Supersets

I am extremely efficient when I work out. We all know how precious time is so the last thing I want to do is waste valuable hours in a gym. The key to being fast and effective is to work large muscle groups, covering the entire body. I don't focus on one single muscle group during workouts but rather focus on moves that incorporate and recruit numerous muscles at one time. The more muscles you can work at one time, the shorter overall time it will take to get a full body workout. My workouts are extremely efficient and effective, lasting around 30-40 minutes and burning 350-500 calories on average. I begin with a 5-10 minute warm-up, move on to the superset work out, do a 5-10 minute cool down then stretch for a few minutes.

My favorite way to do this is with supersets. Supersets are comprised of two exercises performed back to back with no rest between moves. You can rest between sets of the two back to back moves, but you will increase overall calorie burn if you decrease rest times. You want to complete three full sets of both moves. The key is to work opposite muscles groups so you can perform the exercises back to back with limited need for rest. For example, a good superset would be 20 goblet squats immediately followed by weighted rows. I really like to add in a matching plyometric exercise between the two sets. (For the example given, I would follow the squats with 10 quick jump squats before moving on to the rows). Adding in the plyometric component is more advanced, stick with traditional supersets at first and build yourself up to adding in the extra quick burst of cardio. Let your body get used to the difficulty of performing two exercises back to back with no rest before increasing the difficulty level.

To start, I choose six different exercises to pair up for three different groups of supersets. So after finishing three rounds of squats followed by rows, I would then move on to the next set of two exercises, perform them back-to-back for three sets total, rest for 30 seconds or so then move on to the last two exercises. So in total, you are performing six different exercises, two at a time, for three sets, then moving on to the next pair of exercises, finishing all three sets then finally moving on to the last two exercises.

Example exercises to mix-and-match for supersets:

Legs:	Arms:	Abs/Core:
Lunges	Rows	Russian Twists
Side Lunges	Flys	Planks
Reverse Lunges	Bicep Curls	Side Planks
Squats	Tricep Dips or Kickbacks	Crunches on Stability Ball
Split Stance Squats	Shoulder Presses	Leg Lifts
Plie Squats	Push-ups	Bicycles
One-Legged Squats	Front or Lateral Raises	Glute Bridges

 

 

Example exercises to mix-and-match for advanced supersets:

Multi-Body Exercises:	Plyometric Exercises:
Squats with shoulder press	Jump Squats
Lunges with bicep curl	Jump Lunges
Split stance lunges with shoulder press	Skates
Reverse lunge with lateral raises	Plie Squats
Side lunges with front raises	Mountain Climbers
Walking lunges with bicep curls	Burpees
Deadlifts	Jumping Jacks

 

Ice Vs. Heat

One of the most popular questions I get asked by patients during practice is, 'how do I know when to ice and when to heat?' This can be a very confusing issue for people and is very important to address as it can affect healing times. If applied at the right time, recovery times will be decreased. The problem is that the answer is not 100% cut and dry and can vary between individuals, however there are some general guidelines to follow.

You always want to apply ice within the first 48 hours following an injury. This time is crucial to control and decrease inflammation. As soon as there is an injury, the body begins the inflammatory process as an attempt to begin healing. Ice vasoconstricts/closes the small blood vessels, decreasing the amount of swelling. Ice also helps to decrease sensation through the nerves, decreasing pain felt. There is a great acronym to follow when icing: C-BAN - cold, burning, aching, numb. You want to make it through and experience all four stages in order, then leave the ice source on for another few minutes once you reach the numb stage. This whole process should take less than 20 minutes. If not, be aware of the time and don't leave the ice on for longer than 25 minutes. You want to repeat this as frequently as possible throughout the first 48 hours, resting at least 30-60 minutes between ice sessions so the skin can recover fully before the next application. Rest, compression and elevation go along with icing to speed up healing. The RICE method: rest, ice, compress, elevate; all of these help to minimize the inflammatory process.

