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Exercising In The Cold

I am one of those people who enjoy the winter. We spend so much of our time indoors that exercising outdoors is one of the ways to be outdoors and get some fresh air and light. Too much darkness in the winter is not good for you and there is a syndrome called SAD(Seasonal Affective Disorder) where people get depressed from not enough exposure to light in the winter. Not only that, I feel that part of being Canadian is battling the elements of our climate. Now, while exercising in the cold can be quite invigorating, there are some risks and some precautions that must be adhered to. Certain problems can happen. The most common is frostbite. Frostbite is freezing of the skin and superficial tissues. It most commonly affect the exposed skin such as the face or the extremities (toes and fingers).

Superficial frostbite when caught early is easily reversible with rapid thawing. Prolonged exposure and deeper frostbite can cause lasting disability. Certain factors will make a person more prone to problems from the cold. Some of these include alcohol, old age, injury, bleeding, and certain medical problems such as thyroid or diabetes. People with heart disease should be more careful in the cold as the cold may trigger chest pain. . I am often asked about freezing lungs. This is a common misconception. Even temperatures well under 50 degrees below zero will have no effect on the lungs. Asthmatics may have more problems in the cold weather. Breathing through a face mask or scarf will allow warm breath to be recirculated. The following are some tips to help you get through the winter by enjoying exercising in the cold.

1/ Warm up before you go out. A cold muscle is easier to injure than a warm muscle. This also helps to eliminate the initial chill of being outside.

2/ Exercise within your means. Avoid sudden bursts of exercise that will rapidly increase your sweat.

3/ Watch the windchill factor. A moderately cold day with a strong wind can be even more damaging than an even colder day. Always exercise into the wind first and come home with the wind at your back. Watch for quick shifts in the weather. A change from sunshine to clouds can lower the temperature several degrees. Watch for potential incoming storms.

4/ You will sweat even in the cold so remember to continue to drink.

5/ Avoid alcohol

6/ Avoid 100% cotton clothing because once it becomes wet it loses its insulation capabilities.

7/ Polypropylene long underwear, tights, socks, and glove liners is excellent to wick moisture away from the body and keep you warm.

8/ Mittens are warmer than gloves.

9/ Layered clothing is more effective in retaining heat. This also gives you more versatility to remove and add garments as the conditions change.

10/ Choose outerwear that is made from material that is waterproof yet breathable. Try to find outerwear that has zipped openings that open to cool you when hot and can close to keep you warm when needed.

11/ You can lose up to 40% of your heat through your head. Wear a hat.

12/ Men may need extra insulation in the groin to prevent frostbite of the penis( A very painful experience I can tell you from a personal occurrence.)

13/ Boots should be comfortable but not too tight. Choose shoes with good traction on the outsole.

14/ After exercise cool down indoors where it is warm to prevent getting chilled. So, as the winter has now arrived, do not despair. Keep exercising by following these simple tips and have your body ready for the beach next summer well ahead of time.

The Bad Wheels

Every day in my office I see many athletes of all shapes and sizes. Little developing athletes and masters athletes. Perhaps the most discouraging problem I see is the masters athlete with a degenerating joint. Here is a person keen to participate but is limited by a part of their body that is breaking down. This person has developed osteoarthritis. Arthritis is the most common cause of disability and osteoarthritis is the most common type of arthritis. While the cau se is multifactorial, there is no doubt that age is a big factor where one third of people over 60 will have some form of osteoarthritis. The most common joints affected are the large weight bearing joints, the hip and the knee. The main cause of this degenerating process is age, previous injury to the joint, and genetics.

The unfortunate thing is that it is not something we can cure. The treatment is based on increasing mobility and decreasing pain while at the same time the process is degenerating; sometimes an onerous task. In a previous article, I explained all the different treatments available to treat osteoarthritis. In this article I will only discuss the role of exercise. I have been a runner for over 20 years. I often have people ask me why I run because they think I will be wearing my joints out. The fact of the matter is that the evidence is opposite. There is absolutely no evidence to show that running will harm a healthy joint, and in fact, the evidence seems to show that people who run may even have less arthritis. A study at Harvard University showed that swimmers actually had a higher incidence of arthritis than runners.

