Show Osteoporosis Who’s Stronger

26 04 2012

Weakening Your Bones
As we age, our muscles and bones begin to wear. Without consistent physical exercise and proper nutrition, the marrow in your bones begin to deteriorate and/or stop forming. This condition is called osteoporosis (meaning “porous bone”). It is a condition where the marrow in your bones become brittle, leaving larger spaces within the bone. Osteoporosis affects half the population of women in the world, while affecting only one in every four (1:4) men. The National Osteoporosis Foundation (NOF) states that today in the US, ten million individuals are effected by the disease while another 34 million are estimated to have low bone density which increases their risk for osteoporosis and broken bones. The two sites that are most commonly identified as osteoporosis is the lumbar (lower) spine and femoral neck (hip). When these two sites become too brittle, the risk of fractures increase and life expectancy decreases. Another condition may occur in the spine due to osteoporosis. As the vertebral discs weakens, a forward curvature of the upper spine will occur known as the “dowager’s hump”. Someone with a dowager’s hump can have balance problems, which will increase the risk fractures from falling, while at the same time subjecting their internal organs to a lot of overbearing pressure.

RiskFactors
There are several risk factors that increases the chances for osteoporosis. These include:

  • Age – anyone can get osteoporosis but it is more common to see it in older adults
  • Gender – females are more susceptible than men
  • Family History – genetics play a role in the predisposition of osteoporosis
  • Menopause – Females going through or have gone through menopause have a higher risk
  • Low Body Weight or Small/Thin Framed – People with small bones increases their risk of osteoporosis
  • Poor Diet – lack of calcium and vitamin D slows down and can stop bone growth
  • Alcohol – consuming excessive amounts will reduce the formation of bone
  • Sedentary Lifestyle – inactivity can lead to lack of strength, poor balance, and reduced bone growth resulting in falls and fractures

Get Tested
The only way to diagnosis osteoporosis is to get a bone density test. Other methods like ultrasounds, blood tests, and normal x-rays are used as quick estimations, not accurate data and can cause a false sense of security in individuals who actually have osteoporosis. The most common bone density test or scanning method is a DEXA or DXA (Dual Energy X-Ray) scan. The two most common sites tested are the left hip (Femoral Neck) and the lower spine (lumbar spine). Other sites that can be used are the right hip, ankles,  and wrists if surgery or injury was prevalent in one of the other sites (e.g. hip replacement, spinal fusion). The results of a DEXA scan will show three possible outcomes: Normal (T score ≥ -1), Osteopenia (T score between -1 and -2.5), and Osteoporosis (T score ≤ -2.5). Your bone density scores are critical when talking with your physician about treatment plans.

Medications 
If you are diagnosed with either osteopenia or osteoporosis, your physician will probably discuss medication options with you to help treat your condition. There are a number of medications currently available for patients with osteoporosis and osteopenia. However, each medication may not be suitable for you, so you might not want to take what you’re next door neighbor is taking. Read up on the medications so that you are as informed as your doctor about the medication that you are prescribed. Sometimes, the physician is not as knowledgable about your treatments, so be a team and know your information. The NOF has a great listing of the current medications and information on each one (click here for medication listing).

Strengthen Your Bones
Another way to prevent fractures and reduce the risk of further deterioration of bone is to follow a healthy diet of fruits, vegetables, and dairy rich in calcium and vitamin D. Adding a little bit of sun exposure (vitamin D) can help improve absorption of calcium. For those of you who are concerned about skin cancer, all you need is 15 minutes of sun exposure to absorb enough vitamin D to get health benefits. Note that applying sun block while outside will prevent you from getting the vitamin D that you need. While you’re outside, do some weight bearing exercise (e.g. walking, jogging, jumping) to strengthen your muscles and also increase the density of your hip. To build up the density in your spine, resistance training should be done. A creditable, certified personal trainer can help you identify the correct resistance training for you. The American College of Sports Medicine recommends 3-5 days a week of moderate intensity weight bearing cardiovascular exercise for 30 minutes. Supplement that with 2-3 days a week of resistance training. Those with osteoporosis should also implement a daily balance and stretch program to prevent possible falls.

