Joint Pain

Are you at risk for having serious joint pain and even osteoarthritis later on in life?  There are several risk factors that can play a role in how healthy your joints are or will be as you age.

What is your age?
Primary osteoarthritis, a degenerative joint disease, usually develops gradually after age 40.  As you age, cartilage degenerates and loses its elasticity.  In fact, an astounding 75% of people over the age of 65 suffer from osteoarthritis.   But don’t let age slow you down, staying physically fit and healthy is an important way to protect your joints.  Strong, fit muscles support joints more effectively, protect joints from undue strain and injury, and help you perform everyday tasks more efficiently and with less pain.

Do you fit any of the following?
•      Have you experienced repeated trauma or surgery to the joint structures?
•      Were you born with abnormal joints?
•      Do you have gout, diabetes, and other hormone disorders?

All of these life factors can cause secondary osteoarthritis.  Repeated trauma can increase the mechanical stress placed on joints.  People with gout may also experience crystal formation in their joints causing damage to the cartilage tissue.  Diabetes, some hormone disorders and congenital (at birth) abnormalities of the joints may also lead to increased wear and tear.

Are you male or female?
Osteoarthritis is more common in men before age 45, but more prevalent in women after age 45.    Though the symptoms of osteoarthritis can vary between patients, the most common symptom is pain in the affected joint, which may worsen later in the day or after repeated use.  The joints may also be tender, swollen and warm and you may hear or feel creaking.  Osteoarthritis can also cause pain after an extended period of rest.

What is your BMI (Body Mass Index) underweight, normal, overweight, obese?
Excess weight can also contribute to secondary osteoarthritis. Weight control and injury prevention measures can lower a person’s risk of developing osteoarthritis. Weight loss also can reduce symptoms for people with knee osteoarthritis. Excess weight can place undue stress on our weight bearing joints. Therefore, it is important for the health of your joints (and your overall health), that you maintain a healthy weight. If you find weight maintenance difficult, a registered dietitian (RD) can help you achieve your goal weight.
Read more

Risk of Developing Painful Knee Osteoarthritis Increases with Weight 
Healthy Weight 30%
Overweight 47%
Obese 61%

Source: Arthritis Care and Research 2008; 59:1207-13

How often do you experience joint pain?
Joint pain is often the first sign of osteoarthritis. Pain is a signal from your body that something is wrong. Osteoarthritis causes some chronic joint pain. Though your joint pain may make you cringe at the thought of exercising, exercise can actually help relieve some of your pain, ensure that you maintain a good range of motions, make the joint more stable, help you lose weight or maintain your weight and keep your spirits up. Which type of exercise should you choose? That depends on what joints are involved, whether you’ve have surgery on any of your joints and your current range of motion. A combination of strength training, aerobic exercise and proper stretching are often recommended for osteoarthritis patients. And, a physical therapist can prescribe a program tailored to meet your needs and goals.

Read about stretching for joint pain


Have you had any serious joint injuries in your life?
Damage to a joint can contribute to the development of osteoarthritis in that joint.  This is especially common in athletes who have repetitively injured their joints over the years.  If you are an athlete try switching sports or taking time in between your soccer matches and running for non-impact activities such as swimming and stationary cycling.  You’ll still obtain the benefits of exercise but give your joints a break.

Does your family have a history of osteoarthritis?
A history of arthritis in your family can put you at higher risk for also getting the disease.  More and more doctors today believe in a hereditary cause behind several forms of arthritis. As with many other conditions, a mixture of environmental and genetic factors is attributed to the onset of disease or disorder. Most current research, though, focuses on showing substance behinds models of hereditary arthritis.  A recent study found that a form of knee osteoarthritis is the newest addition to the collection of genetically-caused arthritis.  Rare variants in the GDF5 gene have been associated with disorders of skeletal development, and more common variants recently have been tied to susceptibility to osteoarthritis of the hip and knees.  If anyone in your family has a history of osteoarthritis, it is even more important to take preventative measures to help prevent the onset or at least postpone it and make it more manageable.

Do you currently or have in the past, engaged in heavy physical activity for 3 or more hours per day such as heavy lifting, standing or bending?
Athletes and people who have jobs that require doing repetitive motion, such as landscaping, typing or machine operating, have a higher risk of developing OA due to injury and increase stress on certain joints.  Certain occupations involving repetitive knee bending and squatting are associated with osteoarthritis of the knee.  If you are experiencing joint pain or have been diagnosed with arthritis, it may become necessary to alleviate or decrease the amount of heavy physical activity you do.  Repetitive motions for long periods of time can accelerate the onset of osteoarthritis.

Do you experience joint stiffness in the morning or do your joints ache more if there is a change in the weather?
Stretching when you first get up is a great way to alleviate joint pain.  According to the Arthritis Foundation website, stretching will keep your body limber and improve flexibility. Gentle stretching exercises should be done every day and are the most important of all your exercises. Flexibility exercises can help you protect your joints by reducing the risk of joint injury, help you warm-up for more strenuous exercise by getting your body moving, and help you relax and release tension. These can be done on land or in water such as a pool, hot tub or warm bath. These exercises can be particularly useful for easing those stiff joints in the morning. Good range-of-motion exercises include tai chi and yoga. Work up to 15 minutes of flexibility exercises a day. Once you can do 15 continuous minutes, you should be able to add strengthening and aerobic exercises to your routine. 

Get more exercises here

It’s never too late to start a preventative maintenance program for your joints.  Maintaining a healthy weight and exercising are very important and you can also take a liquid glucosamine and chondroitin to help maintain joint flexibility.  See here

Read more about how glucosamine and chondroitin work here

Walking is one of the most underrated forms of exercise.

