Dr. Kyle: Sport Injury Rehabilitation

 

There are many factors to consider before clearing an athlete to return to sport. Time since injury, improvements in range of motion and increases in joint stability are all good metrics to evaluate before giving an athlete the green light.

Many rehabilitation programs focus primarily on enhancing maximal muscle strength. Current research suggests that Rate of Force Development (RFD) may actually be a better predictive factor in determining whether an athlete is ready for sport.

Common athletic maneuvers such as pivoting, jumping and stop-and-starts require rapid stabilization of the joints in the lower limb. This requires almost instantaneous muscle activation to prevent joint displacement and avoid re-injury. Factors such as neural activation, fiber composition and muscle contractile properties influence RFD and the body’s ability to absorb load on the joint. Therefore, it may not matter how strong the muscle is, but rather how fast the muscle can fire.

So how might this change rehabilitation programs?

Most physical rehabilitation protocols help build strength but fail to include an explosive component. Because athletic demands are often variable and unpredictable, it is important for the muscles to be able to react to any situation. Incorporating explosive plyometric exercises and a variation of sport specific drills will improve RFD and prevent future injury.

Take home points for sport-injury rehab:

• Allow sufficient time to for healing process to occur
• Recover full range of motion and flexibility
• Progressively overload the muscle to build strength
• Explosive training to enhance ability of muscle to generate force rapidly.
• Incorporate plyometric and sport specific drills to complement athletic demands.

As always, the best way to stay in the game is to avoid injury in the first place. So don’t wait for the pain to start before implementing an effective strength AND conditioning program.

If you or someone you know is suffering from a sport injury, call and book an appointment today for a complete musculoskeletal assessment!

 

Reference:
Buckthorpe, M., & Roi, G. S. (2018). The time has come to incorporate a greater focus on rate of force development training in the sports injury rehabilitation process. Muscles, ligaments and tendons journal, 7(3), 435-441. doi:10.11138/mltj/2017.7.3.435

Dr. Phil Shares: Healthy Aging: A Functional Medicine Approach to Sarcopenia

By 2020, more than 20% of the US population will be 65 and over.1 Healthy aging is and will continue to be an important focus in many Functional Medicine offices.

Sarcopenia, the gradual loss of muscle mass that occurs in healthy adults as they age, begins after the age of 30 and accelerates after 60. The difference between the muscle mass of a 20-year-old vs. an 80-year-old is about 30%.2

Loss of muscle contributes to reduced mobility, increased hospitalizations (fragility and falls), prolonged recovery, and mortality.Factors that contribute to earlier onset and more rapid progression of sarcopenia include lack of physical activity, inflammatory conditions, blood sugar imbalances, history of smoking, hormone imbalances, and low vitamin D status.4 Addressing these risk factors is part of an individualized, preventative approach.

Therapeutic considerations that may slow this sarcopenic process down and improve overall quality of life (QOL) in an otherwise healthy, aging adult include:

Protein

Adequate, daily protein intake is essential for muscle health and possibly even more important in the aging population. Based on the evidence, the ideal protein intake for a healthy, older adult is 1.0-1.2g protein/kg body weight/day, while higher intake levels may be required in patients with acute or chronic disease.5

Achieving optimal protein intake may generally be more difficult for elderly patients at high risk for sarcopenia. Based on the results of a 2011 analysis of health and aging trends, nearly 1/2 of all US adults over age 65 have difficulty or receive help with daily activities.6 Protein powders with added BCAAs are a convenient way to support patients in meeting their protein requirements and obtain critical nutrients to help address sarcopenia.7-8

Adequate protein may also reduce risk of other age-associated events such as strokes9 and hip fractures.10 Furthermore, a practitioner does not have to wait until signs of sarcopenia are present before assessing protein requirements. In combination with physical activity, adequate protein throughout adult life may offer protection against early onset and progression of sarcopenia.11

Key clinical points:

  • Addressing increased dietary guidelines for protein intake is important for preventing loss of muscle mass in older adults7
  • Higher protein intake and lower fat mass might be positively associated with physical performance in elderly women12
  • Practitioners may help delay onset and progression of sarcopenia by assessing protein intake prior to presence of clinical signs and symptoms11

Marine omega-3 fats

The diverse, significant health benefits of omega-3 polyunsaturated fatty acids (PUFAs), namely, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are well documented. Specific to the aging population, research points to benefits in cognitive health and cardiovascular markers, as well as physical function.13

Despite the evidence, dietary intake of omega-3 fatty acids is consistently insufficient in North America, with over 90% of the population consuming <500 mg/day of EPA and DHA.14 This is a far cry from the therapeutic intake (for muscle mass and function) suggested in clinical trials of 2g-4g/day.15 Nutritional guidance around omega-3 intake provides a therapeutic opportunity for clinicians to support their aging patients.

Key clinical points

  • Supplementation with fish oil helps address the EPA+DHA nutrient gap from one’s diet14 and may help slow the decline in muscle mass and function in older adults.16
  • Increased omega-3 intake stimulates muscle protein synthesis and may be useful in prevention and treatment of sarcopenia15
  • Improvement in grip strength and muscle tone are positive benefits that may be achieved with fish oil supplementation16

Vitamin D

Vitamin D deficiency is a common occurrence in the elderly population, and its relationship to bone health is well-established. Furthermore, normal vitamin D status has also been positively correlated with functional outcomes in the elderly.18 Optimizing vitamin D status may prove to be an essential component of a protocol addressing age-related frailty and sarcopenia, especially when combined with physical activity and a protein-rich diet.17

Key clinical points

  • Treating vitamin D insufficiency and deficiency may lead to improved muscle performance, reduced risk of falls, decreased bone loss, and reduced fracture incidence18
  • Meta-analysis data indicates that serum 25-hydroxyvitamin D levels are significantly and directly associated with the risk of frailty19

Exercise

Regular exercise is important in the prevention and treatment of sarcopenia. By positively influencing blood sugar levels and body composition, physical activity helps reduce many of the risk factors associated with early onset of sarcopenia. Exercise also directly supports healthy muscle mass and function.

