physical therapy, Running, Naturopathy, Chiropractics
Dr. Geoff Lecovin, MS, DC, ND, L.Ac, CSCS, CISSN
Nutrition for Sports Injuries & Healing: ...

Dr. Geoff Lecovin joins us for a 3 part series on healthy diet and nutrition for rehabilitation.

Nutrition for Sports Injuries & Healing: Part 3 of 3
physical therapy, Running, Naturopathy, Chiropractics
Dr. Geoff Lecovin, MS, DC, ND, L.Ac, CSCS, CISSN
Nutrition for Sports Injuries & Healing: ...
Nutrition for Sports Injuries & Healing: Part 2 of 3
Cross-Fit, Fitness, Physical Therapy, Running
Manny Tharrington
Blood Flow Restriction

“Speed kills” is a phrase often heard in the athletic world to emphasize the idea that the faster the athlete is, the more successful he or she will be. As a health professional and a performance coach, it is important to teach athletes that being fast does not always have to rely on genetic background. There are plenty of specific mechanics that can turn speed into a skill.

Blood Flow Restriction
Cross-Fit, Fitness, Physical Therapy, Running
Katie Hutchins, PT, DPT
Patellafemoral Pain Syndrome (PFPS)

What is Patellofemoral Pain Syndrome?

Patellofemoral pain syndrome (PFPS), also known as “runner’s knee”, is a broad term that describes pain in the front of the knee and around the kneecap. It’s one of the most common overuse injuries of the knee. Although it’s more common in individuals that participate in sports with lots of running or jumping, it can occur in nonathletes as well.

Patellafemoral Pain Syndrome (PFPS)
Physical Therapy, Fitness
Justin Ho
bStrong Bellevue Q & A

Progressive Performance Q&A

By Justin Ho PT, DPT, CSCS

I had a chance to sit down with Jimmy McCurry, head coach and owner of Progressive Performance Strength and Fitness in Woodinville, WA. I've had the pleasure of working with Jimmy in the past, helping our mutual clients and patients rehab from their aches and pains and return to lifting heavy and safely at his gym. Here is our conversation talking about Progressive Performance and how his community is adjusting with the pandemic.

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Me: Jimmy thanks for taking the time to sit down and chat with me today. I'm sure you've been busy adapting to the ever changing environment due to COVID-19. To get started, please tell us a little about what makes Progressive Performance different.

Jimmy: Glad we could find a time to chat! Progressive Performance is for people who don't know what they should be doing for their fitness journey and don't really know where to start. Maybe they've tried different forms of training that hasn't worked for them, or they've been battling with nagging injuries. We work with people who are interested in strength training and those who are looking for a personalized custom approach to their fitness that’s tailored to their specific needs. We do this in a small group environment that is community based. We take pride in meeting people where they are at fitness-wise, getting them stronger, helping them lose fat, and getting them the body of their dreams while also feeling great doing it.

Me: I understand you emphasize your programs around resistance training. Can you speak on that?

Jimmy: Our program is, as you mentioned, resistance training based. What we found is that when you focus on the resistance element, you can get really great results in body control, injury prevention, metabolism, and the ability to gain muscle. Our typical age demographic is between age 40-65, where resistance training to compete against sarcopenia and osteopenia is important. No matter where our clients start from, we can position them with a custom training program that's going to work with them specifically and progress their exercises appropriately so they'll continue to see improved strength and performance.

Me: That's fantastic. There is such a negative stigma behind strength training, but it's so important for individuals entering their 4th and 5th decade because of sarcopenia and osteopenia (muscle wasting and losing bone strength). When working with new clients, I'm sure you have many people coming in from different walks of life and fitness history. Tell us how you find a person's starting point.

Jimmy: With every new member, we sit them down with a coach for 1 hour to start. The first half hour is centered around goal setting and understanding their movement background and then during the second half of the hour we do a general movement screen. From gross moments to individual joint ranges of motions and strength. We formulate a custom warm up routine to address any limitations that we find so they can be as successful as possible with their lifts in the safest way possible.