It’s convenient, low impact (not hard on your joints), can help you manage your weight, blood pressure and blood sugar levels and, walking can decrease your risk of developing some chronic diseases. And the best part about walking?  It requires little equipment and people of all fitness levels can benefit.

Get Proper Shoes
If you want to take up walking or if you walk now, the most important equipment you’ll need is a good pair of walking or running shoes. Go to your local running shoe store (these stores tend to have employees trained in fitting you for walking, jogging and running) and get a good pair of shoes.  Read more on shoes here

Next, consider your attire. Though you don’t need special attire to walk, having comfortable workout clothes, reflective tape (if walking at night) and the necessities to walk outside in the winter (gloves, a hat, face mask if it is very cold) will make your experience both more enjoyable and safe.

Warm Up and Stretching
Always remember to warm up slowly and stretch if you need to (stretching is especially important after you are finished exercising). And, monitor your technique - your head should be held up, eyes looking forward, chin parallel to the ground, shoulders relaxed and arms bent and swinging naturally with each step. With each step, your foot should strike the ground in front of you and push off for the next step on the balls of your feet.

Once you feel very comfortable with walking, try varying your routine by walking hills, walking faster and changing your route. Also, a few simple tools will help you get the most from your workouts – a pedometer, the Wellesse walking challenge and a heart rate monitor. A pedometer will measure how many steps you get each day and a heart rate monitor can ensure that you are exercising at a good pace so you make the most of your workouts.

If you are experiencing painful joints from walking try a liquid glucosamine and chondroitin supplement for improved joint health and flexibility and for muscle and joint pain.


Have you signed up for the Wellesse Walking Challenge yet?  It's a great way to stay motivated to walk and you can win prizes too including a $500 Wellness Package!  Join today!

Let's focus on the legs!

How are your treads holding up?  As you pick up the pace or mileage of your walking program you may find that your legs need a bit of a tune up.  It is not uncommon to feel some pain or discomfort in the muscles of your lower leg when you get more aggressive with your walking technique.  Let’s take a look at why this happens as well as how to prevent and recover from this potential performance barrier. 

In order to pick up your fitness walking pace it takes a more exaggerated ankle action and forward body lean. This technique creates a greater demand on the muscles of the lower leg.  The front of the lower leg or anterior tibialis muscle group must dorsi flex your ankle (which mean pulling the forefoot up closer to the shin) on the forward heel strike.  Then the back of your lower leg or gastrocnemius muscle group must plantar flex your ankle (which means pushing your forefoot away from your shin) to propel you forward and into the next step.  The greater the action the faster you walk.  This increase in ankle action can takes its toll on the lower leg muscles and their attachments, causing a general sense of pain in the shin, calf and ankle areas.  This is especially true when you first start a more aggressive walking program.  In most cases the muscle pain you sense is due to a condition know as DOMS or delayed onset muscle soreness. 

DOMS is your muscles way of telling you that you have introduced it to something new and challenging.  It is nature’s way of slowing you down so that the muscle tissues can progressively get stronger without getting injured.  Keep in mind that any pain that results in swelling or bruising or lasts for more than a week, should be checked out by the appropriate medical professional. 

So what can you do to avoid or treat DOMS in the lower leg muscles? 

Let’s start with a list of ways to minimize or avoid DOMS:
1. Make sure you have proper, supportive footwear.
2. Progress into your program goals gradually.
3. Warm up properly before your walk, including lower leg movements that mimic the positions your ankle will travel through (i.e. walking on your toes then heels for approximately 30 seconds each).
4. Stretch the muscles of the ankle after the walk, holding each stretch for at least 20 seconds (i.e. ankle circles, and calf stretches).
5. Keep the muscles of your ankle strong by doing lower leg condition exercises (i.e. calf raises and dorsi flexion with foot resistance).

 

Now what can be done once you are feeling a bit of lower leg DOMS:
1. Take a few days off from your walk and if possible cross train by doing an activity that does not use the same foot pattern (i.e. swimming or cycling).
2. Massage and stretch the front and rear leg muscles daily.
3. Ice the affected areas.
4. Stay well hydrated and keep your joint lubrication up with the appropriate joint supportive nutritional supplements such as a glucosamine and chondroitin liquid supplement that's easy to take and fast absorbing.

Have a great Walking Challenge!
 

Women with breast cancer should be given high doses of vitamin D because a majority of them are likely to have low levels of vitamin D, which could contribute to decreased bone mass and greater risk of fractures, according to scientists at the University of Rochester Medical Center.

In a study of 166 women undergoing treatment for breast cancer, nearly 70 percent had low levels of vitamin D in their blood, according to a study being presented Thursday, Oct. 8, at the American Society of Clinical Oncology's Breast Cancer Symposium in San Francisco. The analysis showed women with late-stage disease and non-Caucasian women had even lower levels.

"Vitamin D is essential to maintaining bone health, and women with breast cancer have accelerated bone loss due to the nature of hormone therapy and chemotherapy. It's important for women and their doctors to work together to boost their vitamin D intake," said Luke Peppone, Ph.D., research assistant professor of Radiation Oncology, at Rochester's James P. Wilmot Cancer Center. He is a member of the National Cancer Institute's Community Clinical Oncology Program research base in Rochester.

Scientists funded by the NCI analyzed vitamin D levels in each woman, and the average level was 27 nanograms per milliliter; more than two-thirds of the women had vitamin deficiency. Weekly supplementation with high doses of vitamin D -- 50,000 international units or more -- improved the levels, according to Peppone's study.

The U.S. Institute of Medicine suggests that blood levels nearing 32 nanograms per milliliter are adequate.

