obstructive sleep apnea

Could You Have Sleep Apnea? 3 Things to Consider

According to the National Sleep Foundation, sleep apnea affects more than eighteen million Americans. Obstructive Sleep Apnea (OSA), which is a condition characterized by pauses in breathing while you sleep, usually occurs when the soft tissue in the rear of the throat collapses and the airway is blocked. Throughout the night, as an individual struggles to breathe, they repeatedly leave deep sleep and partially awaken as they gasp for air. When morning comes, however, they are unaware of their sleep disturbance.
People with OSA usually snore loudly; although not everyone who snores has sleep apnea. The risk factors for the disorder include being overweight, male, and more than 40 years of age; but the disorder can affect anyone (even small children whose breathing may be obstructed by enlarged tonsils). Unfortunately, most sufferers are unaware that they have the disorder, so it often remains undiagnosed. But ignorance is not bliss.
Untreated obstructive sleep apnea can cause a host of serious medical problems including chronic tiredness, headaches, memory lapses, irritability, weight gain, depression, and increased joint and muscle pain. It also places sufferers at a higher risk of developing heart disease, stroke, and high blood pressure.
Finally, excessive sleepiness has public safety consequences: The American Automobile Association (AAA) estimates that one out of every six (16.5%) deadly traffic accidents, and one out of eight (12.5%) crashes requiring hospitalization of car drivers or passengers is due to drowsy driving.

Watch a 90-second, animated video describing sleep apnea from NIH.

Although there is no cure for sleep apnea, if you suspect you may have it here are 3 things to consider doing now:

  1. Perform a risk assessment.The first step in getting a more restful sleep is determining if you have a sleep disorder. The Epworth Sleepiness Scale asks Eight Questions to assess your risk – if your score is equal to or higher than 10, you are at a high risk for sleep apnea and should consult your doctor.
  2. Examine your lifestyle factors.Weight loss and/or maintaining a healthy weight, eliminating alcohol, and smoking cessation have all been shown to improve sleep. A one-step-at-a-time approach for any major lifestyle modifications will help you maintain these healthier practices for life.
  3. Consider trying a mouthpiece. If you have moderate-to-severe sleep apnea, a CPAP machine may be recommended by your physician. The machine uses a mask that fits over the mouth and nose, or just the nose, and gently blows air into the throat. The pressure from the air helps keep the airway open during sleep, minimizing disturbances due to sleep apnea.

For more information about sleep apnea, please visit the National Institute of Neurological Disorders & Stroke website.

5 Steps to Happier Holidays

Greetings & Happy Holidays!
The holidays can be an intense time for many of us, with parties, travel and house guests, shopping, cooking, and more …. making it quite easy to get overwhelmed. So I would encourage you to try to slow down, if you can – doing so really can help make the holidays more joyful and less stressful! Here are 5 ways that you can try to take it easier on yourself at this time of year:

  • Don’t over schedule! Every day has exactly 24 hours in it — be honest with yourself about what you can accomplish each day.
  • Let go of expectations. Be fair to yourself and to others. If you allow expectations to determine your happiness you will often feel let down. Yes, it is hard, but in the end your efforts will be worth it.
  • Be present in the moment. Meditating twenty minutes per day can help reset your body’s autonomic stress response. Over time, it can change your perspective on life for the better.
  • Exercise. The endorphins released in aerobic exercise are the body’s own natural anti-depressants. Not only does exercise lift our spirits, it boosts our immune system as well.
  • Keep smiling. Research shows the simple act of smiling can lift your mood, help lower stress and boost your immune system. What’s more? Smiling is also contagious!