References:
American College of Sports Medicine, Guidelines for Exercise Testing and Prescription , 8th ed.

National Osteoporosis Foundation http://www.nof.org

WebMD, Anatomy Guide: Curvature Disorders http://www.webmd.com/pain-management/healthtool-anatomy-guide-curvature-disorders





Misconceptions about Personal Trainers

25 04 2012

While I was in Orlando working toward my quest to improve the health of individuals , I felt that I have stumbled on several road blocks. People I talk to either tell me that I’m not big enough to get them to where they want to be, or that they don’t want to get “huge/big.” These thoughts probably cross every average Joe/Jane’s mind when they see a personal trainer. Those who don’t want to bulk up think that personal trainers do only that, while those who are looking to bulk up think that personal trainers should be ex-bodybuilders. What happened to those people in the middle who just want to be healthy or improve their performance? That’s right, they think they can do it by themselves. Road block number 3.

By Doug ShamMisconceptions about a Personal Trainer:
I’m here to clarify some common misconceptions about personal trainers so that people can be educated and have a better understanding of what we, as professionals, are available to do.

- Many personal trainers must be certified through a national accredited certification program before they can work at a fitness facility. These certifications educate trainers on exercise physiology, exercise prescription, nutrition, working with special populations (i.e. older adults, youth, chronic illness, and pregnancy), and anatomy. Some certification programs, such as American College of Sports Medicine (ACSM) and National Strength and Conditioning Association (NSCA), require you to have a B.S. in Exercise Physiology, Exercise Science, or related field before being certified. To find a certification that is accredited by the National Commission for Certifying Agencies (NCCA) please visit http://www.credentialingexcellence.org/NCCAAccreditation/AccreditedCertificationPrograms/tabid/120/Default.aspx
– Whereas physicians are licenced to prescribe exercise to patients, they are not trained on prescribing specific exercise programming to individuals. Therefore, personal trainers should be searched out to have individualized exercise programs designed to meet the client’s specific needs. Personal trainers should communicate with physicians and build a partnership to improve the overall health of individuals.
– Personal trainers do not specialize in only bodybuilding. In fact, all certified trainers are never taught how to train in bodybuilding within the certification program. Rather, programs and education classes teach a personal trainer the exercise physiology and biomechanics in exercise to improve strength gains and muscle size.
– Personal trainers are trained to teach individuals how to exercise properly to optimize their health, while improving on their physiological and physical characteristics (i.e. weight management, endurance, agility, speed, muscle mass, and power).
– Personal trainers come from a wide background. Some may only have a high school diploma, while others have a Masters or Doctorate in an exercise related field. Some were/are bodybuilders, athletes, fitness experts, nutritionists, or an exercise enthusiast who want to help others stay health.  There is no problem in asking for a trainer’s credentials before making your selection to hire him or her. Remember, this is your body that they’re altering.
– You are paying for a professional’s help to improve your health, not just to look good for a cruise. Trainers ask for high prices because they are providing a service that will ultimately alter your health. Like doctors, dentists, neurosurgeons, and even massage therapists, we are all in a health care profession and go through continual education to keep up with the latest research and practices to keep you as healthy as possible. Personal training is a health care service and should not be thought of as a luxury service. Unfortunately, personal training sessions are preventative care services which are not widely covered by health insurance, and thus are thought of as a supplementary service.  However, if you think about the amount of money you pay on health insurance premiums, paying for a personal trainer to improve your health, and therefore lower those premiums, might be a cheaper way to go.

As I continue to work in this field that I love, I know that I will have to deal with the stereotypes of personal trainers. It will be my duty as a professional to explain how times have changed since the world of Arnold Schwarzenegger, Charles Atlas, and the like, and have moved to a way of health care and wellbeing.





