The Truth About Health - The Secret to Happiness

"As to methods there may be a million and then some, but principles are few. The man who grasps principles can successfully select his own methods. The man who tries methods, ignoring principles, is sure to have trouble." - Ralph Waldo Emerson 



We must develop a diet for ourselves.  It is dangerous to be indifferent to what we eat.  What we eat and put inside of our bodies dictates how well we feel and how good we are able to perform at life.  It helps us achieve any other goals that we would like to achieve.  Any one that is aiming for high goals can benefit from being on a good diet to provide them with energy, strength, stamina, focus, immunity, mental acuity and psychological well being.  These aspects are directly related to our ability to function optimally as a human being.


We must have enforce some principles that guide our lives.  We should all be starting somewhere on the path.  However, each of us is in a different position.  We should all be making our eating decisions more based off of health and less based from instant gratification or our culture.  Our food fuels our biochemistry and allows us to be in a state of good health or pathology.  So we must begin to learn and implement appropriate eating behaviors in our lives. It doesn’t matter what grade you are in or how old you are. You should be going to school and learning these health behaviors. 

People change their diets as they mature into adulthood.  The diets we are fed as babies, infants, toddlers and children are not the same as those in which adults eat.  This is for a very good reason.  
We are very concerned with what we feed our children and babies because they are developing at such a rapid rate, have unknown allergies and are very sensitive to foods that are only to be eaten by adults.  As we grow into adolescence and adulthood it seems that emphasis is taken away from our nutrition and many other measures to prevent us from becoming ill.  The difference is illnesses that strike a baby leave immediate, permanent damage and possibly lead to death.  Most adults do not die, they just get the diarrhea.  They get food poisoning, puke and then get diarrhea.  They get fatigue, decreased alertness and depression.  However, adults also get illnesses that can be permanent or fatal.  Unfortunately it takes many years for their poor behaviors to compile to experience the pathology.  It takes many years for the symptoms to burrow out from underneath the surface and smack the person in the face.  

We decide to change only once we experience the negative consequences.  Unfortunately we may not be able to repent.  Our god may still take us to a beautiful resting place following death but after ten, twenty and thirty or more years of poor nutrition and lifestyle behaviors some damage is permanent.  As a physical therapist I can tell you no one wants to have any more experiences with poor health than they have to.  No one is inviting themselves to be dysfunctional, in pain, limited, or disabled.  No matter what age.

The beauty is that it is not the way it has to be.  Some people believe the damage is permanent.  As one of my best friend's dads told me, "I have been way too bad for way too long."  The truth is that any pursuit towards improving our health will work.  Research indicates we get immediate changes when we improve our health behaviors, such as quitting smoking, cleaning up our diets and engaging in routine physical activity and exercise.  


All that it takes is to make the decision to put your health as priority.    The benefits are waiting for you to enjoy them.  Sometimes its hard to tell someone what a rose smells like that has never smelled one before.   I know for certain that no one is as happy as they could be when they are in poor health.  Don't wait.  Start today.  Discover that pursuing good health is the true secret to happiness.

Good Luck.  Join the Revolution!

Lyneil Mitchell, DPT

A sound mind in a sound body is a short, but full description of a happy state in this world. - John Locke

Question Everything: How our brains work

The human brain is very complex and to this day neurologists could tell you we only know a fraction of how it works.  Neurologists can also tell you that humans have a significant amount of uncertainty between what we perceive as reality and what reality actually is.  As a slave to this uncertainty, humans must make choices.  Humans can never be absolutely certain about the outcomes of these choices or anything else for that matter.  We only have the ability to attempt to forecast the future and make best guesses.  Humans are not even able to be 100% certain about their own existence.  When we take a look at science, it offers us the evidence that humans cannot be very certain about anything.  The visual cortex of our brains demonstrates exactly the same activity when we are sleeping, imagining and when we are awake.  This means the brain responds to images in our dreams or imaginations exactly the same as the images we see in real life.  