As always, you have our best wishes for your optimal health,
Gary Kaplan, DO & the Kaplan Center Staff

Yoga Rooms Offer Respite at Busy Airports

Attention yogis! You may think that the airport is the last place you could find a moment of tranquility, but in an effort to make airline traveling a less stressful experience for its customers, a handful of airports are trying to change that perception.
In 2012, San Francisco International Airport made history by being the first to create a dedicated space for the practice of yoga and self-reflection. Since then, a growing number of other airports have caught on to this trend, and we really hope to see it continue!
Air travel today has become more stressful than ever before. 9-11 changed everything, making long lines and multiple security check points the new norm. If you add in the exhaustive media coverage of each air tragedy, cancelled flights, long layovers, and the constant and inescapable background noise at every airport, you may find yourself in the midst of a perfect storm of stress and anxiety which can take a toll on your mental and physical well-being. With minimal overhead, airport yoga rooms offer an opportunity for passengers to focus on their health & well-being, a welcome change from the customary options of restaurants, bars, and shopping venues that bombard travelers as soon as they walk through the doors.
3 Great Reasons to Visit an Airport Yoga Room:

  1. You’ll feel happier. A yoga room provides a brief respite from the hustle and bustle of traveling, keeping the mind calm, and helping to reduce stress and anxiety levels.
  2. You’ll feel healthier. Being able to stretch your body before, after, or in-between flights will help you stay limber and increase circulation. (Circulation tends to slow down during air travel, and can cause lower leg swelling, general discomfort, and even more serious issues like blood clotting.)
  3. You’ll feel wiser. Having the option to practice your regular yoga routine will keep you focused on your health and well-being, instead of the less healthy pastimes like the airport bar or convenience restaurant.

Here is a list of airports that currently have a yoga and/or meditation room available to its ticketed passengers:
Burlington International Airport
Chicago’s O’Hare International Airport
Dallas-Fort Worth International Airport
Helsinki Airport
San Francisco International Airport
Raleigh-Durham International Airport
Heathrow Airport
Chicago Midway International Airport
San Diego International Airport

How Yoga Can Help With Your Chronic Pain

By Julia Westbrook
Improve your brain to stop the pain.
Protect your body from pain by beefing up your mind with yoga, according to research from the American Pain Society. The research found that the areas of the brain that are torn down by chronic pain are built up by yoga, likely due to the meditative aspects of the practice.
“Practicing yoga has the opposite effect on the brain as does chronic pain,” said M. Catherine Bushnell, PhD, scientific director of the Division of Intramural Research, National Center for Complementary and Integrative Health, NIH.
Chronic pain has shown to cause brain damage in gray matter, which can lead to memory issues, emotional issues, and decreased cognitive functioning. Chronic pain is also a symptom of inflammation in the brain. “The inflammation causes reversible damage to the brain with a loss of gray matter and disruption in the normal functioning of the brain,” explains Gary Kaplan, DO, author of Total Recovery.
So, the logical solution: Fix the inflammation, fix your brain, and stop the pain.
Dr. Kaplan recommends meditation and yoga as effective ways to combat inflammation in his own practice. “If we could bottle the beneficial impacts yoga and meditation have on the body it would be the best-selling medication around,” he says.
Improved Coping With Inflammation
Dr. Kaplan says this meditative practice may address the root brain inflammation that causes pain. “We do not know the mechanism via which meditation and yoga protect the brain,” he says, “but since we know that both practices result in repair of the brain and growth of new gray matter, it is reasonable that both practices reduce inflammation. You cannot have brain tissue repair unless you shut down the inflammatory process.”
Reduced Suffering
While yoga doesn’t make people less sensitive to pain, yoga and meditation can help boost their resilience when it comes to dealing with their pain. While these practices don’t decrease your ability to feel pain, Dr. Kaplan says that previous research has found that they do improve the time of reactivity to pain and the emotional consequences of experiencing pain. “Both practices unquestionably can reduce the level of chronic pain and again reduce the emotional import of the pain, i.e. the suffering component,” he explains. “They allow you to ‘distance’ yourself from the pain and see it more objectively.”
Boosted Resiliency
Your ability to deal isn’t just a matter of will—it might be a matter of your brain, too. “There are several studies that look at insula mass interrelationship to resilience,” says Dr. Kaplan. “If yoga is also increasing the insula mass, then we might also expect people doing yoga on a regular basis to have a greater capacity to manage stress and adversity.” In his practice, he sees that a meditation or yoga practice can also help with anxiety, depression, improved sleep, concentration, and energy.
As seen on RodaleNews.com.

Feeling Groggy? You May Be Sleeping Too Much!

