Useful Manual Therapy Techniques to Improve Shoulder Impingement Outcomes

The shoulder gives the most degrees of freedom of any joint in the body. The rotator cuff is an extremely important structure in providing a vital balance between mobility and stability. The rotator cuff consists of the tendons (a tendon is an extension of a muscle which attaches that muscle onto a bone) of 4 different muscles: Infraspinatus, Teres minor, Supraspinatus and Subscapularis. These structures are vulnerable to injury. One of the most common of all shoulder injuries is impingement.

Impingement occurs when the rotator cuff tendons get pinched in the space between the arm bone and the arch of the shoulder blade, which is known as the sub acromial space, as they pass from their muscle to their attachment at the front of the shoulder. This causes a mechanical stress to the tendon which results in swelling and/or damage. This pain is usually felt when lifting the arm up straight in front of you or out to the side as this is when the sub acromial space is at its smallest.

Rotator cuff impingement can be difficult to cure. Stretching or strengthening exercises and non steroidal anti inflammatory (NSAID's) are often prescribed as treatments for impingement. Another valuable treatment option is manual therapy. Manual therapy has been shown to improve the outcomes for rotator cuff impingement treatment ⁽¹⁾. Manual therapy helps to relieve the mechanical stress on the tendon which causes the damage and helps the damaged tendon to recover more quickly.

What is Manual Therapy?

Manual Therapy is a term used to describe a ‘hands on' treatment approach where joints, muscles ligaments and other soft tissues are mobilized or manipulated by a therapist to achieve a therapeutic benefit.  The benefits for the shoulder and rotator cuff muscles in using these techniques includes increased flexibility, increased tissue healing, improved muscle function without impingement, and a patient's increased tolerance to performing functional activities without impingement pain following treatment.

There are a range of techniques which fall into the category of manual therapy, those most commonly used for the treatment of rotator cuff impingement are:

• Soft Tissue Massage
• Friction massage
• Manipulation
• Mobilization

Soft Tissue Massage

Soft tissue massage is the systematic application of pressure and movement on the soft tissues of the body with the intention of facilitating normal range of movement.

Friction Massage

Deep  tissue friction massage is the application of a massage technique whereby superficial tissues are rubbed against deeper tissues. It is useful in assisting the body's own healing mechanisms and as such can help to speed up the healing of injured tendons.

Manipulations

Manipulation is a passive joint movement performed with the aim of increasing joint mobility. It incorporates a small amplitude quick thrust movement at the end of the available joint range.

Mobilizations

Joint mobilization involves the application of a passive force to increase joint range of motion. Mobilizations are performed up to the end of available joint range, but always within that range.

Although manual therapy has been proven to improve rotator cuff impingement recovery, it is not clear which of these manual therapy interventions is better ⁽²⁾. It would seem logical to assume that a combination of these treatments would prove to be of benefit in promoting recovery from rotator cuff impingement.

References

1. The effect of manipulation on the structures of the shoulder girdle as additional treatment for symptom rekief and for prevention of chronicity or recurrence of shouder symptoms. Bergman, GJD, Winters, JC and G, Heijden. 2002, Physical Therapy, Vol. 25, pp. 543-549.

2. Comparison of conservative treatment with and without manual physical therapy for patients wth shoulder impingement syndrome: a prospevtive, randomized clinical trial. G, Senbursa., Baltaci, G and Atay, A. 2007, Knee surgery sports traumatology and arthroscopy, pp. 915-921.

How Exercise Helps to Improve Your Performance in the Workplace

According to the National Institute for Occupational Safety and Health, over 30% of employees report high levels of stress and experience associated health problems on an ongoing basis. While there are a number of reasons for the cause of stress at work, its effect frequently results in illness and injury. The common disorders ensuing from a stressful work environment include psychological, emotional, behavioral and cognitive ailments. If left unchecked, simple issues may evolve over time into serious illnesses such as cardiovascular disease.