Once I see a patient with osteoarthritis, often the first question is if they can still be active. People generally assume they have to be less active and thus become so. This sets up a bad situation. The unused joint becomes more stiff and more painful and the person is even more reluctant to use it. The inactive person will gain weight and put more stress on the joint. Finally there is a decline in aerobic fitness which leads to other health problems particularly cardiovascular health. Exercise has been shown to be beneficial in several ways. The joint becomes more mobile and there is increased strength and flexibility of the muscles around the joint. The end result is less pain and better function. There is no direct blood supply to joint surfaces. The joint is nourished by compression.

Therefore a joint needs to remain active to maintain its nourishment. Exercise may in fact be the best thing to do to help slow the degenerative process down. The key thing is to do a combination of aerobic and conditioning exercises. Aerobic exercise should generally be low or no impact depending on the pain that the person has in the damaged joint. There is never a person that can not even swim or do water exercises. Strengthening should include exercises for the whole body, not only around the diseased joint. Too often I see severe restrictions in joint mobility that are only partly due to the arthritis. It is crucial to maintain as much mobility in the joint as possible. A good exercise program will allow the person to live a higher quality of life with better fitness, less pain and less medication. Exercise once again reigns champion in life. Not only does regular exercise prevent disease, but once you have osteoarthritis it is perhaps the best thing you can do to gain control of your life.

The Beginning

I always enjoy the beginning of the season. All athletes are keen and ready to go. Winners can still taste the success of last seasons victories and previous seasons losers are starting with a fresh slate. All past mistakes and performances are temporarily forgotten in the anticipation of greatness in the coming year. This past Tuesday the Leafs reported to camp. We had over 70 eager bodies report to us for the annual pre season physical, a tradition that marks the beginning of training camp. While in the old days where players reported to camp after a summer of leisure and rest, the players now are put through a battery of physical fitness tests which will indicate which players have taken the summer seriously in preparation for the season. Few players will have to be reminded that they had an extra long summer to prepare for this season. The physicians will carefully examine all players.

Old injuries will be evaluated to ensure there are not any lingering problems. Extra time is spent with rookies or new players to the Leafs whom we did not know previously. The physicians job is to ensure that the player is healthy to participate at the level of the NHL. Not only does hockey start in the fall , but there are many other sports that start as the summer holidays end. All these athletes should have some evaluation before participating. While most of the kids will be healthy and have no problems there are a select few that have problems that should be dealt with. This is one of the roles of the pre-participation examination. Very few of our young athletes will have a physical before starting to play sports. It is my feeling that all children should have a sport specific physical examination by a medical doctor before starting certain sports or on a yearly basis depending on the sport and level of training and competition.

This may be for a 10 year old gymnast or a high school football player. The physical is best done at an appropriate time for the sport. This is when the sport is starting for the year. The fall is the most common time for many sports. This can be done on a team basis or on an individual basis. The following are the objectives of the pre-participation examination. 1. Determine the general health of the athlete. 2. Look for problems that may limit participation. This may be a medical problem such as a heart defect or a structural problem such as very loose joints in a gymnast. 3. Uncover conditions that may predispose the athlete to injury. 4. Bring the athlete to an optimal level of performance. 5. Evaluate the size and level of maturation 6. Introduce the athlete to a sport medicine physician.

The physician will then know the body of the individual athlete and be able to compare the body in a ""healthy"" state as to when it might be injured. The athlete will then have a relationship with a physician with whom he/she can seek future help from. 7. Allow the athlete to ask questions about health and fitness. I have completed hundreds of pre-participation examinations. I am always amazed of the things that we uncover. There have been very few athletes that should not be competing at all, but there are always athletes that require medical or physical help before they can participate. The athlete when they have the examination starts by filling out a questionnaire of their past health and injury profile. Family history is also important especially in regards to sudden death.

There are certain cardiac problems which can cause sudden death in a young athlete which are genetic. There are other symptoms of heart problems which may have occurred to the child. This has to be closely investigated before the athlete can play. Previous surgical and/or medical problems are reviewed and their present status is reviewed. There are certain activities that should not be done with certain medical problems. All medication the athlete may or will be taking is assessed. All previous injuries are reviewed to determine the extent of the injury and how they were treated. This will also help in the physical examination where extra time must be spent on previous injured areas. Any brace or taping requirements are also reviewed. Other important information gathered in the history is allergies, vaccinations, and drug and alcohol use which may affect performance or have other health consequences during the season.