Me: I understand during the first few months of the pandemic, you quickly switched your platform to online coaching and are still offering that to many of your members. As we are continually adjusting to the new normal due to the pandemic, I anticipate you're making a great effort to make your gym a safe and clean space. Can you expand a little more on this?

Jimmy: We have 5 clients to one trainer. In our facility, we set up specific boxes where people would train in. We have protocols in place where higher-touched surfaces are only in contact with our coaches. All of our coaches are required to wear masks. We open the facility, clients come in wash their hands and then go to the area they are assigned. All the equipment for that session will be already set up in the box the client will occupy for the entirety of the session. Nobody shares the equipment. We have 45 minutes of the session and a 15 minute cleansing time. We're doing whatever it takes to make our clients feel safe while they train.

Me: One of my patients mentioned that you were at the helm of getting smaller gyms like yours to open up earlier than originally planned. How did this transpire?

Jimmy: Yeah we actually spearheaded this effort to get small group fitness gyms into the earlier phases of re-opening. Originally we, gyms, were placed in phase 3; however we knew that with our set up we could definitely operate in an earlier phase while following all the precautions and limitations. We submitted a petition with 6500 signatures and sent it to the governor. We were actually broadcasted on local news and on a local radio station. So we thankfully were successful in sharing our message to the government that people are missing and needing their fitness. This ultimately resulted in getting smaller gyms into what we'll call phase 2.

Me: That's some incredible work. Well done!

Jimmy: For us it was more about what makes sense by science. Okay if you can sell a car or open a casino within a phase 1 situation, why can't you do something that's healthy for people. Why can't we let people invest in their fitness and help their immune system versus doing other things that would degrade their immune system. We are also invested in our clients results and invested in bringing greater health in the greater Seattle area. For us to do that, we had to fight the fight and get people back into the gym.

Me: I'm so glad that you had great success with this. Switching gears, I want to share one of my concerns as a physical therapist. You have people who have been either doing home workouts or not exercising at all for a few months. I am concerned that when they return or start up exercising again that they'll injure themselves simply because they've lost some conditioning. How do you plan on approaching this with your returning and new members?

Jimmy: When you're coming back to the gym, we are paying particular attention to the training stimulus. Understand that lifting 40-50% of your maximum ability is where you're going to start. You'll likely also be very sore after that first session back. The main theme is thinking light and easy. This applies both to decreased volume within the workout session and less frequency per week. The muscles remember where they were before, they'll eventually get back to their previous state in 3-4 weeks with steady progressive load. Our clients will be focusing on more full body workouts including pull, push, legs before focusing on individual groups per training session.

Me: That makes a lot of sense to me. Getting people more conditioned first before getting into strength work seems like a great recipe. Say that I wanted to get into strength training with Progressive Performance now, but I don't have any experience in any of those lifts or even the terminology, how do I start?

Jimmy: This is what we have our Jump Start program for. We have everything laid out in a 28 day program. New clients will come in for a movement evaluation, a nutrition evaluation, and they can come in as many times as they want to our small group sessions over those 28 days. Through our interaction we curate that program that's most appropriate for the new member. We'd recommend starting 2-3x/week and then building up to 4x/week. Here we discuss lifting form and make sure you receive live feedback on how to perform each of the exercises safely. After those 28 days, obviously we'd love to keep you as members, but for those who want to lift on their own at their gym, this is still a great gateway to understanding how to lift properly and safely.

Me: That sounds like a great way to get people who are interested in resistance training to do it right and safely. I really do believe your gym provides such a unique opportunity and gateway for individuals who may otherwise never think they’d be able to engage in weight lifting. Jimmy, it was great to chat with you today. Thanks so much for taking the time to sit down and work with me here!