The lack of exercise on a daily basis can exacerbate many of the ailments associated with workplace pressures. However, many of the symptoms of such distress may be alleviated by making lifestyle choices which benefit employees both mentally and physically.

Your health may be at risk if you are experiencing symptoms relating to workplace stress. If you suffer from depression, anxiety, fatigue, lack of concentration, or experience aches, sleep disorders, or pain, then you would benefit from a change in lifestyle habits which encompass a suitable form of daily exercise.

You will need to cope with these pressures because although the causes may not be in your control, you will suffer the effects of job stress. To mitigate these effects, you may need to make lifestyle choices such as taking care of your diet and achieving work-life equilibrium. The set of stress inducing factors you deal with are unique to your individual situation. Implementing a daily exercise routine is just one step in the multi-faceted approach to helping yourself to improve workplace performance. The benefits of following such a routine have been shown to increase morale, improve mood and energy levels, and to achieve focus and induce relaxation.

How does exercising on a daily basis help you improve your performance on the job?  Exercising daily has been proven to improve your mood and overall health, which has a positive impact on your ability to achieve your work goals.

A research study in the International Journal of Productivity and Performance Management by Sameer Kumar, et al (1) conducted a cost-benefit analysis of a company's employee wellness program and healthcare costs. It determined that improving employee health resulted in enhanced worker performance and thereby increased the organization's productivity. Thus it established a direct link between employee health and work productivity.

A second study in the Journal by J.C. Coulson et al (2) measured the specific effects of exercise in the workplace by a group of employees. The employees recorded data on days they exercised as well as on days they did not exercise. On comparison, a direct link between exercise and employee productivity was established. It was found that on the days that the group of employees chose to exercise, they experienced a positive change in mood, which led to enhanced performance outcomes.

If you are experiencing symptoms or know a person who has difficulties related to the workplace, including muscle aches, changes in appetite, sleep deprivation, and fatigue, we can help by customizing a plan to incorporate exercise in your daily routine. Our programs will help you cope with your career goals and help you improve your workplace performance over time.

References:

(1) Operational Impact of Employee Wellness Programs: A Business Case Study Kumar, Sameer; McCalla, Michael; Lybeck, Eric: International Journal of Productivity and Performance Management. 58(6):581-597, 2009. DOI: 10.1108/17410400910977109

(2) Exercising at Work and Self-Reported Work Performance Coulson, J.C.; McKenna, J.; Field, M. International Journal of Productivity and Performance Management. 1(3):176-197, 2009. DOI: 10.1108/17538350810926534

Improve Your Walking Speed, Balance, and Functional Capability with Resistance Training.

Resistance training exercises have been shown to improve muscle strength, metabolism, and endurance.  But what effect does resistance training have on improving your overall lifestyle.  In other words, how does it help you to do your daily activities such as walking, lifting objects, work, or maintain balance?

Many people rely on other forms of exercise to stay in shape, maintain balance, and normal function.  These include aerobic or cardiovascular exercise, yoga, and pilates.  Although these are all great forms of exercise, one needs to remember that resistance training is a key exercise component that should be included with other forms of exercise to maintain total body fitness and function.

This is why our programs here emphasize a variety strength training exercises even when a member is performing an "Energy Day" or cardiovascular routine.  Resistance exercises increase core strength and stability allowing you to bend down and pick up items with decreased risk for injury and improved balance. 

Resistance training improves balance by increasing lower extremity and core muscles ability to stabilize joints against ground forces and other forces the body comes up against.  Finally, resistance training of the lower extremities improves explosive power and muscle endurance allowing for increased walking speed with less fatigue and risk for balance loss.

A study by Holviala, Jarrko H.S. et al. backs these statements.  Holviala and company looked at how a 21-week resistance-training program improved balance, functional capacity, and strength in middle age to older women.  The program was performed twice a week by a group of 48 women ages 52 and up.  Results showed significant improvements in functional balance, walking speed, and extensor strength of the lower extremities (1). 