The next step is the actual physical examination. A full general physical should be performed. Special attention should be on the heart and musculoskeletal system. The major cause of sudden death is from cardiac problems. Now while not all of these can be determined by a good history and physical, some of these can and should be referred for further testing if there is any indication that there might be a problem. A thorough examination of all joints and muscles should be done. Any previous injury is assessed to ensure proper healing and to make sure the injury has been fully rehabilitated to full strength and flexibility before the athlete can continue. Certain problems are sport specific and those areas should be assessed for any predisposing problems which might lead to the common injuries in that sport.

All other systems are examined. There may be other relevant findings that may preclude or effect the athletes involvement in the sport. The athlete may have to be referred to other specialists if there are problems discovered in the examination. After completion of the examination the doctor will meet with the athlete. All results are discussed with the athlete and a plan is made to deal with any problems. A follow up appointment is made to make sure the problem is dealt with appropriately. This is as important as the physical itself. Any rehabilitation or conditioning required is arranged for the athlete. If there is a more serious problem where the athlete's participation is in question a meeting should be arranged with the athlete, coach, and parent. A game plan is then made to decide the future of the athlete. In summary, the pre-participation examination although not proven to be cost effective is an excellent method to help athletes especially those involved in contact or strenuous sports. It is the law in certain parts of the United States that athletes must have an pre-participation examination before being allowed on the field. Serious problems that may even lead to death may be discovered. The athlete is assessed to make sure they are performing at their optimal level with the least risk of injury.

The Dreaded Mono

One of the worst words you can tell a young athlete is that they have ""Mono"" v. The diseaese infectious mononucleosis will caused them to be unbelievalbly tired and be out of competetive sports for an extended period of time. Their friends and teammates will avoid them in the fear that they will catch this incredibly ""infectious disease"" Athletes in the not too distant past were told that they needed extended periods of rest for up to 6 months. Physicians were worried about relapses and more important the risk of a ruptured spleen. A ruptured spleen is a potentially fatal occurance. Some physicians believe that all ruprured spleens in sports occur because the spleen is swollen from mono or a similar mono type illness. Several years ago I saved the life of Nick Borschevsky of the Toronto Maple Leafs. Early in the first period Nick who was not the biggest player on the ice took a hit to the head and body.

I was initially concerned about his head injury as he had several bad head injuries in the past. Nick at that time spoke very little English. Soon after I realized that there was something else going on and Nick was rushed to the hospital for emergency surgery. By that time Nick had lost half his blood and would have probably died if he did not have the surgery. Infectious Mononucleosis is an acute self limiting viral illness. Although transmission is by intimate oral contact you rarely see Mono spread between family, team mates or even lovers. I recently diagnosed two players with mono on the same junior hockey team. Now while the rest of the team and coaches are paranoid that the rest of the team may get mono, I believe it is more of a coincidence. It usually affects young adults between 15-21. If you become infected with the virus you will develop symptoms within five weeks. The most prevalent symptoms are a severe sore throat, fever headache, and large lymph glands. They may or may not be very tired.

The diagnosis is made by the physician based on clinical examination and confirmed by blood tests. The initial treatment is rest. Severe cases require almost total bed rest. Fortunately this only lasts for less than a week. Gargles are used for the throat which is the most painful part of the illness. Exercise is usually not allowed for the first week or two until some of the energy is regained. The most important factor is the enlarged spleen and the risk of rupture. Once the fever has subsided light exercise is started such as stationary biking. Activities that compress the abdomen like sit ups are avoided. Special attention is given to eating a proper diet and fluids. Contact sports have to be avoided until the spleen is returned to normal size. This usually takes 3-5 weeks but can take longer. The spleen must be 2-3 times normal to palpate it on clinical examination. Therefore, I use special tests to determine the size of the spleen before I will allow an athlete to return to contact sports. Once the athlete is cleared to compete in contact sports it usually takes several weeks to get back into playing shape and conditioning. If things go well Mono is not that terrible a disease, but it must be treated very carefully in order that the athlete recovers fully and only goes back to play when there is no threat of rupturing a spleen.

