September 2019

Arthritis is a broad term referring to greater than 100 rheumatic diseases. The two most prevalent types of arthritis are: Osteoarthritis (OA) and Rheumatoid Arthritis (RA). Osteoarthritis affects over 21 million people in the United States. Approximately 2.1 million people in the United States have Rheumatoid Arthritis

Osteoarthritis is the most common form of arthritis. It is a degenerative joint disease. A joint is a structure that allows movement at the meeting point of two bones. Cartilage is a firm cushion that covers the ends of the two bones, absorbing shock and enabling the bones to glide smoothly over each other. The joint is wrapped inside a tough capsule filled with synovial fluid. This fluid lubricates the joint and keeps it moving smoothly. In Osteoarthritis, the cartilage becomes brittle and breaks down. Deterioration of cartilage can lead to inflammation in the joint. Eventually, the cartilage breaks down so much that it no longer cushions the two bones. The most common joints affected are knees, hips, hands, and spine. The most common symptoms are stiffness, joint pain, and muscle weakness.

In Rheumatoid Arthritis, the second most common form of arthritis, the immune system attacks the tissues of the joints, leading to pain, inflammation, and eventually joint damage and malformation. It typically begins at a younger age than Osteoarthritis, causes swelling and redness in joints, and may make people feel sick, tired, and feverish. Also, the joint involvement of Rheumatoid Arthritis is symmetrical; that is, if one joint is affected, the same joint on the opposite side of the body is usually similarly affected. Osteoarthritis, on the other hand, can occur in a single joint or can affect a joint on one side of the body much more severely.

RA can spread to tissues surrounding a joint, causing bone and cartilage erosion, joint deformities, movement problems, and limitations in activity. Of particular importance to your trainers are the effects RA has on functional capacity, decreases in range of motion, muscle strength, and aerobic capacity.

The center for disease control states that strength training can reduce arthritis pain by 43%. Strength training is as effective as or better than medication.

Benefits of a resistance-training program include:

A. strengthens muscle groups around affected joints

B. offers protection and stabilization of affected joints

C. reduces mechanical stress that hasten cartilage degeneration

D. increases functionality

E. decreases pain

F. improves endurance

Another benefit of exercise as a treatment for arthritis is its positive effect on facilitating weight loss. Researchers in the Framingham Osteoarthritis study found that a weight loss of approximately 11 pounds decreased the risk for pain and stiffness by 50%.

The knee can experience an increase of three times a person's body weight during walking and five times body weight while going up or down stairs or when running.

Exercising an arthritic joint is important to:

a. Maximize the health of the cartilage

b. Maintain joint movement

c. Improve muscle strength.

Cartilage does not have a blood supply, so it relies on the synovial fluid moving in and out of the joint to nourish it and remove its wastes. Exercises that involve moving the joints through their range of movement will also help maintain flexibility that is otherwise lost as a result of the arthritis.

Pain associated with arthritis has a weakening effect on the surrounding muscles. However, by undertaking strengthening exercises, muscle weakness can be reversed. Strong muscles will support sore joints. Strength training is crucial to weight control; because individuals who have more muscle mass have a higher metabolic rate. Muscle is active tissue that consumes calories while stored fat uses very little energy. Strength training can provide up to a 15% increase in metabolic rate, which is enormously helpful for weight loss and long-term weight control.

Bottom Line: While strength training cannot cure Arthritis, it can be a critical component to managing pain and being able to thrive!

College and professional sports teams and individual world-class athletes are notorious for engaging in behavior that is both superstitious and nonsensical. Baseball players still use a weighted "donut" on their bat when swinging it in the on-deck circle prior to an at-bat. Basketball players often go through an extensive dribbling and ball handling routine prior to shooting free throws. For years, boxers and baseball players, in particular, were strongly discouraged from strength training. Boxing trainers (even the great Angelo Dundee, who trained Muhammad Ali and Sugar Ray Leonard) thought that weight training made fighters "muscle-bound" and slowed their reflexes. Old-time baseball people thought weight training would compromise a batter's swing and ability to hit. Fortunately, this has been disproven, and we now know that nearly every collegiate and professional athlete performs some form of strength training (although, not with our safe and effective exercise protocol) in order to enhance their performance and protect against injury.

