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How to Recognize and Treat a Groin Strain Injury

How to Recognize and Treat a Groin Strain Injury

When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times?

How to Recognize and Treat a Groin Strain Injury

Groin Strain Injury

A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013)

  • A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
  • There may also be swelling or bruising in the groin or inner thigh.
  • An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)

Symptoms

A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013)

  • A popping sound or snapping sensation when the injury occurs.
  • Increased pain when pulling the legs together.
  • Redness
  • Swelling
  • Bruising of the groin or inner thigh.

Groin pulls are graded by severity and how much they impact mobility:

Grade 1

  • Mild discomfort but not enough to limit activities.

Grade 2

  • Moderate discomfort with swelling or bruising that limits running and/or jumping.

Grade 3

  • Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.

Signs of a severe groin strain

  • Difficulty walking
  • Groin pain while sitting or resting
  • Groin pain at night
  • A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
  • In severe cases, surgery is necessary to reattach the torn ends.

Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013)

Causes

Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017)

  • Have weak hip abductor muscles.
  • Are not in adequate physical condition.
  • Have a previous groin or hip injury.
  • Pulls can also occur from falls or extreme activities without the proper conditioning.

Diagnosis

A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013)

Medical History Review

  • This includes any previous injuries and specifics about where and when the symptoms started.

Physical Examination

  • This involves palpating – lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.

Imaging Studies

  • Ultrasound or X-rays.
  • If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.

Differential Diagnosis

Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013)

Sports Hernia

  • This type of inguinal hernia occurs with sports and work injuries.
  • It causes a portion of the intestine to pop through a weakened muscle in the groin.

Hip Labral Tear

  • This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.

Hip Osteoarthritis

  • This is the wear-and-tear form of arthritis that can present with groin pain symptoms.

Osteitis Pubis

  • This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.

Referred Groin Pain

  • This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.

Treatment

Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises.

  • Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
  • Physical therapy will be a part of the treatment plan.
  • Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
  • If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
  • Surgery is not usually necessary. (Andreas Serner, et al., 2020)

Recovery

Recovery times can vary based on the injury’s severity and physical condition before the injury.

  • Most injuries will heal within four to six weeks with rest and proper treatment.
  • Severe groin strains can take up to 12 weeks or longer if surgery is involved. (Andreas Serner, et al., 2020)

Injury Rehabilitation


References

Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. doi.org/10.5812/traumamon.12666

Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247. doi.org/10.1177/2325967119897247

Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279. doi.org/10.5435/JAAOS-D-16-00171

Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570. doi.org/10.5435/JAAOS-21-09-558

Comprehensive Guide to Recovery from Osteitis Pubis Injury

Comprehensive Guide to Recovery from Osteitis Pubis Injury

Athletes and physically active individuals who participate in activities, exercises, and sports that involve kicking, pivoting, and/or shifting directions can develop pelvis overuse injury of the pubic symphysis/joint at the front of the pelvis known as osteitis pubis. Can recognizing the symptoms and causes help in treatment and prevention?

Comprehensive Guide to Recovery from Osteitis Pubis Injury

Osteitis Pubis Injury

Osteitis pubis is the inflammation of the joint that connects the pelvic bones, called the pelvic symphysis, and the structures around it. The pubic symphysis is a joint in front of and below the bladder. It holds the two sides of the pelvis together in the front. The pubis symphysis has very little motion, but when abnormal or continued stress is placed on the joint, groin and pelvic pain can present. An osteitis pubis injury is a common overuse injury in physically active individuals and athletes but can also occur as the result of physical trauma, pregnancy, and/or childbirth.

Symptoms

The most common symptom is pain over the front of the pelvis. The pain is most often felt in the center, but one side may be more painful than the other. The pain typically radiates/spreads outward. Other signs and symptoms include: (Patrick Gomella, Patrick Mufarrij. 2017)

  • Lower abdominal pain in the center of the pelvis
  • Limping
  • Hip and/or leg weakness
  • Difficulty climbing stairs
  • Pain when walking, running, and/or shifting directions
  • Clicking or popping sounds with movement or when shifting directions
  • Pain when lying down on the side
  • Pain when sneezing or coughing

Osteitis pubis can be confused with other injuries, including a groin strain/groin pull, a direct inguinal hernia, ilioinguinal neuralgia, or a pelvic stress fracture.

Causes

An osteitis pubis injury usually occurs when the symphysis joint is exposed to excessive, continued, directional stress and overuse of the hip and leg muscles. Causes include: (Patrick Gomella, Patrick Mufarrij. 2017)

  • Sports activities
  • Exercising
  • Pregnancy and childbirth
  • Pelvic injury like a severe fall

Diagnosis

The injury is diagnosed based on a physical examination and imaging tests. Other tests may be used to rule out other possible causes.