Triumph Over the Female Athlete Triad

25 04 2012

In the last 30 years, females have been engaging in more sports and athletic events than ever before. This is significantly due to the passing of Title IX in 1972, which entitled women to equal participation in sports. Women of all ages have become fitter and more active throughout the last couple of decades, and the advocacy for fitness is great for improving overall health in women. However, within the past 25 years, the female population has been putting its health at risk with a condition known as the “female athlete triad.”  This condition is often noted in the younger age groups, but it affects all ages.

 

Body image is an underlining concern for many girls in this country. Throughout their young lives, media, peers, and even family members have caused girls to pay considerable attention to their body image. Now that athletics have been added into the equation, we see more stress on females to improve their physiology. Girls participating in ballet, gymnastics, crew, and martial arts are victims of female athlete triad. Coaches, teammates, and parents tell these girls to lose a couple more pounds so that they can perform better.  In actuality, weight loss beyond a healthy weight, does not improve athletic performance.

The consequences of female athlete triad include eating disorder, amenorrhea (menstrual disturbances), and osteoporosis (bone loss). When a person engages in physical activity, the body needs enough nutrients to sustain the energy demands. Female athletes who are self-conscience of their weight will tend to eat less. The energy imbalance begins to affect not only their physical appearance, but also performance and their health. A lack of sustainable fuel in a female body will cause hormonal changes. One known result of the body’s change is amenorrhea (no period or irregular periods). A lack of valuable nutrients, even though the female is participating in physical activity, can potentially cause the bones to become brittle. This process over time will result in osteoporosis. The common signs and symptoms of the condition include: weight loss, no periods or irregular periods, fatigue and decreased ability to concentrate, stress fractures, and muscle injuries. Those who engage in an eating disorder might not even feel like they are doing it. It is important to identify the signs and then to take a correct approach to improve a woman’s health.

If you know of someone who has female athlete triad or feel that you might be heading in that direction yourself, take some time to evaluate the situation and then the steps to improve the condition. Know that the disorder doesn’t just strike young girls. Adults and even non-elite athletes can fall into the triad. If you are physically active or engage in daily exercise, you may be a victim of this disorder. Talking to your physician or internist is the first step to providing the body with the right intervention. The Female Athlete Triad Coalition (www.femaleathletetriad.org) and kidshealth.org provide additional information on the treatment and prevention of female athlete triad.

References:
L DiPietro and N S Stachenfeld. (2006). The myth of the female athlete triad. British Journal of Sports Medicine, 40(6): 490-493

Female Athlete Triad from http://kidshealth.org/teen/food_fitness/sports/triad.html#

Female Athlete Triad Coalition from www.femaleathletetriad.org





Repair Your Keen Muscles With Quinoa

22 04 2012

So you’ve just finished your hard workout and you’re trying to figure out what to consume to bring those muscles back from the dead. You know that protein is the key essential nutrient that your body needs for muscle repair. But before you pick up that powder mix that you normally swig down with your shake, try this alternative that packs more punch and comes from a natural source.

Quinoa (KEEN-WAH) has been around for over 5,000 of years. Native to the Andes Mountains, this grain-like seed is known to be a complete protein. Complete proteins contain all 8 essential amino acids that your body does not produce by itself. All proteins that are found in meats and fish are not complete. The only additional way to get all 8 amnio acids would be to buy protein supplements that contain all amino acids. But why put a processed substance into your body when you can get the same benefits from this power food? Prepare this recipe the next time your muscles are starving to repair themselves.

Peppers Stuffed With Quinoa and Spinach (From Better Homes and Gardens New CookBook 15th ed.)
Serving size: 4
Prep time: 25 min
Cooking time: 63 mins

Ingredients:

  • 1 – 14oz can vegetable broth
  • 1/4 cup quick-cooking barley
  • 1/4 cup uncooked quinoa, rinsed and drained
  • 2 tablespoons olive oil
  • 1/2 cup chopped onion (1 med)
  • 2 cloves garlic, minced
  • 2 cups sliced fresh mushrooms
  • 1/4 teaspoon each salt and black pepper
  • 1 – 14.5oz can diced tomatoes
  • 1/2 of a 10oz package frozen chopped spinach, thawed and well drained 
  • 1.5 cups Monterey Jack cheese, shredded (6oz)
  • 4 large red sweet peppers

1. Preheat oven to 400°F. In a medium saucepan bring broth to boiling. Add barley and quinoa. Return to boiling; reduce heat. Cook, covered, about 12 minutes or until tender. Drain, reserving cooking liquid; set aside.

