BBPT Health Tip: Eat your Fiber

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Fiona McMahon, DPT, PT

What is fiber?

Fiber, it’s the hot ticket. It is being marketed to us like crazy. But why is fiber is so important? What fiber is best? Should you get more fiber with supplements? Let’s take a closer look into the benefits of fiber in this edition of BBPT’s Health tips.

Fiber is the part of food that we cannot digest. It is separated into two types, soluble and insoluble. Both bulk up the contents of your stomach and colon, which can help you feel more full but after that, the similarities end.

As the name implies, soluble fiber dissolves in water but insoluble does not. Insoluble fiber increases the mass of the stool and helps to get things moving, in terms of passing feces. Soluble fiber absorbs water. The truth is, most people are not getting enough fiber. Less than half of people in the United States consume the recommended amount of fiber. Let’s discuss the benefits of fiber and how to make sure you are getting enough.

 

So what if you don’t have issues going number 2? What else can fiber help you with?

 

Fiber has been shown to help with reducing the risk of the following conditions:

  • Coronary artery disease
  • Stroke
  • High blood pressure
  • Diabetes
  • Obesity

Fiber has also been shown to:

  • Improve insulin sensitivity in people who have diabetes
  • Enhance weight loss
  • Improve GI conditions like acid reflux, duodenal ulcers, diverticulitis, constipation, and hemorrhoids
  • Enhance the function of the immune system

 

How much to eat and where to get it?

Men under 50 years and under should consume at least 38 grams of fiber daily, Women under 50 should consume at least 25 grams of fiber daily. Women over 50 should eat at least 21 grams and men over 50 should get 30. Those who suffer from constipation may add more to your diet. We suggest contacting a nutritionist for proper amounts of soluble versus insoluble in these cases and anyone with a history of GI issues. Also, please discuss with your doctor before making any drastic changes to your diet.

Adding fiber to your diet when you are not used to it can sometimes be a little difficult. If you add too much too quickly, you may experience gas and bloating. Start slow and work your way up. Also, drink plenty of water.

Start by adding in whole wheat items (unless you have a gluten sensitivity), legumes, fruits, and vegetables slowly to your diet. Check out the Mayo Clinic’s full list of fiber rich foods here http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/high-fiber-foods/art-20050948

Sources

 

Anderson J, Baird P, Davis R, et al. Health benefits of dietary fiber. Nutr Rev. 2009. 67(4)188-205

Family Doctor.org Decermber 2010: http://familydoctor.org/familydoctor/en/prevention-wellness/food-nutrition/nutrients/fiber-how-to-increase-the-amount-in-your-diet.printerview.all.html. Accessed November 11, 2016.

Medlineplus. Soluble vs. insoluble fiber.https://medlineplus.gov/ency/article/002136.htm. Accessed November 17,2016.

Shoulder Pain – What Can Be Done?

Back and Shoulder Pain

Kaitlyn Parrotte, PT, DPT, OCS, CFMT

Shoulder pain is a fairly common issue amongst adults, with a reported lifetime incidence of up to 70% in various countries and estimates of cost burden up to $7 billion a year for treatments of it.

Subacromial shoulder pain is defined as pain that originates from the subacromial space, which is a very small area between part of the shoulder blade called the acromion (“roof of the shoulder”), and the shoulder joint (the glenohumeral joint). In this area lies the rotator cuff tendons and the subacromial bursa (a fluid filled sack that helps minimize friction on these tendons). Subacromial shoulder pain is commonly located on the top and outside of the shoulder, and is often aggravated by overhead activity. The pain from this area is typically caused by inflammation and/or tearing of the rotator cuff tendons, as they are pinched/rubbed against the underside of the acromion.