As the famous poem by Chuang Tzu reads;

Once Zhuangzi dreamt he was a butterfly, a butterfly flitting and fluttering around, happy with himself and doing as he pleased. He didn't know he was Zhuangzi. Suddenly he woke up and there he was, solid and unmistakable Zhuangzi. But he didn't know if he was Zhuangzi who had dreamt he was a butterfly, or a butterfly dreaming he was Zhuangzi. Between Zhuangzi and a butterfly there must be some distinction! This is called the Transformation of Things.

Q&A: Leg Strength Science - Enhance Performance and Avoid Injuries

Hey Lyneil,

I have a PT related question for you. When I was going through physical therapy after my knee surgeries, the PT's told me that leg extensions are bad for my knee and I should stay away from them.

I'm getting back into lifting on a regular basis, and I read in muscle & fitness that the only problem with leg extensions is that they don't work the tear drop shaped muscle on the inside of the quad above the knee, which helps stabilize your knee. It said that they're fine to do as long as you're doing exercises that will work that muscle, such as squats in a smith rack. Do you agree with that? And if so, are there any other exercises that you suggest I do for that muscle?

-Bosko

Response-

First, excessive stress to the patellofemoral (knee cap and thigh bone) joint is the primary reason that knee extensions are not recommended by physical therapists or in many rehab protocols for the lower extremity.  The anatomy of the knee is much different than many of the other joint of the body because it has the patella lying over top of it.  The patella is connected to the tibia and the quadriceps muscle by the patellar tendon.  When a force is placed at the end of a lever versus closer to the axis of motion(the joint) the force is considerably increased.  It is like holding a weight in your hand far from your body with your elbow straightened.  It will make your shoulder and arm muscles considerably more fatigued than if you hold it close to your body.   It's physics. The lever is long, the force at the knee is exponential relative to the load applied at the end of the lever.

The patella tendon exerts force on the tibia and is enhanced by the increased distance away from the knee joint secondary to the patella.  This creates a mechanical advantage for the patella tendon allowing less muscle force to tolerate force creation and absorption.  However, when the load is placed further from the body this can cause excessive compression and shear forces at the patella.  This can eventually lead to break down of the soft tissue and stress reactions to the bony structures of the knee especially the patella tendon.

Following a knee surgery the quadriceps muscle is not functioning appropriately as many people have experienced.  This also occurs when the knee joint experiences trauma.  This phenomenon is called reflex inhibition.  The phenomenon occurs because of swelling in the knee joint.  There is a reflex between the joint capsule and ligaments of the knee and the central nervous system that occurs to allow continuous tension to the quadriceps muscle. The swelling that occurs following knee surgery or injury places pressure to the ligaments and joint capsule.  When pressure is place upon the tissue it distends and the small receptors inside the tissue are activated.  Nervous system receptors can only tolerate so much activity before they shut down.  This is called inhibition.  When they shut down so does the reflex loop.  Therefore the quadriceps muscle does not fire appropriately. 

Most times this does not completely shut down all of the muscle fibers.  Some of them are still working which allow the knee to function in a limited capacity.  Many believe this is a survival mechanism that causes the person to have to immediately limit the forces they are able to exert on the injured lower extremity.   The force that is placed upon the knee during knee extension with the weight placed at the end of the shin (a long lever arm) eventually causes stress injury to the soft tissues of the knee that are healthy. This will also cause further detriment to the surgically repaired or damaged tissues that are healing.  Therefore this exercise is not recommended for someone during a rehabilitation of the knee.

From a performance and strengthening standpoint, knee extensions are also inefficient for several reasons.   Less weight is able to be used during knee extensions than squatting or lunging motions which we term closed kinetic chain, CKC (feet are on the floor and multiple joint are moving at once).  During CKC movements greater forces are placed upon the muscle and therefore the muscle will adapt to these forces for increased strength gains.  You may ask if this increase in force can be detrimental?  It can be if poor technique is utilized but that is a topic for another day.  The mechanics are different because the direction of the force is directed close to our center of gravity and not distally as in the knee extension.  This places significantly less compressive and shear forces to the patellofemoral and knee joint.  Therefore we get better improvements in strength and less chance for wear and tear.

