Located in Sterling, VA (703) 421-1200

December 2023

Treat Ailments With Aggressive Therapy

If you are a regular reader of this blog or a Total Results client, you probably know that I am not a big fan of traditional physical therapy. I believe that conventional orthodoxy is centered around outdated modalities that do little more than check off a box and satisfy an insurance company, but in reality offer little to no benefit. Here is the familiar scenario: you experience some lower back pain that doesn't seem to go away in a few days or a couple of weeks. You decide to schedule an appointment with your regular doctor, who then refers you to an orthopedist. Naturally, appointments with a specialist are harder to come by, so you have to wait a couple of weeks. In the meantime, your back pain is no better. After being examined by the orthopedist, you are prescribed six weeks of physical therapy. The therapist has you undergo electrical stimulation (in the misguided attempt to trigger muscular growth), ice the area, as well as perform a series of random exercises with no consideration for safety and very little supervision or instruction (in fact, you probably could have done them just as effectively in your living room). After six weeks of this, there is little to no improvement; sounds like a big waste of time, doesn't it?

If this story has happened to you, you are not alone. I have instructed exercise for nearly 25 years, and in the course of working with clients and injuries, the above scenario is what my clients have experienced approximately 90 percent of the time. Not only is traditional physical therapy largely a waste of effort and resources, there is a solid chance that these misguided practices could make you worse off than before you started! I saw this first hand when I worked at Fairfax Racquet Club; our studio was across the hall from a physical therapy clinic. I would see therapists juggling multiple patients at a time and offering little to nothing in the way of instruction or guidance. It was no surprise that the patients didn't get much better, at least until they started strength training with me once or twice per week. That is because high-intensity, slow speed weight training is the embodiment of what physical therapy should be. The trigger that reduces pain and restores function is working to build strength in the injured or affected area. If you do not work aggressively (but safely) to treat the ailment, it will not improve in a timely fashion.

As a former competitive athlete approaching 50 (still hard for me to believe) and with a lot of miles on my odometer, I occasionally experience some discomfort in my knees, hips, and lower back. I recently had a bout with some significant right lower back pain from an unknown source. I have a very active job that involves a lot of crouching, bending, and standing, and this proved to be difficult in some planes of motion. Over the years I have learned that the natural tendency for most of us in this situation is to do nothing, to just simply let the area rest. That may be good for a day or two, but you need to keep moving. If you don't, it gets easier to become averse to the discomfort, but a certain amount of discomfort is a part of living a useful life. You can choose to fight through it or accept it; I chose the former. Rather than skip my weekly workout, I resolved to do my very best even though I was not 100 percent. I performed the Lumbar Extension exercise, and even though I didn't set any records my back felt better afterward. The next day as an experiment, I decided to perform a very low intensity set of the Linear Spine Flexion exercise. This exercise is not part of my normal routine, largely because it is challenging to use without assistance in setting the timing crank. The Linear Spine Flexion helped me to work out the kinks, and it felt like getting an adjustment. I performed this exercise one more time on the following day, and after that my back pain was gone. This recipe should be used in the future.

Weight training is therapy. You can just as easily substitute knee, shoulder, elbow, hip, or ankle pain for back pain, and our approach in treating it will be the same. Simply avoiding that injured area makes sense on an emotional or psychological level but if you do nothing the muscles surrounding that joint will eventually atrophy, thus compounding the problem. I can treat shoulder pain by modifying movement arm positioning or substituting upper body exercises, and also incorporate a hanging exercise to relieve impingement in the shoulder joint. Hip pain can be addressed by performing variations of the Leg Press exercise. Knee pain can be improved by strengthening the quadriceps and hamstrings; the Calf Raise exercise helps to rehabilitate ankle injuries. I have accumulated a lot of tools to treat different ailments, it's just a matter of finding the right combination. No, exercise is not a cure-all, but it is our best weapon to improve health and improve orthopedic ailments.