Getting Too Little or Too Much Sleep Is Unhealthy

by Julia Westbrook

Article featured on www.RodaleNews.com, Feb 25, 2015

The most common red flag is often the one we’re likely to ignore.

Sleep is a fickle creature—like Goldilocks. Too little, and you’re pounding back coffees in the morning. Too much, and your head is stuck in a groggy fog all day. And in the search for sleep that’s “just right,” researchers have found health issues on both sides of the happy medium. Sleep deprivation can lead to depression and cancer, and too much sleep (more than eight hours) quadruples your risk for stroke, according to new research published in the journal, Neurology.

While the researchers point out that it’s not clear whether too much sleep is a cause, a consequence, or simply an early red flag of ill health, it’s clear that optimizing your sleep patterns should be a priority.

“Our lives—not to mention our sanity—depend on our ability to fully experience each stage of sleep,” says Gary Kaplan, DO, author of Total Recovery. “Ironically, the sleeping pills many people rely on do not support the quality of their sleep in the night and may be heightening their experience of pain the next day.”

The first thing to do is practice good sleep hygiene, such as turning off all electronics an hour before bed and having a consistent bedtime.

Next, work with your doctor to address any possible underlying health issues. “Taking a sleeping pill is like yanking the batteries out of a screeching fire alarm,” Dr. Kaplan. “If that’s all we do, in some cases, we’re shutting down the irritating warning while the house burns down.” Sleep disorders like sleep apnea can cause hypertension, weight gain, type 2 diabetes, and stroke.

If you suspect you have a sleep disorder, such as sleep apnea, he recommends taking the Epworth Sleepiness Scale Quiz or finding a location for a sleep lab overnight evaluation at the American Academy of Sleep Medicine. You can get a general idea of your sleep patterns with a home sleep test device that’s reliable, such as the WatchPAT, says Dr. Kaplan.

7 Steps to Re-energize Naturally

Beat the Seasonal Energy Crisis

Outsmart the mid-day urge to take a nap
Article reprinted from Well!, a publication from TuftsHealthPlan.com, Fall/2014
If you find yourself wanting to crawl into bed after work these days, rest assured you’re not getting lazy. And it’s not your imagination that you feel more sluggish now that the sun goes down earlier. “The lack of sunlight makes us feel more tired,” says Gary Kaplan, DO, director of The Kaplan Center for Integrative Medicine and author of Total Recovery. “We’re programmed to be up with the sun and down when the sun is gone.” We can’t control the sun’s activities, but we can do a few things to energize.
1. Wake up to light
If the sun is up when you wake up for work, open up your curtains and let light in, as research shows this can help you feel more awake.
2. Jump-start energy with the right breakfast
Start your day with a bowl of oatmeal made with low-fat milk, topped with almond butter and chia seeds, says Keri Gans, MS, RD, author of The Small Change Diet. A combination of fiber, protein, and healthy fat will keep you energized until lunchtime. Low-fat plain yogurt with fruit is also a good choice.
3. Go for a short stroll
A 10-minute brisk walk (even indoors) can translate into 2 hours of increased energy, Dr. Kaplan says. He suggests that if your job or schedule allows it, break up your day with brief activity bursts to keep energy levels high.
4. Recall the good things in your life
Practicing gratitude is another way to feel uplifted and energized. Spend a few minutes daily writing down or thinking about the things you’re most grateful for. Doing this regularly will increase energy, boost mood, and help keep your immune system strong, according to Dr. Kaplan.
5. Breathe deeply
Often when we’re concentrating hard on a task, we fall into shallow breathing patterns. To feel more awake and alert, take slow deep breaths for 30 seconds. “Deep breathing is a signal to the body that it needs to wake up. You’re getting more oxygen, increased blood flow, and more oxygenation in the body, waking your brain up,” Dr. Kaplan says.
6. Don’t miss magnesium
This mineral helps us get a good night’s sleep, and it also helps break down glucose for energy, Dr. Kaplan says. You need 300 mg to 350 mg of magnesium a day. Dark greens, whole grains, and Brazil nuts are good sources. If you’re routinely feeling low on energy, ask your doctor if you need more magnesium.
7. Make time for belly laughs
If you’re having trouble concentrating, watch online videos that make you chuckle. “Laughing for a few minutes will help you wake up, increase your heart rate, and release endorphins so you feel more energized,” Dr. Kaplan says.