This problem is not unexpected, Peppone said, because previous studies have shown that nearly half of all men and women are deficient in the nutrient, with vitamin D levels below 32 nanograms per milliliter. Vitamin D, obtained from milk, fortified cereals and exposure to sunlight, is well known to play an essential role in cell growth, in boosting the body's immune system and in strengthening bones.

Symptoms of Vitamin D deficiency include muscle pain, weak bones/fractures, low energy and fatigue, lowered immunity, symptoms of depression and mood swings, and sleep irregularities, many of which are common for women undergoing breast cancer treatment.

Source:  EurekAlert Press Release, University of Rochester Medical Center


A daily liquid vitamin D supplement of at least 1,000 IU per day is recommended to maintain healthy blood levels.  Everyone should have their blood levels tested to see where they are at and to find out how much vitamin D they should be taking.  To find out if you are at risk for vitamin D deficiency, take this quiz now 

Stretching is a must especially if you are experiencing joint pain and for managing arthritis for better joint health.

Have you ever wondered how to get the most out of a stretch?  Well try a little self-PNF.

PNF stands for proprioceptive neuromuscular facilitation and it simply means that our muscles receive messages from our nerves that can facilitate a better stretch reflexively.  Our muscles have sensor nerves (proprioceptive neurons) that pick up sensations like a strong contraction or a rapid bouncy movement and react by sending a message to the muscle to relax or contract in response.  When it comes to enhancing a stretch your goal is to get the muscle to relax as much as possible, thus you want to stimulate the sensor nerve with a 10 to 15 second held contraction (called and isometric contraction). 

Immediately following this contraction the muscle will reflexively respond by releasing and relaxing.  This reflex allows for an immediate gain in range of motion and extensibility.  Many physical therapists use a technique called the ‘contract/release method’ to rehab chronically tight muscles.  You can try it on your self with the help of a bath towel or stretch strap.  Lie down on your back and use the towel or strap (wrapped around your thigh) to pull your leg towards your chest.

Next press your leg away from your body into the towel, while holding the towel firmly in pace and forcing the back of the leg and hip to contract.  Hold that contraction for three deep breaths.  Release the pressing action and use the towel to pull your leg back towards your body into a deeper stretch position.  You should notice an immediate increase in range and flexibility. You can try to perform this same contract then release type stretching for various parts of your body.  Keep in mind that the contraction happens by moving and holding in the opposite direction of the stretch position. 

So for another example, if your target is your lower leg (calf muscle), stretch the muscle by wrapping a towel around the bottom of your forefoot and pulling your toes towards your shin; to contract, point your toe away from your shin while pressing into a towel, hold for 3 deep breaths, then repeat the stretch position. 

Here is a quick list of moves to stretch the major body parts:

• Chest- open arms outward and behind the body
• Upper back and neck – move head towards the opposite shoulder
• Front shoulder – open arm out or behind body 
• Rear shoulder: move arm across the chest
• Spine – round spine forward, side ways or rotate
• Buttocks – flex hip by moving the thigh forward towards torso or across the torso
• Front thigh – extend hip by moving the thigh back behind the body and bending the knee
• Rear thigh – hip flexes by moving forward towards torso and extending knee
• Low leg or calf – move forefoot towards shin

Remember to use the stretch/contract method, you need to move the body part in the opposite direction of the stretch and hold it in a static contraction for 3 deep breaths.

Try it ... to take your stretch routine to a new limit.  Stretching is a great treatment for joint pain and can help keep your joints on the move.  Be sure to take your liquid glucosamine and chondroitin supplement too for improved joint health and flexibility.

Don’t let joint pain keep you from springing forward in life.

One great thing about spring is the weather.  Warmer weather can make life a lot easier on arthritic joints.  If you have arthritis (in particular the wear and tear related osteoarthritis) you will undoubtedly feel more like moving once your body and joint tissues have warmed up. 

So lets discuss a spring forward warm up plan that can reduce the twinges from your hinges during a workout. Your spring forward warm up for joint health includes
1) environmental, 2) temporal and 3) physical tips
  
1. Your joints will feel better when working out in warmer environments.  This can be accomplished by staying indoors or keeping the cooling system low, or by wearing workout gear that keeps your body well insulated (i.e. sweats and wraps).  You can also enhance your body temperature pre-activity by taking a hot shower or sitting in a Jacuzzi.

2. In terms of the best time to exercise, your joints will feel best around midday.  This will give your body a chance to naturally loosen up and warm up with your daily routine without feeling overtaxed by a full day of life tasks. 

3. Last but not least are some physical tips that can help prepare sensitive joints for various types of physical exercise. 
 
In terms of your cardio-vascular exercise, be sure to start off slowly with modest range of motion.  Gradually increase your movement range in both your upper body and lower body movements until you are working at near full range capacity.  This could take a good 10 to 15 minutes.  So for example, start your fitness walk with small steps and minimal arm swinging, as you warm up and loosen up try rolling the shoulders up, back and down while you walk.  Also add in some ball and heel walking.  By this I mean, walk on the balls of your fee for about 10 seconds followed by walking on your heels for 10 seconds.  Go back to a normal footfall and gently reach a bit further with each step.  Once you feel your overall body temperature has elevated (usually noted by a desire to take off your outer jacket) you can stop and hold a few hip and leg stretches, if those areas still feel restricted.  Keep those stretches light (8 to 10 seconds in length).  Then continue with your walk, using the best arm swing and leg stride that you can.  

Your muscle-conditioning workout should follow a similar warm up plan of action.  When performing strength training exercises always do the first set of any exercise with limited range and very light resistance.  Then for the second set you can gradually increase the range and/or resistance.  Keep in mind that strength training is important but so is joint sense.  Use resistance loads that you can safely handle for about 15 repetitions even if that means no resistance other than the weight of your body or body part. 