So when you are going through a strength training day, remember the benefits of doing so will help you either maintain or improve your capacity to perform all of life's daily functional, work related, and recreational activities including walking faster and maintaining your balance. 

Reference:

1) Effects of Strength Training on Muscle Strength Characteristics,Functional Capabilities, and Balance in Middle-Aged and Older Women. HOLVIALA, JARKKO H.S.; SALLINEN, JANNE M.; KRAEMER, WILLIAM J.; ALEN, MARKKU J.; HÄKKINEN, KEIJO K.T.  The Journal of Strength & Conditioning Research. 20(2):336-344, May 2006.

How 40 Minutes of Exercise Helps Lower Blood Pressure in Hypertensive Individuals!

High Blood Pressure is one of the many cardiovascular conditions that places a significant health risk on a large portion of the population. Why do you think there are so many commercials promoting blood pressure management medications or drug commercials warning against the use of a particular drug if you are taking blood pressure medications?

On average, ~70% of people treated for a Stroke, Heart Attack, or Congestive Heart Failure have blood pressure readings that are equal to or greater than 140/90. High blood pressure can also lead to other more serious conditions including atherosclerosis (hardening of the arteries), kidney damage, vision loss, erectile dysfunction, and memory loss.

Your risk for developing high blood pressure increases even more if you have Diabetes, are overweight or obese, smoke, have high cholesterol, or are inactive. As indicated earlier, there are medications that address high blood pressure and high cholesterol, but these medications only work effectively if they are combined with other lifestyle changes. These changes include a healthier diet, losing weight, and increasing activity levels including exercise.

How does exercise help to lower blood pressure? Regular exercise has been proven to help people reduce stress, weight, and improve heart health; all of which contribute to lowering blood pressure. If fact a recent study in the Journal of Strength and Conditioning Research by Marcio Mota, et al (1), looked at a group of 15 white collar workers who averaged 43 years old and all had hypertension and provided them with a routine of 20 minutes of treadmill running and 20 minutes of resistance exercise. They compared this group to a control group of hypertensive white collar workers that did not do any exercise.

The study found that the systolic and diastolic blood pressures of the people in the exercise group remained significantly lower not only within 1 hour after the exercise routine, but up to 7 hours later (after they completed their work day). So, within only one session of exercise, these individuals benefitted for a significant part of the day from lower blood pressure.

The take home here is, if you or anyone you know is at risk for or has high blood pressure, we can assist you in lowering it by developing a customized exercise and nutrition program. Our programs will also help reduce the risk for heart disease and stroke, along with giving you more energy for your daily activities.

If you are unsure of whether or not you have high blood pressure, call the All-Access Fitness Academy @ 508-845-3974 and schedule yourself for a FREE fitness assessment. A Fitness Academy trainer will take your blood pressure during the assessment and discuss fitness options for a healthier lifestyle.

Reference: Effects of Treadmill Running and Resistance Exercises on Lowering Blood Pressure During the Daily Work of Hypertensive Subjects Mota, Márcio R; Pardono, Emerson; Lima, Laila C J; Arsa, Gisela; Bottaro, Martim; Campbell, Carmen S G; Simões, Herbert G: The Journal of Strength & Conditioning Research. 23(8):2331-2338, November 2009. doi: 10.1519/JSC.0b013e3181bac418

ACL Injury Causes and How Proper Strength and Conditioning Can Help Decrease Your Risk for This Type of Injury.

One of our primary concerns when treating any of our patients who are athletes is further injury prevention. More specifically, what we do within our treatment plans to help our athletic patients decrease their risk for other common yet traumatic injuries.  One such common injury is an anterior cruciate ligament (ACL) tear at the knee.   The ACL prevents anterior translation of the tibia in respect to the femur during walking, recreational, and sport related activities.  These types of tears occur as a result of both contact and non-contact movements where the increase in force of the movement is too much for the ligament to hold.  The movement event places increased stress on the knee joint, typically with forces in both rotational and horizontal planes in respect to the knee, which causes the ACL to tear.

