Isometrics and Bone Health

Isometric exercise has been around for a long time in both the fitness and rehabilitation world, but is most definitely having a rebirth! After years of limited results and cumulative injury with dynamic, movement based exercise, health and fitness professionals along with a host of academic and medical journals are looking at isometric exercise as not only the safest, but most effective exercise available.

Isometric exercise is a contraction of a muscle without any visible movement occurring. It is a static exercise where the muscle is contracted in a fixed position against an immovable object. When doing workouts at the gym with free weights or machines, you are performing isotonic exercises. Both forms of exercise increase the tension of a muscle, but isotonic exercise also affects the muscle’s length. The benefits and results of an isometric exercise program have always been exceptional in increasing the tension of a muscle, but with advent of technology affecting the fitness and exercise world over the past forty years, isometric exercise has been virtually forgotten.

Now fitness experts and the most prestigious health and fitness journals in the world are publishing studies that endorse isometric exercise as an exceptional route to improving muscular strength, bone health, cardiovascular function, and athletic performance with minimal stress to joints, tendons, and the body’s other supporting structures.

Now with the focus on bone health, isometric exercise is again mentioned as a means to improve the status of your skeletal system and its bones. With that, there are two terms related to your bone health that I feel need to be clarified. That is “osteoporosis and osteopenia.” Simply put, osteoporosis suggests a disease process whereas osteopenia is a description of lowered bone density scores. Osteoporosis is not and I repeat not a normal response to aging. It is indicative of long term imbalances within the body’s systems that lead to a bone weakening disease process. When you have been diagnosed with osteoporosis, it means you have an actual disease or disorder that can be seen under the microscope. The word osteoporosis actually means “porous bones” since the bones look like Swiss cheese under closer inspection and lose their normal, healthy spongy appearance. This condition occurs when your body gets rid of more bone than it is creating. Some people are genetically prone to it having a family history. You are also more likely to get it if you are a woman. Osteopenia, on the other hand, is not a diagnosis. It’s a description of “low bone mass” and all it is doing is stating an observation that your bone mass is lower than that of someone who is in their late twenties. Someone who is at the peak of their bone building and strength.

Let’s clear up this confusion even further, osteoporosis warrants an extensive work-up looking for the cause of excess bone loss. Osteopenia may or may not be an early warning sign of bone weakening and generally does not trigger the need for a work up or conventional medical treatment with some exceptions. In fact, osteopenia is the result of statistics again comparing your bone density to the bone density of someone who is in their late twenties which is the considered the normal range.

So now the question arises, “When is osteopenia something to take seriously?” Remember, women have a higher incidence of osteoporosis and most of the studies have been done on women in their late twenties. Therefore, it only stands to reason that some amount of bone loss takes place with each passing decade. Whether or not slipping into “osteopenic” bone density range is a serious enough concern depends on each individual case. However, saying one has osteopenia does not necessarily say it is a precursor to osteoporosis. If you have ranges that have been defined as osteopenic, diet and exercise can help to change your numbers. Medication is not always warranted.

So the question then is, “What should you do if you have osteopenia? As just mentioned, diet and exercise can help your bone strength. I am not going to go into diet, but you can get information on dietary guidelines for bone health at https://americanbonehealth.org/nutrition/dietary-guidelines-for-bone-health/. As far as exercise is concerned, we are going to discuss osteogenic and isometric exercise. It is a given that bone responds to certain levels of physical strain making the bones stronger. Any type of activity that puts enough strain on bone such as gravity and ground reaction force or tensile forces from muscle tension to stimulate new bone growth is called “osteogenic loading.”

I am sure you have heard from your doctor that you need to do a weight bearing exercise program if you have been designated as osteopenic. Now, fitness experts and the most prestigious health and fitness journals in the world are publishing studies that endorse isometric exercise as an exceptional route to improving muscular strength and bone health. For example, the “Journal of the Facility of Medicine” in 2012 published that isometric exercises not only prevents reduction of bone density, but may also increase the mineral density of injured bone.

So you can see why I have become an advocate for “isometric exercise.” Therefore when treating your musculoskeletal pain and dysfunction at Terry Kern Physical Therapy, I will be using a combination of isometric and stretching exercises in order to alter the length and tension of your muscles with the goal of improving your musculoskeletal balance and health.

“A Paradigm Shift”

Over my 37 years as a physical therapist, I have come to the belief that our present medical system needs a change in its foundational philosophy. A “paradigm shift.” The buzz words today in health include integrated healthcare, integrated practitioner, and integrated health. These words refer to alternative medical practices. But what do these words really mean and what are the implications of these words to the development of integration within our healthcare system today?

The word integrate is defined as to make into a whole by bringing all parts together; unify. To join with something else; unite. To make part of larger unit. Words with similar definitions include combine, amalgamate, consolidate, and incorporate. According to the National Center for Complementary and Alternative Medicine (NCCAM) it refers to medicine as integrative or integrated when it “combines treatments from conventional and alternative medicine for which there is some high-quality evidence of safety and effectiveness.” According to Andrew T. Weil, M.D., a well known proponent of integrative medicine, “integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.” Combining these three aspects of a person, integrated/integrative medicine would then be defined as: the evidence-based merging of conventional and complementary therapies for the good of the whole person.