There have been multiple research studies that have looked into the benefit of surgery for the treatment of subacromial shoulder pain. Today, we will be focusing on one article that looks at the effect of arthroscopic subacromial decompression (a common surgery for pain by removing tissue), as compared to a placebo surgery (no tissue actually removed), and no treatment. Here is a quick summary of the study:

313 patients were randomly assigned to treatment groups: 106 to decompression surgery, 103 to arthroscopy only, and 104 to no treatment. For the decompression surgery, surgeons removed soft tissue and other structures within the subacromial space, a nearby ligament, and removal of any bone spurs. For the arthroscopy, structures were inspected and irrigated, but nothing was removed or repaired. Following surgery, both groups (decompression and arthroscopy) received appropriate post-operative care, including follow-ups with the surgeons, as well as physical therapy. Those participants assigned to the no-treatment group attended one reassessment appointment with a shoulder specialist, 3 months after entering the study, but with no planned intervention. The pre- and post-test findings were mainly based on a functional shoulder measure.

The findings in this study turned out to be very interesting, although perhaps not what the authors originally intended. Not because both surgical groups reported higher scores on the functional measure, as compared to the no-treatment group, which is something that one can expect when an intervention is appropriately applied. The main take home message from this study is not even that researchers reported participants in both surgical groups ended the study with similar outcomes. A major plot twist in this article is that both surgical groups were given physical therapy post-operatively. Remember, the group who received arthroscopy did not actually have any structures repaired or removed, yet this group made statistically significant gains after all intervention were completed, that matched, if not bested, the results of an actual surgical intervention. How could this occur? We must consider the common denominator – physical therapy! Physical therapy is the only thing that both groups had in common, so it is safe to assert that it likely played a significant role in the improvement of shoulder pain.

If that isn’t convincing enough, let’s now focus on a research article that takes a closer look at the impact of physical therapy for patients with subacromial impingement syndrome. This article published in 2012 looked at a specific exercise routine vs generalized exercise for 102 patients in Sweden, who had already failed conservative treatments for their shoulder pain, and would likely become candidates for surgery due to their continued pain. Participants in both groups received a subacromial injection of corticosteroids two weeks prior to the commencement of any exercise. The control group received general exercises that including shoulder and neck movements and stretches. The experimental group was given six exercises to perform, which included eccentric strengthening of the rotator cuff, meaning these muscles were actively controlling resistance while lengthening, stabilizing exercises of the shoulder blade, and stretching of the back of the shoulder. After performing these exercises two times per day for up to 12 weeks, and attending one physical therapy session per week, these patients reported significant improvements in functional measures for the shoulder, as compared to the control group. The authors also reported that significantly fewer participants from the specific exercise group opted for surgery after the trial was over (20%), as compared to 63% from the control group. This study not only shows that physical therapy is beneficial for decreasing subacromial shoulder pain, but it also proves that when it is tailored specifically toward the needs of an individual condition or presentation, it can still be effective even after a person has failed conservative treatment.

In summary, subacromial shoulder pain is a very common condition, that can successfully be treated with physical therapy, even if conservative treatments have previously failed to relieve symptoms. The emphasis must be on finding the correct intervention program that meets the needs of each individual patient. If you or someone you know is dealing with shoulder pain, whether it is new or old, you could benefit from a tailored physical therapy program. Here at Beyond Basics Physical Therapy, all of our therapists have extensive training and are experts in orthopedic and sports-related injuries, and will work one-on-one with you to develop a rehab program that helps you achieve your goals, so make and appointment today!

 

 

Sources:

1. Cadogan A, Laslett M, Hing WA, McNair PJ, Coates MH. 2011. A prospective study of shoulder pain in primary care: prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskeltal Disorders, 12 (119).

2. Kulkarni R, Gibon J, Brownson P, et al. 2015. BESS/BOA Patient care pathways – subacromial shoulder pain. Shoulder & Elbow, 7 (2), 135-143.

3. Mesilin RJ, Sperling JW, Stitik TP. 2005. Persistent shoulder pain: epidemiology, pathophysiology, and diagnosis. Am J Orthop, 34 (12 Suppl), 5-9.

4. Beard DJ, Rees JL, Cook JA, et al. 2017. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet, 17 (32457), doi: 10.1016/S0140-6736.

