Have you ever gone into a gym, looked at all the equipment, and not known what to do or where to start?  Have you ever felt uncomfortable performing exercises on your own without any supervision?  Do you need to make an appointment with yourself to make sure you work out?  Has having to exercise on your own prevented you from reaching your fitness goals?  Have you become bored with exercising in the same way because it is all you know to do?  If you have answered yes to any of these questions, I have one more for you…Have you ever tried a Group Exercise Class?

There are many benefits to becoming involved in a group exercise class.  Beyond the fun of working out with a group of people, a group exercise class provides support, accountability, and structure.  It is possible to get a more intense or harder workout because instructors are trained in how to push and motivate you.  Group exercise classes can also boost you over a plateau by offering your new ideas and working your body in a different way.  Group exercise classes reduce social isolation and allow you to develop lasting relationships with people who have similar goals. 

All Access Fitness Academy and Studio Joy at All Access offer a wide variety of group classes for you to try.  To learn how to get started contact the Fitness Academy at (508) 845-3974 or visit www.allaccessfa.com

Resistance bands are a fast, fun, and simple way to get a killer workout wherever you are.  You don't have to be in a gym, but can use them at home, work, or even the beach.  All  you need to get a kick ass resistance band workout are a few bands and a strong work ethic.  Using a little creativity, just about any movement can be executed using bands as resistance.  While free weights are a great way to increase strength and muscle mass, bands have just about as many benefits.  

Bands are convenient and safe.  You do not need a spotter.  Bands have the added component of increased tension throughout the entire range of motion.  As the band stretches, more resistance is generated.  This creates more tension during the stronger phase of the movement forcing more overall work to be performed.  Resistance bands utilize both the concentric (shortening) and eccentric (lengthening) part of the movement, allowing for increased muscle stimulation.

For the most effective workout, pick a place where you can attach one side of your band to a solid base like a tree, post, door, or hook in the wall.  This will increase the number of exercises to be performed.  For any standing movement place the band under your feet to create a base for the resistance.  From here you can perform squats, lunges, bicep curls, shoulder presses, lateral raises, or anything you can think of.  Lie on your back with the band under your back for bench press or tricep extensions.  Attach the band to a base and you can perform a face pull, trunk rotation, standing or seated row, hip extension and many other variations.  

For a fast effective workout, include a variety of bands with different resistance levels.  Perform 2-3 sets of 6-10 exercises with minimal rest between sets.  Make sure there is plenty of resistance during the movement and push yourself to the appropriate number of repetitions for a hard workout.

for more information about resistance band workouts or to get help in designing a resistance band program tailored for your needs, contact your All Access Fitness Academy trainer.

During the aging process we lost about 1% of our bone and muscle mass each year.  Strength training not only helps to preserve your bone health but helps you to maintain muscle mass which can reduce your risk of bone fractures as you age.  Strength training also assists in disease prevention and management.  For those with Type II Diabetes, strength training combined with healthy lifestyle changes can improve glucose control.  Strength training may be effective as use of medication in decreasing arthritis pain.

Incorporating strength training into your exercise regimen can also enhance your mood and your energy levels, improve your sleep quality, and may work as a natural anti-depressant. Endorphin (a natural opiate produced by your brain) levels are increased after resistance training leaving you feeling rejuvenated. 

There are many ways in which to incorporate strength training into your exercise routine - exercise machines, resistance bands, free weights, and body weight activities.  The All Access Fitness Academy staff can help you develop a customized strength training program to meet your individual needs and concerns. 

The Facet joints are located at the back on either side of the spinal column, between the discs and the vertebral bodies. Each vertebra has bony prominences on each side that form a facet joint with the vertebra above and below. The role of the facet joints is to limit excessive movement and provide stability for the spine.