2. In a large skillet, heat oil over medium-high heat. add onion and garlic. Cook and stir 2 minutes. Add mushrooms. Cook and stir 4 to 5 minutes more or until mushrooms and onion are tender. Stir in 1/4 teaspoon each salt and black pepper, undrained tomatoes, and spinach. Stir in quinoa mixture and 1/2 cup of the cheese. Remove from heat.

3. Cut peppers in half lengthwise. Remove and discard seeds and membranes from the peppers. Sprinkle insides of peppers lightly with additional salt and pepper. Fill pepper halves with quinoa mixture. Place peppers, filled sides up, in a 3-quart rectangular baking dish. Pour reserved cooking liquid into dish around peppers.

4. Bake, covered 35 minutes. Uncover; top each with remaining cheese. Bake uncovered, about 10 more minutes or until peppers are crisp-tender and cheese is brown.

Nutritional Information:
415 calories, 22g total fat (10g sat. fat, 0g trans fat), 45mg cholesterol, 1,206mg sodium, 39g carbohydrates, 9g fiber, 19g protein

References:
E.A. Oelke, D.H. Putnam, T.M. Teynor, and E.S. Oplinger. (2012) from http://www.hort.purdue.edu/newcrop/afcm/quinoa.html

 





D.R. Doesn’t Stand For Dietitian

18 04 2012

There are times when I hear a member give nutritional advice to another member based upon what has worked for her. This upsets me because I know that even though the member has lost weight and wants this other person to lose weight too, the tips she suggests doesn’t work long-term. Getting the right nutritional advice for weight loss should come from someone who specializes in this area, such as a Licensed (LD) or Registered Dietitian (RD). I know this sounds common sense, but I’ll let you in on a secret, not many people see a dietitian when it comes to weight management. Even when the studies show that incorporating a registered dietitian into a weight loss program increases success rates, we steer clear from making an appointment with one. The American Dietetic Association (ADA) conducted a multi-year study in 2010 to research the benefits of adding a RD to a health promotion program for weight loss. The results showed programs with a RD had participants losing at least 5% of their current body weight.  Yet we feel like we know enough through what we read and hear from books, media, friends, and other professionals, that we go on these crazy “instant diets” only to succumb in the end to hunger and eventually weight gain.

The worst of all is that you justify the misfortunes of gaining back all your weight by telling yourself that you did it once and it was easy, so you’ll go back on the same diet and start back on phase one. The other option that I’ve seen is that it didn’t work and this shouldn’t have happened because the books were written by doctors, fitness professionals, or celebrities.  Then we go out and pick up another book off the shelf because some top-rated talk show host told you to buy it. This leads to more depression when you find out that the next “quick fix” book leads to another quick turn-around and the weight is back on.

I just received the latest issue (April 16, 2012) of Newsweek in the mail and on the cover was Dr. Phil (Click on photo to read the article). Now, I want to know how many people think that because he has the title “Dr.” in front of his name it suddenly makes him a physician or registered dietitian? The article is now one of my favorites because it exposes what celebrity talk-show hosts will do to get something sold. The whole article describes how Dr. Phil McGraw used his show to promote not just one, but two diet books that his son published. The craziness of it all is that Dr. Phil opposes diets! In a show back in 2010, he states, “Do you know that people that go on diets gain more weight during the year than people who don’t?” This is coming from a person who suddenly flips the switch later that year to promote extensively (the article claims that Dr. Phil pushed the book in 17 episodes and mentioned the book  27 times in one episode!) a diet book that claims to lose 10 to 15 pounds in just 17 days. This just doesn’t seem like a person who you’d want giving you nutritional advice.