Heat is typically applied to muscle spasms and soreness to help loosen and relax the muscles. Heat vasodilates/opens the small blood vessels which allows new, fresh blood to flow through, improving circulation. (This is the opposite effect of ice and will actually promote inflammation). Moist heat is far superior to dry heat. Dry heat is a simple heating pad or sauna whereas moist heat includes hot showers, whirlpools, gel packs that can be heated up, etc. Moist heat penetrates deeper than dry heat; dry heat just heats the surface of the tissue, not really reaching down to those sore and spasmed muscles. If all you have is a traditional heating pad, you can moisten a towel so that it is slightly damp and layer between your skin and the heating pad.

What to eat before and after workouts for optimal energy and recovery

What you eat before and after a workout will affect how well you workout and how easily you recover from that workout. You need the proper combination of carbs, protein and fats for optimal results.

Before a workout, you want a mix of simple and complex carbohydrates along with some protein, but heavier on simple carbs than complex. Simple carbs include sugar, white bread, white rice, pasta, fruit, etc. Complex carbs include whole wheat bread, brown rice, quinoa, vegetables, etc. The simple carbs will help give you an immediate burst of energy while the complex carbs will provide sustained energy. You want this meal to be around 200 or less calories and heavier on carbs because they are easier to digest than protein. Complex carbs, protein and fats need energy and oxygen to digest which will take away from your exercising muscles. You want to make sure the meal is light and not too heavy or you will feel sluggish and even nauseous before your workout is over. Aim to eat at least 30 minutes to an hour before working out. Lastly, you don't want to start out dehydrated so be sure to have at least an 8-ounce glass of water before your workout (the colder the better to get the metabolism fired up)!

Examples of pre-workout meals: - whole wheat toast with peanut butter and bananas, apples, or strawberries - smoothies: with fruit, low-fat yogurt (plain is best to cut down on sugars) and some granola or oats - oatmeal made with low-fat milk and fruit - eggs, whole wheat toast and a piece of fruit

I also like to have a coffee, skim latte, shot of espresso or green tea pre-workout for an extra boost of energy and metabolism, and not to mention antioxidants!

Post workout, you want lean protein to help muscles recover and complex carbs to replenish glycogen stores (the fuel used during exercise). You want to eat this snack or meal within an hour after working out, but ideally within 15-30 minutes for optimal recovery. This meal can be heavier on lean protein since there is more time available to digest. If this is just a snack, not a full meal, aim for 200-250 calories. If it is a meal, aim for 450 calories. Also, same as pre-workout, be sure to rehydrate and replenish any lost liquids.

Examples of post workout snacks: - chocolate milk - whole wheat toast with peanut butter - Greek yogurt and fruit - apples with nut butter - trail mix with nuts, seeds and dried fruit

Examples of post-workout meals: - lean protein (chicken, fish, turkey) with a side of complex carbs (sweet potatoes, brown rice, quinoa) and veggies sautéed in olive oil for some healthy fat - turkey or ham on whole wheat bread with hummus or avocado - whole wheat pasta with lean protein (chicken breast, sauteed shrimp or lean ground beef or turkey meat balls)

There is also such a thing as 'fasted cardio,' first thing in the morning, on an empty stomach, after fasting all night or waiting at least 4 hours after your last meal to workout. The idea is that you will burn through any remaining glycogen/glucose stores then move to burn fat stores. But if there is not enough there, your body will then turn to its own muscle for fuel. This could be a good way to burn fat, but you have to be conscious of the fact that it can result in the break down your own muscle tissue for energy.

Quinoa, a hearty and healthy whole grain!

