Should Patients Continue with a Wellness Plan Following The Completion of Physical Therapy?: MythBuster Monday

Physical Therapy is a catalyst for keeping people moving following an injury.  However, due to current limitations in the system, Physical Therapist are typically unable to fully correct the underlying causes of an individuals injuries. Under the current limitations Physical Therapy can serve as a powerful tool to lead people to long term health. This is where a quality wellness plan can become incredibly important in building upon the gains we have made during Physical Therapy.  If you are interested in my Wellness coaching options please reach out and we can set up a free consultation.

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Should Physical Therapy School Curriculum Include Strength and Conditioning?

Should Physical Therapy School Curriculum Include Strength and Conditioning?

As I finish my last few weeks of didactic course work for Physical Therapy School, while simultaneously studying for my practice NPTE board exam, I am blown away by how much I have learned.  Topics ranging from Acute care to advanced sports, pediatrics to geriatrics, Integumentary to Cardiovascular Pulmonary and everything in between.  However, there has been one glaring hole in my educational experience; that being Strength and Conditioning.  I have had to try to fill this knowledge gap through other avenues.

Although we claim ourselves as “The Movement” and “Prescribers of Exercise” experts; when I think about the best movement and exercise prescribers, most are not Physical Therapist but instead individuals in the Strength and Conditioning world.  The Sad truth in Physical Therapy, more often than not Physical Therepist are still under loading our patients using 3 sets of 10 and therabands for every exercise.

"But we are Doctors?"

Yes and we should be proud of that!  But we need to leave our letters and egos at the door.  We need to understand that compared to other professions we are uniquely qualified to help highly complex patients, due to the depth and bredth of our education.  However, as a profession we are dropping the ball in terms of being the “movement” and exercise prescription expert.

How Can We Improve As A Profession?

In my opinion, I feel the curriculum at each and every Physical Therapy School should include an entire course on Strength and Conditioning.  I understand many will point out that this may be linked to my orthopedic and sports bias.  However, I would argue that learning the science behind strength and conditioning and evidence based loading principles would be beneficial for every population to drive meaningful adaptation.  Not only will this be meaningful learning to better us as clinicians, but if the school prepared you for the CSCS exam, it would set you up to have a marketable certification that is widely respected not, not just in strength and conditioning but throughout the entire healthcare field.

Expand the Reach of Physical Therapy

As i talked about a few weeks ago in my blog “Does Physical Therapy Have An Impending Unemployment Crisis? ” The Physical Therapy profession, will not offer the job security it has in the past. Instead, more and more programs are being created, current programs are expanding and the job opportunities are growing at a slower rate.  This will  leave about 10% of Physical Therapist unemployed in 10 years. In the article mentioned above, I discussed possible solutions to this dooming problem.  One of which, was expanding our reach as a profession to play larger roles in other sections of health care.  One of which would be serving as primary care doctors in Emergency Rooms and taking the lead on all Musculoskeletal injuries.  However, I believe taking a larger role in “personal training” “wellness coaching” and Strength and Conditioning are other areas in which our profession may be able to expand and maximize our influence.  Another benefit of including Strength and Conditioning coure is that it will prepare students for their CSCS and give students a strong foundation to lead in these areas.

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Saucony Triumph 18 Shoe Review

Shoe Review: Saucony Triumph 18

Saucony Triumph 18

Category- Neutral Daily Trainer-Premium Cushioning

Weight-9.7 oz(W), 11.1(M)

Heal to Toe Drop: 8 mm

Stack Height (Heel/toe): 32.5 mm (Heel), 24.5 mm (Forefoot)

Preferred Surfaces: Track and Road

Cost: $150

My quick Opinion:

Most of the serious runners I work with have made the triumph their go to shoe to eat up miles.  Its TPU foam offers it asuper bouncy and soft feel that makes your long run effortless.   Around the foot it fits true to size and has a lot of plushness around the heel.  For none runners, I think this is one of the most comfortable shoes on the market, without having a the ultra cushion look of the Hokas.

Pros for Saucony Triumph 18:

Cons for Saucony Triumph 18:

  • Heavier shoe and not optional for speed days
  • Expensive

Comparable shoes to Saucony Triumph 18:

  1. Mizuno Wave Sky 4:
    • In many ways this the same shoe. The Mizuno run slightly more narrow.  However, the underfoot foam is very similar.
  2. New Balance 1080:
    • The 1080 is another premium cushioned shoe that serves as a workhorse for your training.  The Fresh foam in the 1080 does not hold up as well as the TPU foam in the triumph.
  3. Hoka Bondi
    • For people who are standing on their feet both the triumph and bondi are good options.  Triumph has a more sleek look compared to the bondi

Who would I recommend the Saucony Triumph For?

Most of the serious high end runners I know have made this their “work horse” shoe.  These shoes offer them the ability to eat up miles with a smooth and cushioned. The TPU foam offers a high energy return.  High end runners will be who I suggest this to the most.  I would also recommend it to someone who is on their feet all day and looking for a more sleek option than the Hoka Bondi.

Is Creatine Bad For Your Health? MythBuster Monday

For all of you that don’t want to read, The answer is if you are a healthy individual with properly functioning Kidneys and Livers, Creatine is extremely safe and effective.

History of Creatine

Creatine was first discovered in 1832, as a natural compound that plays an important role in cellular energy homeostasis. Creatine stores are used to provide energy in short explosive movements. Creatine along with our ATP serve as our instant fuel. Since this time it has become common place to use creatine to improve physical performance. In fact over $400 million worth of creatine is sold each and every year.

Over the last 30 years, creatine has been studied extensively and shown incredible results in both improving overall health and sports performance.

Creatine Improving Sports Performance

The International Society of Sports Nutrition put out a position stand that to into account an extensive accumulation of all the research on creatine and found these results.