Now I need to give Dr. Phil some credit, he is not a M.D., but he is a Ph.D psychologist who too had troubles with weight. He’s worked his magic by understanding how the human mind works and finding ways to profit from his knowledge. After leaving the clinical psychology gig, he hit a gold mine representing Oprah in a court case when he cofounded Courtroom Sciences, Inc. He was able to network with Oprah to become “one of the wealthiest and most powerful figures on television” describes Forbes magazine. So he’s able to get his own television show and get people to listen to him and suddenly everyone’s trying to lose weight quickly. That’s how it goes with all quick fix diets. Just read about your fad diets like Atkins, South Beach, Weight Watchers or watch the commercials for Jenny Craig, Nutrisystem, and any other infomercials on Saturday mornings. You’ll lose weight in a jiffy, but what they don’t tell you is how quickly those pounds come back.

Weight management is really about keeping your calories in balance. Calories in verses calories out. If you eat more than you burn off; weight gain. Eat less than you burn off; weight loss. Very simple idea, but so many people have a problem with this concept (hence the 33% of Americans who are overweight). One reason is because people don’t want to wait for the results. They want everything quick. Just ask yourself, “how long did it take you to get to your current weight?” Most likely it didn’t happen overnight. Therefore, the only way to lose weight long-term is the slow method. Losing one to two pounds a week by having a deficit of 3500 cal/wk is the only healthy and known long-term plan for weight loss. Know what you’re eating so you can stay one step ahead. This is where a dietitian or nutritionist can help to teach you which foods you should eat to maintain the energy level you need without stacking on the extra calories. Even your general physician will not be able to tell you what to eat and will refer you to a dietitian. The other component to this equation is the physical activity. I do not require people to join a gym to obtain their cardiovascular exercise. However a facility that provides resistance training will help keep your muscle strength while you lose the weight. The American College of Sports Medicine recommends 45 to 60 minutes of moderate cardiovascular exercise to lose weight. Studies have shown that exercising five to six days a week at 60 to 80 minutes a day leads to scientifically significant results. Biking, walking, running, kayaking, hiking, and playing sports can all count for cardiovascular exercise.  Combine exercise with a well-balanced meal and you’ll be shedding those pounds for good in no time.

References:
ACSM’s Guidelines for Exercise Testing and Prescription, 8th ed. (2010), Weight Management
American Dietetic Association, ADA Foundation 2010 Annual Report, p. 4

Wingert, P. & Roston, A. (2012). All in the Family. Newsweek, 28-33





Dog Gone It! Our Pets Are Obese!!

14 04 2012

I posted this on my other blog a few months ago and feel that it’s still relevent and so I want to share it with you all here.

 My wife and I were out strolling around old downtown Venice, FL a few weeks back and she pointed out something that made both our mouths drop. An older couple was walking by us with a stroller and my wife caught a glance at the carry-on. Inside the stroller was not a baby or heavy groceries, but a small dog! REALLY?  Then there was another one! Crossing the street we both saw a similar stroller, with mesh in the front and a roof to block the sun, and inside a little puffy terrier standing on all fours rolled ahead of the couple. This was ludicrous! I mean, come on people! What is wrong with this picture? These animals have legs, more legs than we do (remember why God gave us legs right?), and we’re carting them around! This was totally crazy in my eyes and as a trainer I had to notice that the couples were not daily exercise-goers either.

Then four days ago while at work making our country a little bit healthier one client at a time, I happen to glance up at one of our televisions that is set to CNN. Right in the middle of a screen was a video of a large overweight dog and the caption read “OBESITY EPIDEMIC STRIKES U.S. PETS.” I had to laugh. (You can read about it on CNN: http://www.cnn.com/2012/02/03/living/overweight-pets/index.html) Then I made the connection. Why are 41 million dogs and 47 million cats obese? Because we’re abusing them worse than we abuse ourselves with lack of exercise and too much food! According to the veterinarian on CNN, foods for our pets are higher in calories than the past and we aren’t providing them enough exercise. Get up and move people! Not just yourself, but with your pets too! Our pets, like our children, share similar lifestyles as you do. Why is Brutus turning into Fluffy? Most likely because we don’t have time to exercise ourselves, and so he doesn’t get the exercise either.  That is unacceptable! And so is going for a walk while you push Sparky around in a stroller. Walk your dog, get some exercise and make this country a healthier place for humans and pets. Remember 33% of people and 21% of pets are obese. Help us out!