Quite the craze right now, quinoa seems to be everywhere right now...there are even comedic commercials about it! Even though quinoa is considered a whole grain, you are actually eating the seeds of the grain crop. Either way, quinoa is considered a complete protein, providing the body with all 9 essential amino acids, which is extremely rare for any grain source. Quinoa also possesses phytonutrients with antioxidant and anti-inflammatory properties. Another big fad right now is gluten-free, which quinoa also happens to be so there is a decreased, very low risk of allergy. Not only is quinoa delicious on its own but it is a great substitute for rice or pasta and a great addition to any soup or stew. Since quinoa is such a super food, I figured I'd share a few of my favorite recipes and uses for quinoa. 1. Baked Quinoa Broccoli Casserole I have made this swapping the broccoli for zucchini or asparagus but really, you can use any veggie you like in this recipe.

2. Mexican Quinoa I have added in diced green chilies before or used a can of tomatoes with diced green chilies or habaneros in place of regular diced tomatoes. I also add in some taco meat, but you can add in any protein of your choice, if any!

3. Hearty Chicken Stew with Butternut Squash & Quinoa I add an extra 1/2-1 cup of chicken broth, I use chicken breasts instead of thighs and I use fire roasted tomatoes for an extra boost of flavor. Also, I have made this recipe both with and without the olives (using only about a 1/2 cup when I do add them in) so feel free to omit them if you are not an olive person.

4. Parmesan Quinoa Bites I use regular or whole wheat flour instead of rice flour and have used zucchini instead of carrot before.

5. Quinoa Stuffed Peppers (Giada recipe, subbing quinoa for orzo)

Lastly, a great way to serve quinoa as a delicious side dish or even main dish is to prepare it as you would risotto. Toast the quinoa with onions and garlic (and any other veggies you like, i.e. mushrooms, asparagus, etc) in a little olive oil until slightly browned. Add a cup of warm chicken broth, simmering until it is absorbed, then add another. Repeat until quinoa is cooked through. Once done, add in any cheeses or wilty vegetables (spinach, arugula, kale, etc) and serve with extra cheese for topping. Delicious, easy and healthy!

How to ease back in to working out

I've been talking a lot about how to know when to stop, not push yourself, how to take care of an injury, etc. Now it is time to talk about how to properly get back to working out after a healed injury. The trick is knowing when the right time is. Just because you are feeling good does not mean it is the right time. You can feel as if you are back to 100% but your body is not actually at 100%. Depending on the injury, rest times will vary. As frustrating as it is, you do not want to attempt something you are not ready for and end up on the injury list for another month! Better to wait it out those last few days and get back sooner overall. Your first time back in the gym, you want to take things extremely slow and really listen to your body. Any hint of sharp pain or reproduction of symptoms you were having should be an immediate reason to stop whatever it is you are doing. Your first workout should be no impact (i.e. no running, no plyometrics, no load-bearing exercises or use of heavy weights that will load the joints, etc). A good way to ease back in to exercising from an injury is something with low resistance, such as resistance bands where you can control the load or body weight exercises which do not put an extra unwanted force on the body and joints. You also want to cut your normal workout time in half the first few times back, so if you usually do an hour workout, aim for no more than 30 minutes. After your first few workouts, increase to 3/4 of your normal time (i.e. 45 minutes if you normally do an hour). Stick with 3/4 of your normal for another few workouts, then increase to full time. You also want to scale back a day or two a week from your norm, so if you normally do 4-5 days a week, start with 2-3 days the first week, then 3-4 the second week then to your norm by the 3rd or 4th week back. It is also important to continue with rehab type exercises throughout the first month back (here is a refresher on the blog post about back specific exercises). You want to focus on core strengthening to prevent future injuries; the stronger your core, the less recruitment of wrong muscles will occur. If the injury was an ankle/knee/foot, wobble board exercises are very important to get proprioception back to those muscles and nerves. For shoulder or upper back injuries, you want to also focus on postural exercises and stretches. If you begin back to your normal routine right off the bat, you are just setting yourself up for re-injury, more time off and more frustration! So to recap, take it slow and really listen to your body. Don't try and push yourself those first few times back, you do not want to experience any pain or discomfort (this is not the time to push through the burn)! Remember how good it feels to work out and be back in a gym so do everything you can to not set yourself up for re-injury and keep yourself away even longer!