Research has shown that athletic women suffer this type of injury on average of 3 times more than men competing in the same sports. It has been suggested that women are more susceptible to ACL tears due to the differences in hip and knee alignment they go through during adolescence.  As a result, they are more susceptible to the rotational and horizontal forces mentioned above during sports participation, especially during cutting movements, quick direction changes or when landing from a jump.

One recent study by Imwalle et al., published in the Journal of Strength and Conditioning Research looked at the possible link between cutting movements and non-contact ACL injuries using a subject sample of high school women soccer players. The study compared rotational forces placed on the hip and knee during 45 degree and 90 degree cutting movements.   The researchers found that hip and knee internal rotation were increased more during the 90 degree cut versus the 45 degree cut.  As a result, the subjects’ knee abduction increased during a 90 degree cut, putting the subject at greater risk for an ACL injury.   The researchers concluded that targeted neuromuscular strength training to the trunk and hips may improve the athletes’ ability to control knee and hip internal rotation during cut movements, and therefore decrease their risk for ACL injury.

Our patient strength and conditioning plans fall in line with this research.  Our programs focus on core strength with target areas that include the low back, gluteus maximus, gluteus medius, and abdominals.  Targeting these muscle groups improves the participants’ ability to control hip and knee internal rotation during cutting movements.  Furthermore, our therapists look at our patient/athletes’ form during agility and plyometric activities that put greater stress on the knees, then correct that form via verbal cues and other training techniques.  The take home point is an increase in strength and conditioning to target muscle groups helps our athletic patients avoid common non-contact injuries after they are discharged from physical therapy.

Reference: Relationship Between Hip and Knee Kinematics in Athletic Women During Cutting Maneuvers: A Possible Link to Noncontact Anterior Cruciate Ligament Injury and Prevention.  Lauren E. Imwalle, Gregory D. Meyer, Kevin R. Ford, and Timothy E. Hewett; Cincinnati Children’s Hospital Research Foundation Sports Medicine Biodynamics Center and Human Performance Laboratory, The University of Cincinnati College of Medicine, Cincinnati, OH, and Graduate Program in Athletic Training, Rocky Mountain University of Health Professions, Provo, Utah.  Journal of Strength and Conditioning Research: Volume 23, Number 8, November 2009, pgs. 2223-2230.

What Are Kettlebells? How Can They Help Me?

Kettlebells are cast iron balls about the size of bowling balls with a curved handle on one side. Ranging in weight from two to 100 pounds, they are used to promote functional, whole-body conditioning. Some models are designed so that additional weight can be added in small increments to create a progressive resistance regimen.

 

Because Pavel Tsatsouline, a Soviet strength and conditioning trainer, popularized kettlebells in the United States, they are sometimes called “Russian kettlebells.” Popular among athletes, mixed martial artists and actors, kettlebells are showing up in more and more fitness and rehabilitation centers.

 

Kettlebells owe their popularity to the fact that they provide a coordinated

full-body workout. While many fitness routines emphasize isolation and strengthening of individual muscle groups, a kettlebell workout requires all the muscles of the body to work together. For example, a kettlebell cannot be lifted without properly engaging the hips.

 

To prevent injury, correct positioning and movement of the body when performing kettlebell exercises is extremely important. Monitored by an experienced instructor, training should begin with lightweight kettlebells, until proper execution of the exercise becomes second nature. Later, more weight and more repetitions can be added.

 

Enthusiasts find that kettlebell exercises not only increase core strength but also promote flexibility, coordination, cardiovascular fitness and the development of explosive power. This whole-body approach is believed to more closely mimic the way the entire body needs to work as a unit during athletic activities.