This woman is the only one smiling. Please don't do this to your pet.





Stretching-The Truth

14 04 2012

If you grew up in the 80’s, then you would remember Gumby and Stretch Armstrong.  Although these characters posses inhuman characteristics, such as no bones, that allows their limbs and bodies to rotate, flex, and extend beyond what’s humanly possible, we should not take our flexibility for granted. According to the Bureau of Labor Statistics, more than one million people sustain a back injury every year at work. In the US alone, over six million (that’s 6,000,000!) people require medical attention due to a fracture. Fractures, broken bones, sprains, strains, and even the common back injury are caused by exceeding one’s range of motion (ROM) limits. The previously mentioned characters proved to the world that being flexible could be a great asset.

Every time I speak at a seminar on the topic of stretching I like to first start by asking the audience to throw out some information that they know or heard about stretching. The following are some responses:

  • Stretching is for athletes only
  • Bouncing gives me a better stretch
  • All I need to do is hold a stretch for a few seconds
  • The more pain, the better the stretch

My next slide I present after I ask the previous question shows some myths about stretching and I always get a couple of people taking in their breath or being surprised that their answers are on this slide. It happens all the time. That’s because too many sources are giving people contradictory information. Therefore, they’re left confused, which leads to dropping the stretch component of their workout, and ultimately sustaining an injury because their ROM is very limited. That’s why, I want to debunk what people have heard over the years in magazines, on television, and from friends. This way, you can walk away from this article knowing that you’ll move forward towards your goals without any limitations or severe setbacks.

To begin understanding the possibilities of our human bodies, we must first ask why. Why do we stretch? I know this might sound elementary, but do you really know why you’re stretching? The most common and sometimes only response that I get from the audience is: “to prevent injuries.” This is great! We know of only one reason why we stretch. The main reasons we stretch:

  1. To improve flexibility and ROM
  2. Increase blood circulation
  3. Obtain normal muscle length
  4. And through all of the above, the resulting benefit is injury prevention

Let’s go a little deeper to understand what each of these mean. Flexibility and range of motion (ROM) are the ability to move a body part in one direction through its limit . Flexibility and ROM are used interchangeably. The more flexible you are, the greater the ROM of that body part. As you move your body through its ROM, more blood is supplied to those muscles allowing for contractions, therefore, increasing the blood circulation within your body. We will touch on reason number three  later. So when all parts come together, the body will be more limber and thus injuries will be fewer.

Now that you know why you’re stretching, knowing what kinds of stretches to do before and after you exercise is important. That’s right, the stretches that you do before and after are different. Stretches that you do after your warm up and before you exercise should be dynamic stretches. A quick note before describing dynamic stretches. A warm up is needed to increase your body’s core temperature and move more blood to the muscles that will be used in the exercise. Dynamic stretches should be done after a warm up to prevent injury. These stretches are called dynamic because they are done by moving your body through a full range of motion for a number of repetitions. Dynamic stretches include; head circles, arm circles, trunk rotations, high knees, and butt kicks. These stretches are to prepare the muscles and joints for their movements within the exercise routine.