However, the word integrate cannot only be used in the description of our healthcare system, but also in how the body is viewed. Our conventional medical philosophy is better defined as “reductionist medicine.” The driving principle behind our medical science is the paradigm of physical reductionism, which reduces medical issues to physical explanations and usually prescribes a purely physical solution. In this simplistic view of the body, it would be fair to say that the human body is seen as a machine; every time someone is sick, it’s simply because one of the body’s gears (body systems) is clogged. This reductionist view of the body is not in itself a bad thing and its focus on specialization is preferable to alternative medicine practices in circumstances such as emergency surgery or in triage situations as seen in our nation’s emergency rooms. On the other hand, holistic medicine, also known as alternative or complementary medicine, evaluates the entire person, physical (body) and non-physical (mind) and seeks to heal any imbalances between the two. It views the body as a complex system that is affected by both internal and external factors. It also emphasizes the body’s own ability to heal itself, as well as promoting healthy lifestyle changes and preferring naturally occurring remedies, such as meditation and herbal medicines, to synthetically produced compounds. Because it is not reductionist in nature, holistic medicine can also be used as a counterpart to modern medicine.

The problem with modern medicine is that its science and philosophy purposely excludes anything that does not fit its paradigm of physical reductionism. It cannot, by its very definition, consider that humans have both a physical and a non-physical nature. Because of this, many people feel that the mainstream, western medicine fails to evaluate them as a complete human being.

In discussing these various views of how the body is looked at, there needs to be a distinction made between the view of a M.D. (medical doctor) and a D.O. (doctor of osteopathy). A medical doctor practices allopathic medicine, the classical form of medicine, focused on the diagnosis and treatment of human diseases. Osteopaths, on the other hand, practice medicine that is centered around a more holistic view of medicine in which the focus is on seeing the patient as a “whole person” to reach a diagnosis, rather than treating the symptoms alone.

Early in my career, I worked at Heights General Hospital in Albuquerque, an osteopathic institution. I therefore came to incorporate their philosophy into my own physical therapy practice. That is, view the body as a unit, an integrated organism in which no part functions independently. Also, realize the body has an inherent capacity to maintain its own health and to heal itself. In addition, recognize that structure and function are interrelated in that the musculoskeletal and musculofascial systems reflect changes in and can produce changes in other bodily systems. Finally, rational treatment is based upon integration of the first three principles into total care of the patient.

Patients at my facility will always be viewed and treated according to these principles. I recognize each person as a unit of body, mind, and spirit. I also look at the whole-person which emphasizes learning as much about the person with the disease as the disease itself. Finally, I understand that each body is capable of self-regulation, self-healing, and health maintenance.

Terry Kern, P.T.

January 2019 “Breathing”

As a physical therapist for thirty-seven years, I have become more aware of how poor posture along with poor alignment of the human, skeletal structure affects breathing. Dr. Karel Lewit states, “Respiration is our primary and most important movement pattern…and also the most dysfunctional.”

The diaphragm which is the primary muscle of respiration plays a major role in patterns of dysfunctional breathing. This dome-shaped muscle is located just below the lungs and heart separating the abdomen from the chest. As you breathe in and out, the diaphragm contracts continually generating a negative intra-thoracic pressure. In fact, the diaphragm will lower and establish increased abdominal pressure before any of your daily, functional movements. During inhalation, the rib cage increases it anterior, posterior, and lateral dimensions at the same time giving the diaphragm the room to fully contract. With MRI studies, researchers have found that when the diaphragm does not have the room to fully contract, intra-abdominal pressures are affected. As a result, other respiratory muscles or accessory breathing muscles have to be recruited more in order to compensate.

When you breathe in, the diaphragm should be able to fully contract and move inferiorly. This action flattens the dome-shaped muscle causing a decrease in pressure within your thorax or chest and an increase in air taken into the lungs. As you breathe out, the diaphragm relaxes restoring its dome-shape decreasing the air space in your lungs causing you to push air out.

This involuntary action of breathing works in close coordination with the thoracic spine, rib cage, and “core” muscles. Because of this close relationship, when your thoracic spine and rib cage become limited in their mobility, the diaphragm will not be able to fully contract with each breath and becomes weak affecting your breathing pattern. In addition, if your “core” muscles are not fully engaged, the diaphragm loses its ability to fully contract. The resultant weakness again affects not only your breathing, but also makes you more susceptible to musculoskeletal dysfunction and pain. According to a MRI study done in 2013 by Vostatek, “Dysfunction of the cooperation among the diaphragm and abdominal, pelvic floor, and deep, back muscles is the main cause of vertebrogenic disease and structural spine findings such as hernia, spondylosis, and spondyloarthrosis.”