Don't let pain make you fearful and keep you on the sidelines. Working through the discomfort will give you a feeling of active participation, or being in charge rather than passive. Exercise is both a remedy and a preventative measure; building and maintaining strength lessens your risk for injury and also minimizes any injuries or ailments that you do incur. Therapy should be about restoring strength, function, and range of motion while working to reduce pain. Traditional therapy leaves a lot to be desired. Take charge today with Total Results!

Posted December 28, 2023 by Matthew Romans

Force, not Weight

One major concern that many people have about starting an exercise program is the risk of injury. Some have experienced injuries in the distant past, may be just coming off of an injury, or have been told by someone (often a doctor) that they need to avoid injury. Injuries should be a major concern; after all, you cannot reap the benefits of an exercise regimen if you are hurt. In many cases injuries are completely unnecessary and can easily be avoided if you exhibit the proper behavior. Unfortunately, many people are mistaken as to what the root cause of injury is when it comes to weight training, and they think the risk of injury is commensurate with the amount of weight they use on a given exercise. The primary cause of any injury is the amount of force produced and incurred by the body, not the amount of weight that is lifted.

Force is equal to mass times acceleration (f=ma). How you move is far more important than how much weight you move. It is possible to lift a relatively light weight unsafely; in fact, some injuries that people incur involve no additional weight at all (think about a person who is distracted by their phone, steps off a curb, and sprains an ankle). It is also possible to lift a fairly heavy weight in a completely safe manner. We have several clients at Total Results that use over 400 pounds on the Leg Press exercise, and perform that exercise very safely. The major consideration is the client's behavior (read: form); this dictates whether an exercise is safe or unsafe. All of our machines are designed to track muscle and joint function properly, so they should not inherently pose any biomechanical problems. Proper form is paramount in terms of keeping the potentially dangerous forces to a minimum. Abrupt acceleration, ratcheting, off/oning, firing out of the stretch, and wiggling or adjusting during an exercise will exponentially increase the risk for injury. It is important to maintain the correct mentality and mindset, while understanding the true objective of exercise: inroading the muscular structures rather than achieving an arbitrary number of completed repetitions.

It is important to understand the distinction between weight lifting and weight training. Some people think the terms are interchangeable, which is a source of the problem. Weight lifting involves violently and explosively throwing and catching weights in a misguided attempt to build strength. It is very much skill-based and often involves free weights, such as you would see in Olympic events like the clean-and-jerk and the snatch. Much of what you see in commercial gyms amounts to some variation of weight lifting, and there is very little understanding about the dangers of high force. This is why so many people experience injuries performing CrossFit and Orange Theory; unfortunately most people just accept this as a price that must be paid. Total Results feels differently. Weight training involves raising and lowering the resistance in a smooth, slow, and controlled fashion until another repetition cannot be completed in proper form. It is pursued for the purpose of building strength, not demonstrating it. The volume of exercise is low and it is performed infrequently, in accordance with principles of biology, chemistry, physics, and concepts of motor learning. While weight training and weight lifting may sound similar, the two entities could not be more different.

When we talk about sports and athletes, it's important to understand that injuries are a part of any sport. Generating a high amount of force in the course of running, jumping, and changing directions can and often does involve either a sudden or overuse injury of some sort. The main reason that any athlete should strength train, aside from improving their level of performance, is to protect against injury. No matter how strong and well-conditioned you are, injuries can happen, but you give yourself the best chance for success by pursuing an intelligent exercise regimen like Total Results. Most Total Results clients are not competitive athletes, although many participate vigorously in recreation activities of a physical nature. Clients coming off an injury or experiencing joint discomfort often ask me to lower the weight on a given exercise. There is often not a physical need to do so, since they haven't lost any strength, but using a slightly lower weight makes them feel better and helps to rebuild confidence.

The major thing to remember is that when it comes to injury, force is a far larger consideration than weight. Certain activities carry with them an inherent risk and higher amounts of force, but weight training is an undertaking that should place a high priority on safety. You cannot reap the benefits of an exercise program if it injures you. If you follow the directions of your Total Results instructor and do what is asked of you, the chances of you getting injured are virtually zero. Our exercise program is safer than stepping off a curb.

Posted December 14, 2023 by Matthew Romans