Why no pain, no gain is not always a good motto

We like to push our bodies to the limit, see just how far they can go and are constantly amazed by all they are capable of. But sometimes, there is a limit, and it shouldn't be crossed. Some pain is good when working out or performing daily activities, sometimes it means we are activating and using muscles we don't typically use, which is a good thing. Or our muscles start to fatigue and burn out because we have hit a rep maximum and our body is screaming to stop and rest. But sometimes, there are pains that we should not fight through and ignore; anything sharp, uncomfortable or unusual should make us stop what we are doing immediately. After a few weeks off, I was feeling well and healed so decided to go to the gym yesterday for a very light first workout back. I followed the advice I would have given to my patients. If you are feeling good after three weeks, have gotten treated and done the recommended stretches and exercises you were supposed to, easing into a short, low impact workout should be fine. Just listen to your body and if there is ever discomfort or pain, stop immediately. To my surprise, after a brief 10 minute warm up on the elliptical, I was not even through my first set of body-weight squats before I felt a resurgence of pain in my low back. I stopped immediately and headed back downstairs to my apartment. Within an hour, I was barely able to move, having re-aggravated a disc and bursitis issue. Not only is this extremely frustrating, seeing how excited I have been to get back in the gym, but it is also discouraging. I want to share this with everyone just so they understand how the body works, and that this can still happen even when you are doing everything right and have access to the best treatment possible. Healing takes time and effort. That's one of the biggest pet peeves I see in practice, patients come in with acute pain and expect to jog out of the office or run a marathon the next day! It takes time and patience, even for us that do the treating! Just so everyone understands exactly what's going on when you hear 'bulging,' 'herniated' or 'slipped disc:' there are discs located between each of the vertebra in the spine that act as a cushion/shock absorber to help with impact and spinal movements. When a compromising motion or movement imparts too much pressure on an area of the disc, it is susceptible to bulge or herniate. When one of these discs bulges or herniates, it can put pressure on nerve roots travelling through the intervertebral foramina (the tunnel where the nerve exits the spine and enters the body). When there is pressure on a nerve, that pain can be felt as a radiating pain felt along the route the nerve travels. This is typically into the glutes, down the back of the leg, or wrapping around the hip region to the front of the thigh/groin. This can cause a great deal of pain and discomfort. This picture shows the disc bulging and putting pressure on a nerve root. Undesirable, painful and uncomfortable. But with the right treatment, effort and patience, it can be fixed!

Ahh, Sleep, Zzzzz

With daylight savings and the clocks changing over the weekend, I was reminded of just how much we love and need our sleep! Today's feed is flooded with 'I want my hour back!' We all know that you are supposed to get 7-9 hours of sleep a night and that our bodies function optimally with an average of 8 hours a night. But does that mean that we all do it? Some of us find it extremely difficult and end up with sleepless nights, tossing and turning or not being able to fall asleep. Well, here are some tips on how to maximize your time spent horizontal and try and get the recommended 7-9 hours a night:

1. Cut caffeine off after 4 pm or at least 5 hours before bedtime. Caffeine is a stimulant and is found in coffee, soda, tea, etc. 2. Do not exercise within at least 3 hours of bedtime. Exercise gets the blood flowing, the muscles engaged, awakens the brain and stimulates the senses. 3. Do not drink a lot of fluids a few hours before bedtime. This will allow your body to stay asleep and decrease mid-night trips to the bathroom! 4. Turn off all electronics at least 30 minutes before bed time. This allows the brain and body to relax and not be stimulated by bright lights and over thinking. It also signals to the body that it is time to begin shut-down for the night! 5. Start getting into a nightly routine that lets your body know it is bedtime. For example, this could be anything from taking a hot bath, stretching or having a cup of non-caffeinated tea or warm milk. 6. Make sure you have a good pillow and mattress, a real pillow and mattress. When choosing, you should think of Goldilock's, look for firm but not too hard and you do not want super squishy where you sink right into the pillow or mattress; you need to feel some resistance when lying so your body is supported. Memory foam is best. Pillows and mattresses have everything to do with sleep so they are good items to invest in. At our office, we recommend Bioposture products because in our opinion, they are the best, they speed blood flow during sleep and they are environmentally friendly to boot. Here is a link for more information if you are interested: www.bioposture.com 7. Natural sleep remedies such as: Melatonin, which is a hormone naturally produced by the brain. Recommended dosage: 1-3mg daily. Valerian, thought, but not proven to increase the amount of GABA neurotransmitter. Recommended dosage: 300-700 mg 30 minutes to two hours before bed. 5-HTP, which gets turned into seratonin so it increases seratonin levels in the brain. Recommended dosage: 200-400mg nightly. These are all known to help regulate sleep but are not scientifically proven methods. If you do decide to go this route, speak with your physician first.

Back Pain

As I mentioned in my last post, I'm still battling an injury and have been unable to workout or do much activity the past three weeks. For us active people, this is hell! I wake up every morning thinking 'hopefully today's the day I can get back into the gym!' No such luck yet, however that does not mean just sit on your butt waiting to feel better. There are exercises and stretches you can do to be proactive and help you heal faster, especially if you are dealing with a back injury or back pain. My go-to moves are the cat/camel and bird/dog. These help strengthen the stabilizing muscles of the spine without any additional weight or load on the body which helps protect the spine as well.

Cat/camel is performed on all fours, hands directly under shoulders with fingers pointing forward and knees directly below hips. With a slow, controlled movement, arch spine up towards the ceiling as much as possible, holding position for 15-20 seconds, then slowly return to starting position with a neutral spine. Next, slowly arch your back the other way, pressing your belly towards the floor, hold 15-20 seconds. Return to neutral. Repeat entire series up to 5 times.

For bird/dog, begin in the same position on all fours. First engage and tighten core muscles for control, then slowly lift opposite arm and leg, extending arm forward away from body, do not let arm pass shoulder level and pushing leg back away from body, do not let leg raise above hip level. Be sure not to arch or sway back and focus on keeping a neutral, flat spine.

Two others I like to do are McKenzie extension and/or Williams flexion. Depending on your specific pain or injury, your body may respond better to either extension or flexion, but sometimes it can even be both. You will have to attempt both and see which makes your pain better. One side note that is extremely important and confusing is the concept of centralization; if you are experiencing any radiating pain (pain down one or both legs, into the glutes, etc), performing these exercises may intensify pain in the low back but diminish radiating pain...this is actually a good thing, even though there may be more pain felt overall, since it is localized, that means the pain is 'centralizing.'

To perform McKenzie extension, begin laying flat on stomach. For beginners, come up onto your elbows with weight resting on forearms (like you are watching TV), letting hips relax and sag into floor. Hold this position for 30 seconds, slowly relax back down to prone lying, then push back up and repeat up to 10 times. After you've done that one for a few days and are comfortable coming up on the elbows, the next step would be to push up all the way onto the hands (prone press-up), with hands directly below shoulders, fingers facing forward, hips still touching floor and stomach relaxed and sagged towards floor. Relax shoulders, being sure not to hunch them up towards ears.

There are three steps to Williams flexion, all begging lying supine/flat on your back, knees bent, feet flat on floor and low back pressed into floor as well. For beginners, slowly bring one knee into chest, holding for 15-30 seconds, then slowly and controlled, switching legs, drawing other leg towards chest and holding. Repeat entire sequence 5-10 times. The next step would be to draw both knees into chest at the same time, instead of alternating, holding 15-30 seconds and repeating up to 10 times as well.

If there is an increase in pain or any discomfort with any of these moves, be sure to stop immediately, do not force through the pain. (Except in the case of centralization explained aboe, if pain is drawn from the extremities and into the low back, that is ok)!