Achieving "Wellness"

4 Things Your Body Wants You to Know

by Julia Westbrook
Article reprinted from www.RodaleNews.com, October 7, 2014
Wellness is well within your grasp, as long as you know what you’re looking for.
“Wellness” is always the goal when it comes to health: Boost your mental well-being; feel great every day; relieve pain, symptoms, and stress! While the idea of wellness paints a pretty picture, for many it seems like nothing but a dream without a concrete path for achievement.
However, there’s good news: Wellness isn’t a myth. You just need the right definition and the right tools. We sat down with Gary Kaplan, DO, author of Total Recovery and speaker at Prevention Magazine’s R3 Summit for wellness to learn how many of us are missing the boat when it comes to our health and what we can do to fix that.
Defining ‘Wellness’
Dr. Kaplan has a clear understanding of wellness, one that considers your unique situation, abilities, and disabilities. “Optimal wellness is about being able to engage in life fully,” says Dr. Kaplan. “And you may still have some disability and you may still have some pain problems, but the fact is, you are at the absolute best health you can be, even with these things — so that you’re doing things that have meaning for you in life.”
Why Do We Miss the Boat?
When including our individual limitations, Dr. Kaplan creates a picture of wellness that is attainable. For instance, if running is meaningful to a person with arthritis, he or she can achieve the wellness to do so — but only with a plan that addresses, not ignores, his or her pain.
Dr. Kaplan explains that ignoring the signals that our bodies send out is the reason many people don’t hit their personal bests, even though the definition of wellness already includes our shortcomings. “So you’re taking lots of anti-inflammatory medications in order to push through an activity. When you’re doing that, you’re not listening to your body, and the other thing is you’re actually harming your body because regular use of the anti-inflammatory medications actually results in ulcers in the small intestine.”
“It’s about not pushing through,” he explains, “but paying attention.”
The No. 1 Thing You Can Do Today
The simple solution is then obvious, he says: Listen to your body. “We can step back and really design our lives such that we’re respectful of what we need and who we are.”
Of course, many of us are really bad at doing that. Dr. Kaplan blames a lifestyle that keeps us constantly bombarded with demands. “We’re connected 24/7,” he says. “One of the things I have people do is move their phones out of their bedroom, so that bedtime is for sleep. Simple, easy. Recharge that phone in the hall, but not in the bedroom.”
Shutting off the bells and whistles gives you the opportunity to check in with your self and your loved ones, strengthening your health and your relationships. “It’s a matter of unplugging and taking some time for quiet; taking some time to have real connection time with your family and friends. We don’t do enough of that because we’re rushing around too much.” Without the pressures and distractions, you may finally hear what your body is trying to tell you.
Four Things Your Body Wants You to Know
Dr. Kaplan is a speaker at Prevention’s R3 Summit, a wellness weekend designed to help people revive, refresh, and reinvent their lives and their health.
“I’m really privileged and very excited to be attending the R3 program,” says Dr. Kaplan. “Most of my work is with people who have end-stage disease and have been sick for a very long time. I’m glad for the opportunity to explain to people that it doesn’t have to be this way: We can prevent many of the illnesses that we suffer from from happening. So being able to get to people and keep them healthy is really a very exciting prospect for me.”
The R3 summit revolves around six pillars for wellness — Healthy Epicurean, Health, Beauty, Peak Performance, Mind-Body, and Happiness — four of which Dr. Kaplan stresses in his own practice and shared with us.
Peak Performance
“The thing you want to make sure you’re guarding is your sleep,” Dr. Kaplan says. “People think that they can get by on six hours of sleep. People can’t get by on six hours of sleep.”
He cites a study that reduced people’s sleep schedules from eight hours to six hours. “At the end of two weeks, everyone will tell you that they’re getting enough sleep,” he says. “However, if you measure performance in the people who are only getting six hours, their ability to focus, concentrate, their motor skills, reaction times are decreasing to the point that they’re actually performing at the level of being drunk.”
“Meditation is not simply about relaxation; it’s really about brain rejuvenation,” Dr. Kaplan explains. “It helps improve resilience in the brain.”
It’s not just your yoga teacher who’s interested in meditation. Dr. Kaplan points out that the military is researching this age-old practice. “The military has been looking into this to see if they can improve decision making in the field and also prevent the occurrence of post-traumatic stress syndrome. This is hard science.”
Healthy Epicurean
Dr. Kaplan circles back on the idea that we’re not listening to ourselves, especially when it comes to what we eat. “If you’re eating foods that you shouldn’t be eating and you’re putting up with gas, bloating — this kind of low-grade discomfort — it’s telling us that there’s stuff brewing that needs to be addressed.”
“Helping people clean up their diets and address these early warning signs becomes extremely important. Pay attention to ourselves, listen to ourselves, and help us restore our health before we get to the point of being really sick.” (The first step? Embark on an elimination diet to find out what’s really bothering you.)
You might want to think of weight loss as a secondary benefit of exercising, because it’s your brain that really gets a workout. “Inflammation occurs in the brain anytime that there has been damage to nerve cells in the brain, and there is a wide range of things that can cause that damage,” he explains. “So focusing on the repair process, we know that exercise down-regulates the inflammatory cells of the central nervous system and actually helps regenerate brain tissue.”
Read this article on www.RodaleNews.com.