 

Our All-Access Fitness Academy training staff will be happy to develop a program that incorporates kettlebells into your total fitness or rehabilitation program. This equipment might be just the ticket to improve your body strength and conditioning through a full-body workout.  For more information on our training programs, click here.

5 Reasons Why Dynamic Stretches are Better than Static Stretches!

While treating patients in our clinic, we often times need to help them increase their muscle flexibility in order to overcome pain from an injury.  Back when I was in school and taking part in clinical experiences, I was taught to stretch patients or teach them stretching exercises using “static” techniques.   This means I would or the patient would hold a muscle stretch for a period of time, typically 20 to 30 seconds, before relaxing.  This was repeated a few times in order to gain muscle length and flexibility.  

 

Dynamic stretching exercises are different than static stretches because they involved continuous movement throughout the exercise in order to gain muscle flexibility (hence, the use of the word dynamic to describe them).  Occasionally, we still use static stretching techniques in our clinic, but we have found “dynamic” stretching exercises to be more effective for patients for reasons listed below:

 

1)   Dynamic stretching exercises are more effective in “warming” up a muscle and promoting blood flow to the region.  This allows the muscle to feel more “loose” as compared to when stretching the same muscle statically.  This in turn prevents injury to “cold” muscles that have not been stretched prior to treatment or exercise, as can happen when people try to stretch using a static stretch technique.  

 

For example:  Try stretching your hamstrings statically by standing on one leg and placing the stretch leg on a chair seat while leaning forward.  The muscle feels tight, even after you have stretched for 20 – 30 seconds.  Now try the Front to Back Leg Swings exercise shown in this video link for 20 to 30 repetitions.  What felt better as a stretch?  Which stretch was more effective for increasing flexibility?  Which was easier to do?  My bet is you chose the dynamic stretch.

 

2)   Dynamic stretching allows for increased flexibility for more than one muscle group.  Take the hamstring sample again.  With a static stretch, you only feel the hamstring stretching.  With the dynamic Front to Back Leg Swings stretch, you involve movement of more than just the hamstring muscle.  You also involve the gluteal muscles, low back muscles, along with the hip flexors and quads when you move your leg backwards during the exercise.   Because our movement patterns for any activity we do typically involve more than one muscle group, the dynamic stretch is more functional and effective in respect to our movement patterns.

 

3)   Dynamic stretches are generally more comfortable to do than static stretches because the muscle is not held in a stretch position for a long period of time.  Think about when you try stretching a muscle to far – it can hurt.  That is why even a regular static stretch is not the most comfortable thing for people, and typically why we tend to avoid doing them.  With a dynamic stretch, the muscle is lengthened only for a very short period of time, and then released.  This allows the muscle to more effectively release, helping you to gain more movement range with each repetition.

 

4)   Dynamic stretching exercises are also effective in promoting strength and stability, two additional key components to proper muscle function.    Take the leg whip stretch again.  While stretching the motion leg, the muscles in the opposite leg are required to be active in order to maintain balance.  Another example is the Windmills stretch shown here – in this exercise, the hamstring and low back muscles are not only being stretched, they are being strengthened eccentrically, meaning the muscle is gaining a greater ability to lengthen while decelerating movement against gravity.  For someone who carries a lot of upper body weight, this type of strength is extremely important in preventing injury.  It is also another example why dynamic stretches are more functional than static stretches. 

 

5)   Overall as shown above, dynamic stretching exercises give you more bang for your buck in usually less time.  We have designed dynamic warm-up routines that improve total body flexibility in 10 minutes versus doing 4 or 5 static stretches for only 4 – 5 muscles over the same period of time.  Because dynamic exercises also promote blood flow, energy use, and muscle strengthening, you also feel like you have done a bit of a workout after performing them. 