5. Holmgren T, Hallgren HB, Oberg B, et al. 2012. Effect of specific exercise on need for surgery in patients with subacromial impingement syndrome: a randomized controlled study. BMJ, 344 (787), doi: 10.1136//bmj.e787.

The Scoop When Kids Have Trouble with Poop

 

Kiddo

Fiona McMahon PT, DPT

I spend a lot of my time at work talking about poop. In fact, poop discussions run in my family. My great grandmother, a nurse in the 1920’s, would always inquire about her charges and her children’s movements when they’d complain of any ailment. This scatological interest was passed to my grandfather, a civil engineer, designing and working in wastewater treatment plants, to my mother who was a nurse practitioner, who dealt with digestive issues and famously asked a guest at her parents’ dinner party when she was a child, “how are your bowel movements, lately?” This familial interest in the distal end of the alimentary canal was bequeathed unto me and I now spend much of my working life trying to help people of all ages with issues defecating to live more comfortable and full lives when it comes to bowel movements.

Anyone who has had any issues concerning their ability to poop, or to hold it, can attest to how much havoc issues with bowel movements can cause in one’s life. This is especially true when it comes to children. Children often have continence requirements to attend school, camp, and other activities. Not to mention other children may not always be very kind to another child who is experiencing difficulty with their bowels. Aside from the obvious issues of constipation and incontinence, kids with bowel issues can experience other symptoms like pain in their belly or with defecation, foul body odor, problems with their bladder, including incontinence, as well as skidmarks in their underwear or itchy bums. It really does all come down to poop.

The largest driver of bowel problems in kids is constipation. Constipation is surprisingly common and occurs in 4-36% of children. It accounts for 3% of visits to the pediatrician and 30% of visits to pediatric gastroenterologists. Constipation can be tricky to diagnose and many people who have children who are constipated, do not identify constipation as the culprit for issues like bowel and urinary incontinence, and pain. According to Afzar and colleagues, constipation would be missed nearly 50% of the time in children, if infrequent bowel movements was the only criteria used in assessing constipation in children.

So what criteria do we use to assess constipation in kiddos? We obviously look at how often a child is defecating. Two or less bowel movements a week is considered constipation, but it is important to keep in mind that a child with difficulty evacuating may move one or two small pellets multiple times a day and still be severely constipated.  Check out the Bristol Stool Chart here to determine if your child’s BM’s are normal. Types one and 2 indicated constipation. Bowel incontinence is also an indicator of constipation in children. In fact, 90% of children with constipation experience fecal soiling. Kiddos with large fecal masses felt in the rectum by a doctor or through the abdomen, those with history of painful bowel movements, and those who produce large toilet clogging poops are exhibiting symptoms of constipation. Children with constipation may also exhibit retentive posture in an effort to prevent painful bowel movements. They may go up on their toes, squeeze their butt cheeks and thighs together, cry, and rock back and forth. Retentive postures can trick parents into thinking their child is trying to defecate when in fact they are working hard to keep everything inside. If you see any of these symptoms in a child under 4 years lasting for a month, and over 2 months in kids over 4, you are dealing with constipation

Constipation can be divided into two different types, functional and constipation due to an organic or pathological cause. Around 95% of constipation in both adults and children is considered functional. Functional constipation can occur for a variety of different reasons in children. One of the most common reasons is that children can get in the habit of delaying or trying to prevent defecation. Children are often just as busy as the rest of us. They may simply be too busy in the morning to have a full bowel movement. Once they arrive at school, they are faced with bathrooms that have doors that may or may not lock, or they may have to contend with intimidating multi-stalled public toilets. Either way both are not conducive to pooping. After school is usually filled with activities and a mad dash to do homework. You can see that it may be very difficult to schedule in a good time to use the toilet. Kids also delay going to the bathroom because it hurts or may be uncomfortable to go. The more they delay their bowel movements, the more uncomfortable it can be to go. Thus creating a negative feedback loop that just feeds back on itself and worsens the constipation symptoms.