The Bionic Athlete

As the advances in Sport Medicine grow at an exponential rate we tend to think of ourselves as more and more invincible. There is nothing we can do to our bodies that doctor's can not fix and get us back participating at the same level as before. If Bo Jackson can play with an artificial metal hip; is there any thing that will stop us from playing? Is there hope for a come back for Bobby Orr? Last weekend The Sports Medicine Specialists hosted our annual conference for sport physicians and therapists to discuss what is the latest information in Sport Medicine. One of the father's of Sport Medicine Dr. Charles Bull talked on the status of joint replacement. Not only is he qualified to speak as one of the leaders in the field and a great athlete himself but he in fact had a knee replacement a couple of years ago. After years of painfully watching Dr. Bull hobbling on his degenerative knee he was finally convinced to have the operation.

The main indication to having a joint replaced is a degenerative disease where the joint basically wears out. In a previous column I discussed what causes a joint to wear out and as the case with most athletes it usually the result of an injury which damages the joint. Once the joint is damaged it begins to wear. The three most common problems to cause a joint to disfunction are pain, instability and loss of mobility. Therefore, if those three criteria are not too bad and you can still perform at a reasonable level than you should put off having a joint replaced. The two most common joints to be replaced are the hip and the knee. They usually last 10-15 years and a second operation is not nearly as good as the first. That is why the operation is put off as long as possible if the person is managing not too bad. The key concept is to improve the above three variables of pain, mobility, and stability.

The fact is that you can theoretically do more sports and more aggressively with your painful degenerative joint than with your new metal joint. When you can not do your activities with your bad joint, it is time to consider the new one. People think that they may be able to do more sports with the artificial joint, but you have to realize that it is still an artificial joint and a foreign substance to the body. If abused it will become loose and not function. As mentioned previously the second or third operations get progressively less functional. The question most asked by my patients is what sports they will be able to do after joint replacement. The following are Dr. Bull's guidelines to what sports are recommended.

A: VERY GOOD stationary cycling golf dancing walking swimming cross country ski machine

B: GOOD bowling cross country skiing speed walking (4 mph) no jogging or running

C: SKILLED SPORTS (require prior skills) street cycling ice skating in-line skating downhill skiing horseback riding

D: WITH CARE(permission from Doctor) low impact aerobics weight lifting free weights step machines-quick short steps tennis(doubles)

E: BAD ALL contact sports baseball basketball football hockey soccer squash

There are extremes like Bo Jackson who will attempt contact sports with an artificial joint but there he is with already on his second surgery at a very young age. He is obviously hoping that technology can keep up to his abuse of his body but that certainly is a big unknown. Dr.. Bull's final advice is to avoid pain, avoid impact loading and to stay in shape by doing lower intensity exercise more frequently and consistently. He and many others with artificial joints continue to try and get the most out of life.

Todd's Quad

Last week Todd Warriner became another victum of a Darius Kaspiritis hit. While his name sounds like an illness, his low hits have become known around the league as something you have to watch out for. Todd was hit and had to be helped to the bench. He certainly could not continue to play. We immediately took him into the dressing room to examine his leg. It was immediately obvious that Todd had a significant injury to his quadricep muscle. Some part of his opponents body hit his thigh with sufficient force that his leg was injured through the protection in his hockey pants. Todd had sufdferd a contusion to his thigh which is commonly called a Charley Horse. What happens when you get a charley horse? A good blow usually to your thigh or upper arm like in a cross check will cause disruption in the muscle.

The force of the blow will cause enough damage to break blood vessels. The blood that leaks out forms a pool of blood that we call a hematoma. As the hematoma gets bigger it restricts the muscle. The severity of the injury is determined by how little you can bend the knee. The whole key in treating these injuries is how fast you treat them. Of all the sports injuries nowhere does it matter as much to treat the injury as soon as it happens. This can not only save you weeks or even months of recovery time, but prevent a more serious injury from developing. Immediately after the injury occurs ice and compression is applied. The contusion is iced for 20 minutes at the same time it is wrapped in a compression bandage. It is also very important to keep the knee flexed as much as possible. Between icing the knee is kept compressed and flexed.