The vastus medialis, aka tear drop muscle, is one of the four muscles that comprise the quadriceps muscles that blend into the single patella tendon.  Therefore we have four muscles that exert force on one tendon.  The rectus femoris is a two joint muscle because it attaches at the front of the pelvis just superior to the hip joint and assists with hip flexion.  The other three muscles attach to the femur are one joint muscles.  There have been many studies that show a deficiency of muscle firing in the vastus medialis in people with patellofemoral and knee joint pathology.  There have also been many studies that attempt to preferentially cause the vastus medialis to fire through different types of exercise.  Two of the primary myths that exist are squeezing or pinching the knees together or externally rotating the knee to the outside during squatting exercises.  Neither of these has been shown to be effective.   Most of the muscles which exert force on the knee pull laterally on the patella.  The vastus medialis is the lone, small, muscle that supports the patellofemoral joint medially with dynamic muscle contraction to balance the forces.  If it is weak or not firing it can cause abnormal forces to the patella and potential injury. 

Open chain exercises (feet not on the floor and one joint moving at a time) for the lower extremity is not very efficient for functional development either.  Unless you need to develop strength in a seated position to kick something, the exercise is not functional.  The lower extremities were designed to create and absorb force while in contact with the ground such as in running, jumping, lunging or a double leg take down which I know you know nothing about!(Brendan and I wrestled together in college for those of you who do not know)  Even during most kicking activities, most of the force is created by the trunk and hip muscles.

In conclusion, it is recommended to perform CKC exercises for lower extremity development.  The best exercises are done in single leg positions because the instability and isolation will cause enhanced recruitment of muscle fibers of the lower extremities.  When performed with good technique, this can significantly increase strength and functional ability.  If you are going to utilize machines, hack squats and leg presses are best.  The should also be performed unilaterally to enhance recruitment and functional ability.  If you have enough strength developed it is also wise to incorporate speed into your CKC movements with lighter resistance of course.  The quadriceps muscles are heavily distributed with fast twitch muscle fibers and recruitment can be significantly enhanced by doing plyometrics or adding speed to the movements.  This should only be done if you have first developed considerable strength in CKC exercises.  Also, doing OKC hamstring exercises are not typically thought to be potentially injurious and can significantly increase strength.  I do however recommend strengthening the hamstrings with CKC exercises as swell such as swiss ball hamstring curls and Russian hamstring curls/glute ham machine.  I hope this helps.

Here is an example -

Split Squats 1 set of 3 and 3 sets of 5 with 2 minute rest period between each set followed by 3 sets of 12 Lunge Jumps with a 1 minute rest period between each set.                                        

Reverse lunges off of a 12 inch box 1 set of 3 and 3 sets of 5 with a 2 minute rest period between each set followed by 3 sets of 12 Box Jumps or jump squats with a 1 minute rest period between each set.

Lyneil Mitchell, DPT

A sound mind in a sound body is a short, but full description of a happy state in this world – John Locke

A body with a purpose, a mind with choices

A body with a purpose, a mind with choices.  As Deepak Chopra spells out in his Book of Secrets, the body has a purpose and would live to fulfill it without hesitation if it were not attached to a human mind that can go against the body’s design principles.  If it was up to our body, we would only live to fulfill our primary responsibilities.  Once we had accomplished our primary responsibilities, the body would turn to the secondary, the tertiary and so on.  The human body was created to perform specific functions to be carried out on a daily basis for survival and enhanced future performance.  These are the only concerns of the body.  Get the jobs done and be able to do our jobs better in the future through adaptation.  If our minds were as lacking of choice as much as the body, human life would be very different.  All of our jobs would get done.  We would have minimal distractions.  This would be very advantageous for our survival yet unfortunately boring.  We have so many choices to make which keeps life very exciting and uncertain.  It is paramount that we learn to make informed decisions to keep a balance between excitement, health and our survival. 

Lyneil Mitchell, DPT - A sound mind in a sound body is a short, but full description of a happy state in this world - John Locke

New Year's Resolutions - Tips for enhancing performance and avoiding Injuries

It’s that time of year again.  People are getting off of the couch and heading to the gym to keep with their New Year’s resolutions.  This is great but it is one of the best times for physical therapy business.  I truly believe that most injuries occur because people poorly progress themselves back into physical activity.  Whether they twist their knee because they pushed themselves too hard or they sustain an overuse injury like tendonitis, the culprit is usually improper progression.