Facet joints are a potential source of pain which can affect the neck, middle back or lower back. Poor posture is commonly implicated in the development facet joint pain. Prolonged sitting and bending postures places an increased load on the facet joints which then become inflamed and painful. The muscles surrounding the spine also become affected. When considering how poor posture can affect the neck and thoracic spine (middle back) we can see that the thoracic spine becomes round, the shoulders hunch and the head pokes forwards; this leads to tightness of the muscles at the front of the chest and overload of the muscles around the shoulder blades and neck. The paraspinal muscles (long muscles which run the length of either side of the spine) in particular become knotted and tender ⁽¹⁾. 

How can foam rollers help with cervical and facet joint injuries?

A foam roller is a firm solid cylinder which is about 6 inches in diameter and 3 feet long. A roller can be used to isolate specific injured areas of the body and treat restrictions in the soft tissue⁽²⁾as well as perform balance training exercises, core activation exercises and stretching.

Stretching exercises on the foam roller for neck and thoracic facet joint pain.

This exercise is great for extending the middle back and neck and opening out across the front of the chest.

Lie on your back with the roller placed vertically along the length of the spine, feet on the floor and knees bent. Try to keep the spine in contact with the roller and open the arms out to the side. Feel the stretch across the front of the chest, lengthen the neck by tucking the chin inwards.

Muscle release techniques for the middle back using the foam roller

This exercise is to release tension in the muscles either side of the spine, it may feel a little uncomfortable initially but this does ease the more you do it.

Lie on your back with the roller placed horizontally between you and the floor. Your feet should be on the floor with your knees bent. Use the legs to push the body up and down the roller (like a rolling pin) to release tension within the muscles either side of the spine.

By improving your posture, the alignment of your spine is more efficient and the loads placed on the facet joins are reduced.

One of the major benefits of using a foam roller is that it is a relatively inexpensive way to treat injury on your own. It can be used to maintain joint alignment and muscle flexibility in between treatment sessions or for prevention of recurrence of symptoms.

For more information about the use of foam rollers to treat back and neck pain or to purchase a foam roller contact us at (508) 845-3500. 

References

1. Referred pain distribution of the cervical zygapophyseal joints and cervical dorsal rami. Fukui S, Ohseto K, Shiotani M, et al.  1996, Pain, Vol. 68 (1), pp. 79-83.

2. A comparison of the pressure exerted on soft tissue by 2 myofascial rollers. Curran, PF, Fiore, RD and Crisco, JJ. 2008, Journal of sports rehabilitation, Vol. 17, pp. 432-442. 

Patello-femoral syndrome is a relatively common condition which causes pain at the front of the knee. The pain is associated with positions of the knee which result in increased or misdirected mechanical forces between the kneecap (patella) and the thigh bone (femur) (1).

Despite being a common and relatively easy to diagnose injury there is much to learn about the exact pathology involved in the presentation of this condition. There are a number of probable causes which include:

• Muscle Tightness (calf, hamstrings, ITB)
• Weakness or lack of coordination in muscles that should help maintain normal patella tracking
• Altered hip, knee or foot posture
• Anatomic variations

Stability and normal function of the knee joint depends on precise interaction between the muscles, ligaments and fascia which surround and support the joint. Any tightness or weakness can cause an alteration in the normal mechanics which leads to pain. Exercise programs used to treat Patello-femoral pain syndrome should be based on sound biomechanical foundations and sensible exercise progression (2).

The quadriceps muscle group is directly involved in the mechanics of the patella-femoral joint as the patella is enclosed within the quadriceps tendon. Strengthening of the quadriceps is considered to be beneficial. However, the pain of patella-femoral pain syndrome is typically associated with movements which result in strong forces going through the joint so traditional knee extension exercises are not appropriate. Knee extension exercises will stress the already aggravated patella-femoral joint. Therefore, “closed chain exercises” (those where the foot is in contact with a solid surface) are preferred and should initially be performed within a pain free range of motion. Once larger ranges of motion are tolerated without pain, open chain exercises may be introduced. Research data tells us that between 0-50 degrees of knee flexion closed chain exercises produce less stress on the patella-femoral joint, beyond this range open chain exercises produce less stress (2).

