Exercise – 5 Posts
Goals of Therapeutic Exercise
Enable ambulation
Release contracted muscles, tendons, and fascia
Mobilize joints
Improve circulation
Improve respiratory capacity
Improve coordination
Reduce rigidity
Improve balance
Promote relaxation
Improve muscle strength and, if possible, achieve and maintain maximal voluntary contractile force (MVC)
Improve exercise performance and functional capacity (endurance)
The last 2 goals mirror an individual’s overall physical fitness, a state characterized by good muscle strength combined with good endurance. No matter which types of exercise may be needed initially and are applied to remedy a patient’s specific condition, the final goal of rehabilitation is to achieve, whenever possible, an optimal level of physical fitness by the end of the treatment regimen.
(taken from Medscape)
Intense Exercise, Muscle Soreness, Recovery, and Anti-inflammatories
Rehab Deb’s Comments: One of the most important bits of this report is something I’ve been reading more and more research regarding, and that is that nsaids (non-steroidal anti-inflammatories) stifle the healing process. I have also read several reports regarding the same and ice. Nsaids in animal medicine include Previcox, Deramaxx, Rimadyl, Metacam, etc…and for humans include Advil, Ibuprofen, Motrin, Tylenol, Aspirin, Aleve (sodium naproxen), etc…Does this mean to cut them out altogether? NO…it means think about the application, and possibly combine smaller doses of several analgesics, depending on the issue, rather than higher and continuous doses of nsaids.
This is only one suggestion.
Ultimately this should be discussed with the medical practitioner who prescribed the meds in the first place. There are other reasons to minimize nsaids and use Tramadol and/or Gabapentin and/or other analgesics to alleviate pain for the short run while building muscle to support damaged joints. Many practitioners are aware of using these other drugs, and while they may not know about this more recent news regarding nsaids delaying healing and muscle growth, which came out of human sport science, vets seem to be interested in the information when it is presented to them.
Article from Dr. Gabe Mirkin’s Fitness and Health E-Zine
May 6, 2012
How to Recover from Muscle Soreness Caused by Intense Exercise
Muscle soreness should be part of every exercise program. If you don’t exercise intensely enough on one day to have sore muscles on the next, you will not gain maximum fitness and you are also losing out on many of the health benefits of exercise. The benefits of exercise are much greater with intense exercise than with casual exercising.
You must damage your muscles to make them grow and become stronger. When muscles heal, they are stronger than they were before you damaged them. All athletes train by “stressing and recovering”. On one day, they take a hard workout in which they feel their muscles burning. Eight to 24 hours after they finish this intense exercise, their muscles start to feel sore. This is called Delayed Onset Muscle Soreness (DOMS). Then they take easy workouts until the soreness is gone, which means that their muscles have healed.
DOMS IS CAUSED BY MUSCLE DAMAGE. Muscles are made up of fibers. The fibers are made up of a series of protein blocks called sarcomeres that are lined in a long chain. When you stretch a muscle, you stretch apart the sarcomeres in the chain. When sarcomeres are stretched too far, they tear. Your body
treats these tears in the same way that it treats all injuries, by a process called inflammation. Eight to 24 hours after an intense workout, you suffer swelling, stiffness and pain.
The most beneficial intense exercise program is:
* severe enough to cause muscle pain on the next day, and
* usually allows you to recover almost completely within 48 hours.
ACTIVE, NOT PASSIVE, RECOVERY: When athletes feel soreness in their muscles, they rarely take days off. Neither should you. Keeping sore muscles moving makes them more fibrous and tougher when they heal, so you can withstand greater forces and more intense workouts on your hard days. Plan to go at low intensity for as many days as it takes for the soreness to go away. Most athletes try to work out just hard enough so that they recover and are ready for their next hard workout in 48 hours.
TIMING MEALS TO RECOVER FASTER: You do not need to load extra food to recover faster. Taking in too much food fills your muscle cells with fat, and extra fat in cells blocks the cell’s ability to take in and use sugar. Sugar is the main source of energy for your muscles during intense exercise. Using sugar to drive your muscles helps them to move faster and with more strength. Timing of meals is more important than how much food you eat. Eating protein- and carbohydrate-containing foods helps you recover faster, and the best time to start eating is as soon as you finish a hard workout. At rest, muscles are inactive. Almost no sugar enters the resting muscle cell from the bloodstream (J. Clin. Invest. 1971;50: 2715-2725). Almost all cells in your body usually require insulin to drive sugar into their cells. However during exercise your muscles (and your brain) can take sugar into their cells without needing insulin. Exercising muscles are also incredibly sensitive to insulin and take up sugar into their cells at a rapid rate. This effect lasts maximally for up to an hour after you finish exercising and disappears almost completely in around 17 hours. The best time to eat for recovery is when your cells are maximally responsive to insulin, and that is within a short time after you finish exercising. Not only does insulin drive sugar into muscle cells, it also drives in protein building blocks, called amino acids. The sugar replaces the fuel for muscle cells. The protein hastens repair of damaged muscle. Waiting to eat for more than an hour after finishing an intense workout delays recovery.