Whether young or old, encouraging patients to live an active lifestyle is an important and healthy addition to a sarcopenia prevention and management plan. Therapeutic benefit is optimized when fitness programs include resistance and endurance exercises 3x/week.2

Key clinical points

  • Physical activity consistently mitigates frailty and improves sarcopenia and physical function in older adults20
  • Older patients who participate in resistance and endurance exercise programs may improve not only their function and independence but also their quality of life21

The implications of sarcopenia are potentially severe. Many complications may be reduced and QOL improved with a Functional nutrition approach.

References

  1. Ortman J et al. Population Estimates and Projections Current Population Reports. https://www.census.gov/library/publications/2014/demo/p25-1140.html. Accessed September 14, 2018.
  2. Frontera W et al. Aging of skeletal muscle: a 12-yr longitudinal study. J Appl Physiol. 2000;88(4):1321-1326.
  3. Prado CM et al. Implications of low muscle mass across the continuum of care: a narrative review. Ann Med. 2018:1-19.
  4. Szulc P et al. Hormonal and lifestyle determinants of appendicular skeletal muscle mass in men: the MINOS study. Am J Clin Nutr. 2004; 80(2):496-503.
  5. N. Deutz et al. Protein intake and exercise for optimal muscle function with aging: recommendations from the ESPEN Expert Group. Clin Nutr. 2014;33(6):929-936.
  6. Disability and Care Needs of Older Americans: An Analysis of the 2011 National Health and Aging Trends Study. https://aspe.hhs.gov/report/disability-and-care-needs-older-americans-analysis-2011-national-health-and-aging-trends-study
  7. Garilli B. https://www.metagenicsinstitute.com/articles/bcaa-leucine-supplementation-increases-muscle-protein-synthesis-healthy-women/. Accessed September 14, 2018.
  8. Devries MC et al. Leucine, not total protein, content of a supplement is primary determinant of muscle protein anabolic responses in healthy older women. J Nutr. 2018;148(7):1088–1095.
  9. Zhang Z et al. Quantitative analysis of dietary protein intake and stroke risk. Neurology. 2014;83(1):19-25.
  10. Kim BJ et al. The positive association of total protein intake with femoral neck strength (KHANES IV). Osteoporos Int. 2018;29(6):1397-1405.
  11. Paddon-Jones D et al. Protein and healthy aging. Am J Clin Nutr. 2015;101(6):1339S–1345S.
  12. Isanejad M et al. Dietary protein intake is associated with better physical function and muscle strength among elderly women. Br J Nutr. 2016;115(7):1281-1291.
  13. Casas-Agustench P et al. Lipids and physical function in older adults. Curr Opin Clin Nutr. 2017;20(1):16-25.
  14. Richter CK et al. Total long-chain n-3 fatty acid intake and food sources in the United States compared to recommended intakes: NHANES 2003-2008. Lipids. 2017;52(11):917-927.
  15. Smith GI et al. Fish oil–derived n−3 PUFA therapy increases muscle mass and function in healthy older adults. Am J Clin Nutr. 2015;102(1):115–122.
  16. Smith GI et al. Dietary omega-3 fatty acid supplementation increases the rate of muscle protein synthesis in older adults: a randomized controlled trial. Am J Clin Nutr. 2011;93(2):402-412.
  17. Bauer JM et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2015;16(9):740-747.
  18. Dawson-Hughes B. Serum 25-hydroxyvitamin D and functional outcomes in the elderly. Am J Clin Nutr. 2008;88(2): 537S–540S.
  19. Ju SY et al. Kim. Low 25-hydroxyvitamin D levels and the risk of frailty syndrome: a systematic review and dose-response meta-analysis. BMC Geriatr. 2018;18(1):206.
  20. Phu S et al. Exercise and sarcopenia. J Clin Densitom. 2015;18(4):488-492.
  21. Landi F et al. Exercise as a remedy for sarcopenia. Curr Opin Clin Nutr Metab Care. 2014;17(1):25-31.

By Melissa Blake, BSc, ND

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: The Impact of Ketogenic Diet on Body Composition During Resistance Training

Ketogenic protocols have become an important therapeutic option for a variety of health issues including weight management, cardiometabolic dysfunction, and epilepsy.1 The potential of the ketogenic diet (KD) to help optimize body mass has important implications for the reduction of metabolic syndrome and its related chronic disease aspects such as heart disease, fatty liver, and type 2 diabetes (T2D).

Additionally, the ketogenic dietary approach has gained widespread attention within the professional sports performance and wellness communities for its ability to enhance weight loss and optimize body composition, both critical components in accomplishing training goals for this population.2-3 However, concerns exist in the sports performance community regarding the impact of a KD, including the possibility that lowering total body mass may reduce the ability of an individual to optimize muscle hypertrophy through resistance training (RT) due to increased central fatigue and other related factors.3

To learn more about the effects of a KD in combination with RT, a randomized, controlled, parallel arm, prospective study was conducted, with results published in the Journal of International Society of Sports Nutrition.3 The study’s authors hypothesized that, “a KD with caloric surplus in combination with RT in trained men would have a positive impact in fat reduction, and it would benefit the gains in lean body mass (LBM)”.3

Healthy, athletic men (N=24) from Spain (average age: 30, weight: 76.7kg, BMI: 23.4) with at least 2 years of continuous overload training experience were randomized into 1 of 3 groups: KD, non-KD, or control group.3 The participants followed their approved diets for 8 weeks along with supervised hypertrophy training protocol 4 days/week: 2 days of upper body and 2 days of lower body workouts. The KD group was monitored weekly by measuring urinary ketones with reagent strips to ensure they achieved and remained in ketosis. Body composition was assessed using DXA.