Muscle coordination as well as overall muscle strength is important. The vastus medialis oblique (VMO) muscle forms part of the quadriceps muscle group and is the innermost muscle of the group. It is believed to help maintain the knee cap in its correct position (3). Specific focus should be placed on encouraging activity of this muscle when strengthening the overall quadriceps group. When prescribing strengthening exercise, those muscle groups not directly involved in patella-femoral joint mechanics should be considered as well, especially the “core” muscle group.

Concurrently to performing strengthening exercises, those structures which are tight must also be addressed. The calf muscles, hip flexors, hip rotators, and Iliotibial band are all commonly tight where patello-femoral pain is seen. Foam rolling, static stretches, and mobility drills are used to lengthen these tight structures. Full recovery and return to normal function can be achieved if exercises for managing patella-femoral pain syndrome are appropriately chosen and progressed.

 For more information about patello-femoral pain syndrome and how Physical Therapy can help you in your recovery from knee pain please contact Steve Messineo at (508) 845-3500 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

References

1. Associates of physical function and pain in patients with patellofemoral pain syndromme. Piva, SR, Fitzgerald, GK and Irrgang, JJ. 2, 2009, Arch Phys Med Rehabil, Vol. 90, pp. 285-295.

2. Rehabilitation of patellofemoral joint disorders: A critical review. Powers, CM. 5, 1998, JOurnal of orthopaedic and sports physical therapy, Vol. 28, pp. 345-354.

3. Patellofemoral Disorders: A classification system and clinical guidelines for nonoperative rehabilitation. Wilk, KE, et al. 5, 1998, Journal of orthopaedic and sports physical therapy, Vol. 28.

Regular exercise is an important part of effective weight loss, weight management, as well as disease prevention and improving your overall health.  Research consistently shows that regular exercise, combined with healthy eating is the most efficient and healthful way to control your weight.  In addition, regular exercise can help prevent heart disease and stroke, high blood pressure, diabetes, back pain, and osteoporosis.

Your weight is controlled by the number of calories you consume each day minus the number of calories you use each day.  Everything you do, from sleeping, breathing, and digesting your food, uses calories.  Physical activity, in addition to your usual daily activity, will help you to burn extra calories.  Balancing the number of calories you expend through exercise and physical activity with the number of calories you consume will help you achieve and maintain your desired weight.  The key to effective weight loss, weight management, and improved overall heath is to make physical activity a part of your daily routine.

There are a variety of different types of exercises or activities you can do to achieve the benefits mentioned above.  The key is to participate in a variety of activities and to do them consistently.  Ideally, you should be participating in some sort of physical activity for 30 minutes each day.  Mixing up your activities is important so that your body doesn’t accommodate to one form of exercise.  A program that consists of aerobic exercise, weight training, speed and agility activities, as well as sports participation will prevent your body from getting used to one routine, improve your metabolism, and be most effective for weight management and improving your overall health.

We know that it is easy to find reasons not to exercise:  Limited time, being intimidated by a gym or fitness facility, not knowing how to get started, lost motivation, etc.  Do not let these reasons get in the way of your health.  All Access can help you!  Email This e-mail address is being protected from spambots. You need JavaScript enabled to view it for help and suggestions.

The urge to “fatten up” and “hibernate” in winter is strong, even for us humans. However, you are better off staying in shape than struggling to catch up come spring. Winter exercise benefits more than just your physical fitness: it is also a powerful antidote for the winter blues.

Options for winter workouts vary by your interests and your location. People who live in warmer, sunnier climates have the outdoor advantage over those of us in the Northeast who have to live with the cold temperatures and snow. But being outdoors in the winter can be exhilarating. Look at Rocky Balboa…all he needed was 2-3 feet of snow covered wasteland, a pile of wood to cut and throw around, a cold barn to workout in, a “Paulie” weighted sled, a few trees to chop down, and a snow covered mountain to climb (watch this if you need a visual: http://www.youtube.com/watch?v=W8xHjC27YvM&NR=1). If it worked for him, it can work for you. And look at how much fun he had!!!