All stretches should start off light, never force or bounce. Once your muscles are warm they have better give therefore you get the best results from your stretches after you have completed more active exercises (i.e. walking or strength exercises).  These stretches should be held to a point of slight or mild discomfort for 10 to 30 seconds.

Progress slowly and always stay in the pain free range of motion.  If your joints are experiencing more pain or discomfort than typical two hours after a workout is over, you have probably worked too hard.  Back off a bit and don’t forget to take your joint healthy glucosamine and chondroitin supplements.     
 

Time for a bit of Arthritis Spring-Stretching.

The warmer weather creates a positive environment for many things, in particular joint mobility.  With that in mind it may be a great time for arthritis sufferers to re-evaluate their training program and get back on track with a few daily joint healthy exercises.  Daily stretching has been recommended in particular for those with compromised joints as a treatment for joint pain.  The Aerobic and Fitness Association of American lists flexibility as one of the first fitness components to be addressed when designing a functional fitness program for those with arthritic conditions  http://www.afaa.com .

The reason why is pretty simple.  If you can’t move with good range of motion it is pretty hard to do any exercise or daily activity with proper form and alignment.  Exercising with pore alignment is a major cause of joint stress and further joint damage, thus it is important to keep joints as mobile as possible, even when limitations exist.  Below are a few stretching guidelines to follow.
 

• Always increase your body core temperature prior to holding stretch position: performing a physical warm up including light cardio-vascular or rhythmic movement can do this.  A physical warm up can be enhanced by taking a hot shower or bath prior to your session, scheduling your session toward the later and/or warmer part of the day, performing your stretches in a warm environment and/or while wearing clothing that keeps the body well insulated.

•  Ease into your stretch positions: start at a point of very mild tension, take two or three deep breaths, then try to move into a deeper stretch position, increasing the stretching sensation to a higher degree of tension (or slight discomfort).

• Never stretch to the point of pain or high discomfort: your muscles will actually reject the stretch and try to protect themselves by tensing up.

• Breath fluidly throughout all your stretches: at least 5 deep breaths per stretch.

• Repeat each stretch 2 to 3 times over.

The following includes an upper and lower body stretch series that should be done at least once every day:

The Upper Body wall Stretch:

Stand facing a wall and gently position your hands a comfortable distance above your head. Work your arms up the wall, keep your abdominals tight and lean your torso towards the wall.  Next, turn around and place your backside to the wall with your arms in a ‘T’ position (elbows bent and upper arm parallel to the floor).  Try to press your head, spine and arms against the wall.  Hold both the front and back position for 3 to 5 deep breaths.

The Lower Body chair stretch: 

Start by standing behind a sturdy chair in a lunge position.  Gently work the back leg further away from the front leg until you feel a stretch down the hip, and then press the heel towards the floor until you feel a stretch in your lower leg/ calf muscle.  Follow this up by straightening the front leg and leaning forward with your torso until you feel a stretch down the back of the front leg (keep your spine straight as you lean forward).  Switch leg positions and repeat the series

In my next article I will give you some great ideas for following up your stretch session with bone and joint health strength routines... until next time keep taking your joint protective supplements with glucosamine and chondroitin and MSM. 

We have had several questions recently about whether you can give the liquid glucosamine and chondroitin to a dog.  The answer is Yes!  Even though it is meant for human consumption, it can be safely given to a dog of any size and is a great treatment for joint pain that many dogs have.  However, the dosage amount depends on weight.


Serving size for dogs of liquid glucosamine and chondroitin:

0 - 40 lbs = 2 tsp (10ml) per day
41 - 80 lbs = 4 tsp (20ml) per day
>80 lbs = 2 tbsp (30ml) per day
 

I usually suggest to pour the liquid glucosamine over the dry dog food, or mix it into canned dog food.  Make sure to give it to them every day and you must continue giving it to them for best results. 

A coworker of mine had an older black lab (who has now sadly passed away) that was having a difficult time walking and going up or down stairs because of arthritis in the hips.  Canine hip displasia is a very common occurrence especially in larger dogs such as Labs, Irish Setters, German Shepherds, etc. 

After she started giving him the liquid glucosamine, he was able to get around much easier.  Although not like when he was a young dog, it helped to improve his quality of life.  It's very sad to see them not be able to do as much as when they were younger. 

Here are the signs of when glucosamine may be needed for your dog:

• Difficulty or adverse reaction to walking, playing, or going up stairs
• Falling behind you on walks
• General lethargy
• Difficulty or adverse reaction to walking, playing, or going up stairs
• Limping
• Difficulty getting up when laying down
• Signs of pain when petted or touched
• Aversive to any contacts

Don't let osteoarthritis get the best of you!

A little over a year ago I was told that I have mild osteoarthritis in one knee.  I wasn’t terribly surprised since this disease is so prevalent and I’ve put my knees through years of impact activity.  If you’re like me and have this degenerative joint disease, there are things you can do to ensure that it doesn’t hamper your daily life. 

Take Glucosamine and Chondroitin
Your first line of defense should be glucosamine and chondroitin sulfate.  Taken together, these supplements can help relieve some of the pain and stiffness associated with osteoarthritis. 

Next, you should consider taking omega 3 fatty acids, which can help reduce inflammation. 

Make sure you talk to your personal physician first prior to trying either of these supplements, especially if you are on blood thinners such as warfarin (Coumadin). 