 

I have included additional links to YouTube videos demonstrating some dynamic exercises we teach at our All-Access Fitness Academy and in our clinic below.  If you are interested in learning a dynamic stretching routine, let us know and we’ll discuss designing a program that is right for you.   Exercise Samples:  Toy Soldiers;  Running Butt Kicks;  High Knee Walks.

Preparing Your Body for the Rigors of Golf

Yes!! It is that time of the year again where the weather is nice of enough for all of us to play golf consistently.  But, after reading the headline above you may be asking yourself, "Rigors of Golf?" 

To most of us, golf is a leisurely sport that does not require a great deal of physical conditioning.....or does it?  If it does not, why are all good professional golfers involved in some sort of exercise and conditioning program?  And why are there more and more golf specific conditioning classes or programs being offered?  The reason is golf is a physically challenging sport, and in order to play it properly, you should prepare your body for it.  Let's examine a few ways to do so here by discussing flexibility, balance, core strength, extremity strength, and endurance.

Flexibility:  You need flexibility in your trunk, arms and legs in order to develop a consistently smooth swing that will also be more powerful and accurate.  When muscles are tight around your hips, back or shoulders, your swing plane will be thrown off, causing you to make compensation movements in your swing that may lead to a visit to the pro shop to purchase balls for the ones you lost. 

Balance:  Maintaining balance during your golf shots is important as well.  It is easy to stay balanced on the driving range where you are generally hitting from a flat surface.  But out on the course, more often than not, your ball will land on an uneven surface causing you to adjust your stance and reposition your club to hit it.  Having good balance during these types of shots will prevent that extreme hook or slice from occurring.

Core strength:  Without a stable core (upper and lower trunk), not only is your swing at risk, your back is as well.  Strengthening core musculature properly prevents back injuries that can occur during the swing.  Being able to properly activate your core musculature during the golf swing will also lend to better balance and accuracy, as well as more power.  Poor core control lends to erratic shots because the muscles cannot control your body's momentum or mechanics during your swing.

Upper and lower extremity strength:  Your legs serve to provide a stable base for your entire swing as well as to give you power during your shot.  When these muscles are not conditioned properly, the "base" becomes unstable and you lose both power and accuracy.  Arm strength is important at the wrists, elbows and shoulders.  Wrist strength allows for proper follow-through at impact.  Elbow extension strength is important for the lead elbow in order to drive through the ball with power and consistency.  Shoulder strength important for being able to generate rotational power throughout the swing plane as well as being able to lift the club in the first place. 

Endurance:  A round of golf is generally 4-5 hours long if you are playing 18 holes.  Between the number of swings you take, the terrain of the course, and the amount of walking you do, you need to have good overall endurance to play the game effectively the whole round.  Participation in a conditioning program will allow you to have the endurance you need to play the game at your best the whole round. 

If you would like a customized golf conditioning program, give us a call and we can assist you in that endeavor.

Ways to Get Back into the “Swing” of Things Without Ending Up as A PT Patient This Spring!!

With the arrival of spring there are many outdoor activities that we prepare to participate in throughout the spring and summer.  These include but are not limited to baseball, softball, golf, tennis, gardening, horseshoes, bocce, bags (or whatever backyard lawn sport you enjoy), and fishing.  All of these activities require use of our shoulders and elbows.  So, around this time of year, we start to notice an increased incidence of shoulder and elbow tendonitis injuries (along with a variety of other injuries stemming from these activities which I will discuss at another time.)  Tendonitis is an irritation of the muscle tendon where it attaches to a particular bone.  The irritation, swelling, and pain are due to added stress to the tendon due to a particular activity or several activities.  

Tendonitis injuries to the shoulder and elbow stemming from the activities mentioned above can be avoided by performing some simple stretching and strengthening exercises using thera-band (which you can always purchase from us if you can’t find it in the stores) or hand weights.  I have included pictures below of 4 stretching and 2 strengthening exercises for the shoulder and elbow that will help you avoid tendonitis onset as you get involved with your spring and summer activities.  These 6 exercises should take you no longer than 15-20 minutes at a time to do.  For the two theraband exercises, you should try 2 sets of 10 reps each.  For the 4 stretch exercises, you should hold each stretch gently (no pain) for 20-30 seconds each and repeat 2 -3 times. 