Are You Dying For A Good Night's Sleep?

It is estimated that over 70 million people suffer with a chronic sleep disorder in the United States, impacting not only the individual struggling to get a good night’s sleep but potentially all of us. It is conservatively estimated that more than 100,000 car accidents resulting in 1,550 deaths and 71,000 injuries each year are the result of driver fatigue.
And here’s another thought that might keep you up at night: one of the most common medical responses to helping you sleep may actually be putting your heath at risk. About 4% of U.S. adults use a prescription sleeping aid in any given month. Yet taking as few as 18 sleeping pills a year increases your risk of dying 3.6 fold compared to people not using them. Those who take a prescription sleeping medication more than 132 nights a year have a 6.6-fold increase of death, and a 35% increased risk of developing cancer. A better response? Individualized treatment to discern the underlying cause of sleep loss.
Sleep deprivation, sleeping less than the amount of time your body needs for growth and repair, is the most common sleep disorder. Newborns need as much as 18 hours a day, while teenagers — the most notoriously sleep-deprived group — require nine to 10 hours. Adults should have between seven and eight hours a night of restful sleep, yet a 2013 Gallup poll found that as many as 40% of Americans get only six hours or less of sleep a night.
Sleep deprivation can exhibit as insomnia, taking longer than 20 minutes to fall asleep, multiple awakenings during the night with difficulty returning to sleep, early wakening, and shortened sleep due to demands of work or school. Whatever the cause, its long-term consequences on your health and well-being are the same.
In the short term, your mental performance and reaction time when chronically sleep deprived are the equivalent of being drunk. And like the inebriated, the chronically sleep deprived do not recognize the extent of their impairment. Lack of sleep compromises the normal functioning of your immune system, and long-term sleep deprivation causes your body and brain to be in a chronic state of inflammation, potentially leading to an increase in heart disease, stroke, obesity, chronic pain, ADD, depression, and anxiety. The problem is also bidirectional; conditions such as chronic pain, depression, and heart disease can cause sleep disturbance, which then worsens the underlying condition.
So how sleepy are you? One way to quickly assess your level of daytime sleepiness is the Epworth Sleepiness scale. It takes about a minute to complete the test and should be part of any medical exam when someone is complaining of fatigue. A score of 10 or higher is suggestive of a significant sleep issue; talk with your physician. Being this tired is a potential danger to your own health as well as the health of others.
Here are some steps you can take right now to improve the length and quality of your sleep:

  1. Go to your room! Try to tuck in and rise around the same time each day.
  2. Move it! Regular exercise improves sleep and regular sleep improves exercise performance. The regular practice of yoga, especially in older adults, has been shown to improve the duration and quality of sleep.
  3. Cut caffeine. If you have a sleep problem, minimize or eliminate your caffeine consumption. Caffeine in all forms — tea, chocolate, energy drink or pill — disrupts sleep.
  4. Eat more fish. Eating fatty fish, salmon, and tuna appears to not only lower your risk of heart disease, but also betters your sleep.
  5. Eat at regular intervals. When and how much we eat, as well as the types of foods we eat, impact our internal clock, called our circadian rhythm. While we are just beginning to understand the relationship between food and internal clocks, it is clear that the two are related and the consequences of eating at irregular intervals are obesity and increased risk for disease, in addition to disruption of your sleep.
  6. Cool down to sleep sound. People may have trouble falling asleep because they have trouble cooling down their core temperature, which reaches its maximum typically around 3 pm. A warm room will exacerbate the problem. Temperatures above 75 degrees and below 54 degrees Fahrenheit can disrupt sleep. So what is ideal for sleep? The consensus is that a room temperature between 65 and 68 degrees is probably ideal; this will vary among individuals.
  7. Go dark. Light is a major factor that regulates our sleep-wake cycle. Light exposure at night not only disrupts our sleep but also increases our risk for obesity, high blood pressure, and possibly breast cancer in women.
  8. Keep it quiet. Any amount of noise starting at 30 to 40 decibels, a level between a whisper and a quiet conversation, begins to impact sleep quality. That said, people generally find the sounds of their usual environment relaxing. Sound can also be used to help with sleep. One study looking at patients suffering with a generalized pain syndrome called fibromyalgia found that music embedded with a specific sound frequency called Delta wave that pulsated between .25 to 4 Hertz improved the quality of patients’ sleep and decreased their pain symptoms.
  9. Meditate. Numerous studies demonstrate that the regular practice of meditation can improve the quality of sleep, as well as help in the treatment of anxiety disorders, depression, and chronic pain.
  10. Sample supplements. Some supplements that might help in getting a good night’s sleep include L-tryptophan, 5-HTP, and melatonin. The FDA does not regulate supplements, so be careful that the supplement you purchase actually contains the substance and the amount of the substance stated on the label. Also, supplements are drugs and can have side effects and interactions with other medications. If you are taking medications on a regular basis, please check with your physician before taking any supplement.

For more information on identifying & treating sleep disorders click here.

Embracing the Holidays

Many of us look forward to celebrating the holidays with our friends and family; but probably just as many of us also approach this season with some level of anxiety.
In addition to the fun of gift-giving, enjoying special holiday foods, and reuniting with friends and family, there’s the stress of gift-giving, preparing holiday foods, and reuniting with family and friends! I offer five steps to help you “embrace the holidays” with grace.
1) First and foremost, treat yourself with gentleness. Understand that the holidays can be a challenge for all of us. We’re barraged by advertising telling us that “’tis the season to be jolly” and that the more we buy and do, the happier we’ll be. This holiday season, be realistic about your physical and emotional limits and gently protect your time and energy. Be kind to yourself and you’ll have more of that precious gift to share with those you love!
2) Learn to let go. Let go of expectations of yourself and others. And let go of anger and guilt. If you need rest or a moment alone, then take it. Give yourself permission to skip certain events all together if they are too stressful for you. The quality of time shared with others will be greatly enhanced if you are rested and calm.
3) Stay in the present moment. Most of us spend a great deal of time attending to the thoughts in our minds rather than to our direct experience. Thoughts about past or future experiences can distract us from our actual life experience. Right now, gently bring your attention into this moment. Feel the solid ground beneath your feet or the cool wind on your face. The present moment is the door to your creativity and healing. Embrace it!
4) Breathe. With each in-breath, feel a calm strength within you and with each out-breath, let go of any fear, tension or worry you may be feeling. Performing these deep-cleansing breaths for a few minutes each day can have an enormously rejuvenating effect upon your body and soul.
5) Exercise. If you are able — get up and get moving. A good brisk walk can help reduce anxiety, depression and insomnia. The endorphins released in aerobic exercise are the body’s own natural anti-depressants. Not only does exercise lift our spirits, it boosts our immune system as well.
(This article was first published by the Kaplan Center in December 2007.)