According to the American College of Foot and Ankle Surgeons, New Year’s resolutions result in more foot and ankle injuries, and subsequent surgeries, than any other time of year.  According to them, many of these injuries can be avoided simply by slower progression and the appropriate athletic shoes.

We, as human beings, are meant to move, so I think it’s great that people are getting back into the gym, hitting the treadmills and the weights.  My only concern is that people are jumping back into these workout programs without proper advisement and are taking a serious chance of injury.  Lifting weights and running are not simple, easy activities.  They are highly skilled and we all need to seek more information as to the best techniques and progressions schemes.  Why do it on your own when the information regarding the best strategies and programs are at your fingertips?

I recommend seeing a physical therapist if you are planning to start any type of exercise program.  Physical therapists are movement experts and can assist you with getting back into shape without taking the chance for injury.  We understand exercise and sports movement biomechanics and muscle balance.  Or even better yet pathomechanics and muscle imbalances that maybe placing you at risk for an overuse or traumatic injury.  We can help you avoid injuries and also improve your performance by identifying and addressing these issues. 

Many people are going to experience pain at this time of year from exercising. It's inevitable.  If you have pain, try the age-old ice, rest, and elevation.  If pain is lasting longer than 5-7 days, it should definitely be looked at by your therapist.  The situation may get worse, so seek help sooner rather than later.  Letting things get worse will cause you to end up on the bench, out of work, and possibly out of money.  This can all be prevented by being proactive and reactive if you start to experience pain. 

The main reasons people stop exercise programs are because of injuries and experiencing too much soreness in their muscles.  These two things can be avoided through proper progression and technique.  Your resolution was to get off the couch or bench.  Avoid putting yourself right back where you started by following a steady progression in your program.  I always recommend that people increase their training volume by 5-10% at a time to allow them to adjust to the demands.  Also remember that you are placing new demands on your body which will need adequate nutrition and hydration.   The diet you were on prior to new years will not be efficient for fueling your performance and enhancing recovery.

Tips:

1.  Water intake should be approximately 1 mL per calorie burned throughout the day.  There are numerous calorie calculators that can be found through Google.  A drop of 1% in our hydration status can cause limited performance by up to 10%.  Very counterproductive as many wrestlers, including myself, have had to experience the hard way. 

2.  Get a good warm up for about 5-10 minutes before engaging in vigorous activity.  This allows increases in bloodflow to the muscle, tissue temperature and elasticity.  This is a sure way to avoid injuries because they are less susceptible to tearing when they are warm and elastic.

3.  Perform active dynamic stretching prior to exercise, such as calisthenics, arm circles and leg swings.  Following exercise, perform static stretching where you will hold muscles at their end range position for 15-30 seconds.  Research has demonstrated that holding the stretching positions either shorter or longer time periods are ineffective.  Static stretching prior to high speed or powerful exercise modes can actually cause the muscles to fire more slowly.  It is recommended to warm up prior to exercise with dynamic movements that take the muscles through end ranges but do not hold them there. 

4.  Refuel following your workout.  Your body is in recovery mode, depleted and is looking for nutrition to replenish the reserves it utilized during the exercise session.  You are also very sensitive to insulin at this time for about an hour.  Insulin helps to drive nutrition into our muscles for later us instead of storing them as fat.  This is why many creatine products are combined with sugars to allow for more adequate absorption by the muscles.  Refueling within minutes of finishing exercise will allow you to enhance your performance, recover more quickly and avoid injuries as well. 

5.  Make sure you are wearing the proper shoe for your activity and your foot type.  Most shoes today are designed for a purpose.  Many companies design shoes for specific foot types and activities.  Some shoes are made for pronators and some are made for supinators(flat foot/medial loaders or high arch/lateral loaders).  Many shoes are also made for running straight ahead only and should not be worn to play cutting and jumping sports.  In fact, some of them will actually predispose you to rolling your ankle during lateral movements.