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You can find more information on Jimmy and Progressive Performance Strength and Fitness at https://www.progressiveperformance.com/

Woodinville, WA 98072



bStrong Bellevue Q & A

physical therapy

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Nutrition for Sports Injuries & Healing: Part 2 of 3

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Nutrition for Sports Injuries & Healing: 2 of 3

Dr. Geoff Lecovin
MS, DC, ND, L.Ac, CSCS, CISSN
Naturopathic Physician, Chiropractor, Acupuncturist, Nutritionist, & Personal Trainer

“Unleashing the Power of Food”

The key points to consider with the pyramid of nutritional

Prioritization:

  • Consume adequate calories to ensure energy balance

  • Ensure optimal intake of macronutrients (Carbohydrates, proteins and fats) for energy, repair and reducing inflammation

  • Eat enough nutrient dense foods to avoid micronutrient deficiencies (vitamins, minerals and phytonutrients)

  • Strategic timing of nutrients for energy and repair

  • Select nutrient supplementation for inflammation, muscle, tendon and bone repair

Energy

Adequate calories (energy) are essential for maintaining ideal body weight, fueling activities (e.g. rehabilitation) and promoting healing/recovery. Determining one’s energy requirements can be done using online calculators that take into account one's metabolic rate (BMR) and activity energy expenditure (i.e. rehabilitation, exercise, healing requirements and non exercise activity thermogenesis). Many individuals reduce their calorie intake during injury recovery out of fear that they will gain weight. While consuming excessive simple carbohydrates could lead to unwanted weight gain, supporting the healing process with adequate calories is essential. In addition, some weight gain may be favorable for optimal healing. Also, during recovery, the use of crutches or other ambulation aids can substantially increase one’s energy requirements.

Macronutrients

There are three macronutrients:

  1. Carbohydrates

  2. Proteins

  3. Fats

Each macronutrient plays an important role in the healing process and will be discussed in the context of the three T’s: Total, Type and Timing.

Carbohydrates

Carbohydrates include sugars (simple) and starches (complex). Their primary function is to provide energy for moderate-intense activity. They are also important in keeping the body in an anabolic state by helping to mediate cortisol levels, a main catabolic hormone. Carbohydrates also spare protein, which further aids in maintaining an anabolic state. During injury healing, one should consider meeting carbohydrate requirements for both the healing process as well as rehabilitation. This could be in the range of 3-5g/kg Body Mass, with the focus on low glycemic carbohydrates (e.g. whole grains, vegetables and fruits) as the primary sources.

Proteins

Proteins are essential for muscle growth and repair as well as keeping the body in an anabolic state. They can be categorized as:

  1. Complete - Animal sources, such as beef, poultry, pork, lamb, fish, eggs, dairy and plants such as quinoa and soy

  2. Incomplete - Plants, such as grains, legumes, nuts and vegetables

The general dose for protein to help support healing is 1.5-2.5 g/kg Body Mass. Include some protein with each meal (about 0.4 g/kg Body Mass or about 20-40g). If you are vegetarian, make sure to balance complementary protein sources throughout the day, e.g. Rice and beans, and aim for intakes towards the higher end. Protein needs can be higher in older adults as well as in disuse atrophy, where there can be anabolic resistance.

Fats

Fats and oils can be categorized according to their saturation. The degree of saturation determines the melting point and stability of a fat. Fats are important as an energy source (low intensity activity), hormone production and in controlling inflammation.

Sources of fats include:

  • Saturated fats- Animal fats and coconut Monounsaturated- Avocados, olive oil, macadamia nuts

  • Polyunsaturated:

    • Omega 6 (Proinflammatory if out of balance)- Seed and vegetable oils, e.g. canola, corn, peanut, sunflower, safflower

    • Omega 3 (anti-inflammatory)- Dark green leafy vegetables, flax/hemp seeds, walnuts, cold water fish, grass-fed beef, omega-3 eggs

In general, fats should make up anywhere from 15-20% of one’s diet, with the emphasis on omega 3 polyunsaturated fatty acids and monounsaturated sources. Diets high in saturated fats and omega 6 polyunsaturated fatty acids can put the body in a more inflammatory state.