There are many causes of low back pain; it can be the result of a range of conditions that affect the muscles, joints, ligaments, discs or nerves. Regardless of cause, back pain has a negative effect on the muscles which support and stabilize the lumbar spine (these muscles are collectively known as ‘the core’). This phenomenon is known as pain inhibition.

Counteracting the negative effects of pain inhibition by strengthening the core is essential to overcome chronic low back pain and return to normal function. Core exercise progression, balance activities and dynamic movement exercises all contribute to this cause.

The ‘core’ is a group of muscles which include the Transversus Abdominis, Multifidus, Internal Oblique, Paraspinal, and pelvic floor. Initially it is a big enough challenge to learn how to activate the ‘core’ muscles when lying down still! But for maximum effect therapeutic exercises must go beyond this and the muscles have to be taught how to control the position of the lower back during dynamic, everyday, movements.

It is not just the ability of these muscles to contract that is important, but also the way in which they contract; the order in which they ‘fire’. Transversus Abdominis and Multifidus in particular are what are known as pre anticipatory muscles; this means that their job is to switch on just prior to dynamic movement in order to stabilize the spine in preparation for movement.

Core Exercise Progression

Like any training program, core training needs to be within the capabilities of the individual becoming more challenging in line with improvements. Initially volitional activation of the core muscles should be practised; this is normally done in lying encouraging the Transversus and Multifidus to return to its role of stabilization prior to movement .

Once the muscles are ‘awakened’ this should be transferred to more functional positions. Functional progression is vital, there is no blue print of exercises; a ‘one size fits all’ prescription is useless. Exercises need to be individualized to meet the needs of the individual. All programmes should incorporate exercises in sitting, standing and walking ⁽¹⁾.

Balance Activities

Training using an unstable surface has been shown to increase core muscle activation ⁽²⁾. Examples of such unstable surfaces that are commonly used in recreation and rehabilitation are: physio balls, BOSU’s, foam rollers and wobble boards.

Dynamic Movement Exercise

Everyday activities involve movements which are side to side, front to back and up and down. To complete a rehabilitation programme, the core needs to be challenged in all these planes and at different speeds. Faster movements change the centre of gravity relative to base of support. This means that the muscles are required to make quicker adjustments in order to maintain stability and control of the spine.

By mastering the ability to control the lumbar spine through the application of a progressive and individually tailored exercise programme, full resolution of back pain can be achieved. The negative effects of pain inhibition can be countered and future episodes of back pain can be minimised or even eliminated.

References

1. Core Strengthening. Akuthota, V and Nadler, SF. 2004, Archives of physical medicine and rehabilitation, Vol. 85, pp. S86-92.

2. What I always wanted to know about instability training. Fowles, JR. 2010, Applied physiology nutrition and metabolism, Vol. 35, pp. 89-90.

Our muscles produce movement through the generation of force as they contract. Muscles take on many different shapes sizes and capabilities, but one thing that they all have in common is the way that they react when injured.

Damaged muscles release chemicals that cause pain which alerts the body to the stress placed upon it. Scar tissue forms around the injured area in an attempt to heal the damage.

Despite the body's remarkable ability to detect injury and heal itself, the system is not without inherent faults. The chemicals which are released during injury can accumulate and cause lasting pain. The newly forming scar tissue is less organized and less elastic than the original(1).

It is possible to facilitate a more efficient healing process through the use of soft tissue mobilization. In doing so you can return from injury more quickly and as strong as before with less risk of re-injury.

The use of foam rollers is an excellent way to help treat injured muscles; it is extremely effective and becoming more and more widely used by our patients.

A foam roller is a firm foam log about 15cm in diameter and 1.5 meters long (the black tubes you may have seen in our clinic).  It can be used for a variety of exercises which help stretch the body and activate the core, but it is arguably most useful for the massage like effects it can produce on muscles.

The foam roller can be used to produce a massage like affect; you lie on the roller with the affected muscle(s) on top. Slowly rolling over the target area using body weight to produce force mobilizes the soft tissue in much the same way that a massage would. In the picture to the right, the foam roller is being used to massage the person's hamstring muscle.