Exercise
For exercise, it is important to perform range of motion exercises to keep your joints moving and avoid undue stress on specific joints (the kind of stress that can occur with repetitive motion activities such as running).  Water aerobics and other non-impact activities such as the elliptical machine and stationary bike, are excellent for people with osteoarthritis.  Personally, I like to mix up the activity I am doing to keep my body strong and my joints limber.  And, I frequently do exercises to strengthen the areas around my joints.

See Exercises

Lose Weight
Excess weight increases your risk of developing osteoarthritis and being overweight leads to greater pain and loss of mobility when you do have the disease.  Overweight people tend to be less active which leads to weak muscles and even more painful joints.  Always lose weight gradually and talk to your doctor first before starting any kind of weight loss or exercise program.

Overall, it's important to lead a healthy lifestyle in managing osteoarthritis to minimize your joint pain.  Keep it in control and it won't control your life.

For more information see www.arthritis.org

Many people recognize glucosamine as part of glucosamine and chondroitin sulfate supplements – the most effective combination for fighting the progression of osteoarthritis.  But, what is glucosamine and how does it work?

Osteoarthritis
First, it is essential to understand what osteoarthritis is and how it progresses.  Osteoarthritis is a degenerative, chronic joint disease characterized by cartilage breakdown and the development of bone spurs.  Cartilage cushions the ends of bones allowing joints to move easily.  Can you imagine how your body would feel if your bones were rubbing on top of other bones?  Well, that is exactly what happens with cartilage breakdown.  Bones rub against each other, causing joint pain, early morning stiffness, joint stiffness after periods of rest, pain that worsens with joint use, and loss of joint function.

Osteoarthritis is the most common joint disease.  In fact, an astounding 75% of people over the age of 65 suffer from osteoarthritis.  Obesity and mechanical stress are two of the top contributing factors leading to osteoarthritis.  And, with the growing obesity epidemic, the number of people suffering from osteoarthritis is expected to grow accordingly.

Both glucosamine and chondroitin are taken up by the cells in cartilage (chondrocytes) and used to build new cartilage.  In addition, some research indicates that both may help prevent cartilage breakdown – a hallmark of osteoarthritis.  See picture below depicting the process of osteoarthritis. Several research studies indicate that glucosamine chondroitin supplements offer a safe, effective alternative to non-steroidal anti-inflammatory drugs (NSAIDS) for relieving osteoarthritis pain.
 
The supplement form of glucosamine is derived from sugar and very similar to the glucosamine formed by chondrocytes.  In the body glucosamine is incorporated into connective tissue, skin, tendons and ligaments.

Chondroitin and collagen fibers together form the structure of joint cartilage much like steel beams form the structure of a building.  Chondroitin is incorporated into connective tissue, skin, tendons, ligaments, cartilage and mucous secretions.  It gives joints their elasticity by drawing fluid into cartilage tissue.  This elasticity is essential given the stress and strain we put on our joints every time we engage in activity.  Chondroitin also inhibits enzymes that break down joint cartilage.

Both glucosamine and chondroitin have been used in Europe for over 20 years without significant adverse side effects.  Additionally, glucosamine and chondroitin sulfate have been consumed safely in the US for several years and side effects are considered uncommon and minor.  However, people with shellfish allergies, asthma or those taking diabetes medications or blood thinning medications such as warfarin (Coumadin) should speak with their physician first prior to starting glucosamine supplements.

Anyone suffering from the pain of osteoarthritis or even those who are in the beginning stages of osteoarthritis may benefit from taking glucosamine chondroitin sulfate supplements.  By taking this combination daily, you may prevent further cartilage breakdown and also minimize any joint pain that you have.  Try keeping a bottle of liquid glucosamine and chondroitin on your kitchen counter or even in your bathroom, it’s easier to remember to take 2 Tbsp a day.  It becomes a routine just like brushing your teeth or making our morning cup of coffee!

References:
Sem Arthritis Rheum 2001;31:58-68.
Arthritis Rheum 2001; 44:1089-1095.
Connect Tissue Res 1975; 3:115-122.
Prog Drug Res 2001; 55: 81-103.
N Engl J Med 2006;354:795-808.
Dahmer S, Schiller RM.  Glucosamine. Am Fam Physician 2008;78(4):471-6.

Building a Better Walk Program

Who wouldn’t like to make the most out of every walking workout? As a continuation on my recent series on walking, in this post I would like to talk about the power walk. 

A simple way to increase your walking power and output is to increase the dynamics of your arm swing.  Create a fist with your thumbs resting on your knuckles and bend your elbows to right angles.  Pump your arms forward and back with your fist moving from sternum to hip in an alternating fashion.  As you pump your arms think about driving your elbows down and back right along side of your torso. Keep your arms moving in a straight line; don’t let them swing side to side or cross the body. To progress further try-adding resistance in the form of hand held weights, body vests, or walking poles.  All of these options will help you burn more calories while using them while also increasing your ability to perform a more powerful walk when you walk without them.  

Start off using the lightest increments of weight.  Restrict the time you spend using the added resistance.  Start with 5 or 10 minutes and then gradually build up to your regular workout time.  If you plan to increase your resistance, do so in small increments every 4 to 8 weeks. The maximum recommendation for hand held weights is 3 pounds and the maximum for weighted vest is 30 pounds.  Note: Controversy exists over the use of hand held weights due to the stress to the shoulder joint.  Please check with your doctor first. 

• Active arm swing output increase
  - Using arm swing = 10% increase (approximately .5 cal. per min.)   (Elbow bent to right angle, fist pumps from sternum to hip)

• Hand weights output increase (with active arm swing)
- 1 pound = 10% (approximately .5 cal. per min.)
- 2 pounds = 20% increase (approximately 1 cal. per min.)
- 3 pounds = 30% increase (approximately 1.5 cal. per min.)