Weeks of delay whether it be secondary to pain, scheduling, or plain old distraction, can cause a big build up of poo in the very end of the digestive system, the rectum.  The accumulated fecal matter may be backed up through the  entire length of the colon. This big build up of feces in the rectum causes it to  stretch out.  A stretched out rectum is not good at holding feces in, or sensing that it is time to go to the bathroom, making the problem even worse. Furthermore, soft poo will easily slide by the hard fecal blockage and create smears or “skidmarks” in the underwear, or even more severe incontinence mistakenly labeled diarrhea. Chronic fecal impaction, and fecal withholding can alter how the muscles that control continence work (the pelvic floor), which may further worsen this constipation syndrome. Skidmarks, constipation and fecal incontinence are not anyone’s fault, especially the child’s, but it is a problem that can be solved.

So what to do about all of this? Is it too late if your child has been constipated for a long time? Tackling poo problems in kids is daunting for both parents/guardians alike. The first step is educating yourself, your doctor, and your child. My motto for the kiddos that I treat is, “Accidents are not your fault, but it is your problem to solve.” Letting children know what is happening in their body can help them further internalize this message and become more invested in the process to remedy their symptoms.

Next you have to tackle the poo situation inside of your child’s tummy, This is where a two pronged approach is key. Both physical therapy and your doctor will get you on the right track. Your doctor will screen your child for that 5% of constipation cases that are caused by organic causes like Hirshprung’s disease, thyroid issues, and notably cow’s milk allergies and gluten intolerance/ celiac disease. It is important to be screened for these allergies and food intolerance as they represent a large portion of organic constipation cases. Once organic causes are ruled out, your doctor will start medication to help clean out the bowels. Miralax (Polyethylene glycol), is a mainstay of pediatric constipation treatment and is generally best tolerated. Miralax may be first given in large amounts to clean out the bowel, and then followed with smaller maintenance and then slowly tapered off as the rectum reduces from it’s stretched out size. It is important to remember that when starting miralax, especially at “clean out”, doses will likely increase episodes of incontinence at first, so prepare both yourself and your child. Make sure to consult your doctor before attempting any sort of clean out on your own.

Next up is physical therapy. Our main goal is to keep poo moving and avoid buildups so your child’s body can heal. We will teach you ways to massage the colon through the belly to keep poo exiting and to reduce back ups and the need for laxatives. We also work to teach your child to sit on the toilet in a way that will help the poo as easily and painlessly as possible. More often than not, kiddos with constipation have pretty weak cores that make defecating difficult. As pediatric physical therapists, I humbly assert that we are the masters at dreaming up fun ways to gain a little core strength in session and at home to help make bathroom trips easier.

What Beyond Basics does that is truly unique from non pelvic floor physical therapists, is we train the muscles of the pelvic floor (the muscles that control both the the anal and urethral opening to better open and close). Kiddos with chronic constipation tend to have pelvic floors that are tight and uncoordinated. Paradoxical contraction occurs when a child tries to open their anal canal, and they truly believe they are doing so, however they are I n fact clamping it shut. We can treat this problem at Beyond Basics.

If your child would benefit from physical therapy, or an evaluation, to make pooping a bit easier, give us a call. Stay tuned for our next blog, where we will go over some practical at home tips for improving both you and your child’s pooping situation!

 

Sources

Afzal N, Tighe M, Thomson M. Constipation in Children. Ital J Pediatr. 2011; 37

 

Poddar U. Approach to constipation in children. Indian Pediatri. 2016;53(4) 319-27

 

 

New Year’s Resolutions: Weight Loss

Fitness and health

Fiona McMahon PT, DPT

It’s that time of year again. We are all nobly setting out on our self improvement journeys. Resolutions are often deeply personal goals we set for ourselves and can involve spiritual, physical, and emotional aspects. Overwhelmingly, one of the most common goals people have is weight loss. The desire to lose weight often goes beyond aesthetic. People can be motivated to reduce pain in their joints, improve heart health, and to have more energy. As physical therapists we see the harms of the burden of carrying around extra weight on aching joints as well as the fallout from initiating a program with a little too much vim and vigor.