Although attitudes about weight training have changed, most athletes and fitness enthusiasts still engage in some form of stretching as part of their routines. Is stretching a safe and necessary part of exercise and preparing for the rigors of sport? Let's take a closer look.

The most common form of stretching performed is static stretching. This involves holding a challenging but comfortable position for a particular muscle for a given length of time, often for between ten and thirty seconds. There is also what is called ballistic stretching, which involves the use of momentum to move (bounce) a limb or body part beyond its normal range of motion. Finally, there is what is called Proprioceptive Neuromuscular Facilitation (PNF) stretching, which is a more advanced form of stretching that involves both stretching and contraction of the targeted muscle group. During PNF stretching, the person will have a partner assist them by stretching the limb to a challenging position and hold it for a given length of time. The partner will then provide resistance while the person stretching actively pushes against it. Then the person stretching will be able to increase their range of motion and stretch that limb or body part further. This occurs because PNF stretching overrides the Golgi tendon organ, which is a proprioceptive sensory receptor organ that senses changes in muscle tension.

Now that we have an understanding of the different types of stretching, the question should be asked: is stretching, safe, effective, or necessary? In my opinion, no. Keep in mind that to this point, there has not been a properly conducted study that conclusively shows that stretching protects against or prevents injury. NFL football players stretch quite a bit before practices and games, yet hamstring pulls remain a very common injury. It's important to understand what happens during stretching. You're not only stretching your muscles, but you're also stretching connective tissue (tendons and ligaments). While muscles have elastic properties (the ability to change in length, like a rubber band), tendons and ligaments do not, since their primary function is to stabilize joints. Once a tendon or ligament is stretched, it does not return to its original length, thus it is put at greater risk for injury. Extreme amounts of flexibility are not necessary for performing normal life activities, and can be very dangerous. Many athletes that participate in sports and activities that involve extreme range of motion and flexibility, such as gymnastics and dance, have a greater risk for joint derangement, arthritis, and the necessity for joint replacement later in life. With this in mind, I believe that stretching in any form prior to a workout or athletic contest provides very little benefit and should be avoided (especially PNF stretching).

If stretching is unsafe and unnecessary, what should be done to warm up before a Total Results workout or before an athletic activity? In Super Slow-The Ultimate Exercise Protocol, Ken Hutchins discusses the three aspects of the warm-up, from a safety perspective. First, we want to fatigue the muscle safely enough to perform a maximum effort. Second, we strive for the lubrication of muscle bellies and tendinous sheaths so they can slide against neighboring structures. Lastly, we want to lubricate the joints with the release of synovial fluid from the synovial membranes and articular cartilage. A good example of this last point is how we often have clients perform the Leg Curl exercise just before they do the Leg Press. By performing a knee flexion exercise prior to a knee extension exercise, we ensure that the knee joint is properly lubricated and warmed up.

You do not need to perform a specific warm-up routine prior to a Total Results workout, since the first several repetitions of each exercise we do will serve as a much more thorough warm-up for your muscles and joints. You also do not need to stretch. While stretching can feel good, it is very easy to overdo it and put yourself in harm's way. In my opinion, stretching is a very overrated and romanticized component of fitness, and flexibility beyond normal daily activities is really unnecessary.

At Total Results, we are very conscious of having our clients work through a safe and pain-free range of motion on each exercise, which will safely enhance your flexibility. That being said, if you are preparing to participate in a sporting event or activity, you should perform some low level warm-up specific to the nature of the activity. If the sport is basketball, do a light jog and some moderate dribbling and shooting drills to get ready. If you're playing a round of golf, hit some easy shots off the driving range and do some putting. Regardless of which activity you pursue, it's important to stay hydrated, as dehydration can exponentially increase the risk of injury.