This is done all day and night after the injury. I will even tell the athlete to set their alarm to treat the injury in the middle of the night if it is a severe injury. The knee can be wrapped around the thigh and the shin to both keep the knee flexed and compressed. With the Leafs and in the clinic we will immediately use a special compression pump to really compress the leg and limit the hematoma. I will also prescribe an anti inflammatory pill to reduce the inflammation around the area and allow the athlete to mobilize the leg more quickly. The athlete is then started on therapy. Initially the therapist works to reduce the size and inflammation in the hematoma. Vigorous massage or rubbing will aggravate the injury. Then we work to get the range of motion back in the knee. Finally we work to get the strength back in the leg.

A good functional strength and agility program will ensure the athlete goes back to their sport in the best form possible with the least risk of injury. Depending on the severity of the injury the athlete may be out a couple of days to a few months in the more severe. The biggest thing you have to watch out for is ""Myositis Ossificans"" In certain cases the body responds by developing bone within the hematoma in the muscle. This is bad news. When this happens the injury takes a long time to heal. The leg remains bent for a long time and requires a long intensive course of therapy. The athlete is out at least three months and often up to a year before they can go back to contact sports. Sometimes surgery is required to remove the bone that the body builds in the muscle. The body may eventually absorb the bone but often it stays in the muscle forever even when you are back to full function. Myositis Ossificans develops in the more severe contusions or when athletes go back too soon and have another blow to the same area. Todd's quad will be aggressively treated to allow him to return as soon as possible. The key is get back his full range of motion and functional strength. Then extra padding will be added to his pants to prevent further injury to his muscle. Fortunately these almost all recover 100% with no long term problems.

New Years Column 1998

My favorite column of the year is always the New Year's Column. I enjoy the time to reflect on the previous year and more importantly to put some thought on the upcoming year. Life generally is so busy that it takes times like this to create an opportunity to reflect on your life. Recently, an executive came to see me at my clinic for a sore back that he had been experiencing for several months. He arrived early for his appointment and looked around the environment. The first thing he said to me was ""I now know I am in the right place."" I was certainly flattered by his statement knowing that a lot of my staff""s hard work was working to provide the finest in Sport Medicine care. In further reflection that statement meant a little more to me. Here was a very successful person and the reason he was so successful was his ability to put himself in the best possible situation for whatever he needed.

Life is full of choices and opportunities. It is important to keep your eyes open to explore alternatives. When you see an opportunity or a situation that fits your needs it is important to act on it and take advantage of it. The key is to give yourself the chance to be with the best. It is often said that sport is a reflection of life. What is happening in the sports world is merely mirroring the attitudes and morality of the world. Some people think the opposite where life is a reflection of sport. It is no wonder that many ex coaches and players turn into successful motivational speakers. After watching an average of over 60 professional hockey games a year, I have seen one very common denominator. The majority of games are lost by a goal or two. The majority of goals can be easily traced back to one or a series of small mistakes. The team that wins is the team that makes the fewest mental errors. If a team or player can maintain their focus they will greatly reduce their errors and enhance their chance of success.

The analogy carries over to life. One has to make decisions all day long. It is important to try and stay mentally aware to avoid putting yourself in bad situations. Once you are in a bad situation it either forces you to make a bad decision or be subjected to a situation that you may not have control of. To be successful and happy in life it is crucial to avoid those situations that increase your stress to a higher level than you want to tolerate. Another patient recently asked me how I train all my staff to be so nice. She was always amazed how pleasant everyone was who worked in my clinic. I don't train my staff at all, and I realized that the answer is simple. I only hire nice people. Being around nice people is another of the key's of life. If you can surround yourself with nice people at work and at home your life will be so enriched and easy.

Making company with miserable, cantankerous people will make your life the same. There is no doubt that life is hard, but it can also be very simple. Richness in life is based on personal relationships. If you care at all you do an adequate job, but if you care enough you can do an outstanding job. This is the same in sports. We always hear about teams buying into a system. What they are really saying is that they have the players on the team caring about not only themselves but about everyone on the team. When people care they make less of the mistakes I mentioned earlier. Then they themselves and everyone associated with them are happier and enjoy a more successful enriched experience. In sports we call them winners. The new year is a time to think about the future. Think not about APPREHENSION, but approach the year with ANTICIPATION.