• Weighted vest output increase
- 10 pounds = 10% increase (approximately .5 cal. per min.)
- 20 pounds = 20% increase (approximately 1 cal. per min.)
- 30 pounds = 30% increase (approximately 1.5 cal. per min.)
- Vest should not exceed 20% of ones total body weight (i.e. 130 pound person should go no higher than 25 lbs.)

• Walking poles:
- Using poles = 20+% increase (approximately 1.5 kcal per min.)

As you know, walking is good for increasing energy levels, managing arthritis and joint health.  Increasing or alternating your walking workout is a way to get the most out of your workout.

*Keep in mind that good posture, controlled arm swing and proper overall walking form (see article on walking form) must be maintained during the use of any added resistance device. If the use of added resistance causes, neck, shoulder pain or low back pain discontinue immediately.

3 Part Series

In my previous post, I talked about health walking and I would like to expand on that.  Many older adults are experiencing the joys of walking for fitness and for joint health, including participation in local 10k, half and full marathon races.  It's a great way for managing arthritis.  Over the next three part series, I will lay out a few training options that can help take your walks and races to the next level. 

Strength Walk (part 1)
As you progress your routine don’t forget to include some complementary resistance-training exercises for the muscles you use during your walks.  By strengthening your leg and torso muscles you will reduce joint stress and muscle fatigue, giving you greater stamina no matter how long the race.  It’s best to implement your strength-walk program a few months prior to a given race, but it’s never too late to get started. 

Below is a short series of strength moves that you can add right into your walk or perform on off days.  You should try doing them at least 2 to 3 times per week. 

1. Walking lunges (for the leg and hip muscles): start with your feet together, step forward and bend both knees until you are in a lunge position, then bring the rear foot up to meet the front foot. Repeat leading with the opposite leg.  Continue alternating legs for 10 to 15 steps on each leg.   

2. Scapular Dips (for the upper back and shoulder girdle muscles): Place your arms behind you with your hands resting on the edge of a bench or step.  Walk you feet slightly forward, hips and knees bent.  Fingers are forward and elbows are straight.  Slowly let your shoulder blades slide upward towards your ears and then press them downward in the opposite direction.  Keeping all other joints stable.  Repeat this controlled shoulder shrug and press action 10 to 15 times. 

3. Heel to toe walks (for the lower leg muscles): Stand tall, bending the knees slightly and walk on your heels (toes up) for 30 seconds.  Follow this with 30 seconds of walking on your toes (heels up).  Repeat 30-second toe to heel walk two more times for a total of 3 sets.

4. Scapular Squeeze Circuit (for the mid back, postural muscles): Walk with proper form and arm swing for 5 to 10 minutes then continue walking while performing 20 scapular squeezes.  Tuck both arms in towards your sides and pinch the muscles between your shoulder blades as though you are squeezing a tennis ball between them.  Hold the squeeze for one to two seconds then release for one to two seconds.  Go back to normal walking technique then repeat the squeeze series a total of 3 times over.

Nutritional supplements such as glucosamine and chondroitin along with a sensible walking program may help improve overall joint pain and flexibility.

Everyone seems to have jumped on the yoga train lately... and for good reason.  This often mis-understood form of mind/body exercise is a wonderful way to increase energy, great for managing arthritis and joint pain and reducing the stresses and strains in your body... and life.  The art of Yoga dates back centuries, originating in India as part of a ritual discipline to control, purify and enlighten the mind/body through a variety of forms or schools of practice related to Hindu philosophy.

Hatha Yoga is the style that many people associate with the word "Yoga" today. It has steadily increased in popularity in our western society due to the emphasis on physical health and vitality of the body through the practice of asana (body poses) and pranayama (breath control).
 
The sun salutation is a foundational movement series in Hatha Yoga.  For those with limited time, the Sun Salutation is excellent because it stretches and strengthens all the major muscle groups in the body while also exercising the respiratory system. It consists of a sequence of twelve positions linked by continuous flowing motion. Each position counteracts the one before, stretching, expanding and contracting the body in a different way as you coordinate the movements with a series of five deep breaths.

I have found that this simple series of 12 poses can be performed at various paces to take you from tired to revitalize or from tense and tight to limber and released in about 5 minutes.  Add in some Yoga breathing techniques and you may also experience a great endorphin high.  Endorphins are naturally released chemicals that make you feel wonderful at the end of an invigorating workout. They are believed to enhance the immune system, relieve pain, reduce stress, and postpone the aging process. 

Performance Technique:
This series can be used as a warm up to a more vigorous activity, as a mid day break from a stagnant position or as a great relaxation after a hard workout.  Making it the ideal anytime movement series.  The faster you progress from one move to the next the more heat and energy you build up.  The slower you go through each posture, enjoying the feel of each position, the more relaxing it can be.

Breathing Technique:
Each position alternates between an extended and flexed or folded position of the spine. You will inhale during the extensions and exhale as you flex or bend.  Try to use a full Yoga breathing technique.  This involves slowly filling up your abdomen then chest as you inhale followed by exhaling emptying the chest followed by the abdomen.  Be sure to breath smoothly in and out through your nose.  