Hopefully this article explodes the myths about stretching. We want our clients to exercise safely and intelligently so they can get the most out of life. Our mission is your amazing. Let us show you the way!

The Compound Row is a staple of the Total Results exercise philosophy, and is one that encompasses a large amount of muscle. This exercise primarily involves the latissimus dorsi, rhomboids, posterior deltoids and trapezius muscles, with assistance provided by the biceps and the triceps. While the biceps and triceps usually perform opposite muscular functions (elbow flexion and elbow extension), in this case the long head of the triceps helps to stabilize the shoulder joint. We believe that it is important to perform an equal number of pushing and pulling exercises during a workout, in order to develop symmetrically and avoid muscular imbalances that can lead to injury. The Compound Row is a horizontal pulling movement that is often performed right after the Chest Press exercise in a Total Results workout.

Many of our clients have a variety of shoulder and elbow issues. The Compound Row is the most forgiving of the upper body exercises for the shoulder joint and the elbow joint, largely because the subject uses a neutral rather than a supinated grip. We have two different machines in our studio: one is made by MedX and one is by Super Slow Systems, and they are both outstanding. While both of these machines accomplish the same thing, there are subtle differences between the two. The MedX machine has articulating handles (to minimize elbow irritation), a stationary seat, an additional elevation pad, and the movement tracks in a slightly upward arc, while the Super Slow Systems machine has two fixed handles on each side (to accommodate people with a wider torso), a moving seat, rungs to place your feet upon, and a more horizontal movement. Both machines have a fairly radical resistance curve, meaning that the resistance feels very heavy when your arms are nearly straight, and it feels fairly light when your elbows are in the most flexed position. As I have mentioned in previous articles, this is based on leverage factors, and is something that most equipment manufacturers grossly miscalculate.

To properly enter the machine, shuffle carefully onto the seat rather than stepping over and balancing on one foot. This avoids unilateral loading of the pelvis and spine, which can cause serious injury. Seat positioning is determined by arm length; if you are set properly, the movement arm handles should just barely exceed your grasp. The torso pad is angled slightly forward; this will enable the subject to keep an upright posture and maintain contact between their sternum and the pad at all times. We often start the exercise in the most contracted position, and execute an interpersonal handoff to begin the exercise with the negative movement phase. The weight should be lowered (arms gradually straighten) until just prior to full elbow extension. A lower turnaround is then performed to begin the positive movement phase; think about pushing your sternum into the pad and depressing your scapluae (shoulder blades) as your elbows travel backward. Movement should slow down slightly prior to reaching the most contracted position. Once forward movement is no longer possible in good form (usually somewhere in the mid-range of the movement), a five to ten second thorough inroad should be performed to ensure a quality stimulus. The subject should then step back carefully to clear the edge of the machine and exit safely.

As I mentioned earlier the Compound Row exercise is typically the most forgiving on the shoulder and elbow joints of the four major upper body multiple-joint exercises that we perform at Total Results. It is really only contraindicated for women in the later stages of pregnancy, in which case we would have them just perform the Pulldown or substitute a Timed Static Contraction Pullover. The Compound Row is an essential exercise for maintaining the health and functionality of the thoracic postural muscles and vertebrae, and should be performed regularly as part of our comprehensive exercise philosophy for spinal health.

The relationship in exercise between dynamic movements and Timed Static Contractions (TSC) is something that is often discussed and debated. Is performing a dynamic movement a more effective way to inroad the musculature? Is TSC a safer and more efficient way to achieve maximum benefit? As Total Results instructors, we have many "tools in our toolbox" to help clients achieve their exercise goals, and we use both TSC and dynamic movements as needed. A closer look at both methods will give us a better understanding of when and why to use each one.