Micronutrients

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Micronutrients include vitamins, minerals and phytonutrients. They are required in small quantities to ensure normal metabolism, growth and physical well-being. They also help to reduce inflammation and support the healing process. When it comes to micronutrients, avoiding nutrient deficiencies is the key and this can be done by eating a well balanced, varied, whole foods and unprocessed diet. Supraphysiologic vitamin and mineral supplementation beyond what a balanced diet can provide, is not recommended and in the case of antioxidants (e.g. Vitamins A,C,E,Beta carotene, Zinc and Selenium) can adversely affect healing by disrupting the beneficial aspects of inflammation.

References:

  1. Areestion during prolta, J. L., Burke, L. M., Ross, M. L., Camera, D. M., West, D. W., Broad, E. M., ... & Hawley, J. A. (2013).

  2. Timing and distribution of protein ingonged recovery from resistance exercise alters myofibrillar protein synthesis. The Journal of physiology , 591 (9), 2319-2331 Louise M. Burke, John A. Hawley, Stephen H. S. Wong & Asker E. Jeukendrup (2011)

  3. Carbohydrates for training and competition, Journal of Sports Sciences, 29:sup1, S17-S27, DOI: 10.1080/02640414.2011.585473 Clifford, T., Bell, O., West, D. J., Howatson, G., & Stevenson, E. J. (2016).

  4. The effects of beetroot juice supplementation on indices of muscle damage following eccentric exercise. European journal of applied physiology , 116 (2), 353-362. Close, G. L., Sale, C., Baar, K., & Bermon, S. (2019).

  5. Nutrition for the prevention and treatment of injuries in track and field athletes. International journal of sport nutrition and exercise metabolism , 29 (2), 189-197 Currell , Kevin. Performance Nutrition . Crowood Press (April 1, 2017)

  6. Farup, J., Rahbek, S. K., Knudsen, I. S., de Paoli, F., Mackey, A. L., & Vissing, K. (2014). Whey protein supplementation accelerates satellite cell proliferation during recovery from eccentric exercise. Amino Acids , 46 (11), 2503-2516 Frankenfield, D. (2006).

  7. Energy expenditure and protein requirements after traumatic injury. Nutrition in Clinical Practice , 21 (5), 430-437 Glover, E. I., Phillips, S. M., Oates, B. R., Tang, J. E., Tarnopolsky, M. A., Selby, A., ... & Rennie, M. J. (2008).

  8. Immobilization induces anabolic resistance in human myofibrillar protein synthesis with low and high dose amino acid infusion. The Journal of physiology , 586 (24), 6049-6061 Guo, S., & Dipietro, L. A. (2010).

  9. Factors affecting wound healing. Journal of dental research , 89 (3), 219–229. https://doi.org/10.1177/0022034509359125 Juhasz, I., Kopkane, J. P., Hajdu, P., Szalay, G., Kopper, B., & Tihanyi, J. (2018).

  10. Creatine Supplementation Supports the Rehabilitation of Adolescent Fin Swimmers in Tendon Overuse Injury Cases. Journal of sports science & medicine , 17 (2), 279–288 Kelley, D. S., Adkins, Y., & Laugero, K. D. (2018).

  11. A Review of the Health Benefits of Cherries. Nutrients , 10 (3), 368. https://doi.org/10.3390/nu10030368 Kerksick, C. M., Arent, S., Schoenfeld, B. J., Stout, J. R., Campbell, B., Wilborn, C. D., Taylor, L., Kalman, D., Smith-Ryan, A. E., Kreider, R. B., Willoughby, D., Arciero, P. J., VanDusseldorp, T. A., Ormsbee, M. J., Wildman, R., Greenwood, M., Ziegenfuss, T. N., Aragon, A. A., & Antonio, J. (2017).

  12. International society of sports nutrition position stand: nutrient timing. Journal of the International Society of Sports Nutrition , 14 , 33. https://doi.org/10.1186/s12970-017-0189-4 Laumonier, T., & Menetrey, J. (2016).

