Monthly Archives: July 2011

Easing Into Your Exercise: The Warm Up

One thing that keeps you running, besides good shoes and the gumption to get out of bed, is a good warm up. The warm up is less exciting than shoe technology or finding your zone, but just as integral to your success as a runner.

The type of warm up you do is dependent on the type of activity you are about to embark upon. The warm up for a runner is different than for a tennis player. The primary goal of any warm up is injury prevention. You also get the benefit of less discomfort during the activity after a good warm up.

The first principle of warming up is a gradual increase in intensity of the activity. Walk before you run, if you will. There are a number of adaptations the body must make to go from its idling state to a higher performance level. The circulatory system must ramp up the blood supply. As your heart beats faster, blood supply is shifted to the working muscles and to the central circulation where it is used most efficiently.

The lungs, like the heart, increase both the rate of respiration and the depth of respiration, providing for increased oxygen needs.

All this activity is very good for your body and spirit. The hiccup is in going from a “body at rest” to “a body in motion.” That is perhaps not too surprising, as almost nobody starts their car on a cold morning, then “floors-it.” You would expect to see engine parts coming out your tailpipe. You would prefer not to have this happen to your body.

There is good evidence that a “cold” body is at greatest risk of injury. Studies have shown that back injuries occur more frequently when someone bends at the waist for the first time of the day. We all have experience with pulling a muscle simply doing a big stretch when yawning in the morning. Cold muscles injure easily.

The cardiovascular warm up is straightforward. For a runner it is as easy as a brisk walk for a block or two before running hard. If it’s cold out, some calisthenics indoors can get blood moving before charging outside for your run.

The stretching part of a warm up is much more controversial. More vigorous stretching to elongate muscles and stretch joint capsules has become much less popular among exercise physiologists as some studies show this increases injuries.

Static stretching – steadily reaching for your toes – gradually elongates muscles by continuous pressure. This type of stretching still is favored by many to prevent injuries.

Bounce stretching, colorfully named “ballistic stretching,” has totally fallen out of favor. This type of stretching is where you actively bounce against the limits of your range of motion, to increase it. The bouncing is more likely to hurt you.

Consider making an appropriate warm up part of your exercise routine. Your body will appreciate the few minutes of TLC while coming up to operating temperature. Your injuries will be fewer and your miles will be more enjoyable.

Stay well

Dr B (aka Dr Don Bucklin).


Preventing Arthritis and Giving Your Joints a Break

Degenerative joint disease, or osteoarthritis, is the leading cause of disability in the United States, with some 27 million people affected.

To get more information on this disease, let’s start with some background.

Bones are covered by cartilage anywhere they rub against each other (joints). The end of a bone is kind of like a Tootsie-Pop, where the candy outside is cartilage and the Tootsie Roll center is the bone. Unfortunately, the cartilage is much thinner than the candy on a Tootsie Roll pop. This cartilage is slippery like a Teflon coating, and is what keeps the bones from rubbing together. As long as the cartilage is in good condition on both sides of the joint, there is no abnormal joint wear and no pain. Life is good.

Fast forward to age 65 and things are changing.

80 percent of 65 year olds have joint degeneration that is visible on an X-ray. One of the things that happens to cartilage as it ages is it becomes dehydrated. I guess drying out as you age is no great surprise. When cartilage dries out, it becomes less slippery and more fragile. Thus, relatively modest trauma that a young joint would tolerate can easily injure an older joint.

Degenerative arthritis is an outcome that is the common endpoint to a number of insults to joints.

There is clearly a hereditary side to this problem, with an estimated 60 percent of osteoarthritis inherited. Other causes of arthritis are due to damage to the joint, specifically damage to the cartilage covering the bone. Trauma to the joints through activities such as high velocity contact sports frequently results in joint injuries. This is common enough that people sometimes refer to an arthritic knee as a “football knee.”

Other causes of cartilage damage are infection or gout. Infection breaks down the cartilage and can do devastating joint damage. Gout causes uric acid crystals in the joint that work like sandpaper. Joints that have unusual stress on them are frequently damaged. This is the cause of osteoarthritis of the spine in someone with moderate scoliosis (curvature of the spine). Obesity also puts abnormal stress on joints sometimes causing premature failure.