“Creatine monohydrate is the most effective ergogenic nutritional supplement currently available to athletes with the intent of increasing high-intensity exercise capacity and lean body mass during training.” Here were some of the key take home points of this position stand.

  • Increase single and repetitive sprint performance
  • Increase work performed during sets of maximal effort muscle contractions
  • Increase muscle mass & strength adaptations during training
  • Enhance glycogen synthesis
  • Increase anaerobic threshold
  • Provide possible enhancement of aerobic capacity via greater shuttling of ATP from mitochondria
  • Increase in work capacity
  • Enhance recovery
  • Antioxidant effects
  • Increased Bone Mineral Density

Creatine’s Use in Disease States

I am not a medical doctor and am not offering any medical advice. I am only offering what research has discussed. Creatine has some interesting research that is going on regarding its effects in Neurodegenerative diseases. Neurodegenerative diseases are characterized by a progressive loss of function, and often death, of neurons. Below is the proposed mechanisms.

The theory that started the research in the usage of creatine as a treatment option is based around mitochondrial dysfunction and excess production of free radicals being two primary mechanisms driving the development of neurodegenerative diseases. Creatine supplementation increases the PCr pool which may facilitate improved mitochondrial functioning and more efficient ETC transfer.

In Animal studies creatine has shown positive results. However, these results have not carried over to human studies. This can be explained by decreased mitochondrial function being an important factor in several neurodegenerative diseases, but it is typically not the main factor. Creatine may not be used as the main treatment for any of these neurodegenerative diseases, however, it may still be a valuable part of treatment plans do to its many benefits including maintaining muscle mass and bone health, while also serving as an antioxidant.

Controversy around Creatine being Bad For You?

For years, creatine got a bad name. Thinking back on what I heard growing up, included “creatine is a steroid” “Creatine Only makes your muscle bigger because they fill them with water” and that you HAD to cycle creatine because it was bad for your “liver and Kidneys”.

As we talked about above creatine is not a steroid but instead a natural compound that plays an important role in cellular energy homeostasis. It affects energy production and distribution by being reverse phosphorylated to phosphocreatine. This ability gives us more work capacity while working out which allows us to achieve more #gains.

The second false narrative comes from the fact that creatine does cause your muscles to retain more water. Which is not a bad thing, we are made up mostly of water.

Finally, we get to creatine damaging our liver and kidneys. Since our liver naturally produces creatine, many worried too much would harm it. However, research has consistantly shown for HEALTHY individuals creatine is safe even for long term usage. For individuals with a history of liver issues they should be cautious and talk to their physician prior to taking creatine. For the kidneys, many thought it was bad because a common sign of kidney disease is elevated levels of creatinine, a byproduct of creatine, in the blood. This caused many people who were taking creatine to have false positives for kidney disease. However, the reason they were testing positive wasnt because their kidney was damaged but instead because they were taking more creatine thus having more creatinine by product. This is the same as if you eat alot of protein you would expect to have more amino acids in your blood.

Why I take creatine?

Creatine offers a tremendous amount of benefits for a very low price. On the physical side it increases work capacity, muscle mass, glycogen synthesis, sprint performance and enhances recovery. For my general health, it offer antioxidants to help fight off free radicals that come with my high stress highly active life style. Finally, there is research that shows while in sleep deprivation, creatine has shown to improve cognitive function. As a doctoral student, who loves to overextend himself with research, part time jobs, dog duty and running compass performance, sleep is usually the first thing i give up. So hopefully I get a little boost from my creatine.

I use Bulk Supplements for all of my supplements due to the high quality and insanely low prices. With Bulk supplements you arents paying for advertisements or labeling but instead just high quality products. You can get 200 servings of Creatine for ~$20 @bulksupplements when you use coupon code “COMPASS5OFF”.

References

Butts J, Jacobs B, Silvis M. Creatine Use in Sports. Sports Health. 2018;10(1):31-34. doi:10.1177/1941738117737248

Kreider, R.B., Kalman, D.S., Antonio, J. et al. International Society of Sports Nutrition position stand: safety and efficacy of creatine supplementation in exercise, sport, and medicine. J Int Soc Sports Nutr 14, 18 (2017). https://doi.org/10.1186/s12970-017-0173-z

 Braissant O, et al. Creatine deficiency syndromes and the importance of creatine synthesis in the brain. Amino Acids. 2011;40(5):1315–24. 14. review

Wyss M, et al. Creatine and creatine kinase in health and disease–a bright future ahead? Subcell Biochem. 2007;46:309–34.   review

Beard E, Braissant O. Synthesis and transport of creatine in the CNS: importance for cerebral functions. J Neurochem. 2010;115(2):297–313 review 

Bender A, Klopstock T. Creatine for neuroprotection in neurodegenerative disease: end of story? Amino Acids. 2016;48(8):1929–40.

Should Patients Continue with a Wellness Plan Following The Completion of Physical Therapy?: MythBuster Monday

Physical Therapy is a catalyst for keeping people moving following an injury.  However, due to current limitations in the system, Physical Therapist are typically unable to fully correct the underlying causes of an individuals injuries. Under the current limitations Physical Therapy can serve as a powerful tool to lead people to long term health. This is where a quality wellness plan can become incredibly important in building upon the gains we have made during Physical Therapy.  If you are interested in my Wellness coaching options please reach out and we can set up a free consultation.

Read More »

Saucony Triumph 18 Shoe Review

Shoe Review: Saucony Triumph 18 Category- Neutral Daily Trainer-Premium Cushioning Weight-9.7 oz(W), 11.1(M) Heal to Toe Drop: 8 mm Stack Height (Heel/toe): 32.5 mm (Heel),

Read More »