  13. Muscle injuries and strategies for improving their repair. Journal of experimental orthopaedics , 3 (1), 15. https://doi.org/10.1186/s40634-016-0051-7 Logue, D. M., Madigan, S. M., Melin, A., Delahunt, E., Heinen, M., Donnell, S. M., & Corish, C. A. (2020). Low Energy Availability in Athletes 2020:

  14. An Updated Narrative Review of Prevalence, Risk, Within-Day Energy Balance, Knowledge, and Impact on Sports Performance. Nutrients , 12 (3), 835. https://doi.org/10.3390/nu12030835 Phillips, C. M., Chen, L. W., Heude, B., Bernard, J. Y., Harvey, N. C., Duijts, L., ... & Shivappa, N. (2019).

  15. Dietary inflammatory index and non-communicable disease risk: a narrative review. Nutrients , 11 (8), 1873. Maughan, R. J., Burke, L. M., Dvorak, J., Larson-Meyer, D. E., Peeling, P., Phillips, S. M., ... & Meeusen, R. (2018).

  16. IOC consensus statement: dietary supplements and the high-performance athlete. International journal of sport nutrition and exercise metabolism , 28 (2), 104-125 Myer, G. D., Kushner, A. M., Brent, J. L., Schoenfeld, B. J., Hugentobler, J., Lloyd, R. S., Vermeil, A., Chu, D. A., Harbin, J., & McGill, S. M. (2014).

  17. The back squat: A proposed assessment of functional deficits and technical factors that limit performance. Strength and conditioning journal , 36 (6), 4–27. https://doi.org/10.1519/SSC.0000000000000103 Mountjoy, M., Sundgot-Borgen, J., Burke, L., Carter, S., Constantini, N., Lebrun, C., ... & Ljungqvist, A. (2014).

  18. The IOC consensus statement: beyond the female athlete triad—Relative Energy Deficiency in Sport (RED-S). Br J Sports Med , 48 (7), 491-497 Pence, B. D., & Woods, J. A. (2014). Exercise, obesity, and cutaneous wound healing: evidence from rodent and human studies. Advances in wound care , 3 (1), 71-79. Quintero, K. J., de Sá Resende, A., Leite, G. S. F., & Junior, A. H. L. (2018).

  19. An overview of nutritional strategies for recovery process in sports-related muscle injuries. Nutrire , 43 (1), 27 Sale, C., & Elliott-Sale, K. J. (2019). Nutrition and athlete bone health. Sports Medicine , 1-13 Shaw, G., Lee-Barthel, A., Ross, M. L., Wang, B., & Baar, K. (2017).

  20. Vitamin C–enriched gelatin supplementation before intermittent activity augments collagen synthesis. The American journal of clinical nutrition , 105 (1), 136-143 Smith, Stephen, MSc, PHd, (Cand), NUTRITION FOR INJURY PREVENTION & REHABILITATION applied in an elite powerlifter.2019.

  21. IOPN Performance Nutrition DiplomaTipton, K. D. (2015).

  22. Nutritional support for exercise-induced injuries. Sports Medicine , 45 (1), 93-104 Van Vliet, S., Shy, E. L., Abou Sawan, S., Beals, J. W., West, D. W., Skinner, S. K., ... & Moore, D. R. (2017).

  23. Consumption of whole eggs promotes greater stimulation of postexercise muscle protein synthesis than consumption of isonitrogenous amounts of egg whites in young men. The American journal of clinical nutrition , 106 (6), 1401-1412 Wall, B. T., Snijders, T., Senden, J. M., Ottenbros, C. L., Gijsen, A. P., Verdijk, L. B., & van Loon, L. J. (2013). Disuse impairs the muscle protein synthetic response to protein ingestion in healthy men. The Journal of Clinical Endocrinology & Metabolism , 98 (12), 4872-4881 Yang, D. F., Shen, Y. L., Wu, C., Huang, Y. S., Lee, P. Y., Er, N.X., ... & Tung, Y. T. (2019).