Fitness Follies

The summer is now over and everyone is back to the grindstone. We all looked great on the beach this summer after our spring fitness endeavors, but we are starting to get a bit flabby now. The fall is the beginning of the school year and once summer holidays are over everyone?s life is in order and many of us embark on a fall fitness program or start a sport to last through the winter. Although I am never one to turn away business, I would really rather prevent an injury than treat one. The Hippocratic oath still lives. They say that god judgement comes from experience. Unfortunately experience comes from bad judgement. Whenever I see an injury, I look for the error in judgement. The following are some tips to follow when you start to exercise or increase your level of activity.

1/ Choose the right activity. Do something that not only you enjoy but matches your bodies capabilities. I am often asked as to what is the best exercise. Perhaps the most important criteria is that you choose something that you enjoy or will potentially learn to enjoy. There are very few people that will continue an activity that they do not get some satisfaction from. Try to make sure the activity you choose matches your body. An overweight person may have to start to walk or some other non impact activity before they can think about running. If you have a predisposing medical or physical injury, you will need some advice as to what you can safely start.

2/ We have all heard the old adage ?Too much-to soon?. The majority of injuries are still caused by too much stress on a particular body part. The emphasis is too start slowly and increase at a pace that your body can adapt to. This is different for every person, but we tell our high performance athletes to increase at a rate of 10% per week.

3/The right equipment is crucial to avoid injuries. The shoe industry has gone through enormous changes since I started practicing Sport Medicine 18 years ago. The shoes must be appropriate for your activity .It is not advised to use a running shoe which is designed for straight ahead motion for a twisting sport such as squash. Shoes are now so sophisticated that shoes should match your foot type and exercise goals. It is also important that shoes are changed regularly before they are worn out. Even if they do not look worn , the cushioning and stability of the shoe may not be as effective as when they were new and might need replacing. Make sure that any protective equipment is appropriate and again replaced on a regular basis. When we tested NHL helmets, they fail CSA testing after only one year of use.

4/ Proper technique is crucial. Many sport injuries are the result of improper technique. If your starting a new sport or need some refreshing a lesson from a professional can be invaluable in not only improving your ability to do your sport but also in preventing injury. For example, in line skating injuries usually occur in the first 5-10 times of trying that sport.

5/ Be consistent. So many people are injured are the so called weekend warriors who do nothing or very little all week and the go all out on the weekend. Try to keep your exercise somewhat consistent through the week to maintain your bodies preparation for that increase on the weekend. This will also increase the health benefits of the exercise.

6/ Make sure you do a good warm up and cool down. The warm up prepares the muscle to perform in your activity. A cold muscle is much more injury prone than a warm muscle. The cool down allows you to re stretch your muscle and help prepare you for your nest exercise session.

7/ If you have not exercised for a long time, have any medical concerns or are over 40 please consult your doctor before starting an exercise program. 8/ Proper diet and fluid hydration must match your exercise regimen. These few simple tips will go a long way to help you maintain your fitness program and make you a happier and healthier person.

Women's Weight Lifting

This week two great femle athletes were inducted into the sports hall of fame. Silken Lauman and Myriam Bedard have both exemplified the modern female athlete who have dedicate dtheir lives to hard work and dedication to achieve their goals. This week while there is no professional males playing basketball, there is the WNBA starting to play with many fine athletes driving for the net. These are highly tuned athletes. It was not too many years ago that it was believed that females were not even strong enough to run a marathon and Kay Switzer had to masquarade as a man to compete in the Boston marathon. Now I see so amny female athletes in my clinc that I really feel that it as almost equal between the genders. Females now strive to get bigger stronger and faster. They are using more and more techniques to achieve their goals, but what is safe for them to do and what can their bodies handle. In our high performance centre we see as many female athletes as males.

They all have the same ambition to be as good as they can get. woman have done strength training for many years, but it has been only recently that they have maintained serious weight training. We now utilixze thew same strength training prorocols for men as we do for women. Altthough woman have traditionally been discouraged from doing weights as they should maintain their small frail frames, the woman athletes in our training centre have long stoppefd believeing that notion. In fact most women are much tougher than most of the men we train. Nonetheless, there are some inherent diferences that must be adressed. Woman have about two thirds the strength of the equivalent male. This is the norn and each individual female must be measured and preogressed at the level that they can tolerate. Hormones that exist in our bodies are impoortant in gaining strength.