In our exercise protocol, a dynamic movement involves raising and lowering the resistance in approximately ten seconds (in each direction) through a safe, pain-free range of motion. This will continue until forward movement of the resistance in proper form is no longer possible, at which point the subject will continue to push for an additional five to ten seconds (thorough inroad). This is done to stimulate the body's growth mechanism, and given adequate sleep, hydration, nutrition, and sufficient time, will result in increases in strength, metabolic and cardiovascular conditioning, maintenance of insulin sensitivity, enhanced flexibility, and greater resistance to injury. There are only two objective measurements of muscular effort: zero and 100 percent. While we still do not know and cannot measure what the exact percentage of effort is required to stimulate the growth mechanism, we do know that putting forth zero effort accomplishes nothing of value. That means that in order to be certain that we have created an adequate body stimulus, we should put forth 100 percent effort. It is fairly easy to know that 100 percent effort has been put forth on a dynamic movement because forward movement of the movement arm is no longer possible in proper form. This means that your muscles' force output has dropped below the weight selected on the weight stack. It is also much more objective to track progress with a dynamic movement because you have a weight value and time under load (TUL)/number of repetitions to record on the subject's chart. While those are certainly not the only means of measuring progress, they are two of the more important markers in terms of determining exercise frequency and volume.

Timed Static Contraction involves contracting the targeted musculature without producing any movement. It is an outgrowth of the old isometric (the joint angle and muscle length do not change) exercise concept, but applied in a much safer manner. It can be done with our exercise machines or with other equipment (for the Abduction and Adduction exercises we use a yoga strap and a foam roller, respectively). A TSC exercise will last 90 seconds and will involve three stages of effort. In the first stage, the subject will take a few seconds to slowly ramp up to a 50 percent effort (a contraction that would probably be unpleasant to sustain for more than a few minutes); the second stage will involve slowly working up to approximately a 75 percent effort (almost as hard as you dare); the final stage will have the client slowly work up to a 100 percent effort (as hard as you dare). To guard against potential injury, the instructor should always phrase the instruction in precisely that way, rather than "as hard as you can." The subject should exercise good judgement in interpreting and following through on these instructions. The major drawback to TSC, at least as we utilize it here at Total Results, is that there is no way to objectively measure force output, which means that tracking progress is mostly subjective. Ken Hutchins, who invented our exercise protocol, has developed exercise machines that have both digital and analog computer feedback which can quantify a number value for force output and objectively measure progress. Ken works with many clients that are severely debilitated, and has been able to achieve some pretty amazing results with these machines. While I have never used these machines before, I have read extensively about them and would love to experience them for myself.

Which is the better way to go? Both dynamic movements and Timed Static Contractions are valuable tools to use with a variety of exercise subjects. That being said, I prefer to use a dynamic movement whenever possible. Regardless of which method we use, the primary objective of exercise is to inroad the musculature as safely and thoroughly as possible in minimum time. Your muscles' main function is to produce force; they don't really know or care if they are making a movement arm move. While TSC can be beneficial in working around many joint issues (such as shoulder problems), we can do similar things while using dynamic movements, like gapping the weight stack to alter starting or ending positions and limiting range of motion. This is where you can use trial and error and do a cost/benefit analysis. Sometimes avoiding or minimizing joint pain by using TSC outweighs not being able to objectively measure progress on a given exercise. When going from TSC back to a dynamic movement after an extended period of time, one should expect to use a lower weight on that exercise due to a loss of skill. I have recently transitioned a few long term clients from TSC back to a dynamic movement on the Seated Leg Curl exercise; they had originally switched to TSC due to knee pain. I admit that this is a very small sample size, but I'm happy to report that all three clients have performed extremely well and have experienced no knee pain.

Working to build strength is the most effective way to minimize joint pain and increase functionality. Maintaining the ability to move is a key factor in one's quality of life as we age. Both dynamic movements and Timed Static Contractions are important tools in the Total Results instructor toolbox to help you achieve your goals and get the most out of life. Get started today!