Goal Setting

Goal setting is something almost every article on New Year’s resolutions addresses, for good reason. Goal setting properly is imperative to success. We can think of goal setting in two ways. Sometimes we think of goal setting like a wishlist, “it would be great if I achieved x”. These kind of goals are great for getting you to look at the final picture, but provide no direction on how to get to your end result. Writing down a goal to lose 10 pounds is all well and good, but without a solid plan, you are left without any real steps to put in motion.

In goal setting I suggest you borrow some tools from us physical therapists. When we assess patients we develop short and long term goals to get them to their ultimate fitness and health goals. The short term goals we make, allow us to zero in on small and discrete changes we can make towards the ultimate goal.

Think about what habits you currently are doing that are holding you back from weight loss. Are you having an extra glass of wine at night you could cut out, are you not getting enough sleep, so working out seems impossible? Break things up into small behavioral changes to concentrate on. Keep in mind goals can also be positive, what things are you currently doing that are helping you on your path that you would like to continue doing. It’s important to recognize where you are being an absolute rockstar already and use that positive energy towards things that might be harder to change.

Track your goals and think about how often you want to make sure you are doing them. Personally, I find it helpful to track my goals to see if I am generally sticking to them. There are apps out there, that you can install on your phone that will help track your success in sticking to your goals. I use a free app called “Productive”.  It allows me to make a recurring checklist for my goals. You can use the app to schedule out what time of day you would like to do your goals, how many days a week you’ll do them, and provides stats on how regularly you are achieving them.

Finally, it is important to be realistic with your goals. Goals that are too easy or too hard are less likely to get you where you want to be. Allow yourself some flexibility, to keep your journey less of a burden. Over time, check in with your goals you may find you have outgrown them or they are unrealistic. It is perfectly okay to tailor as you go.

 

Eating

We all know diet plays a major key in weight loss. A friend to the clinic, Nutritionist, Jessica Drummond will often say, “ You cannot exercise your way out of a bad diet”. Poor diets can stymie any exercise plan.

Dietary needs vary widely from individual to individual, but overall it’s best to avoid highly processed foods. These foods tend to be chalk a block with salt and easily digestible sugars that can spike appetite. No good.

Be wary of fad diets and health crazes. Gluten free foods are all the rage right now. I, myself am gluten free for health reasons, but if you do not have celiac disease or non celiac gluten sensitivity, reaching for the gluten free pizza or cookie is not the wisest choice as a weight loss strategy. In addition to usually being more expensive, gluten free options, like cookies, bread, and pizza often are higher in calories than their “glutenful” counterparts. It only took a quick stroll over to my refrigerator to prove this point. I compared a slice of traditional bread next to a gluten free slice. As you can see in the photo below, the traditional bread is larger than the gluten free bread. Not only do you get more food for serving with the traditional bread, the traditional bread has 20 fewer calories per serving than the gluten free bread. This goes to show that regardless of your dietary needs, consuming foods that are not processed like sweet potatoes, quinoa, and rice, over processed food like bread, is a good way to avoid hidden calories.

It is important that you eat enough to sustain your metabolism, your energy, and your mood, and furthermore, to allow your diet to be a sustainable change you can carry out long term to ensure success. There are apps on your phone that can help you track your calorie input, how many calories you have burned off, and what the composition of your macronutrients are. Macronutrients are protein, carbs, and fats. A diet higher in protein is generally used to help build muscles, which can in turn, burn more fat. These apps, like Myfitnesspal and Lose It! can give you target calorie intake for your desired weekly weight loss. It is important to set your target with some element of moderation so it is easier to stick to. Caloric restrictions that are too extreme can backfire by tanking your metabolism, energy, and triggering food binges.