The rib cage, “core”, and spine should work as a unit. Altered rib mobility can not only cause a dysfunctional breathing, but also limited shoulder mobility, reactive muscle guarding, and referred pain to other areas. The “core” which has become the focus of fitness and rehabilitation programs not only consists of diaphragm, but also pelvic floor muscles, transverse abdominis, quadratus lumborum (iliocostal), internal and external obliques, rectus abdominis, and deep, posterior back muscles including the multifidus and erector spinae. Other muscles that are considered “minor core muscles” include the gluteals, tensor fascia lata, adductors, and lateral hip rotators. The engagement of your “core” muscles is not only important in breathing, but vital in maintaining the vertical, upright, human posture. Without the engagement of the “core” muscles, the intra-abdominal pressure is not adequate enough to prevent distortions and compensations of your spine and can lead to the spines collapse as in osteoporosis and other pathological situations. The result is a compensation in your posture that further decreases your breathing capabilities.

It can’t be overemphasized enough how poor postural alignment, limited thoracic spine and rib cage mobility, and weakness of “core” strength affects your breathing. Think about it! The diaphragm, “core, and accessory breathing muscles of the neck and shoulder girdles produce upward of 21,000 breaths each day. When the diaphragm is without restriction when contracting, these accessory breathing muscles will not have to work as hard remaining soft and supple. However when the contraction of the diaphragm is compensated in anyway, increased resting tone of the accessory breathing muscles will occur. These accessory breathing muscles include the scalenes and sternocleidomastoid of the neck as well as the levator scapulae and trapezius of the scapula. In addition, the tone of shoulder girdle muscles including the latissimus dorsi and pectorals will be affected.

The main characteristic of a dysfunctional breathing pattern is that the abdomen will move in on inspiration and out on expiration. Just the opposite of what should happen causing shoulder girdle protraction, forward head position, and alteration of the spine’s normal curvature. The result is that these areas are now asked to bear excessive loads that over time cause musculoskeletal dysfunction and pain.

As you age, it is a given that your thoracic spine and rib cage will stiffen, your core will get weaker, and a dysfunctional breathing pattern will progress making you more susceptible to pneumonia and other lung related ailments. We take our breathing for granted so we usually do not focus on how we breathe. However, you can do something with specific exercises and postural modification no matter your age to change how you breathe and slow this progression. Learning the proper way to breathe with the emphasis on the diaphragm is an essential for optimal health and longevity.

“The Atlas”

The first cervical vertebra, called the “atlas” or C1, plays a primary role in the alignment of the spine and body, maintaining musculoskeletal and fascial balance, and keeping you vertical against the forces of gravity and ground reaction.

Misalignment of the “atlas” might have a “domino” effect on the entire musculoskeletal and fascial, circulatory, and nervous systems, by creating imbalances and dysfunctions in various parts of the body. These malfunctions might turn, over time, into serious health issues: The body is no longer able to function the way it could and should in a state of homestasis. The quality of life can become seriously compromised, even though no clear-cut organic cause might be identified and diagnosed.

When C1 or “atlas”, the spine, and the skeleton are in balance, gravity and ground reaction forces, the forces each one of us compete against each day are distributed evenly between the two sides of the skeleton.

The head’s considerable weight (as much as 11-13 pounds), which should not be underestimated, is entirely supported by the “atlas.” A misaligned “atlas” causes the cranium not to be perpendicular to the spine and most importantly to ground reaction force affecting how your body finds its vertical position when sitting and standing. The “atlas”, therefore, has a great influence on the balance of your entire skeleton and is directly responsible for your upright and vertical posture.

Misalignment of the “atlas” causes a shift in your body’s center of gravity and a musculoskeletal and fascial imbalance from head to toe leading to musculoskeletal dysfunction. The misalignment of the “atlas” causes a static, false posture in which one side of the body is more stressed than the other. This is why your pain is generally concentrated on one side of your body.

Due to the shift in your body’s center of gravity, the stress to your skeletal structure causes muscle tension, spasms, and pain, especially if the muscles are weak and untrained. This results in cervical problems, tension related headaches, vertigo, stiff neck, restricted or painful head rotation, musculoskeletal issues involving the shoulder and pelvic girdles, hips, and extremities.

The misalignment of the “atlas” may have secondary effects on the “axis” or the second cervical vertebra as well the other neck vertebra.  In fact, it also may affect the alignment of the thoracic and lumbosacral vertebra in a “domino effect.”

In this chain-reaction process, misalignment of the “atlas” may cause asymmetry of the entire, integrated skeleton, such as having one shoulder higher than the other or one side of the pelvic girdle being higher causing a leg length difference. In addition, it can cause scoliosis of the spine. Over time, these changes can lead to degeneration of the spine and joints.  Think about it!

Turmeric

Many of you take ibuprofen (n-said or non steroidal anti-inflammatory drug) to help manage the inflammation with your condition. Ibuprofen has a corner on the over the counter pain market, accounting for one third of the over the counter analgesics in the U.S. But this popular pill has serious risks, having been definitively linked to heart disease in a study last year. Fortunately, there are alternatives and one of best options is turmeric.

Turmeric is (Curcuma longa) a culinary spice used in the cooking of many cultures. It is a major ingredient in Indian curries, and makes American mustard yellow. Evidence is accumulating that this brightly colored relative of ginger is a promising disease preventative agent as well, probably due largely to its anti-inflammatory action.