   

 

 

 

 

 

 

 

Of course, if you do develop a tendonitis injury of the shoulder or elbow, please give us a call.  You will want to address this type of injury sooner than later when it occurs, even if you only view it as a nuisance when you first develop it.  As tendonitis injuries get worse, they become more debilitating.  Furthermore, if you let the injury go to long, it becomes that much harder to rehabilitate and can occasionally lead to a tendon tear that requires surgery to repair.   So if you or someone you know has developed tendonitis in their elbow or shoulder, please call or have them call for an appointment with us sooner than later.

Finally, if you would like more information on exercises that will help you prevent tendonitis injury onset, call our new All-Access Fitness Academy (508-845-6738) and schedule an assessment session with one of our Strength and Conditioning Specialists.  You do not have to be a member to schedule an assessment, and you will walk away with an increased understanding of the types of exercises you should be doing to avoid tendonitis injuries.  This will allow you to stay active this spring and summer without worry.  

Benefits You Receive When You Participate in an Exercise Program

Regular exercise is an important part of effective weight loss. It helps to control your weight by using excess calories that otherwise would be stored as fat. Daily exercise also helps prevent many diseases and improve your overall health.

Did you know, your weight is determined by the number of calories you eat each day minus what your body uses?  Everything you eat contains calories, and everything you do uses calories, including sleeping, breathing, and digesting food. Any physical activity in addition to what you normally do will burn those extra calories.

Balancing the number of calories you expend through exercise and physical activity with the calories you eat will help you achieve your desired weight. The key to successful weight loss and improved overall health is making physical activity a part of your daily routine.

Research consistently shows that regular exercise, combined with healthy eating, is the most efficient and healthful way to control your weight.  Additionally, regular exercise can help prevent the following:

* Heart disease and stroke. Daily physical activity can help prevent heart disease and stroke by strengthening your heart muscle, raising your HDL ("good" cholesterol), and lowering LDL cholesterol ("bad" cholesterol), improving blood flow, and increasing your heart's working capacity.

* High blood pressure. Regular exercise reduces blood pressure in people with high blood pressure (hypertension).

* Diabetes. By reducing body fat, physical activity can help to prevent and control type 2 diabetes.

* Back pain. By increasing muscle strength and endurance and improving flexibility and posture, regular exercise will prevent back pain.

* Osteoporosis. Regular weight-bearing exercise promotes bone formation and may prevent many forms of bone loss associated with aging.

Regular physical activity can also help manage stress, decreased your risk for depression by improving how you feel about yourself, and improve your overall mood.

What Types of Exercise Should I Do?

There are a variety of different types of exercises or activities you can do to achieve the benefits mentioned above.  The key is to do a variety of them and do them consistently.   That means spending at least 30 minutes a day doing some sort of physical activity.  It also means not doing the same exercise over and over.  I have seen where people will only do cardiovascular exercise on a treadmill or elliptical trainer and get frustrated because they aren't seeing the results they were looking for from their exercise program. 

You need to mix it up so that your body doesn't accommodate to one form of exercise.  Mixing in weight training activities, aerobic exercise classes, speed and agility exercises, and sports participation will keep your body from getting used to one routine.  This strategy will improve your metabolism and be more effective for achieving the benefits mentioned above. 

Unfortunately, many people come up with reasons not to exercise. These include not having the time to do it, being intimidated working out in a fitness facility, not knowing what to do once they are there, and not being able to maintain their motivation to exercise.   

If you find that any of these reasons apply to you, send me an e-mail @ smessineo@allaccesspt.com, and I will offer you some suggestions to overcome your reasons for not exercising and help you get into a fitness program.