Exercise

Exercise is so important. In addition to helping you progress towards your weight loss goal, exercise has so many health benefits that will pay dividends well into the future. From stress reduction, cardiovascular health, bone health and more, exercise is an essential element of self care even for those who do not wish to lose weight.The

American Heart Association recommends adults exercise at a moderate intensity for at least 30 minutes five times a week or vigorous activity for 25 minutes 3 days a week. In addition to moderate to high intensity  strengthening activity at least 2 days a week.

Finding the right exercise can be daunting. This is where having a physical therapist can be a tremendous advantage. Personally, I don’t believe in “the one best exercise”. Everybody is different and every body is different. Physical therapists are the movement specialists of the healthcare world. We can help you find good workouts for where your body is now, as well as strengthen your body so you can do the workout or event of your dreams while avoiding injury. Take a look at the series we wrote chronicling how physical therapy prepared my body for the rigors of the New York City Marathon and allowed me to complete it in record time, to see a great example of what physical therapy can do for you. I have included our blogs on physical therapy and exercise at the bottom of this article.

Once you have an idea of where to start and where you want to go, then slowly get started on trying out different routines. I once heard a quote from an exercise physiologist who said, “the best exercise is one you actually do”. So remember when starting your exercise program, it is okay to not like a certain exercise routine and move on. You might abhor the treadmill, but find tremendous joy in a Zumba class. Finding  a workout that brings you joy, and at the very least, does not bring you dread is imperative. It’s kind of like dating, keep trying different routines until you find what works for you.

Once you find your dream routine, remember moderation. Allow yourself at least a day of recovery if you are a seasoned exercise veteran, and more if you are an exercise newbie. Rest not only prevents injury, but it gives the body time to get to the job of laying down more muscle fibers and making you stronger.

Injury can happen with new exercise routines and really, nothing is more frustrating than being super gung ho about a new program only to be sidelined with an injury. Again this is where having a good PT on your side really helps. Seeing us before starting exercise can help us spot both literal and figurative achilles heels in your posture, strength, and flexibility and will allow us to address these issues before they become mega impairments later on. We can help you decide when it is time to progress and how to do so safely. Additionally we can help you recover from an injury faster and prevent injury recurrence if you see us when you do have an injury.

 

Failure and Success

Repeat after me, “ I am a person, not a machine”. You will fail at certain elements of your plan. Notice I used “will” and not “may”. When you do overindulge, miss a workout, or whatever else. Remember it is a process and small failures do not indicate that you will fail in your ultimate goal of greater health. Nor is failure in any way an indicator of your worth as a human being, neither is the number on the scale, by the way. Progress will be slow, but you will likely get there if you are consistent. Failure is a good time to re-evaluate your goals. Maybe five workouts a week is completely unrealistic and maybe sticking with three is a much better balance. Regardless of what obstacles you face in your journey, remember to be kind to yourself, you are doing the best you can. Find what changes you can stick with and go from there. It can take a lot to change up your whole routine, but keep working at it and you will find success.

Check us out at BBPT!

Although we do specialize in orthopedic and pelvic floor physical therapy at Beyond Basics, we do so much more than that. All of our physical therapists are trained in orthopedic and sports rehab, and many of our therapists have earned prestigious orthopedic certifications like the OCS and CFMT. We can help you to figure out where to start, how to progress your exercises appropriately, and how to keep your body healthy so you can continue to achieve all of your goals.

 

Additional Blogs Exercise and Fitness:

Time to PUMP SOME IRON! September is Healthy Aging Month

Exercising While Pregnant

Preparing for the Marathon with Physical Therapy at Beyond Basics!

Beyond Basics’ Marathon Prep Program: The Evaluation

Marathon Prep with Beyond Basics: Weeks 1-3

Marathon Update: Sickness When to Run and When to Take a Break

Marathon Training Update

Marathon Update: Shaving Time off my Race with Physical Therapy and Doing Good in the Name of Multiple Sclerosis Research

 

Sources

American Heart Association. American Heart Association Recommendations for Physical Activity in Adults. Updated Dec 14, 2017