Participants all consumed a similar number of calories, which was set for a moderate energy surplus of 39 kcal/kg/day.3 The KD group consumed 20% of calories as protein (2g/kg/day), 70% as fat (3.2g/kg/d), and <10% of their calories as carbohydrates (approximately 42g/d).3 The non-KD consumed the same 20% of calories as protein (2g/kg/day), 25% as fat, and the remaining 55% as carbohydrates.3 Both groups were encouraged to eat 3-6 meals per day, and individuals in the control group were asked to maintain their current exercise and dietary routines throughout the study.

Results:3

  • KD: ↓ fat mass (FM) and ↓ visceral adipose tissue (VAT); non-significant reduction in total body weight; non-significant increase in lean body mass (LBM)
  • Non-KD: No significant changes in FM or VAT; significant ↑ in total body weight and ↑ LBM
  • Control: No significant changes in FM, VAT, total body weight, nor LBM

The overall results indicate the KD intervention was able to achieve a positive change in body composition with a decrease in body weight (non-significant) and reduction in FM and VAT.3 LBM did not increase significantly in the KD group, and the results indicate that LBM may be enhanced through an adequate carbohydrate intake (as was provided in the non-KD and control group diet protocols of this study) while also consuming a calorie surplus with a higher protein intake to support muscle hypertrophy.3

In summary, the implementation of a KD in male athletes taking part in regular resistance training may lead to lowering of VAT and FM, both important factors for body mass optimization and reducing risk of cardiometabolic disease processes.3 However, the lack of lean body mass accrual in this study indicates that the KD  may not be an optimal strategy for building muscle mass in trained athletes when utilized alongside a resistance training program.3 Longer study duration with larger samples, both genders, and less fit individuals (e.g. overweight) would be valuable for further exploration.

Why is this Clinically Relevant?

  • KD in trained men combined with resistance training protocols may improve VAT and FM levels, both risk factors for cardiovascular disease3
  • Trained men desiring to increase LBM and increase muscle hypertrophy may need to consider a dietary approach which includes a calorie surplus with high protein content along with adequate carbohydrate intake

View the article

Citations

  1. Paoli A et al. Beyond weight loss: a review of the therapeutic uses of very-low-carbohydrate (ketogenic) diets. Eur J Clin Nutr. 2013;67(8):789–796.
  2. McSwiney FT, Wardrop B, Hyde PN, Lafountain RA, Volek JS, Doyle L. Keto-adaptation enhances exercise performance and body composition responses to training in endurance athletes. Metabolism. 2018;81:25-34.
  3. * Vargas S, Romance R, Petro J, et al. Efficacy of ketogenic diet on body composition during resistance training in trained men: a randomized controlled trial. J Int Soc Sports Nutr. 2018;15:31.

*Note: In the Vargas S et al. 2018 article, there are discrepancies in body composition outcomes in the written Results section of the article, however, the quantitative results in Table 2 and the Abstract are correct and are summarized above.

Shared by Dr. Phil McAllister @ Forward Health Guelph

Written by Bianca Garilli, ND

Dr. Phil Shares: 11 Signs That You’re Falling In Love, According To Science

If you’re stressed out or suddenly trying yoga, you may just be falling in love.

Knowing you’re in love feels different for everyone. Some have been in love often and know the feeling well, and others may be not so sure if it’s love or just a deep infatuation.

Luckily, your body has some pretty sneaky ways of tipping you off to whether these feelings for your partner are more than just a passing phase. Keep an eye out for these tell-tale signs the next time you catch yourself wondering if you’re actually in love.

You can’t stop staring at them.

If your partner has ever caught you staring at them lovingly, it could be a sign that you’re head over heels. Eye contact means that you’re fixated on something, so if you find that your eyes are fixed on your partner, you may just be falling in love.

Studies have also found that couples who lock eyes report feeling a stronger romantic connection than those who don’t. It goes the other way too: when a study had strangers lock eyes for minutes at a time, they reported romantic feeling towards each other.

You feel like you’re high.​

It’s completely normal to feel out of your mind when falling for someone.

A study from the Kinsey Institute found that the brain of a person falling in love looks the same as the brain of a person who has taken cocaine. You can thank dopamine, which is released in both instances, for that feeling.

This is a good explanation for why people in new relationships can act absolutely nonsensically.

(Getty Images/iStockphoto)

You always think about them.​

If you love someone, you may feel like you can’t get them off of your mind. That’s because your brain releases phenylethylamine, aka the “love drug” when you fall in love with someone.  This hormone creates the feeling of infatuation with your partner.

You may be familiar with the feeling because phenylethylamine is also found in chocolate, which may explain why you can’t stop after just one square.

You want them to be happy.​

Love is an equal partnership, but you’ll find someone’s happiness becomes really important to you when you’re falling for them.

So-called “compassionate love” can be one of the biggest signs of a healthy relationship, according to research. This means that you’re willing to go out of your way to make your partner’s life easier and happier.

If you find yourself going out of your way to keep your partner dry when walking in the rain or making them breakfast on a busy weekday morning, it’s a sign you’ve got it bad.

You’ve been stressed lately.

Although love is often associated with warm and fuzzy feelings, it can also be a huge source of stress. Being in love often causes your brain to release the stress hormone cortisol, which can lead you to feel the heat.

So if you’ve noticed your patience is being tested a little more than normal or you’re kind of freaking out, you may not need to carry a stress ball just yet; you may just be in love.

You don’t feel pain as strongly.​

Falling for someone might be painful, but if you’ve noticed that literally falling doesn’t bother you as much anymore, it could be a big sign you’re in love.

A study conducted by the Stanford University School of Medicine had participants stare at a photo of someone they loved and found that act could reduce moderate pain by up to 40%, and reduced severe pain by up to 15%.

So if you’re getting a tattoo, you may want to keep a photo of your partner handy. Just in case.

(Getty Images/iStockphoto)

You’re trying new things.

Everyone wants to impress their date in the beginning of their relationships, but if you find yourself consistently trying new things that your partner enjoys, you may have been bitten by the love bug.