Remember you can see your physical therapist first to get your injury or pain treated.  Insurance now reimburses for this.  Your physical therapist is also a movement specialist and can guide you in any exercise type to enhance performance and avoid injuries.  If you have any further questions regarding training programs, nutrition or equipment(shoes) for the activity you participate in do not hesitate to contact me. 

Wishing you the best in your New Year's Resolutions

Lyneil Mitchell, DPT - A sound mind in a sound body is a short, but full description of a happy state in this world - John Locke

It's official - Open for Business

Revolution Physical Therapy is open for business!  We are credentialed with all of the major insurance carriers.  We were waiting on our approval from Highmark Blue Cross and Blue Shield prior to making this announcement due to the large volume of people who carry their insurance.  We have a very flexible schedule to accommodate mostly anyone, with evening and weekend hours available.  Appointments are preferred and that includes same and next day appointments if you need to be seen immediately.  


No referral necessary.  Revolution Physical therapy is direct access certified.  This means that when you are in pain, you can come and see us with out a physician referral.  All major insurance carriers now reimburse for this.We treated our first patients on Monday and are currently accepting new patients.  If you or a loved one are experiencing pain please take the time to get it looked at.  We treat the pain and the cause of the pain, not just your symptoms.  The sooner you get treated the sooner you will be pain free and will know how to prevent it from happening again.  Tip:  I always tell people if they have pain longer than five to seven days to have me take a look at it because the cause of the problems is not going to get better on its own.

Highmark BCBS published a study that was conducted in Pennsylvania and Maryland revealing that seeing a Physical Therapist first decreases costs and improves patient outcomes.  This means you get better faster and it costs you and your insurance carrier less.  It just makes sense to see a PT first.  If an athlete sprains their ankle, they do not go to the physician first.  They go to their athletic trainer.  If the trainer thinks they need to see a physician they refer the athlete to their physician.  This is part of what helps athletes get back sooner, they get treated early and often.  Unfortunately most of us are no longer in school and do not have an athletic trainer to attend to us.  As a PT who has worked with high level athletes, I believe everyone deserves to have the same treatment.  The treatment the pro and college athletes get.  Below is a perfect example of a gap in treatment and how it delays getting people from getting better and increases costs.

A patient who sprained their ankle and makes an appointment to see their physical therapist on Monday.  Prior to their visit the next day, the patient contacted their physician and told them they were going to go to see a PT for an ankle sprain.  Their primary care physician told them not to go to PT first and to come to his office for an evaluation.  The patients appointment was set for Friday and the physician ordered prescription  strength Advil to the pharmacy.  The patient then had to limp around for the next 4 days, in severe pain, waiting to see the physician.

Once the patient finally did see the physician, he ordered an MRI which was expensive and unnecessary for an ankle sprain.  The patient was scheduled at the imaging center for Friday and a follow up appointment with the physician on Monday.   At the follow up appointment the patient's MRI revealed a grade II ankle sprain.  This means that the patient had torn two out of the three ligaments in their ankle.  The physician then referred the patient( guess where?) back to Physical Therapy.  Not very efficient. Then the patient was treated for two weeks at my clinic, and had a 100% return to their pre-injury function.

The patient spent nearly 2 weeks limping in pain, developing weakness and movement compensations, getting out of shape, before even coming to Physical Therapy which makes it take longer for them to get back to 100%.  If the patient would have come to therapy first, they probably would have been back on their feet in the time it took to get the MRI.

This is precisely the gap in treatment I want to help patients avoid. The goal is to be back to 100% as soon as possible. At Revolution PT, this is our No.1 priority. We look forward to serving all of you in the future.  In the meantime, I am going to continue to leave updates on Facebook and my blog.  Thanks for following us.   I really appreciate the support.

Wishing you the best,

Lyneil Mitchell, DPT
A sound mind in a sound body is a short, but full description of a happy state in this world - John Locke

The Animal!