WHAT TO EAT AFTER YOUR INTENSE WORKOUTS: Fatigue is caused by low levels of sugar, protein, water and salt. You can replace all of these with ordinary foods and drinks. If you are a vegetarian, you can replace your protein with combinations of grains and beans. You can replace carbohydrates by eating
virtually any fruits, vegetables, whole grains, beans, seeds and nuts. A recovery meal for a vegetarian could include corn, beans, water, bread, and fruits, nuts and vegetables. If you prefer animal tissue, you can get your protein from fish, poultry,or meat. Special sports drinks and sports supplements are made from ordinary foods and therefore offer no advantage whatever over regular foods.
BODY MASSAGE: Many older studies have shown that massage does not help you recover faster from DOMS. Recently, researchers at McMaster University in Hamilton, Ontario showed that deep massage after an intense workout causes muscles to enlarge and grow new mitochondria (Science Translational
Medicine, published online Feb, 2012). This is amazing. Enlarging and adding mitochondria can help you run faster, lift heavier weights, and even prevent heart attacks and certain cancers.
NSAIDS DELAY DOMS RECOVERY: Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may help relieve pain, but they also can block muscle repair and delay healing.
HOT BATHS: Most research shows that a hot bath is not much better than doing nothing in helping muscles recover from exercise (European Journal of Applied Physiology, March 2006) (RehabDeb’s comment: On the other hand, Epsom Salts Soak/Bath works well for humans and the dogs and cats I’ve encouraged toward that therapy. Of course, this is more than “just” a hot bath…)
COLD OR ICE BATHS: A recent review of 17 small trials, involving 366 participants, showed a minor decrease in DOMS with ice water baths. They found “little quality research” on the subject and “no consistent method of cold water immersion” (Cochrane Library, published online February 15, 2012). Cold water immersion can reduce swelling associated with injury, but has not been proven to speed the healing of DOMS.
Water Treadmill is Not Necessary for Rehabilitation
Compared to the number of dogs in the world, then compared to the number of ruptured cruciate ligaments on aforementioned dogs, then compared to the number of said dogs with ruptured ligaments who are treated by a veterinarian, then compared to the number of those dogs who are taken to surgery for structural remedy, there are relatively very few rehab clinics in the world and fewer still water treadmills.
Dogs of the world do relatively “ok” on all areas of the treatment spectrum and definitely do not need to be “put down” due to ruptured cruciate ligament (torn ACL, CCL). I have encountered clients in my practice who were told unless they had surgery, the dog would have to go. Just wanted to clear up that situation.
That being said, and along with explaining the title of this blog, of foremost importance I will note that I came into veterinary functional rehabilitation with approximately 25 years experience in human sport science and nutrition. I decided to call my practice “functional rehab”, not having seen that designation applied much but having presumably heard the term somewhere. I decided to use it when I began an independent, mobile rehab practice in 2007, two years after starting and running a rehab clinic for a veterinary specialty hospital.
I became aware of the water treadmill via my work at the hospital, and I found that the use of it was/is widely promoted within veterinary medicine and the canine rehab model, which draws heavily from structured, academic-oriented, human physical therapy concepts. I think the overall concept is decent, yet the wtm is one very, very small tool in the vast array of protocol and modalities that exist in order to better the health of your pet.
Unfortunately, I found that what is not taught within this same model is a good basis and understanding of program design, writing training programs, and the development of dynamic activities/protocol designed to encourage healing and increase muscle and bone mass. These are principles I began learning over 30 years ago as an athlete, as a self-coached athlete, and then as a coach and trainer to others, even world-class athletes.
What does this mean to you and your pet (primarily dogs…)?
The chief complaint I hear from people who contact me is that they were referred to this clinic or that one for post-surgical rehab, and after many weeks of walking in the treadmill, moving around on balls, and doing a variety of other things, the dog is not much better or is not to a place where the owner feels comfortable with letting them be loose and rambunctious. They aren’t where the owner thought they would be after surgery. When I was in a clinic setting and working on utilising the wtm we had, I did structure the workouts to be progressively difficult, using a 3x workout adjustment protocol, meaning that if three workouts went well, then I changed the protocol, making the workout more dynamic. This could be done by increasing time or lowering water in the tank. Since I do not believe that much benefit is realised by walking in a wtm more than 20 min., and some data is published to recommend that animals not be worked beyond that time anyway, I find more benefit realised by lowering the water height, thus increasing the force on the joint/leg/muscle/bone.
HOWEVER, I also find that after very many years of reading many, many reports in sport science and regarding functional return to activity, the best benefit is realised via gravity-based, slow, structured exercise protocol, and I began developing that for small animal rehab since I did not find any published when I arrived on the scene.
Your dog will use their leg to some extent and increasingly after surgery if he/she is not in pain. That has been my finding after working with hundreds of cases. With that in mind, a structured workout program is entirely necessary and may vary from any standardized protocol depending on the nature of the dog and the owner.
If your dog is not using the leg within 2-3 days after surgery, then my findings are always that they are in pain, and that they are in pain due to 1) not enough post-op analgesic, which I believe should be a combo of at least two analgesics for potentially several weeks while we pursue the best activity and homework for healing (in this area we commonly use an nsaid and Tramadol); 2) infection, the pain of which will only be finally remedied by antibiotics (and subsequently the infection remedied as well); or 3) structural abnormality, i.e. some sort of failure related to the surgery, yet not necessarily the surgeons/your/your dogs *fault*.
The homework protocol I generically recommend is contained elsewhere in this blog. If you are within range of my services, I recommend you contact me for an evaluation appointment and we establish a base for your dog and then you perform the exercises which will bring solid healing while helping to also protect the opposing limb.
Thank you!
The Exercise Cure
How can we motivate people to take a free, safe, magic pill?
By Jordan D. Metzl
“Lack of fitness is the public health epidemic of our time,” says Bob Sallis, past president of the American College of Sports Medicine.
If there were a drug that treated and prevented the chronic diseases that afflict Americans and we didn’t give it to everyone, we’d be withholding a magic pill. If this drug was free, in a country that spends more than $350 billion annually on prescription drugs, where the average 80-year-old takes eight medications, we’d be foolish not to encourage this cheaper and safer alternative as first-line treatment. If every doctor in every country around the world didn’t prescribe this drug for every patient, it might almost be considered medical malpractice.
We have that drug today, and it’s safe, free, and readily available.
Exercise has benefits for every body system; it is effective both as a treatment and for prevention of disease. It can improve memory and concentration, lessen sleep disorders, aid heart disease by lowering cholesterol and reducing blood pressure, help sexual problems such as erectile dysfunction, and raise low libido. Exercise does it all. Even with cancer, particularly colon and recurrent breast cancer, the data show clearly that exercise is a deterrent. Newer studies on a glycoprotein called Interleukin 6 suggests that general body inflammation, a factor in almost every chronic disease, is reduced by regular exercise.
Even the most challenging cases of obesity can be helped with the right incentives.
The United States currently spends more than $2.7 trillion, roughly 17 percent of GDP, on a health care system that is financially incentivized to treat disease. The more tests that are run on patients, the more medicines that are dispensed, the more procedures that are performed, the greater the financial burden for us all. Despite far outspending any country in health care, the United States is currently ranked 28th in life expectancy. Our current system does very little to encourage preventive health care. We are mortgaging our country’s financial future to pay for increasingly expensive treatments for the same diseases we could effectively delay or prevent.
Professionally and personally, I have made dispensing the drug of exercise a large part of my life. I treat limping and hobbled athletes of all ages in my sports medicine practice at the Hospital for Special Surgery in New York City. My waiting room is filled with 8-year-old gymnasts to 80-year-old marathoners, all wanting one thing: movement. My job is to fix their aches and pains and to keep them going. Before and after work, I am one of them, an avid athlete who has run 30 marathons and 11 Ironman triathlons. I’m what you might call an exercise fanatic.
There probably is such a thing as too much exercise, but I’m much more worried about inactivity. As my colleague Bob Sallis, past president of the American College of Sports Medicine, says, “Lack of fitness is the public health epidemic of our time.”
Seventy percent of Americans are overweight, 30 percent are obese, and only a very small fraction exercise for the 150 minutes per week recommended by the American Heart Association. What can we do to motivate them?
In a recent study, Kevin Volpp from the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania took 56 morbidly obese, middle-aged, male participants and studied systems to incentivize weight loss. In the world of obesity, morbidly obese men are tough customers; it’s very difficult to get them to change their behavior patterns. Obesity and related conditions and diseases, including high blood pressure, diabetes, and high cholesterol, account for more than 50 percent of annual health costs in the United States. Solving the obesity epidemic is the key to reducing health care costs.
Volpp randomly divided subjects into three groups: a control group and two financially incentivized groups, in a study in which the goal was to achieve a 16-pound weight loss over 16 weeks. The control group was weighed at regular weekly intervals with no financial reward. One financially incentivized group was given a fixed sum of money weekly that they could win if they hit their target weight-loss goal per week, and the other group was enrolled in a lottery system in which they had the chance of winning smaller or larger amounts of money but could qualify for payment only if they hit their weekly weight goals. Subjects from all three groups were educated on the role of exercise and nutrition for weight loss at the beginning of the study. After 16 weeks, both the fixed payment and lottery system subjects had lost more than 16 pounds while the control group had not. The financial incentive was relatively small, averaging $350 in total payments over 16 weeks. This isn’t a long-term solution: Four months after the study’s completion, most subjects had returned to their prestudy weight. But it shows that even the most challenging cases of obesity can be helped with the right incentives.