In fact, a study found that people who have claimed to be in love often had varied interest and personality traits after those relationships. So even if you hate that square-dancing class you’re going to with your partner, it could have a positive effect on your personality.

Your heart rate synchronizes with theirs.

Your heart may skip a beat when you think about the one you love, but a study showed that you may also be beating in time with each other. A study conducted by the University of California, Davis, suggests that couples’ hearts begin to beat at the same rate when they fall in love.

Although you may not be able to tell if this has happened without a few stethoscopes, feeling a deep connection to your partner is a good a sign as any that you’re in love.

You’re OK with the gross stuff.

If you’re a notorious germaphobe and totally cool kissing your partner after just watching them pick their nose, you might just be in love. In fact, a study by the University of Groningen in the Netherlands found that feelings of sexual arousal can override feelings of being grossed out.

So that means if you’re super attracted to your partner, you may just let them double dip. That’s love, baby.

You get sweatier.​

If you’re nauseous and sweaty, you either have a bad stomach bug or are falling in love. A study found that falling in love can cause you to feel sick and display physical symptoms similar to that of anxiety or stress, like sweat.

Although this feeling will probably pass once you really get comfortable with your partner, it may be a good idea to carry around an extra hanky, just to be safe.

You love their quirks​

If you really get to know a person, chances are you’ll pick on the little things that make them uniquely them. And if you’re in love with them, these are probably some of the things that attract you most about them.

A study found that small quirks can actually make a person fall deeper in love with someone rather than just physical attributes because people have unique preferences. So although you may have judged your partner a little harshly on first glance, if you find that you’re suddenly in awe of their uniqueness, you might be in love.

By Kristin Salaky

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: Should You Work Out With a Cold?

Should You Work Out With a Cold?

When you’re feeling under the weather, does activity help or hinder?

Most experts agree you can still work out when you’re sick — as long as you listen to your body and not push it.

Keep in mind, everyone’s tolerance level for colds and sniffles varies — one person feels like they can sustain a normal workout routine, while another feels too draggy to even consider it.

“Studies show that exercise is beneficial because it can boost your immune system before, during and after sickness,” says Nicola Finely, M.D., integrative medicine specialist at Canyon Ranch in Tucson.

Note: If you have a chronic health condition, such as asthma, you may want to consult your doctor first before exerting yourself.

Does Exercise Boost the Immune System?

“Exercise allows your white blood cells to circulate faster throughout the body, and white blood cells are the immune warriors that fight off infections,” explains Finely.

The American College of Sports Medicine backs that up, too, stating that regular and moderate exercise lowers the risk for respiratory infections and that consistent exercise can enhance health and help prevent disease.

In one study in the American Journal of Medicine, women who walked for 30 minutes every day for a year had only half the number of colds as those who didn’t bust a move.

Working out almost daily at a moderate pace can help keep your immune system strong.

But overtraining and pushing yourself too hard for too long can decrease the levels of IgA, which are antibodies on the mucosal membranes, such as the respiratory tract. These antibodies are needed to battle bacteria and viruses.

According to The American College of Sports Medicine (ACSM), moderate physical activity done every day, such as yoga or jogging, is the most effective way to keep the immune system strong.

Should-You-Work-Out-With-a-Cold

Experts Recommend Exercising With a Cold If:

  •  You have a garden-variety cold but no fever. Exercise can help relieve you from stuffiness by opening up your nasal passages, says the Mayo Clinic.
  •  Your symptoms are above the neck like a runny nose, nasal congestion, sneezing or a slight sore throat.

“Keep the intensity at a moderate-to-low pace,” cautions Finely.

For example, if you typically go for a 30-minute run every day, take a brisk walk instead. And if you start to feel worse with exercising, then you should stop, she says.

Skip Exercise With a Cold If:

  •  You have a fever, discomfort in your chest, or difficulty breathing.
  • Your symptoms are below the neck, such as chest congestion, a hacking cough or an upset stomach.
  • You’re tired, you’re running a fever, or you’re especially achy. “I’d suggest any patient refrain from exercise if fever is higher than 101.5 degrees Fahrenheit,” says Finely, who points out that a fever is considered any temperature over 100 F. Exercising during this time increases the risk of dehydration, and can worsen or lengthen the duration of your cold, she explains.

A 2014 study in the journal Sports Health found that fever can have harmful effects on muscular strength and endurance.

There’s no great advantage in tiring yourself out when you’re feeling ill. After all, you don’t want to risk making yourself sicker, and taking a few days off shouldn’t affect your overall performance. “When you get back to exercise, make sure to gradually increase your level as you begin to feel better,” Finely advises.

Exercising during a cold can be beneficial, but don’t push it.

Remember, it can help flush bacteria out of your lungs and airways and reduce your overall chances of getting a cold in the first place.

The important thing is to listen to your body.

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: 5 Quick + Easy Ways To Incorporate Wellness Into Your Week

With all of the go, go, go that comes with being a busy, working woman, sometimes our own health falls to the wayside. We get it, not everyone has the time to hit a two-hour Pilates class every day…we certainly don’t! We’re all about striking a balance here and figuring out simple ways to improve our health on the daily. Let’s keep it simple and dive right into our five quick and easy wellness tips to improve your week.

easy wellness tips

Increase Your Intake of Hydrating Foods

Every wellness article you read is going to tell you to drink your body weight in water, and you should! But just in case you’re not the best at guzzling gallons of water in one sitting, try snacking on it! Foods like cucumbers, watermelon, strawberries, tomatoes and zucchinis are about 95 percent water. Increase your intake of these tasty snacks and you’ll kill two birds with one stone. We also love mixing in a shot of this hydrating inner beauty boost into our water!

Micro-Dose Your Vitamin D

Set a timer on your phone, write it on your to-do list, do whatever you need to do to incorporate fresh air into your day. Before lunch each day, head outside for a 15-minute walk and soak up the sunshine. Fifteen minutes may not sound like much, but it’s enough to get your blood pumping and also shift your mindset. Pencil in a minimum of one walk per day, but if you can swing more, do it!