The other type of stretching which should be done at the end of a workout after the cool down is called static stretching and this is the most common type that people know. I have provided a routine of static stretches that you can do at the end of your exercise and even at the end of the day to keep your body flexible. I mention at the end of the day because even though you are not exercising, you are contacting your muscles throughout the day to do your lifestyle activities. It is important to do some static stretches at the end of the day to allow your muscles to return to their normal lengths and not wake up tight or stiff in the morning.  Never do static stretches in the morning or before you warm up. Pulling your muscles while they’re “cold” can lead to tears in the muscle or tendon. Also, only stretch to the point where you feel a little pull on your muscles. The name of the game is not to experience excessive amount of pain. Ever stretch a rubber band too far? If you remember what happened to that rubber band, know that your muscles are essentially rubber bands too. Too far too soon can cause that muscle or tendon to pull away from the attachment site. The myth that you should bounce while doing stretches is another fatality waiting to happen. Just like stretching too far, jerking on a muscle can cause as much damage to the muscle. The reason ballistic (bouncing) stretches are done is to allow athletes who’s main purpose is to warm up their legs to jump high.  So when you perform these stretches, use slow, controlled movements.

The American College of Sports Medicine recommends stretching two to three days a week (however, stretching daily saw greater improvements); holding for a count of 15-60 seconds for each static stretch; and performing two to three sets. Dynamic stretches should be done  for 8-10 repetitions.  Following this routine will reduce your risk of injury and improve your quality of life. Who knows, eventually you might be like Gumby and have no problem touching your feet without bending your legs.

Static Stretch Routine
Perform these stretches after you exercise and at the end of the day to keep your body limber and protect yourself from injury. Perform two sets, holding for 30-60 seconds for each stretch.

1. Foward Neck Stretch – (Neck)
Sitting up tall, lower your chin down toward your chest and hold the position.

2. Side Neck Stretch – (Neck)
Sitting up tall, lower your ear to the same side of your shoulder without lifting your shoulder or rotating your head. Place your hand on top of the ear to hold the head in position without pulling more than your neck can tolerate. Switch sides after each set.

3. Arm Across Chest – (Shoulders, Biceps)
Sitting up tall, place one arm across your chest and keep it straight. Place the other hand above the elbow of the crossed arm to keep it in position. Relax the wrist and allow the stretched arm to straighten to stretch the biceps. Do not hyperextend at the elbow. Switch arms after each set.

4. Chest Stretch – (Chest, Shoulders)
 Sitting on a mat with your knees bent , place the soles of your feet on the mat. Place your hands on the mat behind your body with your fingers pointing forward and bend your elbows. Slowly move your butt toward your feet to stretch your chest and shoulders.

5. Child’s Pose – (Back, Shoulder)
Kneel on a mat and place your rear on your heels. Slowly lower your upper torso towards the ground and place your arms outstretched by your head. Place your head on a pillow if it cannot relax on the ground. 

6. Prone Quadriceps Stretch – (Quadriceps)
Lie on your stomach and extend your legs straight. Have your hands at your side and rest your head downward or turned to the side. Lift one heel up toward your butt and using the same side hand, hold the foot or ankle and slowly pull the heel in closer. If you cannot reach your foot, grab a belt and loop it around your foot and hold the other end of the belt strap.

7. Hamstrings and Calf Stretch – (Hamstrings, Calf, Lower Back)
Sitting with your legs extending on the mat, bring one foot up and place the sole on the inside of your other thigh. Flex the outstretched foot back and slowly reach down towards that foot. If you can’t grab the foot, use a belt and hold the strap while looping the other side around your foot.

8. Glute Stretch – (Glutes, IT Band, Lower Back)
In the same position as the last stretch, cross the bent leg over the straight leg and place your opposite hand on the knee of the bent leg. Rotate your body towards the bent leg and hold.

References:
ACSM ‘S Guidelines for Exercise Testing and Prescription, 8th ed.  (2010), Flexibility Exercise. 172
ACSM’S Resource Manual for Guidelines for Exercise Testing and Prescription, 5th ed. (2006). Principles of Musculoskeletal Exercise Programming: Neuromuscular Consideration. 362
LiveStrong.Com http://www.livestrong.com/article/276514-range-of-motion-of-the-spine/
MayoClinic.com (2010), Stretching: Focus on Flexibility. http://www.mayoclinic.com/health/stretching/HQ01447
National Ambulatory Medical Care Survey & American Academy of Orthopaedic








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