There is obviously more testosterone in males than in females. Not only that, the absolute testosterone level in females varies significantly. Therefore the absolute level of testosterone that a woman possesses will influence the amount of strength and power that they can gain. Physiologic diferences between males and females account for the greatest difference in body size and structure between males and females. The upper body of a woman is only about 40-60% the strength of men wqhile their lower body has a higher strength ratio of 70-75%.. Ultimately the absolute strength to body weight ratio is quite similar bettween men and women. The bottom line is that women should so the same strenth programs as males.Most of the myths have been dispelled. Women do not necessarily cause them to become big and heavy.

Depending on the program most weight training will cause a decrease in body fat and an increase in lean body weight. The occasional woman may have a hgher propensity to develop large muscles and may become large.woman do not need to hold back. They should follow a sensible program, but if they truly want to get strong and powerful, than they must do high intensity weights and maximal lifts. This should performed in a structured safe program. Strenght training has many inherent benefits that actually mnake it beneficial for woman. They include increased bone strength to prevent osteoporosis, stronger connective tissue to help prevent injury, increased functional strength to improve sport participation and quality of dailay living, increased lean body mass and decreased body fat, and a higher metabolic rate. Woman have become more and more active. Strength training is one more way to help woman increase self esteem and confidance.

Osteoporosis In Active Women

Last month I receoved a frantic phone call from a friend of mine. This was a dancer who danced proffessionally for years and had maintained her fitness over the years. Two years ago she competed for Canada in the world triathlon championships. She had been to her physician and had been told that she had osteoporosis. After sitting in the waiting room with women many years older than her, she was quit despondent about her situation. At the clinic they could offer her very little information except to avoid activities that would put her at an increased risk of breaking a bone. She was amazed that an active women like herself would have osteoporosis. Two weeks ago I wrote about body building for women. Continuing on the women?s theme, todays column is about osteoporosis in active women. We tend to only think about little old frail women who have osteoporosis, frail bones and prone to fractures in their hips, back and wrists.

The incidence of dying within two years after fracturing a hip in an elderly women is very high. We can picture many elderly women who gradually develop an increasing slumped posture their vertebrae collapse from the increased bone thinning. We never really think that active women have osteoporosis. Bone development is crucial in the early teens into the early thirties. If you do not develop the proper bone mass at that time it will never catch up. Therefore it is crucial that a woman does everything in their power to ensure that she develops the proper bone mass. Osteoporosis is defined as a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. An estimated 20% of woman greater than 50 have this disease. Bone development depends on physical stress and on adequate levels of calcium, parathyroid hormone and estrogen.

If any of these factors are absent than the proper bone mass will not develop. In young athletes the most important thing is adequate levels of estrogen. Young athletes are at an increased risk for several reasons. Certain sports or activities are more dangerous than others. Sports such as gymnastics and dance thinness is stressed. Young female athletes are judged on aesthetics and are forced to remain thin. The prototype Olympic gold medal gymnast is well under 5 feet and under 90 pounds. Menarche is delayed and if the young female does eventually get her periods they are sporadic and often disappear for a long period of time. If the activity is continued there can be a long period when their is insufficient estrogen in the body to promote proper bone growth. The diet is often insufficient as well with generally poor nutrition and low calcium intake. A family history of osteoporosis may make them more prone to developing this problem.

Most young woman are not screened for osteoporosis and it takes an astute physician to check for this and correct the problem early enough to ensure proper bone mass. Frequent injuries especially stress fractures are a clue. I personally make a habit to check all young females menstrual and diet history to ensure there is no problem. Young woman who do not menstruate regularly need to be put on estrogen if their levels are low. Bone density can be now easily checked in special labs that are quite plentiful now. Woman who already are diagnosed with osteoporosis can do several things to try and regain bone mass or to ensure further bone loss. There are now new medications that are proven to increase bone mass. Estrogen therapy may be appropriate. Adequate dietary calcium and regular weight bearing exercise as well as strength training are all important. As always it is better to prevent than treat. It is important that all females build their bones early in life and maintain their bone mass as they grow older.

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