Eat Mindfully

So many of us (*guilty hand raised*) eat like it’s just something else to check off our to-do list. We often eat our lunch at our desk in front of a computer, or at home in front of the television. This often leads to overeating or mindless snacking! When it’s time to eat a meal, choose somewhere intentional to sit that doesn’t involve devices with screens. This will help you feel mindful as you eat, breathing between bites, and taking note of when your body is satisfied.

Try Dry Brushing

Never heard of dry brushing? It has a surprising number of benefits, including lymphatic system stimulation. The lymphatic system is responsible for collecting and transporting waste to the blood. Dry brushing can stimulate the lymphatic system as it stimulates and invigorates the skin. It helps with everything from improving the appearance of skin to supporting digestion. Try our favorite brush here

Do Bedtime Yoga

This is one of our favorite ways to end the day. You literally do yoga in your bed, what could be more relaxing? We follow this routine, but feel free to find one that you look forward to doing each night!

Shared by Dr. Phil McAllister @ Forward Health Guelph

The Back Squat: Tips from Dr. Kyle

Advanced Squatting Technique

 

 

The back squat is one of the most popular and important exercises in the development of lower body strength. Maximal back squat performance shows strong correlations with improved athletic ability.

Although this is one of the most common exercises in strength and conditioning programs there is still variation in coaching styles for the classic back squat. Over the last decade there has been an ongoing debate over what techniques produce the best back squat.

So what does the evidence show?

First I must point out that techniques that work for some people may not work for everyone. Each individual has slight variations in the structure of their hips. Some people are born with more shallow hip joints while others present with a much deeper ball and socket structure.

Contrary to popular belief, the back squat does not produce excessive strain on the ACL. As squat depth and knee flexion increases, the force through the ACL increases as well. However, there is significantly less shearing force on the ACL during the squat as compared to open chain exercises such as knee extensions.

What about depth?

As knee flexion increases, so do the forces on the patella-femoral joint and tibio-femoral joint. Training in a progressive-overload fashion and allowing proper time for recovery will help avoid injury to the quadriceps tendon.

Deeper squats have been reported to result in greater jump performance in controlled trials. A combination of both deep and shallow squats (of greater intensity) demonstrated the greatest improvement in 1 rep max strength in a recent study.

Should the knees go beyond the toes?

Current research shows that when the knees pass beyond the toes while squatting there is an increase in anterior displacement of the tibia in relation to the femur. This may lead to a greater risk of sprain or strain in the knee. Research also showed that when the squat was restricted (knees did not pass beyond the toes) there was a noticeable increase in the shearing forces in the low back. Therefore it is not recommended to restrict the knees from going beyond the toes in and effort to reduce knee strain, as this will disproportionately increase the shearing forces in the lumbar spine.

What is the ideal trunk position?

Positioning of the trunk is directly related to the range of dorsiflexion in the ankle. When the range of motion in the ankle is restricted, the body tends to lean forward during the descent phase of the squat. When full range of motion is achieved in the ankles, the knees can shift forward and the torso remains more upright. Stretching and soft tissue therapy of the posterior calf muscles prior to squat training will therefore improve ankle mobility and prevent excessive forward lean.

Where should I be looking?

Downward gaze while squatting is associated with a greater forward lean. Maintaining a more upward gaze will keep the torso upright and prevent excessive shearing forces in the low back.

Last but not least: Foot position

Foot position will be slightly different for each lifter. A “natural” foot placement is recommended. This means roughly shoulder width apart with the toes pointing slightly outward. As mentioned before, everyone has different anatomical structure of the hips, ankles and knees. Foot placement will therefore be dependent on the natural rotation of the hips.

So what is the optimal back squat technique?

• Heels remain in contact with the floor
• Gaze forwards and upwards
• Natural stance width and foot positioning
• Full depth (115-125 degrees)
• Knees tracking over toes
• Chest up, relatively upright posture, neutral spine

As always, these are just recommendations and each individual should use precaution when beginning a new exercise. Please refer to a qualified strength and conditioning coach or a licensed health care professional for a complete movement assessment. Call 519-826-7973 or visit www.forwardhealth.ca to set up an appointment with Dr. Kyle today!

Visit https://www.facebook.com/drkylearam/ for video demonstrations and more!

Dr. Phil Shares: 8 Great Things About Exercising at Lunch

8 Great Things About Exercising at Lunch

Between work, social obligations and general life responsibilities, it can be difficult to fit everything into one day. That often leads to healthy activities like working out being relegated to extracurricular status and never becoming part of your routine.

Given all that, squeezing in a lunchtime workout might seem impossible. And yet … below we’ve got eight reasons to do exactly that. Once you start reaping the physical and mental benefits of midday exercise, you might never go back.

1
IT WILL DE-STRESS YOUR DAY

Nothing wards off stress quicker than a good sweat session. Per Harvard Medical School, exercise “has a unique capacity to exhilarate and relax, to provide stimulation and calm, to counter depression and dissipate stress.” It’s been successfully used to treat anxiety disorders and even clinical depression, so it can help you cope with a day full of meetings or that big presentation.

2
YOUR WORKOUTS WILL BE MORE EFFICIENT

If you’ve got nowhere to be, it’s easy to move slowly through a workout, taking time to check your phone, scroll through your playlist or just sit and relax on a weight bench. But when you’re due back in the office, you’ve got extra incentive to make the most of your time. And fortunately, between cardio, weight circuits and HIIT classes, you don’t need more than 30–40 minutes to get in a great workout.

3
YOU’LL UNDO DESK-RELATED DAMAGE

It’s just not healthy to sit all day. Over the years, studies have shown sedentary behavior is associated with obesity, insulin resistance, heart disease and poor circulation. In fact, research published in the American Journal of Clinical Nutrition showed a 61% increase in mortality rates in those who sit and watch TV for seven hours or more per day. So getting up from your desk to stretch or walk around is a great start. Getting up from your desk to exercise for 30–45 minutes is even better.