  24. Sleep deprivation reduces the recovery of muscle injury induced by high-intensity exercise in a mouse model. Life sciences , 235 , 116835 Precision Nutrition, Nutrition for Injury Recovery Infographic. https://www.precisionnutrition.com/ http://www.sportsrd.org/wp-content/uploads/2016/08/Nutrition- Support-for-Inury-Recovery-Return-to-Play.pdf

Questions and Contact Info: www.drgeofflecovin.com or email: geoff@drgeofflecovin.com



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Stretching

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Stretching

Everyone knows that stretching is good for you, but most people are wrong in WHY they think it is good for you. As a PT and frequent gym-goer, I often hear that stretching is good because it helps lengthen the muscles. This is completely wrong. I think it is time to debunk some of the myths surrounding stretching. After reading this page, you will have a better understanding of what does and does not happen when you stretch. You might even be able to enlighten those around you in yoga class or at the gym.

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Squat Depth

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Squat Depth

May 8, 2020

SQUAT DEPTH

weight lifting, physical therapy

BY: JORDAN BORK, PT, DPT, CSCS

SQUAT DEPTH: A PHYSICAL THERAPIST’S PERSPECTIVE

One of the most debated topics in the weight lifting world is that of squat depth. At most gyms you will see everything from mini-knee bends, to “A*s to Grass” squatting. So how do you know how deep is deep enough?

ANATOMY AND BIOMECHANICS:

As per usual, let’s cover a quick lesson in anatomy and biomechanics before we dive into the debate.

The classic barbell squat primarily works your gluteal and quadriceps muscle groups. Together with the hamstrings, calves, abductors and adductors, the body works to control the weight as you descend and ascend throughout the lift. Because of its large compound movement the squat it is often considered a full body work out and one of the 3 major lifts (along with deadlifts and bench press).

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Is CrossFit Bad for You?

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Is CrossFit bad for you?
A physical therapist’s perspective

As a PT, I often get asked, “Is CrossFit bad for you?” I usually respond that it is only as harmful as any other form of strenuous exercise.

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The workout that has taken our nation by storm often gets a bad rep from horror stories of back injuries, excessive weights and poor form. However, I feel this has become exaggerated. The reality is you can find the same unfortunate types of injuries in every gym setting.

CrossFit utilizes high intensity work outs with large compound movements perfect for improving lean muscle mass, decreasing body fat and building strength. As a result, these compound movements often require a certain level of skill, practice and coordination.

CrossFit is appealing because it challenges you both physically and mentally. It provides a barrier you must strive to overcome and with completion comes the euphoria of accomplishment. On the other hand, what makes it so great is also its greatest risk. Utilizing large muscle groups, at high intensities with short rest times will make you push yourself and experience significant levels of fatigue. Anytime your body fatigues and keeps pushing, it will be at an increased risk of injury. However, just because something has a risk of form breakdown does not mean that it is harmful or dangerous. If we avoided all activities involving fatigue and poor technique, than no one would be running or even rearranging furniture in their home.

Squat Tired.jpg

It is true that correct form is imperative for exercise, possibly more so in CrossFit due to the high volume/intensity of the workouts. This is why you must be diligent about the basics and progress your weights slowly. Pay attention to form and don’t be afraid to ask the coaches to examine your lifts.

I do want to mention that CrossFit is not for everyone. Those who are new to the world of physical fitness will benefit from classes on the basics of lifting prior to performing dynamic compound lifts. If you are recovering from injury I recommend starting the road back to the gym with light weights and isolated muscle focus rather than large explosive movements. The re-introduction of stress placed throughout the body is best done in a manner that won’t involve excessive fatigue or the urge to push your limits. Lastly, if you think you have an injury or have not performed physical exercise I recommend that you seek assessment from a physical therapist or other trained medical professional prior to starting physical activities.

BOTTOM LINE:

Like all physical activity, CrossFit has inherent risk for injury. These risks can be magnified if poor form is used. However, with the right instructors, correct progression of resistance and proper technique CrossFit can be an excellent form of exercise for people of many fitness levels.

Local CrossFit

Kirkland CrossFit
Accuo CrossFit
Lake Washington Crossfit