It’s not a sprint. It’s not a marathon.  Performance in life is all about intervals.  Who can go the hardest longest with the shortest rest periods?  Just to try a more difficult task and go harder the next time.  The process strengthens itself and each time we get better and better.  10/10 is a difficult intensity to maintain for extended periods of time.  But when you go, go hard and take as little rest as possible.  The warrior approach to life never causes burnout.  Survival is not an academic skill, neither is it mandatory.   

Not everyone is privileged to realize previously unrealistic goals. Most people turn the wrong direction when facing adversity.  The weak call us mad, extreme and fanatics.  The competitive mindset is not granted to all comers.  Many have seen a glimpse of this inside of themselves.  Many have not harnessed their full power.  Many more will never understand.  There is an animal inside of all of us.  Stay tapped into your "animal"!

Lyneil Mitchell DPT - A sound mind in a sound body is a short but full description of a happy state in this world - John Locke 

Mankind shall prevail!

Life is the most difficult game that may possibly exist that humans have the privilege of participating in.  Life is the only game that is continuously changing.  It is a game full of games, continually moving around and within each other, all related to perpetuating our own existence and the existence of our loved ones.  Whether it is a human’s limited sensory perception or God’s will; we can never know what the rules are for certain, when the game will change, when it will be over, and exactly who or what we are up against?  We only know that we have to adapt to survive.

Adaptation is a necessary component in order for a certain organism or group of organisms to become better suited for their habitat.  Some adaptations occur on a biological, evolutionary type of development.  Most adaptations occur simply from learning how our actions result in certain specific outcomes.  Once the organism knows that its action will yield an outcome it can properly navigate its way through the world allowing the optimal chances for survival. 

For human organisms, we can optimally navigate our way towards wellness and away from danger.  Learning is the number one way that we become better suited for our environment.  Our environment is constantly changing however.  Today we may have the most dangerous environment to live in when considering our health.   We no longer have to worry about being attacked by a wild animal while we lay asleep on the ground of a cave.  In most areas of the country the crime rates are low and human predators are virtually non-existent.  Our environment is now, what I consider, the most dangerous of all time because it is deceptive.  We are led to believe that we are in a safe environment that allows us to have our freedom when in reality there are many aspects of our environment that lay just beneath the surface that cause disability, mental illness, and chronic disease states.  

I was recently at a conference in which the real Patch Adams gave a lecture on caring for the medical profession.  He is a medical doctor that does not practice for a salary.  He does everything for free.  His message was that we need to place the care back in healthcare and that we are too focused on the bottom line which is distorting the outcomes of our medical system and the health of our people.  He said that all of the problems we have today such as chronic diseases, mental illness and disability were a normal, natural outcome derived from us living in a spoiled society that is losing its moral compass. 

The beauty is that all we have to do is learn.  Well, first we have to be open to learning.  We are learning new things each day in our lives, it never stops.  For some however, paying attention to and learning about navigating the world in terms of health and wellness has fallen to the wayside as a second class priority.  However, many of these people discover that ignoring a critical component of their life business plan causes significant difficulties instead of living well into their golden years when it is their time to retire.  They see their life begin to crumble around them with more and more frequent trips to the doctor, a medicine cabinet full of chemicals to be ingested to alleviate their awful symptoms of a misguided and misinformed life, and a progressive limitation on their independence and functional capacity.  This pathway only leads us further from enjoying life and towards a life of limitations and suffering.  But there is an answer, there is a solution. 

We can have our cake and eat it too.  When it comes to wellness, all we have to do is be open to learning new ways to look at life.  We have to understand how our bodies work and not completely ignore the truths that are all around us.  We cannot sacrifice the health of our people simply to make money.  The short term riches are not worth the long term pain.  We can however be very wealthy and optimally healthy at the same time.   It takes a long time to earn a good living for most people and unfortunately by the time they are making enough money to come up and take a breath, they’re barely healthy enough to enjoy it.  We simply have to recognize that many of the problems we have today have been derived from indifference, disuse, inactivity, neglect and ultimately beliefs that are incongruent with good health.  We have the ability.  We are humans.  Survival and the pursuit of a better life is our foundation.  We can make a difference in our lives.  We change our outcomes.   We must be consistently open to learning and adapting across our lifespan.