What doesn’t cause joint damage is at least as interesting as what does.

Running for exercise doesn’t cause degenerative joint disease of the knees. Cracking your knuckles does not cause arthritis of the hands. Most researchers see no correlation between physical labor and osteoarthritis unless accompanied by joint injury.

So it seems more “use it or loose it” than “don’t wear it out.”

Prevention is all about maintaining the cartilage covering of bone in good condition. Picking your parents would be a good start. There is limited data that glucosamine, commonly available in vitamin stores, can rehydrate cartilage. This works pretty well on paper, but has not yet shown benefit in any big study. While we are talking magic supplements, I can say with complete confidence that chondroitin is absolutely no use to any joints; except the sharks.

So stay active, this has been shown to both lessen arthritis pain and slow down the damage. Keep yourself lean. Maybe add glucosamine to your vitamin list, and think twice about pursuing professional hockey or skydiving as a vocation.

I may be somewhat of an expert. I have 1,300 skydives – and the arthritis – to prove it.

Take care

Dr B (aka Don Bucklin).

Staying Safe in Extreme Heat

When sustained heat waves hit a region, heat related injury and health ramifications can be serious, including sunstroke and even major organ damage due to heat.

According to the Center for Disease Control, extreme heat is blamed for 700 deaths each year in the U.S. They tend to happen in small epidemics when we are confronted with heat waves as we are experiencing this time of year. Some experts predict this may be more commonplace due to overall global climate changes.

Heat exhaustion is a relatively common reaction to severe heat and includes symptoms such as dizziness, headache and fainting. If left untreated, it can progress to heat stroke. When severe, it requires medical attention. The severe form manifests when someone can no longer cool their body after profuse sweating, leading to dry skin, a body temperature above 103 degrees Fahrenheit, heat rash, muscle cramps, confusion and sometimes unconsciousness. Profoundly dangerous effects to the central nervous system and circulation can happen quickly when warning signs are ignored.

Humans cope with heat by expelling some heat through their breath and perspiring. The evaporation of moisture off the surface of our skin dissipates the internal heat. High humidity makes this very difficult because the cooling effect is seriously impaired. The published Heat Index estimates how it feels and how much the humidity can increase the effect of a given temperature, which can be 15 degrees or more when humidity is high.

Urban areas are known to be “islands of heat.” The vast amount of concrete and asphalt absorbs and radiates the heat to a great extent. The increased density of people and heat producing machinery put urban dwellers at much greater risk than their rural counterparts. This is particularly dangerous when a heat wave lasts more than two days. The nights do not cool down due to the stored heat and people do not get a break from the prolonged heat. More urban heat related deaths occur at night.

Who is affected most?

Elderly, the very young, people with chronic illness are most vulnerable. Some medications may make people more sensitive to the heat (diuretics, beta blockers, mental health meds) Discuss your concerns with your physician to see if any special precautions are recommended. But even healthy people who have to work or exercise in extreme heat are subject to dangerous effects.

The single most helpful thing you can do in extreme heat is spend several hours a day in air conditioning. If you do not have air conditioning, plan to spend time with someone who does. Many public buildings are available that have climate control such as libraries, schools, shopping malls, coffee shops. Fans do help with the evaporation/cooling process. They can also be more detrimental when simply blowing more hot air around. It can be comparable to a convection oven, magnifying the bad effects of the heat. During periods of extreme heat stay indoors and avoid direct sun. Slow down and avoid strenuous activities.

Even healthy, well-conditioned athletes are vulnerable to dangerous effects of heat.

What can you do?

If you have to work outside you need a plan — wear loose fitting, lightweight, light colored clothing. Use a wide brimmed hat to protect the head and face. Drink plenty of fluids. Water is the best. Alcohol and caffeinated beverages should be avoided as they can make things worse. Eat light food in smaller amounts but more often. Take frequent breaks to get out of the direct sun and catch up on fluids. Water consumption is top of the list. Two liters a day is a good start for a normal healthy person. In extreme heat the need goes up dramatically. Some sports drinks without caffeine can be suitable but should not be the sole source of fluid replacement.