6 Tips on Exercising Safely

Just Do It! 6 Tips to Help You Exercise Safely

From biking and jogging to playing golf, tennis and weekend basketball, millions of us regularly enjoy athletics. As we all know, there are many benefits to participating in sports, but to do it safely, it is important to take precautions. Otherwise, we run the risk of incurring injuries that not only cause us pain and inconvenience but also cost us financially in terms of medical expenses and lost productivity.

I encourage virtually all of my patients to engage in regular, physical exercise to improve their health. Time and time again, however, I’ve found that most people can benefit from learning more about how to exercise properly — the goal being to gain strength and flexibility while avoiding injury.

Whether you are a competitive athlete or just starting a new exercise routine, here are 6 tips that everyone who is physically active should consider adopting:

1. Customize your workout to achieve your personal fitness goals. Whether your goal is to improve your cardiovascular health, body composition (including the ratio of muscle to fat), strength, endurance, or your position and motion awareness, not all exercise is the same, and more is definitely not necessarily better!

  • To improve your cardiovascular health: You will need to get your heart rate up to 70-85% of its maximal rate for at least 30 minutes per day, three days a week. To determine your maximal heart rate, subtract your age from 220. (e.g. The maximal heart rate for a 50-year-old is 170 (220 – 50 years = 170), so his or her target heart rate will be 70 to 85 percent of 170, or between 120 and 145.)
  • To improve your body composition (ratio of fat to muscle) and to optimize your body’s fat-burning capacity: You will want to exercise in a way that gets your heart rate up to 40-60% of your maximum heart rate.
  • To increase your muscle power and endurance: To maximize muscle power, you should engage in a lower number of total exercise repetitions at a higher level of weight/resistance, whereas to improve muscle endurance, you’ll need a higher number of repetitions at a lower weight/resistance. For example, athletes wanting to develop power might design a program where they perform 2-3 sets of 10 repetitions, with each lift set at 70% of their single-repetition, maximum weight. On the other hand, to develop endurance, the same athlete should perform 2-3 sets of 20-30 repetitions, with each lift set at 30-50% of their single-repetition, maximum weight. Your single-repetition, maximum weight is how much weight you can lift one time using the maximum effort that you can safely exert. Be very careful not to push past your maximum limit when you test yourself – you don’t want to get injured before you get started!
  • To improve your motion awareness and bone strength: Consider cross-training with soccer, basketball, tennis, or other activities that encourage more side-to-side movement and speed changes. Research has shown that pure long-distance runners, particularly women, can actually be more at risk for stress fractures because the straight-line movement of running only strengthens bones in one plane, whereas cross-training strengthens bones in a more complete, multi-directional fashion.

2. Ditch the myth about stretching prior to exercise to prevent injury. Contrary to popular belief, recent scientific reviews indicate that stretching only before and after intense exercise does little to prevent injury. What does matter is your baseline level of flexibility. In other words, if you are already flexible, you have some reduced risk of muscle injury even if you do not stretch much before you exercise. But if you are not very flexible, doing a bunch of stretching just before exercise is unlikely to prevent muscle injury. Therefore, you need to stretch regularly over a period of time, and not just as a method of warming up before exercise.

  • To stretch correctly: Hold each position for a minimum of 30 seconds. If the stretch is not held long enough, then the muscle fibers will simply return to their pre-stretch length after you stop, and your stretching will be of minimal benefit. Once a muscle is properly stretched, the effect lasts for about six hours. Therefore, to improve flexibility most efficiently, one should stretch three times per day, for at least 30 seconds per muscle stretched.
  • Be aware that having too much flexibility can be as much of a problem as having too little. For example, with increased flexibility, the ligaments holding our joints together can become more vulnerable to being overstretched and sprained. How flexible is too flexible? The Beighton Hypermobility Score, which is easily located on the Internet, provides a quick method to rate joint hyperflexibility. If you already are very flexible, then stretching may not be in your best interest. Instead, focus on strengthening and balancing your muscles, which will help stabilize and protect your joints and ligaments.
  • When strengthening: Work with a qualified and experienced physical therapist, personal trainer, or athletic trainer so that you can develop proper form and safe sports-motion habits early on. Give yourself a day between exercise sessions to allow for muscle cell repair and growth, for example, doing upper body strengthening on Mondays, Wednesdays, and Fridays, and lower body strengthening on the other days. When increasing your exercise intensity, a generally safe approach is to increase your weight/resistance level by no more than 10% every 2 weeks.