Sun Salutation 12 Step Series:

Step 1: Stand tall with feet together and hands palm to palm, at heart level.
Step 2: Inhale, keeping the palms together and stretch the arms up towards the sky as you extend your spine, bending slightly backward. Keep your abdominals held in.
Step 3: Exhale and slowly flex or bend forward with your spine, until your hands touch your shins or feet.  Keep your head tucked towards your knees.
Step 4: Inhale and step back with the right leg into a deep lung position while extending your spine and lifting your head towards the sky.  Keep your hands on the ground with one on each side of the front foot.
Step 5:  Exhale and bring the left foot back next to the right while lifting the hips towards the sky.  Keep the arms straight along side of your ears, forming an A frame with the body. You may want to stay in this inverted position (known as the downward dog position) for several deep breaths.
Step 6:  Slowly lower the body towards the floor, touching the knees, chest and forehead to the ground.
Step 7: Inhale as you straighten the arms, lift the chest and extend the spine towards the sky, arching your back as much as you comfortably can.  You pelvis and thighs stay on the ground.
Step 8:  Exhale as step up with your left leg and get back into the downward dog position performed in step 5.
Step 9:  Inhale and step back with the right leg into the deep lung position used in step 4.  Hands on the ground, head and spine lifted towards the sky.
Step 10: Exhale and slowly bend forward as in step 3; Hands on shins or feet and head tucked towards your knees. 
Step 11: Inhale and raise the arms upward as you extend the spine back repeating the position in step 2.
Step 12: Exhale as you finish he series by returning to the first position, stand with both feet touching and hands together, palm-to-palm, at the heart.

To see illustrations of these visit http://santosha.com/asanas/suryanamaskar.html 

One round of Sun Salutation consists of two reps through the series of 12 poses, the first leading with the right foot in steps 4 and 10, the second leading with the left. Start by doing 2 to 4 four rounds and gradually build up to 8 to 12 rounds.

Modification Technique: 
For beginners or those with limited back mobility and or leg flexibility, the best way to modify the series is to bend the knees slightly during all of the flexed or folded postures (#’s 3, 5, 8,&10) and to reduce the arch in the back during the extended postures (#’s 2, 4, 7, 9&11).

 

I love to walk and hike and I used to run, but the older I get the more my knees hurt.  Lately, I have noticed that my knees make a strange sound when I bend them.  A friend of mine recommended some great knee braces from Nikken and they do help a lot, especially when it is cold out. 

I also take the liquid glucosamine and chondroitin supplement on a daily basis.  My greatest fear is not being able to walk and hike when I get older because my knees hurt too much or needing to have knee surgery later. 

Strengthening the muscles above around the knees can also help tremendously such as the quadriceps and hamstrings.  Exercise keeps your joints from stiffening and provides needed support, making movement easier and reducing joint pain.

Here are some great exercises for these muscles from Jen Mueller, a certified trainer, from the Spark People website. 

STRETCHES

1. Chair knee extension: Sitting in a chair, rest your foot on another chair so the knee is slightly raised. Gently push the raised knee toward the floor using only leg muscles. Hold for 5 - 10 seconds and release. Repeat 5 times on each leg.
2. Heel slide knee extension: Lie on your back, with left knee bent and left foot flat on floor. Slowly slide the left heel away from your body so both legs are parallel. Hold for 5-10 seconds, return to starting position. Repeat 5 times on each leg.
3. Knee flexion: Sitting in a chair, loop a long towel under your foot (resting on the floor). Gently pull on the towel with both hands to bend the knee, raising your foot 4 - 5 inches off the floor. Hold for 5 - 10 seconds, then release. Repeat 5 times on each leg.
4. Hamstring stretch: Standing, put one foot in front of you, toes up. With hands on the small of your back (or one hand holding a chair for balance), bend the opposite knee and hip (not your lower back), until you feel the hamstrings stretch. The upper body comes forward at the hip. Hold for 5 -10 seconds, then release. Repeat 5 times on each leg.

STRENGTH TRAINING

1. Wall slide: Leaning with your back against a wall, bend your knees 30°, sliding down the wall, then straighten up again. Move slowly and smoothly, using your hands on the wall for balance. Keep feet and legs parallel, and do not allow knees to go out over the toes. Repeat 5 -10 times.
2. Bent-Leg Raises: Sitting in a chair, straighten one leg in the air (without locking the knee). Hold for about one minute. Bend your knee to lower the leg about halfway to the floor. Hold for 30 seconds. Return to starting position. Work up to 4 reps on each leg.
   
3. Straight-Leg Raises: Sitting in a chair, rest your foot on another chair. Lift the foot a few inches off the chair while keeping your leg straight. Hold for 5 -10 seconds. Return to resting position. Repeat 5 -10 times. (Also work on increasing the time, up to 2-3 minutes if possible.)
4. Abductor Raise: Lie on your side, propped on one elbow. The leg on the floor bent, the other straight. Slowly lift the top leg, hold for 5 -10 seconds, then lower. (Ankle weights will increase the intensity). Do 1-3 sets with 12-15 repetitions each. Remember to rest in between sets.
5. Hamstring Curl: Stand with the front of your thighs against a surface (a table or wall). Flex one knee up as far as is comfortable. Hold for 5 - 10 seconds, then lower slowly. If possible, do not touch the floor between repetitions. (Ankle weights will increase the intensity.) Do 1-3 sets with 12-15 repetitions each. Remember to rest in between sets.
6. Step-Ups: Stand in front of a step, like a sturdy bench or stairs, about two feet high (or less if necessary). Step up onto the support, straighten your knees fully (without locking them) and step down. Maintain a steady pace. If you are comfortable with your balance, pump your arms while doing this exercise. Start with 1 minute, slowly building your time. Gets your heart pumping too!
7. Stationary Bike: Biking is a good way to increase strength and range of motion. Make sure you have the right positioning of the legs. At the bottom of the pedal stroke, the bend in the knee should be 15 degrees. Start with 10 minutes and slowly increase your time.

Always check with your doctor before beginning an exercise program. These exercises are designed to help, not hurt. If you experience pain at any time during the exercise, stop. Pain is your body’s way of telling you that something is wrong.