4
IT FREES UP YOUR EVENINGS

If you’re tired of choosing between the gym and dinner with friends, well, now you won’t have to. Exercise during lunch and your night will be free to spend as you please, without the guilt of knowing you’ve missed yet another workout.

5
YOU’LL BEAT THE CROWDS

Sure, this article could cause everyone to make a mad dash to the gym. But the reality is that, on weekdays, most people work out in the morning or in the evening. That leaves the gym less crowded for lunchtime exercisers like you, so you can nab a coveted bike in that popular spin class or knock out a quick gym session without waiting on machines.

6
YOU’LL MAKE BETTER FOOD CHOICES

Even though you may feel hungry after working out, studies show exercise can help to regulate appetite and even promote satiety. It does this by releasing hormones that help the body better recognize when it’s full. So if you work out during the day, you’re not only getting the healthy benefits of exercise, but you’re more likely to make smart choices at lunch and dinner.

7
YOU’LL FEEL MORE ENERGIZED

A good workout gets the endorphins flowing, and endorphins contribute to that feeling of euphoria, often referred to as a “runner’s high.” That good feeling doesn’t stop the second you stop moving. Instead, the increased heart rate and blood flow can be accompanied by improved mood and energy for several hours after a workout, which means you’ll have the energy you need to tackle the rest of your afternoon.

8
IT’LL BOOST YOUR PRODUCTIVITY

In addition to improving your physical energy, exercise can also increase mental alertness and creative thinking. According to British researchers, workers who spent 30–60 minutes exercising at lunch reported an average performance boost of 15%. And 60% of workers saw improved time management skills, mental performance and ability to meet deadlines on days they exercised.

With all those reasons to work out during lunch, you might as well give it a try. And if your boss gives you a hard time about leaving in the middle of the day, just say (diplomatically) that you’re exercising because you care about your job and want to perform at your best.

 

by Kevin Gray

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: 10 Keto Recipes to Satisfy Your Cravings

Livin’ La Keto Loca

Creative cooking for the keto lifestyle

When it comes to a ketogenic diet, it’s no surprise that many of your favorite foods are off limits (e.g., sugary treats, carb-filled breads and pastas, etc.). And for most people, that’s enough of a deterrent to stay away from keto altogether. Don’t write it off just yet—you can enjoy delicious savory and even sweet foods even when following the strict keto macronutrient profile. These amazing recipes will prove it.

Egg-citing Breakfasts

Delicious Dinners

Savory Snacks

California Sunrise Bowl
Blueberry Scones
Ketolicious Chicken Empañadas
Fat Pizza
La Keto Loca Quesadillas
Bacon-Wrapped Asparagus
Cheesy Chicken Casserole
Taco ’Bout It Keto Skillet
Jalapeño Parm Crisps
Keto-Style Pigs in a Blanket

 

Egg-citing Breakfasts

California Sunrise Bowl

Makes 1 Serving

INGREDIENTS:
  • 2 large eggs
  • ½ link chorizo sausage (4″ long)
  • ½ ripe California avocado
  • 2 Tbsp. sour cream
  • ¼ cup cheddar cheese, shredded
  • 2 Tbsp. salsa
  • ⅛ cup cilantro

DIRECTIONS:

  1. Cook chorizo over medium-high heat in a skillet.
  2. Place chorizo on a paper towel and pour out some of the grease, setting some aside for the eggs.
  3. In a skillet over medium heat, add leftover chorizo grease, then break in eggs and scramble. For extra fluffiness, add milk (optional). Once cooked, add eggs to the bottom of a bowl.
  4. Top eggs with chorizo and layer on avocado, cheese, tomato, sour cream, and cilantro.
    Serve warm and enjoy!
Per Serving: 530 calories, 13 g carbs, 43 g fat, 26 g protein

 

Blueberry Scones

Makes 12 Servings

INGREDIENTS:
  • 2 cups almond flour
  • ¼ tsp. stevia
  • ¼ cup coconut flour
  • 1 Tbsp. baking powder
  • ¼ tsp. salt
  • 2 large eggs
  • 1 Tbsp. coconut oil
  • ¼ cup heavy whipping cream
  • ½ tsp. vanilla extract
  • ¾ cup fresh blueberries

DIRECTIONS:

  1. Preheat oven to 325°. Line a large baking sheet with parchment paper.
  2. In a large bowl, whisk together almond flour, stevia, coconut flour, baking powder, and salt.
  3. Stir in eggs, whipping cream, oil, and vanilla and mix until a dough forms. Add blueberries; carefully mix through.
  4. On the baking sheet, pat dough into a rectangle, about 10” x 8” in size.
  5. Cut dough into 6 squares, then cut each square diagonally to form two triangles. Gently lift scones and distribute them around the pan.
  6. Bake 20 to 25 minutes, until golden brown and slightly firm. Remove and allow to cool. Serve and enjoy!
Per Serving: 150 calories, 6 g carbs, 12 g fat, 5 g protein

Delicious Dinners

Ketolicious Chicken Empañadas

Makes 3 Servings

INGREDIENTS:
Crust:
  • 1 cup mozzarella cheese, shredded
  • ½ cup almond flour
  • 1 oz. cream cheese
  • 1 large egg

Filling:

  • 6 oz. ground chicken
  • 1¼ tsp. Metagenics MCT oil
  • Salt and pepper

DIRECTIONS:
Crust:

  1. Cut cream cheese into 4-5 pieces and add to a bowl along with mozzarella cheese. Microwave for 30 seconds. Stir, then microwave for another 30 seconds. While cheese is still hot, mix in almond flour. Add egg and mix well.
  2. On a nonstick sheet, roll out dough into a flat circle.
  3. Using a cookie cutter, create 6-8 circles, approximately 5″ in diameter.