3. Be cautious about taking anti-inflammatory medications if you sustain an injury. Although inflammation has a bad reputation for causing many painful conditions, it’s essential to the process of healing. After an acute injury, healing occurs in three complex phases over a long period of time, during which new connective tissue is created that replaces and reinforces the injured tissue. The first of these phases is inflammation, which causes pain in order to restrict our range of movement to protect the area from further injury. Perhaps even more importantly, the inflammation triggers cellular activity that initiates healing of the damaged tissue. The inflammatory phase typically lasts 4-6 days.

Although clinical research has shown that taking an anti-inflammatory after an acute injury can speed one’s return to activity by decreasing pain, several studies also have demonstrated that using an anti-inflammatory immediately after being injured can reduce tendon and ligament strength during healing. In sum, taking anti-inflammatory medication can interrupt the inflammatory process and thereby reduce the potential, maximal healing of the injured area.

I tell my patients to try to avoid using anti-inflammatories, such as Aspirin (unless you are taking it for heart protection), ibuprofen (a.k.a. Motrin, Advil, Nuprin) and naproxen (a.k.a. Aleve, Naprosyn) for at least the first few days after injury. Instead, I recommend taking acetaminophen (a.k.a. Tylenol) up to 4000 mg. per day, as long as you do not have any liver problems and are taking it for less than a two-week period. In cases of more severe pain, you should consider seeing your doctor for a check-up and, if appropriate, obtaining a prescription for a muscle relaxant or other pain medication that you can take for a few days until the pain from inflammation subsides.

4. Be diligent about getting regular physicals to address significant or persistent injuries. Routine physical exams are very important for identifying conditions that may affect your ability to exercise safely, such as certain heart and lung problems or uncontrolled high blood pressure. Let your primary-care doctor know about any concerns you have regarding your exercise regimen. It’s also a good idea to see your physician if you are experiencing any of the following:

  • An inability to bear weight on an injured limb due to severe pain;
  • Pain that persists for more than 3 or 4 weeks without improvement;
  • New or progressive numbness, tingling or — especially — weakness in your arms or legs; or
  • Persistent dizziness or light-headedness during or after exercise.
  • Head, neck or back injuries that are causing deterioration of your balance, problems with your mental faculties, or changes in your bladder and/or bowel function (any of these symptoms could indicate a rare but urgent medical emergency!).

5. Consider innovative treatment options. Musculoskeletal injuries are extremely common; in fact, it is estimated that over 100 million injuries occur every year worldwide. Of these, 30-50% involve ligament and tendon injuries. Fortunately, there are some exciting, new options available to treat these conditions, including platelet-rich plasma (PRP) therapy and prolotherapy, which enhance the body’s own healing capability to repair damaged tissue. A growing body of medical research has demonstrated the effectiveness of these therapies in treating various painful conditions of the neck, shoulder, elbow, hand, low back, hip, knee, and ankle.

  • PRP therapy involves taking a patient’s blood, centrifuging it to concentrate the platelets — which contain numerous growth factors responsible for tissue healing as well as blood-clotting factors — and then injecting it into the injured area to promote healing. This process has successfully helped such athletes as golfer Tiger Woods and football wide-receiver Hines Ward, among others, to recover from their injuries and return to play more quickly.
  • Prolotherapy is another injection method, which uses simple, fluid solutions other than blood for treating injured tendons, ligaments, and joints.

6. Don’t be shy about checking a physician’s credentials. If you have sustained a particularly difficult injury or if you participate in elite/competitive sports, I recommend consulting with a physician who is board-certified in either Sports Medicine or Physical Medicine and Rehabilitation. Although patients often turn to an orthopedic surgeon when their medical problem is exercise-related, many orthopedic surgeons specialize in areas other than sports medicine and thus may have limited experience in providing non-surgical care for athletes. For the best results, you need a medical specialist who can not only comprehensively assess your musculoskeletal system, but also provide you with the widest range of treatment options, from the least to the more invasive procedures.

By David Wang, D.O.