You can ice your knees for 10-20 minutes if they are sore after doing these exercises.


 

Setting the right goal is the most important step in starting a new fitness program... unfortunately it is often underestimated or completely overlooked.  How often do you hear people tell you that they joined a health club last year, but never go? Or they lost 5 pounds only to put back on 10? These unfortunate endings could have been prevented if the right goals were established in the beginning of the process.  

So how do you set the right goals and then actually achieve them?

The first thing to keep in mind is that most fitness related goals need at least 12 weeks for you to see measurable results.  Most people give up just about the time their bodies start changing.

Secondly, you need to focus on one primary goal at a time. Then it is important for you to have a way to monitor and track how you’re doing during the process.  And finally after the 12- weeks are over, you should re-establish a new goal based on your training results.  In doing so you are creating smaller more manageable goal increments. Success of any type often happens in small steps rather than unrealistic leaps.

Use the following steps to select the right fitness goal:

Meaningful: Make sure you’re goal is something that is truly meaningful in the ‘now’...

List 3 things you really want to change or improve about your body (in order of priority)
1.
2.
3.
(For example: 1. Lose weight; 2. Improve Joint Health; 3. Tone up)

Measurable: Now look at the three goals you listed and decide if and how you can measure them.

1. ____________________________
2. ____________________________
3. ____________________________

(For example: Lose weight: measure by scale; Feel better: self evaluation of energy level; less joint pain; Tone up lower body: tape measure)

Manageable: Take another look at your potential goals and decide which might be the most manageable, realistic and achievable over a twelve-week training period.

List the increment you would be trying to achieve per week.
1. __________________per week
2. __________________per week
3. __________________per week

(for example: Lose weight: 1 pound; Feel better:10%;  Tone up: lose ¼ inch off hips and/or thighs)

This process will help you recognize which of your potential goals might be the best to work on first.  Once you have achieved your goal, you can continue on the same path, advance the measurement or start working on one of the remaining two goals.

This systematic approach to goal setting and achievement can make the difference between ‘success’ or ‘depress’ when it comes to your next fitness program... so get goal setting and GO!

• In the weight room seniors may want to stick with the circuit machines if balance is an issue.  They may also need to omit certain exercises all together if they have joint limitations or suffer from for low back problems.  For this reason it is wise to hire a personal trainer when training in a gym.  A certified fitness professional should be able to help seniors recognize limitations, select the right exercises and spot proper movement execution. 
   
• Lightweights, exercise bands and balls offer seniors a great option because they are not as intimidating as heavy weight room equipment. The portability and handling ease make them ideal for senior strength training programs.  Some of these exercise devices are even designed with special gripping features, which make them easier to handle and hold like these here, soft weights and compressible balls. 
  
• Some seniors may need to wear a weight-training glove to improve grip and/or protect sensitive skin on the hands when handling weights or resistance bands.

• Another equipment consideration when training is joint stability and protection devices... This is where a physician’s recommendation should come in.  It could involve orthopedic braces or raps for the wrist, low back and knee.
   
• Some physicians will recommend water exercise for seniors with severe joint pain or limitations.  The water acts as a natural body support and the buoyancy factor keeps stress off joints.  Even for water exercise there are a variety of floatation and resistance devices that can to help make the most out of a water workout.  

Flexibility training equipment is pretty much the same for senior as any adult exerciser:

·        A comfortable floor mat is a must if seniors are planning to stretch on the floor.

·        A stretching strap is also helpful for leveraging limbs into a stretch position.

·        A rolled pillow or towel for neck support is also recommended for when lying on ones back.

One note on stretching:
Some seniors do not feel comfortable moving up and down from the floor.  Thus stretching can be done from a seated position, while standing behind a chair or even while lying on a firm bed or couch.  It is also a good idea for seniors with balance issues to have a sturdy chair nearby if moving down onto the floor for stretching.

Senior fitness equipment is a broad area, which I will cover based on what is relevant when conditioning the heart verses the skeletal muscles of the body.   

Lets start by discussing senior cardio-respiratory equipment:

• In general the stationary cardio machines are built for any adult user, but some offer features that better address senior adult’s special needs.  For example, if a senior has problems maintaining good posture or balance, they will want to use the machines that offer back support or take place from a seated posture. 
    
• If seniors have a specific joint that doesn’t function like it use to or joint pain issues, for example the knees or low back, they will want to find the equipment that places the least stress or weight on those areas.  This might mean a glider style machine that distributes the workload between the arm and leg muscles, or a recumbent bike that puts the back in a more comfortable posture. 
  
• If seniors are into outdoor cardio activities like walking or jogging a pedometer is a great tracking tool.  Look for one that has easy to read numbers. Many aging adults feel more comfortable accumulating their cardio-respiratory training minutes throughout the day.  By wearing a pedometer seniors can easily track their daily steps.  Harvard research has shown that as little as 6000 steps a day correlates to a lower death rate. http://walking.about.com/cs/measure/a/locke122004.htm
   
• A heart rate monitor is also a helpful device to insure a person is training at the right intensity.  Keep in mind that some seniors are on heart medications that are designed to keep the heart rate from elevating thus a electric monitor may not reflect how hard they are truly working.  In these cases seniors will need to base their intensity on how they are feeling during the activity and try to stay in a moderate to somewhat hard perception range.
  
  Always check with a doctor before starting any exercise program and he may be able to advise you further on what exercise equipment to use and how to manage joint pain and arthritis with exercise. 
  
  My next post will discuss strength training options for seniors.  Be sure to check back!  If you have any helpful tips or advice, please comment below.