Filling:

  1. Preheat oven to 350°. Place dough circles onto a nonstick baking pan. Layer filling on one side of the circle.
  2. Fold and press down the edges, creating a half-moon shape.
  3. Bake for 18-20 minutes, until puffed and golden brown. Serve and enjoy!
Per Serving: 370 calories, 4 g carbs, 27 g fat, 26 g protein

 

Fat Pizza

Makes 4 Servings

INGREDIENTS:
Crust:
  • 4 large eggs
  • 6 oz. shredded mozzarella cheese
  • ½ cup almond flour
  • ½ Tbsp. psyllium husk powder

Topping:

  • 3 Tbsp. tomato paste
  • 1 tsp. dried oregano
  • 5 oz. shredded cheese
  • 1½ oz. pepperoni

DIRECTIONS:

  1. Preheat oven to 400°. For crust, melt cheese in a bowl and add eggs to combine. Add flour and husk powder to mixture and knead dough into a ball.
  2. Apply some olive oil to the bottom of the baking pan to keep from sticking. Flatten the ball of dough directly over oil, then bake for 10-15 minutes or until golden. Remove and allow to cool.
  3. Increase oven temperature to 450°. Spread tomato paste on crust and sprinkle oregano on top. Top with cheese and pepperoni.
  4. Bake for another 5-10 minutes or until golden brown. Serve and enjoy!
Per Serving: 355 calories, 8.4 g carbs, 26 g fat, 23 g protein

 

La Keto Loca Quesadillas

Makes 3 Servings

INGREDIENTS:
Low-Carb Tortillas:
  • 2 large eggs
  • 2 large egg whites
  • 6 oz. cream cheese
  • 1½ tsp. ground psyllium husk powder
  • 1 Tbsp. almond flour
  • ½ tsp. salt

Filling:

  • 5 oz. shredded Mexican cheese
  • 1 oz. spinach
  • 1 Tbsp. avocado oil

DIRECTIONS:
Tortillas:

  1. Preheat oven to 400°. Beat eggs and egg whites together until fluffy, then add cream cheese and continue to beat until smooth.
  2. Combine salt, psyllium husk powder, and almond flour in a small bowl and mix well. Beat flour mixture into batter until combined; ensure batter is thick and allow to rest. (If needed, add more husk powder to increase thickness.)
  3. Using a spatula, spread batter over parchment paper-lined baking sheet and bake 5-7 minutes until edges brown, then cut into pieces; alternatively, you may fry batter in rounds on the stove.

Quesadillas:

  1. Heat oil (or butter) in a small, non-stick skillet. Add tortilla to pan, top with a handful of spinach and sprinkle with cheese, then fold in half; fry for a couple minutes on eat side until cheese is melted. Alternatively, you may leave tortilla open and add a second tortilla on top to close. Serve warm and enjoy!
Per Serving: 410 calories, 6 g carbs, 36 g fat, 17 g protein

 

Bacon-Wrapped Asparagus

Makes 4 Servings

INGREDIENTS:
  • 16 slices bacon
  • 16 medium spears asparagus
  • 1 tsp. garlic powder
  • 2 tsp. salt
  • 2 tsp. pepper

DIRECTIONS:

  1. Preheat oven to 400°. Wrap each slice of bacon tightly around each asparagus spear, then season with garlic powder, salt, and pepper. Bake for 15 minutes.
  2. Use tongs to turn each piece around, then bake for an additional 10-15 minutes until bacon is crispy. Serve and enjoy!
Per Serving: 233 calories, 5 g carbs, 16 g fat, 18 g protein

 

Cheesy Chicken Casserole

Makes 4 Servings

INGREDIENTS:
  • 1 cup heavy whipping cream
  • 2 Tbsp. green pesto
  • ½ lemon juice
  • 1½ lb. chicken breasts
  • 7 tsp. olive oil
  • 1 lb. cauliflower
  • 1 leek
  • 4 oz. cherry tomatoes
  • 7 oz. shredded cheese
  • Salt and pepper

DIRECTIONS:

  1. Preheat oven to 400°. Mix cream with pesto and lemon juice. Salt and pepper to taste.
  2. Season chicken breasts with salt and pepper and fry in oil until golden brown.
  3. Place chicken in a greased 9” x 13” baking dish, then pour in cream mixture.
  4. Chop leek, cherry tomatoes, and cauliflower into small florets and add to dish to top chicken.
  5. Sprinkle cheese on top and bake for at least 30 minutes or until chicken is fully cooked. Serve and enjoy!
Per Serving: 355 calories, 11 g carbs, 25 g fat, 29 g protein

 

Taco ’Bout It Keto Skillet

Makes 4 Servings

INGREDIENTS:
  • 1 Tbsp. avocado oil
  • 1 lb. ground beef
  • ½ medium white onion, diced
  • ½ large bell pepper, diced
  • 1 can green chilies
  • 3 Tbsp. taco seasoning
  • 2 Roma tomatoes, seeded and diced
  • 12 oz. cauliflower rice
  • 4 sprigs cilantro
  • 1 cup shredded Mexican blend cheese

DIRECTIONS:

  1. Heat oil in a large cast-iron skillet over medium-high heat, then add in beef and stir occasionally with a wooden spoon until brown.
  2. Add in onion, bell pepper, and taco seasoning and for cook 3 more minutes.
  3. Stir in green chilies and tomatoes along with cauliflower rice. Cook 5-7 minutes until moisture is gone.
  4. Sprinkle with cheese and cover until melted, about 2 minutes. Add toppings of choice (avocado, sour cream, cilantro, or jalapeno), serve, and enjoy!
Per Serving: 376 calories, 12 g carbs, 21 g fat, 33 g protein

Savory Snacks

Jalapeño Parm Crisps

Makes 2 Servings

INGREDIENTS:
  • 8 Tbsp. Parmesan cheese, grated
  • ½ tsp. salt
  • 2 slices sharp cheddar cheese
  • 1 medium jalapeño

DIRECTIONS:

  1. Preheat oven to 425°. On a baking mat or parchment paper, create 8 mounds of Parmesan cheese, 1 Tbsp. each spaced 1” apart.
  2. Slice jalapeño thinly, then lay on a baking sheet and bake for 5 minutes; remove and allow to cool.
  3. Once cooled, lay a jalapeño slice on top of each mound of Parmesan, pressing down slightly.
  4. Split both cheddar slices into 4 pieces (8 total) and lay each piece on top of the jalapeño and Parmesan.
  5. Bake for 9 minutes. Serve warm and enjoy!
Per Serving: 200 calories, 4 g carbs, 15 g fat, 13 g protein

 

Keto-Style Pigs in a Blanket

Makes 4 Servings

INGREDIENTS:
  • 4 medium hot dogs
  • ½ cup mozzarella cheese, shredded
  • 1 Tbsp. cream cheese
  • ¾ cup almond flour
  • 1 large egg
  • ¼ tsp. baking powder
  • ¼ tsp. garlic powder
  • ½ tsp. salt
  • ½ tsp. sesame seeds

DIRECTIONS:

  1. Preheat oven to 350°. Cut each hot dog into 3 equal-sized pieces; set aside.
  2. Melt mozzarella in microwave and combine with almond flour and egg.
  3. Add baking powder, garlic powder, and salt to the mixture; mix well.
  4. Form dough in hands, split into 12 pieces, and roll pieces into balls.
  5. Place dough balls onto a parchment-lined baking sheet. Press each ball flat into an oval shape.
  6. Wrap each piece of hot dog in the pieces of dough. Sprinkle outside with sesame seeds, pressing down to stick.
  7. Bake for 17-20 minutes. Serve warm and enjoy!
Per Serving: 330 calories, 5 g carbs, 28 g fat, 15 g protein

 

Thanks for sharing Metagenics: Ketogenic

Shared by Dr. Phil McAllister @ Forward Health Guelph

Dr. Phil Shares: 10 of the Best (and Worst) Workout Buddy Types

10 of the Best (and Worst) Workout Buddy Types

rward… but there are more soulmates in your life than just your spouse.

There’s your work husband/wife — that person in your office whom you tell everything. Then you have your book club bestie who loves the same characters and hates the same novels you do. And of course, your workout buddy — the one who keeps you on track with your meal preps and daily sweat sessions.

“When figuring out who your workout buddy is going to be for Double Time, choose someone you care about,” says Tony Horton. “You can choose a friend, a co-worker, or a family member. Double Time is also a great way to promote an active lifestyle for your family and have some fun bonding time with your kids.”

You’ll be spending a lot of time with your workout buddy, so it’s best to choose wisely. There are certain qualities that your buddy should possess—and a few you want to avoid at all cost. Here’s a guide to the different workout buddies you’ll encounter, and the best attributes of a true swolemate.

1. The Cardio Fanatic

“Wanna spin? Kickbox? Dance? Maybe go for a run?”

She’s always up for an energizing class — it doesn’t matter what it is as long as it gets the heart pumping and the sweat pouring. It’s beyond motivating to be moving and grooving next to this Energizer bunny — if your spirits are sagging, he’ll keep you going.

2. The Debbie Downer

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Studies actually show that social interaction plays an important role in your interest in an activity, even beyond experience of the activity itself. So make sure you not only find an activity you like, but a partner you favor, too.

3. The Constant Chatter Box

Trying to maintain a conversation while you’re lifting weights or powering through a cardio routine is no easy task. You don’t want to be rude and ignore the Chatty Cathy, but forcing yourself to respond can prevent you from getting the most out of your workout.

In fact, an inner dialog can be more helpful to your workouts than having someone else talk your ear off. This tactic, called “self-talk,” is useful for both motivational (i.e., mastery and drive) and cognitive (i.e., skill-specific and general) purposes, according to a study in the Journal of Psychological Sport and Exercise. So don’t let someone else’s talk get in the way of crushing your PR.

4. The Friendly Competitor

It doesn’t hurt if your workout partner is a bit competitive. A study of head-to-head cycling competition showed that it encourages participants to increase their performance. Having some friendly competition in the weight room or on the track will push you to be better than you thought you could be on your own.

5. The Flake

You make plans to go running at 7 a.m., but it’s 15 minutes past the hour and they’re still fast asleep. If only you had a dollar for every time The Flake has stood you up. It’s important to recognize these people for what they are — enthusiastic, fun friends who, when they do show up, add a lot to your workout. But they’re not people you can count on. So invite them to join, as long as you have someone else whom you can really rely on to be your workout buddy for the day.

6. The Muscle Head

He knows the best pre-workout supplements to improve your performance. She can tell you the difference between your gluteus maximus and your adductor longus — and which exercises work each. This buddy is a terrific partner, but only if you’re willing to put up with all the technical jargon.

7. The Drama Queen

There’s always something wrong with this workout buddy — the room is too warm or it’s too drafty. The machines are too old and broken down or they’re too new and complicated. No matter how hard you try to appease The Drama Queen, something will always be off. This will inevitably delay the act of working out for who knows how long, so it’s probably best to ditch this brand of buddy and find someone who’s not as high maintenance.

8. The One-Trick Pony

We all know that person who thinks whatever they’re doing — be it a diet or a workout plan — is the only way to do things. Sure, a low-carb diet may have helped her drop a few pounds or minute-long planks helped to strengthen his core. But just because it works for your friend doesn’t mean it will work for you. Figure out what kind of workout plan is best for you, and take this kind of buddy’s advice with a shaker of salt.

9. The Recovery Pro

Some days you just need to recover, sit on the couch, and binge on Netflix. A great workout buddy will know when to let you chill out and how to maximize your recovery time so your muscles can fully recharge. They’re always pushing you to foam roll, and they always bring the best healthy snacks to enjoy on rest day.

10. The Motivator

But you can’t sit on the couch for too long! On those days when you’re just not in the mood to workout, it’s crucial to have a support system to keep you motivated. When you can’t get going on your own, the best workout buddy will know just what to say to get you moving.

It’s a tall order finding your perfect workout buddy, but it sure beats working out on your own! What qualities do you look for in a workout partner?

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