With only a small bit of planning and common sense you can survive the heat wave comfortably and safely.

Dr. Bruce Kaler

On the Issue of Men’s Health

I always feel a bit undemocratic when discussing the heath concerns of a particular group, even so large a group as men, given the amount of disease and pestilence affecting us all. But men do have reason for concern as demonstrated by the following fact:

Of the 15 leading causes of death, men have higher mortality rate from every single one of them. Men have a disproportionate risk of death from heart disease to suicide, from cancer to tuberculosis.

Interestingly, men’s health in the medical literature is concerned with diseases of the genitalia and testosterone. Men’s heath in the popular culture has embraced a much larger definition, largely been shaped by publications like Men’s Health Magazine. This is published in 44 languages and distributed world-wide; that’s a lot of influence. Men’s health here is concerned with fitness, nutrition, male specific disease and disparate risk of disease, sexuality and the celebration of youth.

Men lose 0.5 to 1% of their skeletal muscle every year after age 25. Your only salvation is exercise. Fitness in men’s health is strength and muscle development, think the Old Spice advertisement. Jack Lalanne (1914-2011) is considered the godfather of fitness. The story goes in a body building contest: when he was 54, Jack beat Arnold Schwarzenegger (who was 21 at the time). Arnold quipped that “Jack Lalanne’s an animal.” Higher praise does not exist in Arnold’s vocabulary. Strength building is based on the following simple principal. Exercise a muscle to exhaustion (fatigue), rest, and repeat. The damage done to the muscle forces it to rebuild bigger and stronger.

Muscle strength is associated with quality, not quantity, of life. Hard spent hours in the weight room won’t make you live much longer, but you will live better. We are not talking about the attention given to quality biceps here. We are talking about function and ability. For example, elderly men in wheelchairs, sometimes for years, were put on strength training program. Much to everyone’s surprise, a serious (coached) physical strengthening program can actually give these men the ability to walk again. Throwing away the wheelchair must feel almost miraculous. How much better is your life when you can park the wheelchair and take care of yourself? Loss of strength is a common result of any number of diseases and the disability may be as much the weakness as the disease. The weakness can be improved with strength training.

Aerobic exercise is what makes you live longer.

The accepted ideal goal is to exercise 3-5 times per week for 20-60 minutes at an intensity achieving a heart rate of 65-90% of maximum (220 minus your age). Regular aerobic exercise has been proven to prevent and treat hypertension, obesity, coronary artery disease, hyperlipidemia, type 2 diabetes, insomnia and depression. The World Health Organization (WHO) estimates lack of exercise is responsible for 17% of the heart disease, 10% of the colon and breast cancer, and 12% of falls (weak legs) experienced.

As to the disparate risk of death, we need a book, not an essay to approach this in any reasonable way.

In short, start by looking for the common element in this list of the 15 leading causes of death. The one that immediately comes to mind is blood vessel disease in at least half of the list. That we can work with. Most of what goes into blood vessel disease is under our control. Blood pressure, cholesterol, weight, diet, exercise, stress and smoking are under your control. Can’t do much about family history, but you can add a glass of red wine.

Ultimately, men’s health is a subset of human heath. Many of the same life style decisions plague humans of all sexes. These decisions stand between taking control of your health and going along for the ride. Men, it would seem, are particularly suited to taking control of their health.

Take care
Dr B (aka Dr Don Bucklin).

The Doctor Is …. Out: California’s Inland Empire Region Faces Primary Care Physician Shortage

The San Bernardino Sun recently detailed the increasing demand for primary care physicians and the effort to draw new doctors to that role.

San Bernardino Sun
The Doctor Is … Out

Jim Steinberg, Staff Writer

San Bernardino/Riverside counties have a significant physician shortage of about 3,000, according to local medical school officials.

While the situation has not yet reached crises for the area’s larger cities, medical experts have concerns about the future, when a series of events could push current shortage levels into unhealthy territory.

To continue reading: