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In today’s world, it is considered common knowledge that a healthy diet and regular exercise will improve your quality of life. Whether you are an elite athlete, a grandma, a high-school athlete, a teacher, or an accountant, proper diet and exercise will help you lose weight, maintain a healthy weight, and reduce the risk of numerous chronic diseases such as heart disease, diabetes, hypertension, and much more. Many people are under the misconception that to eat healthy one must count calories, buy expensive foods, and that they will never get to eat “pleasure” foods. Similarly, in regard to exercise, many people think they need a gym membership and hours of extra time each day dedicated to being physically active. Unfortunately, these are all factors that stop people from eating healthy and exercising and most of them are not true! The best thing a person can do to start eating a healthy diet and to sustain a regular exercise plan is to become educated about the benefits of each. Following are the latest diet and exercise recommendations to maintain a healthy lifestyle.


Proper nutrition is a key component of a healthy lifestyle, which includes energy levels, mental, and emotional health. To function in daily life, one must have energy. Carbohydrates, proteins, and lipids (fats) are the sources of energy for the body. Vitamins, minerals, and water are also required for the regulation of the functionality of the body.

Carbohydrates (CHO)
The majority of dietary CHO is derived from plant sources, primarily grains, seeds, fruits, and to a lesser extent, vegetables. In a practical context, the most common forms of dietary CHO are from simple sugars, such as soft drinks, candies, and cereals high in sugar. Although high in caloric content, these types of foods provide little in the way of other nutrients. These refined sugars lack vitamins, minerals, and fiber. A superior form of dietary CHO is derived from eating whole-grain cereals, whole-grain breads, and fruits. The CHO in these foods is in the form of starch, commonly known as the complex carbohydrates. These complex carbohydrates typically contain dietary fiber which may lower cholesterol absorption and is beneficial to the digestive tract.1

Recommended daily amount of CHO: The recommended percentage of CHO in the diet should range between 60% and 70% of the total calories consumed daily, depending on the amount of exercise performed that day. One gram of CHO is equivalent to four calories of energy.1

Food sources: whole grain breads, whole grain pastas, whole grain cereals, bagels, starchy vegetables, legumes, and oatmeal.

Proteins produce as much as 10% to 15% of the energy requirements for activity. The body is capable of synthesizing protein. However, of the 20 amino acids required to construct the body’s proteins, only eight can by made by the body, therefore, protein must be ingested in the diet. Proteins are vital to metabolic functionality, cell functions, immune responses, and energy production. Proteins are often referred to as the building blocks of the muscles in the body and they also help in regeneration.1

Recommended daily amount of protein: The recommended percentage of protein in the diet should range between 10% and 15% of the total calories consumed daily. One gram of protein is equivalent to four calories of energy.1

Food sources: eggs, meats, and dairy products.

Lipids (Fats)
Fats serve a variety of functions in the body including energy production, insulation, and the protection of vital internal organs. Fats are categorized into two forms: saturated and unsaturated. Generally speaking, saturated fats are the “bad” fats, and unsaturated fats are the “good” fats.1

Recommended daily amount of lipids: The recommended percentage of lipids in the diet should be 30% or less of the total calories consumed daily.1 It is recommended that the majority of the lipids consumed be unsaturated to avoid the problems attributed to excessive amounts of saturated fats related to heart disease.

Food sources: saturated fats most often come from animal products such as beef, poultry, pork, milk, butter, and cheese. Unsaturated fat food sources include oils, walnuts, and fish (i.e., salmon, trout, herring).

Supplement and Vitamin Recommendations
Vitamins are chemicals that are needed by the body in relatively small amounts, yet adequate amounts of vitamins are essential to health and human performance.1 Vitamins contain no caloric value so they do not directly provide energy to the body. There is no evidence that taking any vitamin in an amount greater than the recommended level provides any sort of health enhancement. People who eat a healthy, balanced diet, as described above, are most likely getting adequate amounts of vitamins through their food and beverage consumption. In addition, there is no evidence that vitamins marketed as organic or natural provide any benefit over those that are manufactured synthetically and often sold at a higher cost.1

Today, especially in the athletic environment, there is a huge commercial market for supplements, one of the most common being protein supplements. There are several problems with supplementing nutrients. For example, with protein, a high source of dietary protein is also high in saturated fat and often simple CHO, the most ineffective form of CHO. In addition, the body may be unable to to efficiently eliminate the byproducts of excess protein, causing extra stress on the vital organs such as the liver and kidneys. Most supplements are not monitored by the Food and Drug Administration and they are extremely expensive, often exceeding the cost of the most common and natural sources of protein.1

Along with a nutritious diet, regular physical activity is vital to a healthy lifestyle. Over the past century, advancements in technology have transformed the perceptions of hard-work and physical activity and have limited the opportunities for physical activity on a daily basis. These advances have enabled our society to live a life of ease and comfort. However, this ease and comfort can ultimately lead to inactivity, which is directly related to the incidence of disease, injury, weight gain, and other health related problems.

Why exercise?
Regular physical activity is known to result in the following benefits:

  • Stress often suppresses the immune system. Exercise reduces stress levels, thus strengthening the immune system.
  • Regular exercise can slow down the aging process.
  • Regular exercise increases the body’s ability to circulate blood and oxygen to all the vital organs and muscle groups in the body.
  • Exercise, most often, has a positive affect on one’s mental and emotional health.
  • Physical activity is known to reduce and sometimes eliminate the risks of common diseases and illnesses such as heart disease, diabetes, and hypertension.

Who should exercise?
EVERYONE should exercise (with the few exceptions listed below). Exercising is safe and can be enjoyable for most people if done correctly and in the right amounts. Even people with health conditions or older adults should exercise. In fact, these people often benefit the most from physical activity. If you are normally a sedentary person or are out-of-shape, be cautious when starting an exercise program and start with low-intensity exercise for a short amount of time, gradually working up to the optimal amount.

Do not exercise without the advise of a doctor if:

  • You have recently undergone surgery or another form of serious injury.
  • You feel dizzy, nauseous, or have severe pain in your muscles and/or joints.
  • You are experiencing shortness of breath.
  • You have a chronic disease in which your doctor has told you not to exert yourself.
  • You have any reason to believe that your body is not functioning normally.

When and how often should you exercise?
According to the Center for Disease Control and Prevention, adults need moderate-intensity aerobic activity every week, in addition to two or more days a week of muscle-strengthening activities that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms).2 Although the recommendation is per week, it is better to exercise five or six days per week for 30 minutes each day, than to exercise one or two days in the week for an extended amount of time. You should exercise at the most optimal time of day for you and whatever time works best for you and your schedule. This may be early in the morning, in the middle of the day, during your lunch break, or late at night. You should never exercise on an empty stomach and you should drink water before, during, and after exercise, regardless of the intensity.

How should you exercise?
Aerobic Activity — Also known as “cardio,” aerobic activity increases your breathing rate and your heart rate. Aerobic activity improves your cardiovascular health and improves your bodies ability to circulate blood and oxygen throughout the muscles and organs. This is where the concept of the “target heart rate” (THR) is important. The THR is the minimum rate at which your heart should be beating to get the aerobic conditioning effect. To determine your THR, you need to know your maximum heart rate (MHR), which is 220 minus your age. Once you have your MHR, multiply that number by 65% and 80% to get your THR range. To get the most benefit from your aerobic exercise, you should work hard enough to make your heart beat at least at 65 percent but at no more than 80 percent of the maximum for your age. For a 40 year old, the calculation would be as follows:

220 40 = 180
.65 x 180 = 117 (low end of THR)
.80 x 180 = 144 (high end of THR)

Examples of aerobic exercise include:

  • Running/jogging
  • Walking briskly (a 15-minute mile pace)
  • Hiking
  • Water aerobics
  • Rowing
  • Jumping rope
  • Treadmill machines
  • Stationary bike

Perform aerobic exercise for at least 20 minutes each session and at least three times per week.

Muscle-strengthening activities — These activities work to strengthen all major muscle groups in the body. To gain health benefits, muscle-strengthening activities should be done to the point where it’s hard for you to do another repetition without help. A repetition is one complete movement of an activity, such as performing a bicep curl. There are many ways you can strengthen your muscles, either at home or at the gym.

Here are some examples:

  • Lifting weights
  • Working with resistance bands
  • Doing exercises that use your body weight for resistance (i.e., pushups, sit ups)
  • Heavy gardening (i.e., digging, shoveling)
  • Yoga

Some additional exercise tips:

  • Find an exercise buddy
  • Keep track of your physical activity
  • Decide how you will reward yourself
  • Find activities you like to do so it’s easier to stay active in the long run
  • Wear comfortable shoes and clothing

Chronic disease affects roughly 100 million Americans. Overwhelming evidence in modern studies link most chronic diseases to physical inactivity and inappropriate diet.3 One of the most effective ways of battling chronic disease is by engaging in physical activity. It is critical that you enjoy your exercise regimen so that it becomes a source of pleasure for you, giving you a positive feeling of well-being as well as a positive outlook on life. Exercising effects muscle tone, blood pressure, and many other factors that are important to everyone, especially to individuals with a chronic disease.4 Exercise effectively reduces weight, overall body fat and intra-abdominal fat, a hidden risk for many chronic illnesses.5 Below are diet and exercise tips for some of the most common chronic diseases.

*Note: These are just recommendations and it is important to talk to your doctor about your health prior to following a long-term diet or exercise plan.

Diabetes: Type 1 & Type 2
Healthy eating, along with physical activity and, if needed, diabetes medicines, helps keep blood glucose in the target range. Below are diet and exercise recommendations to help achieve this goal.

You can take good care of yourself and your diabetes by learning what to eat, how much to eat, and when to eat. (If you are taking diabetes medicine, what you eat and when you eat affects how your diabetes medicines works. Talk with your doctor about when to take your medications).

Here are some dietary guidelines:6

If you are a small woman who exercises, a small or medium-sized woman who wants to lose weight, or a medium-sized woman who does not exercise much, eat about 1,200 to 1,600 calories a day.

Eat the following servings from each food group:

  • Six starches
  • Two milks
  • Three vegetables
  • Four to six ounces of meat and meat substitutes
  • Two fruits
  • Up to three fats

If you are a large woman who wants to lose weight, a small man at a healthy weight, a medium-sized man who does not exercise much, or a medium-sized to large man who wants to lose weight, eat about 1,600 to 2,000 calories a day.

Eat the following servings from each food group:

  • Eight starches
  • Two milks
  • Four vegetables
  • Four to six ounces meat and meat substitutes
  • Three fruits
  • Up to four fats

If you are a medium-sized or large man who exercises a lot or has a physically active job, a large man at a healthy weight, or a medium-sized or large woman who exercises a lot or has a physically active job, eat about 2,000 to 2,400 calories a day.

Eat the following servings from each food group:

  • Ten starches
  • Two milks
  • Four vegetables
  • Five to seven ounces meat and meat substitutes
  • Four fruits
  • Up to five fats

What are healthy ways to eat starches?
Buy whole grain breads and cereals and eat fewer fried and high-fat starches such as potato chips, french fries, or pastries, and instead try pretzels, fat-free popcorn, baked potatoes, or baked tortilla chips. Eat cereal with fat-free or low-fat milk and use low-fat or fat-free substitutes (i.e., low-fat mayonnaise, light margarine).

What are healthy ways to eat vegetables?
Eat raw and cooked vegetables with little or no fat, sauces, or dressing and steam vegetables using water or low-fat broth. Try using low-fat or fat-free salad dressing on salads.

What are healthy ways to eat fruits?
Eat fruits raw, cooked, as juice with no added sugar, canned in their own juice, or dried. Choose pieces of fruit more often than fruit juice, as whole fruit is more filling and has more fiber.

What are healthy ways to have milk?
Drink fat-free (skim) or low-fat (1%) milk, eat low-fat or fat-free fruit yogurt and use low-fat plain yogurt as a substitute for sour cream.

What are healthy ways to eat meat and meat substitutes?
Buy cuts of meat that have only a small amount of fat on them and trim off the extra fat, eat chicken or turkey without the skin, limit the amounts of nuts, peanut butter, and fried foods eaten (they are high in fat), and cook meat in low-fat ways: broil, grill, steam, and stew.

*Talk with your diabetes specialists about how to make a meal plan that fits the way you usually eat, your daily routine, and your diabetes medicines.

Physical Activity
Sometimes, it may seem easier to pop a pill or even have a shot than to put on your walking shoes and walk in the park. But the truth is that exercise, in combination with a healthy diet, is one of the best things you can do to take care of yourself if you have diabetes.7

Why is it important for people with diabetes to be physically active?5

  • Physical activity burns calories, which will help you lose weight or maintain a healthy weight.
  • Regular exercise can improve the body’s ability to use insulin and is known to be effective in managing blood glucose. Exercise can lower blood glucose and possibly reduce the amount of medication you need to treat diabetes, or even eliminate the need for medication all together.
  • Exercise can improve your circulation, especially in your arms and legs, where people with diabetes have the most problems.
  • Exercise can help reduce your cholesterol and high blood pressure. High cholesterol and high blood pressure can lead to a heart attack or stroke.
  • Exercise helps reduce stress, which can raise your glucose level.
  • In some people, exercise combined with a meal plan, can control Type 2 Diabetes without the need for medications.

How much and how often should people with diabetes exercise?4
If you’re out of shape and have recently been diagnosed as having diabetes, see your doctor before you begin an exercise program. Your doctor can tell you about the kinds of exercise that are good for you depending on how well your diabetes is controlled and any complications or other conditions you may have. Moderate-intensity physical activity for at least 30-minutes on five or more days a week is recommended. However, you will see improvements if you exercise at least three times a week. Examples of moderate-intensity exercise are walking briskly, mowing the lawn, dancing, swimming, or bicycling. Try to do some physical activity everyday; it is better to walk for 10 to 20 minutes each day than one hour once a week.

What are quality types of physical activity for people with diabetes?4

  1. Be extra active every day (i.e. walk around while you talk on the phone, take the dog for a walk, get up to change the channel instead of using the remote control, clean the house, wash the car).
  2. Aerobic exercise (i.e. walk briskly, hike, climb the stairs, dance, swim).
  3. Strength training with hand weights, elastic bands, or weight machines two to three times a week to build muscle. When you have more muscle and less fat, you’ll burn more calories because muscle burns more calories than fat.
  4. Stretching increases flexibility, lowers stress, and helps prevent muscle soreness.

Are there any safety precautions for physical activity for people with diabetes?4

  • Build up the time you spend exercising gradually. If you have to, start with five minutes and add a bit of time each day.
  • Physical activity can lower your blood glucose too much, causing hypoglycemia, especially in people who take insulin or other oral medications. To help prevent hypoglycemia, check your blood glucose before you exercise. If it’s below 100, have a small snack prior to exercise.
  • Bring food or glucose tablets with you while you exercise, just in case. On the other hand, you should not exercise if your blood glucose is too high because exercise could make it go even higher. Do not exercise if your blood glucose is above 300.
  • Drink plenty of fluids before, during, and after physical activity.
  • Always wear your medical identification or other form of ID while exercising.
  • Stretch for five minutes before and after your workout regardless of the intensity of your exercise.
  • Avoid lifting heavy weights as a precaution against sudden high blood pressure.

*Talk to your diabetes specialist about a safe exercise plan for you.

The combination of weight loss, exercise, reduced salt intake, and a healthy diet can dramatically lower blood pressure.8 Below are diet and exercise recommendations to help achieve this goal.

By following a particular eating plan, called the Dietary Approaches to Stop Hypertension (DASH), and reducing the amount of sodium consumed, blood pressure may be lowered. While each step alone lowers blood pressure, the combination of the eating plan and a reduced sodium intake gives the greatest benefit and may help prevent the development of hypertension. It is important to know that the DASH eating plan was not designed to promote weight loss, but is rich in lower calorie foods.

Here are dietary guidelines based on the DASH eating plan (based on a 2,000 calorie per day diet):5

7-8 daily servings of grain and grain products
Significance: Major source of energy and fiber.

4-5 daily servings of vegetables
Significance: Important sources of potassium, magnesium, and fiber.

4-5 daily servings of fruits
Significance: Important sources of potassium, magnesium, and fiber.

2-3 daily servings of low-fat or fat-free dairy foods
Significance: Major source of calcium and protein.

2 or less daily servings of meats, poultry, and fish
Significance: Rich sources of protein and magnesium.

4-5 daily servings of nuts, seeds, and dry beans
Significance: Rich sources of energy, magnesium, potassium, protein, and fiber.

2-3 daily servings of fats and oils
Significance: DASH has 27% of calories as fat, including fat in or added to foods.

5 servings per week of sweets
Significance: Sweets should be low in fat.

*The number of daily servings in a food group may vary from these listed, depending on your caloric needs.

Tips to Reduce Salt and Sodium5
Buy whole grain breads and cereals and eat fewer fried and high-fat starches such as potato chips, french fries, or pastries, and instead try pretzels, fat-free popcorn, baked potatoes, or baked tortilla chips. Eat cereal with fat-free or low-fat milk and use low-fat or fat-free substitutes (i.e., low-fat mayonnaise, light margarine).

  • Start by cutting sodium intake in half.
  • Use reduced sodium or no-salt-added products.
  • Buy fresh, frozen, or canned with no-salt-added vegetables.
  • Choose ready-to-eat breakfast cereals that are lower in sodium.
  • Rinse canned foods to remove excess sodium.
  • Use spices instead of salt when cooking to flavor foods.

*For more information on the DASH eating plan, please visit http://dashdiet.org

Physical Activity

Exercise Guidelines5
Ideally, hypertensive individuals should exercise five to six times per week. However, improvement can be achieved with three sessions per week. The total exercise time should range from 30 to 60 minutes each session. People with lower levels of fitness should start with shorter durations (10 to 15 minutes) and gradually increase (5 minute increments every 2 to 3 weeks) to the 30 to 60 minute goal. Current research suggests that moderate-intensity activity may be most effective in lowering blood pressure.8 Endurance activities such as walking, swimming, cycling and low-impact aerobics should be the core of the exercise program. As fitness levels improve, add low resistance, high repetition weight training.

How Exercise Lowers Blood Pressure5
Nearly 50 million Americans have a resting blood pressure that is high enough to endanger their health.8 Evidence shows that moderate exercise can reduce both systolic and diastolic blood pressure by 7 mmHg.8 Exercise can lower blood pressure through several mechanisms. One possibility is that after exercise, cardiac output and peripheral vascular resistance, which are the primary determinants of hypertension at rest and during exercise, are lowered. Exercise may also decrease central fat deposition, a factor linked to hypertension.

What should be avoided during exercise?5
Exercises that include an intense isometric (muscle contraction without joint movement) component that can cause extreme and adverse fluctuations in blood pressure should be avoided. In addition, holding one’s breath should be avoided because it can result in large fluctuations of blood pressure.

*Prior to starting a new exercise program, individuals with hypertension should obtain clearance from their doctor.

High blood cholesterol is a major risk factor for heart disease, which is the leading cause of death in America. Nearly 17% of adults in American have high cholesterol.9 Not only do you get cholesterol from the food you eat; your body also makes cholesterol to use in normal body functions, such as hormone synthesis. The problems arise when too much cholesterol is in the wrong place at the wrong time, clogging blood vessels. Humans synthesize around 0.5 to 0.75 grams of cholesterol per day and may take in an additional 0.25 to 0.5 grams per day in their diet.9 A healthy diet and regular physical activity can help prevent abnormal cholesterol levels.

Certain foods have types of fat that raise your cholesterol levels. These fats include saturated fat, trans fatty acids or trans fat, and dietary cholesterol.10

What foods should you eat?

  • Fats such as monounsaturated (i.e., nuts, vegetable oils, olive oil, avocado, sunflower oil) and polyunsaturated fats (i.e., corn oil, soybean oil, canola oil, walnuts) can help to lower blood cholesterol levels.
  • Fish is a great source of Omega-3 polyunsaturated fat. Fish, such as trout, herring, and salmon provide an essential fatty acid that our bodies need.
  • Getting enough soluble fiber in your diet can help to lower cholesterol. Soluble fiber, such as the fibers found in oat bran, is the type of fiber that actually washes away the bad cholesterol that clings to the inner walls of the arteries. Fresh fruits and vegetables are a great source of this fiber. Carrots and apples are two top choices.11
  • Choose a soft margarine spread instead of stick margarine.

What foods should you avoid?

  • Saturated fats, trans fats, and dietary cholesterol tend to raise blood cholesterol levels.
  • Saturated fats come largely from animal fat in the diet and are found in some vegetable oils, such as palm oil.
  • Dietary cholesterol is found in foods that come from animal sources such as egg yolks, meats, and dairy products.
  • For some people, a diet that has too many carbohydrates can lower the “good” cholesterol and raise triglycerides.
  • Alcohol can raise triglycerides and excessive alcohol use can lead to high blood pressure.

Physical Activity
Lack of regular physical activity can lead to weight gain, which could raise your LDL (“bad”) cholesterol levels. Below are some recommendations for moderate-intensity exercise which will help maintain healthy blood cholesterol levels.

Type of Exercise to Perform
If your breathing and heart rate is noticeably faster but you are still carrying on a conversation, it is most likely moderate exercise. Try to perform this level of physical activity for at least 30 minutes, at least three days a week.

Here are some examples:

  • Walking briskly (a 15-minute mile pace)
  • Light yard work (raking/bagging leaves or mowing the lawn)
  • Actively playing with children
  • Biking at a casual pace

Tips to Getting Started with an Exercise Program

  • Look for opportunities to reduce sedentary time and to increase active time. For example, instead of watching TV, go for a walk after dinner.
  • Set aside specific times for physical activity in your schedule and make it part of your daily routine.
  • Start with activities, locations, and times that you enjoy.
  • Try activities with friends or family members to help with motivation and encouragement.
  • Start slowly and work your way up to more physically challenging activities.

*Prior to starting a new physical activity program consult your doctor for individual specifications to meet your needs.

“The foods we eat and our activity level directly influence our heart health. By beginning a weight loss and exercise program, we may postpone or prevent heart disease.”

Despite the recent educational efforts to make people aware of the causes of heart disease and the measures necessary to prevent it, heart disease remains the leading cause of death in America for both men and women, claiming a life every 33 seconds. Each day 2,600 people die of this disease.11 Coronary heart disease is the major form of cardiovascular disease. You cannot control risk factors such as gender, age, and genetics, but you need to be aware of what you can control, which is a healthy diet and regular physical activity.12

Diets high in cholesterol and saturated fats are often the cause for high blood cholesterol, a risk factor for heart disease. People with a heart disease should be getting less than 200 milligrams of cholesterol each day.13According to the American Heart Association, people with a heart disease should get less than 30 percent of their calories from fat and less than seven percent from saturated fat. In addition, salt intake should be limited to no more than a teaspoon a day.

What should you eat?

  • Your diet should consist primarily of fruits, vegetables, grain products, lean meats, and fish.
  • Try to decrease your level of fat (especially saturated fats) and cholesterol (i.e., fatty red meats, whole milk, whole milk cheeses, eggs, cream-based dishes, and rich desserts).
  • You can cut fat and cholesterol by replacing fried foods with roasted, baked, grilled, steamed, and broiled foods.
  • Buy only lean cuts of meat and trim away visible fat prior to eating.
  • Remove the skin of chicken and turkey—the skin doubles the fat!
  • Limit your intake of nuts and seeds, which are high in fat and calories.

Foods to avoid (high saturated fat content) include scones, cookies, pizza, cheese, milk, and other baked foods rich in butter, cheese, or cream.

Physical Activity
Activity that reduces the risk or improves the symptoms of CHD does not require a structured or vigorous exercise program. The majority of the benefits of physical activity can be gained by performing moderate-intensity activities. Furthermore, physical activity must be performed regularly to maintain these benefits.7

What type and what quantity of physical activity is recommended to prevent CHD?
The appropriate type of activity is best determined by the individual’s preferences and what will be sustained. People who are currently sedentary or minimally active should gradually build up to the recommended goal of 30 minutes daily by adding a few minutes each day.

  • It is recommended that all children and adults should accumulate at least 30 minutes or more of moderate-intensity physical activity on most, or preferably all, days of the week.
  • Intermittent or shorter bouts of activity (at least 10 minutes), including tasks of daily living, also have similar cardiovascular and health benefits if performed at a level of moderate intensity (i.e., brisk walking, cycling, home repair, yard-work).
  • Developing muscular strength and joint flexibility is important for an overall activity program to reduce the potential for injury and improve one’s ability to perform tasks. Upper extremity and resistance training can improve muscular function.

*Talk to your doctor prior to starting a new exercise program.

Stretching is one of the fastest growing types of exercise in America today.14 Stretching is a form of physical activity that targets a specific muscle group. It works to elongate the muscle fibers to their fullest length in order to improve the muscle’s elasticity, or flexibility. Stretching results in an increased feeling of muscle control, flexibility, and range of motion.

Why stretch?
Stretching should be part of your everyday life whether you are an elite athlete or someone who sits at a desk all day. It is a relaxing activity that prepares the body for movement and helps you make the regular transition from inactivity to strenuous activity without unnecessary strain. Although the research regarding stretching and the prevention of injury are very controversial, stretching is proven to do many other things. A strong, flexible, pre-stretched muscle resists stress better than a strong, stiff, non-stretched muscle.6 Stretching allows you to get in touch with your muscles and learn about your body’s limits, as well as its abilities. One of the most important benefits of stretching is the promotion of relaxation. Excessive muscular tension tends to decrease sensory awareness and raise blood pressure. It also is a waste of energy; a relaxed muscle uses little energy compared to a stressed, contracting muscle.15 Many athletes deliberately stretch before and/or after exercise in order to increase performance and reduce the risk of injury because stretching is a way of signaling the muscles that they are about to be used. You may find that regular stretching will result in the following benefits:

  • Reduced muscle tension and an increase in feeling of relaxation
  • Increased coordination by allowing easier movement
  • Increased range of motion
  • Prevention of injuries
  • Prolonged level of flexibility
  • Prevention of post-exercise muscle soreness

Who should stretch?
Regardless of your age or flexibility, everyone can learn to stretch. There is a misconception that only individuals in top physical condition, who are regularly active, benefit from stretching. This is far from the truth. Whether you sit at a desk, cook in the kitchen, drive a truck, or exercise regularly, the same stretching techniques apply.1 The techniques conform to individual differences in muscle tension and flexibility.

*Note: Please consult your health care professional before you start a stretching program if you have had any recent physical problems or surgery, or if you have been inactive or sedentary for some time.

When should you stretch?
The benefits of stretching are not felt overnight. Therefore, it is important to stretch daily to maintain or increase flexibility and relaxation. Generally speaking, stretching can be done whenever you feel like it: at work, at home, in the park, or at the gym. You do not need a large area or special equipment to stretch properly. You should stretch before and after physical activity, but when you can, also stretch at various times of the day. Here are some examples of when you could stretch:

  • In the morning before you leave your bed
  • At work to release tension
  • After sitting or standing for a long period of time
  • When you feel stiff
  • When you’re watching TV or reading

How should you stretch?
Stretching is easy, but when it is done incorrectly it can do more harm than good. This is why it is essential to understand the proper techniques of stretching. The greatest thing about stretching is that it is adjustable to the individual. Each one of our bodies are unique in strength, endurance, and flexibility and although there are research-based techniques and tips for stretching, it can always be modified to meet your individual needs. It is important to note that it is the quality of the stretch, not the quantity of the stretch, that determines the degree of flexibility. Therefore, the common misunderstanding of “no pain no gain” is NOT true with stretching. Pain is an indication that something is wrong and you should modify your stretch immediately. Stretching should be comfortable and enjoyable. Go to the point where you feel mild tension and relax as you hold the stretch. The feeling of tension should subside as you hold the position. If it does not, ease off slightly and find a degree of tension that is comfortable.3 Hold the position for 10 to 30 seconds and maintain a steady breathing pattern during the duration of the stretch. You should wear loose and comfortable clothing and have a positive mental attitude to maximize relaxation. Below are some of the most common mistakes made when stretching:16

  • Improper warm-up; stretching is not a warm-up. Stretching with cold muscles will often result in injury. To get the body warmed-up, walk for 5 to 10 minutes prior to stretching.
  • Over-stretching.
  • Bouncing up and down; this also will result in injury. Keep a steady position with a constant, comfortable tension on the muscle being stretched.

What should you stretch?
Stretching should target specific muscle groups. Below are descriptions of common stretches for some of the major muscle groups.


Hamstrings (backside of thigh): Perform this stretch in a lying position on your back. Begin with both legs straight on the ground, then slightly lean forward and with your arms, gently pull one leg at a time toward your chest until you feel a stretch in the butt and upper hamstring. Hold the position for 15 to 20 seconds, then switch legs.

Quadriceps (frontside of thigh): Perform this stretch in a standing position. If needed, position yourself next to a table, chair, or railing for balance support. Standing upright, raise one heel behind you toward your butt. Reach around with the opposite hand and grab the ankle that you have lifted. Gently pull ankle toward your butt until you feel a stretch in your quad muscles. Keep your knees as even as possible. Hold position for 15 to 20 seconds, then switch legs.

Calves (backside of lower leg): Perform this stretch in a standing position. Stand 1 to 2 feet away from a wall and lean on it with your forearms, head resting on your hands. Bend one leg and place your foot on the ground slightly in front of you, with the other leg straight behind. Slowly move your hips forward, keeping your lower back flat, until you feel a stretch in the calf muscle in the back leg. Be sure to keep the heel of the leg behind you flat on the ground, with toes pointed straight ahead. Hold for 15 to 20 seconds, then switch legs.


Elongation Stretch: Perform this stretch in a lying position on your back. Extend your arms overhead and straighten out your legs. Now reach as far as is comfortable in the opposite direction with your arms and legs (extend your fingers and point your toes). Hold for 15 seconds, then relax and repeat.

Spinal Roll: Perform this stretch in a sitting position. Sitting on a mat or rug, hold your knees with your hands and pull them to your chest. Lean your head forward and curl your shoulders into your knees, curving your back. Using your arms, pull your knees toward your chest until you feel a stretch down both sides of your back. Hold for 15 seconds, then relax and repeat.


Front of Shoulders: Perform this stretch in a standing position. Interlace your fingers behind your back and slowly turn your elbows inward while straightening your arms. If this is fairly easy, then lift your arms up behind you until you feel a stretch in your upper arms, shoulders, and chest. Keep your chest out and chin in. Hold for 15 to 20 seconds.

Chest Stretch: Perform this stretch in a sitting position. With your fingers interlaced behind your head, keep your elbows straight out to your side with your upper body in an upright position. Pull your shoulder blades together until you feel a stretch through your pectoral (chest) muscles. Hold for 15 seconds, then relax and repeat.


Butterfly Stretch: Perform this stretch in a sitting position. Bend your knees and slowly bring both your feet in toward your body, keeping them in contact with the ground. Position your feet so the sole of one foot is touching the other. Using your hands, slowly pull your feet toward your body and use your elbows to push both knees toward the ground until you feel a stretch on both sides of your groin. Hold for 15 to 20 seconds.


Triceps (backside of upper arm): Perform this stretch in a standing or sitting position. With arms overhead, hold the elbow of one arm with the hand of the other. Gently pull the elbow behind your head, creating a stretch in the triceps of the arm being pulled. Hold for 15 to 20 seconds, then switch arms.

Forearms and Wrists: Perform this stretch in a sitting, standing, or lying position. Fully extend your arm so it is straight out in front of you, with your palms facing upward. With the opposite hand, grab the fingers of the outstretched hand and pull them downward toward the floor until you feel a stretch in your forearm and wrist. Hold for 10 seconds, then switch arms and repeat.

Strengthening exercises are both safe and effective for men and women of all ages, including those who are not in perfect health and those who are aging. In fact, people with health concerns and older adults often benefit the most from an exercise program that includes lifting weights a few times a week.17 For older adults, a decline in muscle strength potentially has more severe consequences in daily living than a decline in cardiovascular fitness.15 The aging process is traditionally viewed as a progressive decline in health, but studies show that this decline is most often linked to inactivity.18 Below are recommendations for an effective strength training program that will significantly improve your overall health.

*Regular physical activity is fun and healthy. Being active is safe for most people, however, before starting a strength training program you should check with your doctor to make sure your strength training plan is safe for your health.

What is strength training?
Strength training are activities that help you build strength, maintain bone density, improve balance, maintain proper posture, improve coordination and mobility, reduce your risk of falling, and help you maintain independence in performing activities of daily life.14 Strength training requires little time and minimal equipment.

What are the benefits of strength training?

  • Strength of the arms, legs, and back declines at approximately 8-10% per decade after, approximately, age 30.15 Physical frailty (i.e., a severe impairment in strength) is an inevitable consequence of a long life. Therefore, an exercise program with strength training activities will reduce the risk of accidents due to physical frailty.
  • Strength training can be very powerful in reducing signs and symptoms of numerous chronic conditions such as arthritis, diabetes, osteoporosis, obesity, and back pain.
  • Restoration of balance and reduction of falls.
  • Strengthening of bones; post-menopausal women can lose 1-2% of their bone mass annually. Strength training can increase bone density and reduce the risk for fractures among women.14
  • Provides a healthy state of mind.

Strength Training, Balance, and Falls
Falls are the most common of all accidental events in the elderly population.15 Lower limb muscular weakness is the major cause of falls. Performing a regular strength training program will almost always result in improved balance, coordination, and a reduced risk of falling. Strengthening exercises, when done properly and through the full range of motion, increase a person’s flexibility and balance. The causes of falling are multiple and complex and it is important to realize that some balance problems, particularly those caused by irregularities in the vestibular system, may be irreversible.15 But exercises that challenge balance on one or both legs, coordination, flexibility, antigravity strength, trunk strength, and ankle strength can significantly improve balance of older adults. An active muscular system depends mostly on muscle strength, which serves as the body’s most effective energy absorber.15 Therefore, muscle strength, gained through strength training exercises, can potentially reduce the severity of the impact if a fall does occur.

Frequency, Intensity, and Duration of Strength Training
The frequency, intensity, and duration of a strength training program is going to vary from person to person, depending on their initial strength, physical fitness level, and other pre-existing health conditions. It is important to find the right balance between exercising conservatively to prevent injury and exercising consistently to increase strength.

  • As a general guideline, when weight lifting, if you are unable to perform two sets of ten repetitions in good form, reduce the weight to an amount so you can lift ten times in good form; rest for one to two minutes, then repeat for a second set.
  • If you can do up to 20 repetitions at one time in good form, without a break, then during your next workout, increase the weight.
  • Your exercise plan should involve weight lifting, or strength training, at least three times per week.

Exercise Safe and Smart
Refrain from exercising and strength training if you:

  • Have a cold, flu, or infection accompanied by a fever.
  • Have significantly more fatigue than usual.
  • Have a swollen or painful muscle or joint.
  • Have any new or undiagnosed symptom.
  • Have chest pain, or irregular, rapid, or fluttery heartbeat.
  • Have shortness of breath.
  • Have been advised by your doctor not to exert yourself for an extended period of time due to illness, surgery, etc.

Exercises to Improve Your Strength
These activities will help you build strength, maintain bone density, improve balance, coordination, and mobility, reduce your risk of falling, and help you maintain independence in performing activities of daily life. As you’ll see, strength training requires little time and minimal equipment.

Always perform a warmup prior to strength training (and stretching is NOT a warmup). To get your muscles warm and loose, walk for 5 to 10 minutes. Walking will help direct needed blood flow to your muscles, prepare your body for exercise, prevent injury, and gain maximal benefit from the exercise. Warm muscles respond better to the challenge of lifting weights.14

Squats—Lower Limb Strength
In front of a sturdy chair, stand with feet slightly more than shoulder-width apart. Cross your arms over your chest and lean forward slightly at the hips. Making sure that your knees never come forward past your toes, lower yourself in a slow, controlled motion, until you reach a near-sitting position. Pause, then slowly rise back up to a standing position, keeping your knees over your ankles and your back straight. Never let your knees touch throughout the entire motion. Repeat ten times for one set. Rest for one to two minutes, then complete a second set of ten.

Wall Pushups—Upper Limb Strength (arms, shoulders, chest)
This exercise is less challenging than a normal pushup and will not require you to get down on the floor. Find a wall that is clear of any objects. Stand a little farther than arm’s length from the wall. Facing the wall, lean your body forward and place your palms flat against the wall at about shoulder height and shoulder-width apart. Bend your elbows as you lower your upper body toward the wall in a slow, controlled motion, keeping your feet planted. Pause, then slowly push yourself back until your arms are straight, but do not lock your elbows. Repeat ten times for one set. Rest for one to two minutes, then repeat for a second set of ten.

Heel Raises or Toe Stands—Lower Limb Strength
This is a good way to strengthen your calves and ankles and restore stability and balance. Near a counter or sturdy chair, stand with feet shoulder-width apart. If needed, use the chair or counter for balance. Slowly push up as far as you can, onto the balls of your feet and hold for two to four seconds. Slowly lower your heels back to the floor, in a controlled motion. Repeat ten times for one set. Rest for one to two minutes, then repeat for a second set of ten.

Biceps Curl—Upper Limb Strength
This exercise will make lifting daily objects, such as a gallon of milk, seem much easier! With a dumbbell (or if you do not have a dumbbell, a soup can will work too!) in each hand, stand, or sit in a chair, with feet shoulder-width apart, arms at side, and palms facing facing in front of you. Slowly lift up the weights by flexing your elbow. Keep your upper arms and elbows close to your side, as if you had a newspaper tucked beneath your arm. Keep your wrists straight. Slowly lower the dumbbells back toward your thighs, keeping palms facing forward. Repeat ten times for one set. Rest for one to two minutes, then repeat for a second set of ten.

Cool Down
Refer to the Stretching section on the main page of Health Tips for proper stretches to perform for cool down. A proper cool down will prevent future muscle soreness and help prevent injury.

For more information on strength training, including animations of recommended exercises, visit http://growingstronger.nutrition.tufts.edu/exercises/index.html

A sports injury is defined as an adverse effect acquired from athletics that results in decreased ability and/or is harmful to performance.19 The treatment of these injuries are approached differently, depending on the onset and severity of the injury. The easiest way to prevent injury is to know the risk involved with the sport at hand.

Causes of Injury
In sports, there are two main injuries, acute injuries and chronic, or overuse injuries. An acute injury is characterized by a rapid onset or sudden trauma such as a contusion, sprain, strain, or fracture. Most acute sports injuries consist of soft tissue damage and are characterized by pain, swelling, instability, inability to bear full weight, loss of joint motion, and weakness. Overuse injuries are characterized by a slow onset and symptoms are acquired overtime. Examples of overuse injuries are tendonitis (i.e., patella, achilles, bicep), rotator cuff injuries, and impingement. Injuries in sport are caused by a number of factors, either intrinsic or extrinsic. Intrinsic factors resulting in injury may include lack of flexibility, lack of conditioning, psychological factors, and previous injuries.16 Extrinsic factors include the type/nature of the activity, weather conditions, equipment, and overtraining.

Classifications of Acute Injuries
A sports injury is defined as an adverse effect acquired from athletics that results in decreased ability and/or is harmful to performance.19 The treatment of these injuries are approached differently, depending on the onset and severity of the injury. The easiest way to prevent injury is to know the risk involved with the sport at hand.

  1. Sprains (injury to ligaments)
    1. First-degree: mild stretching of ligament, pain, no swelling, mild loss of function
    2. Second-degree: pain, moderate loss of function, mild/moderate swelling
    3. Third-degree: complete tear of ligament(s), significant loss of function, lack of stability, severe swelling
  2. Strains (injury to muscles)
    1. First-degree: mild damage/stretching of muscle
    2. Second-degree: moderate stretching of muscle
    3. Third-degree: torn/ruptured muscle, severe swelling
  3. Contusions (AKA bruise): a direct blow to the body structure, discoloration due to blood vessel damage, blood enters surrounding tissues
  4. Fractures: breaks or cracks in the bone. There are four types of fractures;
    1. Stress fracture
    2. Closed fracture
    3. Open fracture
    4. Salter-Harris fracture
  5. Dislocations: displacement of contiguous surfaces or bones comprising a joint.

Treatment of Acute Athletic Injuries
Treating an acute sports injury promptly will speed the healing process so you can get back to your favorite sport or recreational pursuit faster. Treatment of acute soft tissue injuries consists of RICE, which stands for Rest, Ice, Compression, and Elevation. RICE is employed for the first two to four days after an injury occurs. The goal of treating the acute injury is to minimize further damage by controlling swelling and protecting the injured joint or muscle.

Rest is important as further activity can cause further tissue destruction. This means stopping the activity and not playing through the injury.

Ice or cold packs should be applied for 15 minutes every hour to two hours to control inflammation. A damp towel between an ice pack and the skin should be used to protect skin from frostbite. If you don’t have a commercial ice pack, a big zip-lock bag full of 50% ice and 50% water works well – double bag to prevent leakage. Also frozen vegetables in a plastic bag work well.

Compress the affected part or joint by wrapping an elastic bandage around the afflicted area. Be careful not to wrap too tightly. Compression will protect the area from further injury and help control swelling.

Elevate the affected body part above the level of the heart while icing and resting. This will also control swelling.

If you feel you have a serious injury see your doctor immediately. Signs of a more serious injury include:

  • Visible deformity of a body part.
  • Severe pain which prevents the use of an arm or leg.
  • Inability to bear any weight through a leg.
  • Loss of feeling or numbness and/or tingling.

Prevention of Athletic Injuries
By participating in sports, you are assuming the risk of injury, but here are some common and easy ways to prevent an injury from athletic participation:

  • Conduct pre-participation evaluations to identify pre-existing injury risk factors (i.e., allergies, high blood pressure, vision deficits, previous injury).20
  • Water loss is the biggest risk for active people. If you feel thirsty during activity, you are already 2-3% dehydrated. Dehydration can impair performance and cause muscle cramps, dizziness, excessive fatigue, headaches, and more.21 Drink fluids regularly during sports to prevent these symptoms.
  • Stretch before and after workouts, games, or practices to prevent muscle soreness.
  • Recognize faulty equipment and dangerous facilities and avoid these situations.
  • Educate athletes about hazards and risks involved in the activity.
  • Participate in pre-season conditioning.
  • Wear proper protective equipment; virtually all sports can benefit from the use of some form of safety equipment (i.e., mouth guards, knee pads, helmet).

A basic understanding of how your body structures work will help them remain healthy and strong. Although some common injuries are accidental and are influenced by uncontrollable factors such as gender and variations in the anatomy and physiology of each individual, there are many ways to prevent the most common injuries. Knowing the causes of these injuries may also lead to a reduction in the occurrence of injuries.

Acute vs. Overuse Injuries
The most common injuries to the human body are a combination of acute and overuse injuries. Acute injuries are characterized by a rapid onset of symptoms or a sudden exposure to trauma. Contrastingly, overuse injuries are characterized by a slow onset of symptoms and tend to worsen over a period of a time if left untreated.

Anatomy & Physiology
The shoulder is a complex of four joints that is capable of three different anatomical movements; 1.) flexion and extension, 2.) internal and external rotation, and 3.) abduction and adduction. The ultimate function of the shoulder complex is to facilitate movement of the arm.22 The soft tissue structures originating from the front and back of the scapula bone, which hold the humeral head (top of the upper arm bone) to the shoulder socket, form the rotator cuff, where a lot of shoulder injuries occur.

Causes and Types of Injury
The shoulder sacrifices stability for mobility so we can perform higher functionality tasks, such as a cartwheel and throwing a ball at great velocities. Since the shoulder requires the movement of four joints, the function of one affects the function of another.

  1. Shoulder Impingement Syndrome—Increased laxity of ligaments makes women more susceptible to shoulder impingement, especially female athletes whose activities require repeated overhead arm movements. Shoulder impingement occurs when the muscles and tendons of the shoulder are injured, causing swelling. Swelling causes the muscles and tendons to be squeezed between the bones of the shoulder joint.23 Signs of shoulder impingement include slow onset of pain in the upper shoulder or upper arm and difficulty sleeping on the shoulder. Pain may radiate down the upper arm to the elbow.22
  2. Rotator Cuff Injuries—RC injuries can develop as a result of repeated impingement or can occur suddenly because of a fall on an outstretched hand, sudden trauma, or simply pulling bed covers over oneself. A small or partial tear may heal with rest, but a full thickness RC tear calls for surgical repair.21 Symptoms include pain along the outside aspect of the shoulder more significant in attempts to raise the arm. General weakness in elevating and externally rotating the arm is also common.22
  3. Shoulder Dislocation—When a shoulder dislocates, the soft tissue structures are injured, the shoulder capsule is stretched, and it becomes increasingly easy for the shoulder to dislocate again. In fact, once a shoulder is dislocated, the chances of it dislocating again are 85% to 90%!18 Pain is intense and common and swelling, numbness, and weakness are also expected.
  4. Glenoid Labral Tear—Commonly known as a SLAP (superior labrum anterior and posterior) lesion, this is a common injury in overhead-athletes (i.e. volleyball players, swimmers, baseball players, tennis players), where repetitive force is placed on the shoulder joint. The glenoid labrum is cartilage that deepens and surrounds the glenohumeral joint. This area, where the biceps complex attaches to the superior glenoid labrum, can be the site of tears and detachments of the biceps. SLAP lesions are usually classified into four categories: Type I is just fraying of the superior glenoid rim. Type II is a detachment of the biceps anchor and of the attachments of the anterior and superior labrum from the superior rim. A type III tear is a bucket handle tear of the superior labrum without detachment of the biceps anchor to bone. Lastly, a type IV lesion is a type III tear with extension of the tear up into the biceps tendon itself.24

Symptoms may include a dull, throbbing ache in the shoulder joint brought on by strenuous exertion and pain or a catching sensation in overhead athletes. The pathology, examination, and treatment all vary depending on the findings of the injury.

Preventative Methods

  • Although many of the reasons shoulder injuries occur are unpreventable, there are some things you can regularly do to reduce the risk of shoulder injury.
  • Perform shoulder mobilization exercises (i.e., pendulum exercises).
  • Perform shoulder flexibility exercises (i.e., internal and external rotation).
  • Perform isometric (muscle contraction without joint movement) exercises.
  • Stretch the upper body regularly, including arms, chest, upper back, neck, and shoulders.
  • Talk to a specialist about appropriate bracing and/or taping methods to help prevent injury and reduce pain.

*If you are experiencing discomfort or recognize a sudden decrease in strength and/or stability, consult your doctor immediately about your symptoms and your possible need for physical therapy at a PT Northwest location.

Anatomy & Physiology
The knee is the largest of the 187 joints in the body. As such, the knee is subject to a variety of diseases and injuries and is frequently injured because it is commonly abused.21 The knee is a hinged joint with some rotation to provide locking. Structures in the knee provide cushioning and shock absorption and these structures are frequently injured. Four major ligaments stabilize the knee:

  1. Anterior Cruciate Ligament (ACL)—prevents the knee from unduly slipping forward
  2. Posterior Cruciate Ligament (PCL)—prevents the knee from unduly slipping backward
  3. Lateral Collateral Ligament (LCL)—binds the femur (upper leg bone) to the tibia (lower leg bone) laterally (on the outside)
  4. Medial Collateral Ligament (MCL)—binds the femur to the tibia medially (on the inside)

Causes and Types of Injury
Knee ligaments are prone to stretching and tearing with injury. Ligament laxity will often result in serious injury.

  1. ACL Injuries — ACL tears occur in women more than men. An ACL injury can result either from contact to the knee or from some unexplained noncontact mechanism during sports activities. This suggests that there may be extrinsic factors that lead to ACL tears. Female soccer players and female skiers are at the highest risk for an ACL tear.25 ACL injuries may not always cause pain, although they typically do. Most likely, a loud popping sound can be heard at the time of injury.
  2. Patella tendonitis AKA “Jumpers Knee” — Tendonitis is the inflammation of a tendon, and this often occurs in the knee due to excessive amounts of jumping and landing on hard surfaces. Symptoms of patella tendonitis include pain in the front of the knee. Symptoms will likely increase with climbing stairs or sitting for an extended period of time.
  3. Meniscal Tear — Recent studies support that the menisci have a crucial role in stability, load bearing, and lubrication of the knee joint.21 Menisci performance is related to the mechanical knee function. Therefore, impairment of related knee functions leads to pathology of the menisci. Injury to the menisci is considered to result from traction, compression, or torque forces or from a combination of all three. Injuries occur mainly from entrapment of the menisci between the femoral heads and the tibial plateau. This can happen one of two ways: 1.) a severe external force exceeds the normal alignment of the joint components, or 2.) there is entrapment between the femur and tibia from an unphysiological movement.25 Diagnostic signs and symptoms include the patient complaining of severe knee pain after an incident, which may include feelings of locking and buckling. The patient may also explain it as though something tore within the knee. The incident is most often a turning and twisting movement during an athletic activity or a direct blow to the knee. Pain from an acute meniscal tear usually results in immediate termination of activity.
  4. The “Terrible Triad” – tear in medial meniscus with rupture in both the MCL and ACL—This injury is not uncommon in violent sports, such as football. Extreme pain and knee instability will result from this injury and will require surgical repair.

Preventative Methods
Although some knee injuries occur suddenly and accidentally through sport involvement, there are several ways to reduce the risk of knee injuries:

  • Wear appropriate footwear at all times and consider the surface on which you are moving on. Is it stable/sturdy?
  • Talk to a specialist about appropriate bracing of the knee to help prevent injury.
  • Strengthen surrounding muscle groups such as the lower back, quadriceps, and hamstrings to help take excess pressure off the knee joint. The large muscles of the thigh provide strength and stability to the knee. Both these muscle groups weaken rapidly after knee injury. Maintaining muscle tone is important in preventing injury as well as rehabilitation after injury or surgery.
  • PT Northwest is a Certified Clinical Site in Oregon, which provides Sportsmetrics training to athletes. Sportsmetrics is a nationally recognized sports rehabilitation program proven to significantly reduce the risk of serious knee injury in female athletes by increasing vertical jump height, improving hamstrings to quadriceps muscle strength ratio, improve jumping and landing mechanics, and improving symmetry in right-to-left strength. Sportsmetrics is a 6-week training program, 3x/week, that incorporates a dynamic warm-up, jumping training, strength training, flexibility, and speed and agility.

*If you are experiencing discomfort or recognize a sudden decrease in strength and/or stability, consult your doctor immediately about your symptoms and your possible need for physical therapy at a PT Northwest location.

Anatomy & Physiology
Low back pain is one of the most prevalent complaints afflicting people in modern society.14 Knowing how a healthy spine works may help you understand how moving wisely can protect your back and keep it free of pain. The vertebral column is a spiral spring in the form of the letters “S.” These curves develop to support functions that include holding up the trunk, serving as an anchor for the extremities, and keeping the head erect. The spine is made of 33 small bones, known as the vertebrae. The vertebrae protects many of the nerves in the body and acts as an anchor for many muscles that are attached to it at various segments of the back.21

Causes and Types of Injury21
Although essential for the health of the back and the body, spinal curves are harmful when exaggerated.

  1. Lordosis is an abnormal concave curvature in the spine (swayback).
  2. Scoliosis is extreme lateral (to the side) curvature and it warps posture and upsets the body’s balance.
  3. Kyphosis (hunchback) is an extreme convex curvature of the thoracic vertebrae.
    *These curves are often functional, meaning that they are postural in nature and will improve with growth. These types of conditions are often genetic. Signs of these curvature deformities can be detected through visual examination; an abnormal amount of curvature will get worse as the person bends forward to touch their toes.
  4. Herniated Disc — This can occur, particularly in the lumbar area (low back). A common diagnostic sign is radiating pain while tilting the back. Treatment usually is conservative with rest, medication, bracing, and appropriate exercises, but some cases may require surgery. Symptoms of a herniated disc may begin suddenly or gradually. Sudden aching in the back or neck or being unable to straighten your back without extreme pain are signs of herniated disc problems.21
  5. General Low Back Pain — Sprains (injuries to a ligament) and strains (injuries to a muscle) are the most common causes of low back pain.21 Low back pain is most often linked to weak abdominal muscles, which provide most of the support for the lower back. Most low back pain, whether acute or chronic, usually can be treated without surgery.

Preventative Methods
Some simple methods for reducing or preventing back pain include:

  • Exercising regularly to keep the muscles that support your back strong and flexible.
  • Using the correct lifting and moving techniques. Get help if an object is too heavy.
  • Stretching of the back muscles prior to getting up and before going to bed to reduce stiffness before and after activity.
  • Relaxation techniques to loosen your back muscles.
  • Maintaining proper posture to eliminate excessive stress on unwanted areas of the back.
  • Weight management: excess weight, especially in the abdominal region pulls the lower spine forward, often resulting in the pinching of nerves between the vertebral disks. It is impossible to target weight loss to one area of the body, so overall weight management must be achieved.
  • Performing core (abdominal) strength exercises including pelvic tilts and sit-ups twice daily to strengthen muscles that provide the most strength to the back.26

*If you are experiencing discomfort or recognize a sudden decrease in strength and/or stability, consult your doctor immediately about your symptoms and your possible need for physical therapy at a PT Northwest location.

Delayed Onset Muscle Soreness is quite common and is often irritating, as it typically prevents a person from doing their daily activities free of pain. DOMS describes an experience of muscle pain, muscle soreness or muscle stiffness that is felt 12 to 48 hours after exercise, particularly at the beginning of a new exercise program, after a change in sports activities, or a dramatic increase in the duration and/or intensity of exercise.1 This muscle pain is a normal response to unusual exertion and is part of the adaptation process that leads to greater stamina and strength as the muscles recover and build. This muscle pain is much different from the sort of muscle pain or fatigue you feel during exercise and it is also much different than the acute, sudden muscle pain or injury such as strains and sprains. DOMS is generally at its worst within the first two days following the activity and subsides over the next few days. There are no proven preventative or treatment methods for DOMS, as it is a natural response to exertion. But staying hydrated and stretching before and after exercise may help reduce the severity of DOMS.

For certain people, such as a person who has suffered from a stroke or a lost limb, the return to full function is just not possible. Therefore, physical therapists do their best to work with such patients to help them adjust to their chronic or debilitative condition(s).28 Chronic diseases are diseases of long duration and generally slow progression. They are characterized by a slow, insidious onset, implying a gradual development of structural damage.20 Many chronic diseases such as heart disease, stroke, cancer, chronic respiratory diseases, and diabetes are the leading causes of death in the world. Many people are under the misconception that physical therapy is only for patients with an acute injury, a sports medicine injury, or are in a post-surgical rehabilitative phase. This is not the case.

Physical therapy has been shown to be very effective when treating patients with a chronic disease and/or debilitative condition. In some cases, the chronic condition can possibly be cured through physical therapy, but at the least, physical therapy will likely decrease symptoms and make it easier to function in everyday life. Physicians often recommend physical therapy to their patients suffering from a chronic and/or debilitative condition and it is viewed as a positive approach to treatment. The aim in the treatment of chronic diseases is to arouse the system to acute eliminative effort. In other words, while in acute disease our hydropathic treatment is sedative, in chronic disease it is stimulative.26 PT Northwest offers a variety of different therapies that manage chronic disease, such as:

  • Physical Therapy
  • Occupational Therapy
  • Speech Therapy
  • Aquatic Therapy
  • Women’s Health Issues

*Click on Our Services from our Home Page to learn more about all the therapies offered at PT Northwest

PT Northwest treats patients with many different chronic conditions, such as:

  • Arthritis
  • Chronic Pain (i.e., low back, neck, knee)
  • Fibromyalgia
  • Stroke
  • Headaches and TMJ
  • Congenital Disorders


This article was written by By Kelley Lindstrom, Physical Therapy student and former intern for PT Northwest.

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