Effects of foam rolling on injured muscle

The major benefits of foam rolling on injured muscle tissue are twofold:

• Increase in local blood flow

Chemicals, toxins and debris that surround the injured area can be cleared and flushed away via increased blood flow to the area. This debris is often a painful stimulus when collected in one place so by clearing it, we can reduce pain and discomfort.

• Breakdown of scar tissue

We need scar tissue to form in order to repair the injured area; however this scar tissue has a tendency to become excessive, tight and immobile. Rolling to break down fibrous scar tissue increases the flexibility and pliability of the muscle.

Precautions of Foam Rolling

Mobilizing an injured muscle too soon could be detrimental; rolling too soon might risk re-injury or excessive scar production (2). Injured muscle needs a little time to form scar tissue and actually begin to ‘knit' the injured areas back together. 48-72 hours is usually enough time for the scar tissue to form without it starting to become too tight.  

When used correctly foam rolling will help to maximise recovery from a muscle injury, it can be used instead of, or in addition to physical/manual therapy. The use of a foam roller to aid recovery from muscle injury should be based on an accurate diagnosis; you should always seek professional advice if you are unsure.

References

1. Kolt, G S and Snyder-Mackler. Physical therapies in sport and exercise. 2nd Edition. London : Churchill Livingstone, 2007.

2. The effect of early mobilization and immobilization on the healing process following muscl injuries. Jarvinen, M and Lehto, M U K. 1993, Sports Medicine, Vol. 15, pp. 78-89.

The successful treatment of any injury depends not only on resolving the presenting problem but also addressing the factors which contributed to the cause of the problem. In order to do this the clinician must look towards the kinetic chain to understand where the problem might have come from.

What is the kinetic chain?

The kinetic chain referrers to a biomechanical model of movement; segments or joint of the body work as a whole to achieve motion. This chain of movement transfers forces from proximal (near to the body) to distal (away from the body). For example when kicking a football the kinetic chain of movement passes from the trunk through the hip, to the knee, onto the ankle and then is transmitted through the ball as it is struck by the foot. They say that a chain is only as strong as the weakest link, this is certainly true here. Any disruption to the kinetic chain, i.e. if one body part is not functioning normally, will mean that it places stress/strain on the other segments which will ultimately result in injury.

Consider the example of a tennis serve; an activity which uses the upper limb. The kinetic chain of the upper limb is as follows:

How can the trunk and shoulder cause problems at the elbow?

If the shoulder is not able to fully rotate inwards, then the wrist will have to compensate in order to get the racquet face to the ball at the correct moment (1), this places undue stress on the tendon which is likely to develop into injury if this pattern is repeated.  

The pain around the outside of the elbow joint that is associated with lateral epicondylitis (tennis elbow) develops when there is an abnormal level of stress on the tendon of the wrist extensors which attach the forearm muscles to the lateral epicondyle of the elbow. Issues surrounding the trunk and shoulder can be the cause of this undue stress to the tendon.

Rotator Cuff and Mid Thoracic Strengthening in the Treatment of Tennis Elbow

The rotator cuff consists of the tendons of 4 different muscles: Infraspinatus, Teres minor, Supraspinatus and Subscapularis. These muscles are responsible for providing stability at the shoulder by drawing the head of the humerus (arm bone) towards the glenoid fossa (socket of the shoulder joint). They also produce rotational movements around the shoulder. When strengthening around the shoulder the articulation between the scapula, ribs and thoracic spine (middle back) cannot be forgotten. The muscles around the middle back and shoulder blade work to extend the thoracic spine, and tuck the shoulder blade in towards the rib cage. This serves to place the glenoid fossa into its optimum position for movement of the shoulder.

By stabilizing and generating force within the first two links; it is possible to improve the efficiency of the kinetic chain, thus, helping to not only remove the stressful stimulus that may have caused the elbow injury, but also to prevent further problems in the future.

References

1. Occult periarthrosis of the shoulder - A possible progenitor of tennis elbow. LaBan, MM, Iyer, R and Tamler, MS. 11, 2005, American journal of physical medicine and rehabilitation, pp. 895-898.

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