) requires both calf strength and endurance which is
often lost after an injury or if you have been sedentary and out of shape.
Sometimes one side is deficient and on the hop test or hopping drills you
don’t have your natural spring, and as a result you land with more of a
thud on one side.
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50a&b. Do you measure up?
(Quads, Calves and more)
Muscle Atrophy: Muscle atrophy can
occur pretty rapidly after an injury or surgery especially if there is a
period of immobilization ( i.e. cast, knee immobilizer, sling). If you
have been limping for a week or two you can usually already measures
atrophy especially in your quadriceps (thigh muscle). Ditto if you’ve had
knee surgery, even arthroscopic. Certain nerve related conditions and even
low back problems can result in muscle weakness and muscle loss. Also if
you have been sedentary or inactive, especially over the age of 40, you
can lose muscle very rapidly. Use it or lose! The good news is that with
strength or resistance training (or rehabilitation when needed) it comes
back. Muscle is built much easier when you were younger but is it’s never
too late. Researchers have shown that even 90-year-old previously
sedentary, frail, nursing home residents can rebuild muscle and improve
their function with a simple weight training program.
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51. Calf Raises- How
Many?
Calf Muscles/raise. Your calf muscle is also prone to
atrophy and weakness after injury, immobilization or with certain
neurologic or low back problems. (See prior muscle atrophy
discussion).
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52. Forearm Flexibility /
Tightness
Forearm Flexibility: Forearms can tighten for many
reasons and make you more likely to develop tennis elbow (outer side of
elbow-lateral epicondylitis) and golfer’s elbow (inner side of
elbow-medial epicondylitis) even if you play neither sport. Regular
computer and keyboard use (especially if your workstation is not adjusted
properly) are also culprits. Stretch your forearms regularly if you play
tennis, golf, work at a computer, or do repetitive activities (like being
a checkout cashier) with your arms and hands.
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53a,b&c. Neck (Cervical
Spine) Motion / Mobility
Neck/C-Spine Motion: Neck motion loss
can occur from and injury but is more commonly seen with age-related wear
and tear that we all get. Sometimes motion loss goes unnoticed because
your body compensates.
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54. Tight
Calves?
Calf Tightness: Calf tightness is extremely common and
is a predisposing factor in a variety of musculoskeletal ailments
including heel pain, heel spurs and plantar fasciitis. A tight calf is
more prone to Achilles problems such as Achilles tendonitis and even
Achilles tendon tear/ rupture and calf muscle strains (“tennis leg”).
Tight calves can also predispose to ankle sprains. Women who wear high
heels are particular susceptible as are runners and individuals involved
with ballet and dance. Stretching regularly prevents most calf related
problems.
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55. Tight Hips?
Hip
Tightness: Hip tightness can occur in runners, cyclists, and those who sit
at a desk most of the day. Hip tightness may also be a sign of hip joint
arthritis. Stretching and range of motion (ROM) exercises can help
especially in terms of prevention of problems.
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56a&b. Core Strength and
Flexibility
Core: Your core is that center of your body that
connects your upper body/chest are to the lower body. It is the center of
your fitness universe but is all too often neglected. It is critically
important for not only your FrameWork and optimal musculoskeletal health
but is also a key component of athletic performance, especially at higher
levels. It is made up of your abdominal area (front and sides), your lower
back musculature (especially those important extensor muscles) and your
pelvic area muscles. Core training had been the missing link in fitness
for a long time but is now fortunately becoming more mainstream. Step 3 of
the FrameWork Program is devoted to building a core. Other great
activities to improve your core include martial arts, Pilates and
yoga.
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57 a thru g. Muscle Tightness (Hamstrings,
Quads, Shoulders, Low Back, ITB)
Muscle Tightness: Stretching
is the most neglected area in the majority of workouts and many muscle
groups pay the price. Some individuals are just more tight jointed, with
tight muscle groups, than others. Certain sports and fitness activities
predispose to muscle tightness. Runners typically have tight hamstrings,
shoulders, low backs and calves. Cyclist, volleyball and basketball
players get tight quads. Weightlifting, done properly, does not cause
muscle tightness-so much for that myth. Most of us, especially as we age
develop tightness in 4 major areas: the front of the shoulder; lower back;
hamstrings; and calves. Muscle tightness not only diminishes athletic
performance but also predisposes you to muscle pulls and certain injuries.
For example:
Hamstring tightness _ patellar pain, low back pain
Quad tightness _
Jumper’s Knee (tendonitis)
Calf tightness _ Heel pain, Achilles
tendonitis and tears
Regular stretching pays off in many ways. Better yet, take up
yoga.
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58a&b. Pushups and
Crunches- How many?
Push-Ups/Crunches: Push-ups and crunches are
a great calisthenics you can do almost anywhere and are great for building
upper body and core strength and endurance. There are many variations to
keep things interesting and challenge you body in different ways. Always
use good form and strive to add a few more each workout.
Push-Ups are a great overall indicator of upper body strength and
endurance. Crunches are one important indicator of abdominal and core
strength. Abdominal weakness is linked to many orthopaedic problems
including low back pain. Also core strength is critical for optimal
athletic performance and injury prevention.
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59a&b. How’s your
Posture?
Posture: For most of us, excluding Marines and Navy
Seals, good posture does not come easy. It’s a habit we need to work at
but can be a challenge because daily activities (i.e. sitting at a desk,
driving in car, watching TV, etc) tend to create poor posture. Improperly
designed workouts that lack balance can have the same negative effect on
your posture. As your posture worsens, bodily movement becomes less
efficient and you are more prone to fatigue and stress. Tight misaligned
muscles are also more prone to chronic strain especially in the neck and
lower back area. Good posture is important not only when you are standing,
but also equally important when sitting and even lying in bed. The
FrameWork Program will improve your posture.
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The key & page numbers below refer to Dr. DiNubile's original book: "Framework: Your 7-Step Program for Healthy Muscles, Bones, and Joints"