In the United States, we routinely incentivize behaviors deemed conducive to a highly functioning society. Financial incentives encourage marriage, having children, owning property, even accruing debt. As much as we believe we are free to choose, Big Brother’s tax code is pulling our strings from above. I’m not arguing that this is poor policy. On the contrary, encouraging favorable behavior for the greater good helps keep the fabric of our society together and the wheels of our economy turning.
When I began writing The Exercise Cure, my thought was to provide a guidebook to encourage healthy behavior. Having investigated the correlation between disease and fitness, I now believe that we can save billions of health care dollars by incentivizing movement. Rather than mortgage our financial future on a bloated health care system that isn’t doing a very good job of making us healthy, we’d be much better served by incentivizing people to get off the couch. Ideas to make this happen include lowering health care premiums based on activity levels: The more steps you take per month or year, the less you pay. This doesn’t have to be large amounts of money—even a little bit of incentive goes a long way. We also should encourage the use of a fitness vital sign for annual medical checkups where the amount of physical activity that someone is doing per week is monitored in the same way heart rate and blood pressure are. These methods will help encourage movement and health and will reduce disease prevalence.
I can’t promise you that if you work out daily you won’t get sick. I’m also not suggesting that exercise cures all ills. Genetics, chance, socio-economic, and other factors clearly play significant roles in affecting health profiles. What is becoming increasingly apparent, however, is that the drug called exercise can help prevent, alleviate, or treat almost every disease state. I hope my book inspires you to take it for yourself.
Jordan D. Metzl, MD, is a sports medicine physician at the Hospital for Special Surgery in New York. His newest book is The Exercise Cure. Follow him on Twitter.
Anecdotal Progress
Exercise is thought to have beneficial effects on Parkinson’s disease. Jay L. Alberts, Ph.D., neuroscientist at the Cleveland Clinic Lerner Research Institute in Cleveland, saw this firsthand in 2003 when he rode a tandem bicycle across Iowa with a Parkinson’s disease patient to raise awareness of the disease. The patient experienced improvements in her symptoms after the ride.
“”The finding was serendipitous,” Dr. Alberts recalled. “I was pedaling faster than her, which forced her to pedal faster. She had improvements in her upper extremity function, so we started to look at the possible mechanism behind this improved function.” As part of this inquiry, Dr. Alberts, researcher Chintan Shah, B.S., and their Cleveland Clinic colleagues, recently used fcMRI to study the effect of exercise on 26 Parkinson’s disease patients.”
The above is a quote from an article regarding research looking at the benefits of exercise for Parkinson’s patients, found on Science Daily dot com, and as I read it this morning, I thought it to be a perfect example of the practice protocol I have developed that has proved beneficial for several orthopedic conditions in lieu or surgery…whatever reasons one might have for not having surgery performed on their pet.
I am one person working alone, however I have over 30 years background and experience in principles of human sport science, exercise physiology, program design, and the like. There are a few others with similar backgrounds working in veterinary rehabilitation. I began using simple principles based on years of experience, and I’ve seen much success, as evidenced by improved quality of life, improved function, and veterinary professional confirmation.
I don’t have money to drive clinical research, and while I have ideas of those whom I could approach to get involved with this research, I am busy in my practice and haven’t wanted to take the time aside to pursue grants or corporations. At some point I intend to write more about the beneficial outcomes and to further discuss cases, however in the meantime, take the first paragraph as affirmation that science is observation of a particular outcome or experience as well as the steps to prove what we imagine/postulate/thought we observed.
It has been proved anecdotally time and again that when the conservative and slowly progressive non-surgical interventions I have outlined in the homework discussions on this site and/or in my books are followed within the parameters I outline, improvement of the condition ensues, barring extenuating circumstances. I do not see the discussion as being whether surgery or no surgery is better; I present the protocol I use as beneficial guidelines instead of not giving a program of recovery to those who choose to wait or altogether forego surgery for some conditions.
In other words, for injuries and conditions that are not “life or death”, the fact is there are very many people who will not choose surgery for their pet (or for themselves, for that matter). The instead-of-surgery protocol I develop and use fills a need to help the pet recover.
Keep moving forward; there is no time constraint on the “one step at a time” methodology…you can always begin, again, now.
Blessings-
Filed under: HOMEWORK SUGGESTIONS FOR FUNCTIONAL REHAB, QUALITY OF LIFE Tagged: exercise homework for animal rehab, exercise is healing, quality of life, water treadmill animal rehab