  • The physical exam will involve manipulation of the hip to place tension on the rectus abdominis trunk muscle and adductor thigh muscle groups.
  • Pain during the manipulation is a common sign of the condition.
  • Individuals may be asked to walk to look for irregularities in gait patterns or to see if symptoms occur with certain movements.
  1. X-rays will typically reveal joint irregularities as well as sclerosis/thickening of the pubic symphysis.
  2. Magnetic resonance imaging – MRI may reveal joint and surrounding bone inflammation.
  3. Some cases will show no signs of injury on an X-ray or MRI.

Treatment

Effective treatment can take several months or longer. Because inflammation is the underlying cause of symptoms, the treatment will often involve: (Tricia Beatty. 2012)

Rest

  • Allows the acute inflammation to subside.
  • During recovery, sleeping flat on the back may be recommended to reduce pain.

Ice and Heat Applications

  • Ice packs help reduce inflammation.
  • The heat helps ease pain after the initial swelling has gone down.

Physical Therapy

Anti-inflammatory Medication

  • Over-the-counter nonsteroidal anti-inflammatory medications – NSAIDs like ibuprofen and naproxen can reduce pain and inflammation.

Assistive Walking Devices

  • If the symptoms are severe, crutches or a cane may be recommended to reduce stress on the pelvis.

Cortisone

  • There have been attempts to treat the condition with cortisone injections, but the evidence supporting its use is limited and needs further research. (Alessio Giai Via, et al., 2019)

Prognosis

Once diagnosed, the prognosis for full recovery is optimal but can take time. It can take some individuals six months or more to return to pre-injury level of function, but most return by around three months. If conservative treatment fails to provide relief after six months, surgery could be recommended. (Michael Dirkx, Christopher Vitale. 2023)


Sports Injuries Rehabilitation


References

Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology, 19(3), 156–163. doi.org/10.3909/riu0767

Beatty T. (2012). Osteitis pubis in athletes. Current sports medicine reports, 11(2), 96–98. doi.org/10.1249/JSR.0b013e318249c32b

Via, A. G., Frizziero, A., Finotti, P., Oliva, F., Randelli, F., & Maffulli, N. (2018). Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature. Open access journal of sports medicine, 10, 1–10. doi.org/10.2147/OAJSM.S155077

Dirkx M, Vitale C. Osteitis Pubis. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: www.ncbi.nlm.nih.gov/books/NBK556168/

Acupuncture: an Alternative Treatment for Allergies

Acupuncture: an Alternative Treatment for Allergies

For individuals suffering from allergies, could using acupuncture help relieve and manage symptoms?

Acupuncture: an Alternative Treatment for Allergies

Acupuncture Can Help With Allergies

Acupuncture is becoming a more respected alternative treatment for various medical issues, from anxiety to fibromyalgia to weight loss. There is evidence that acupuncture can help with allergies by alleviating symptoms and improving the quality of life. (Shaoyan Feng, et al., 2015) The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends doctors offer acupuncture to patients looking for nonpharmacological treatments for their allergies or refer them to an acupuncturist. (Michael D. Seidman, et al., 2015)

Acupuncture

Acupuncture is a traditional Chinese medicine/TCM practice in which extremely thin needles are inserted into the body at specific points, creating a network of energy pathways known as meridians.

  • These pathways circulate vital life energy/chi or qi.
  • Each meridian is associated with a different body system.
  • Needles are placed to target the organs associated with the condition being treated.
  1. Acupuncture can help with allergies by targeting several meridians, including the lungs, colon, stomach, and spleen. These meridians are believed to circulate defensive life energy or a type of immunity energy.
  2. A backup of defensive energy or a deficiency can cause allergy symptoms like swelling, watery eyes, runny nose, sneezing, allergic eczema, and conjunctivitis. (Bettina Hauswald, Yury M. Yarin. 2014)
  3. The objective is to stimulate the points to restore balance in the energies and relieve symptoms.

Scientific Theories

  • One theory is the needles work directly on nerve fibers, influencing messages to the brain or the autonomic nervous system and transmission of signals within the body, including the immune system. (Tony Y. Chon, Mark C. Lee. 2013)
  • Another is the needles influence certain activities of cells, particularly the transport, breakdown, and clearance of bioactive mediators.
  • The combination of these actions is thought to decrease inflammatory conditions like allergic rhinitis – hay fever, in which the inside of the nose becomes inflamed and swollen after breathing in an allergen. (Bettina Hauswald, Yury M. Yarin. 2014)

A 2015 review concluded there have been high-quality randomized controlled trials demonstrating acupuncture’s efficacy in treating seasonal and perennial allergic rhinitis. Smaller studies have shown some preliminary benefits of acupuncture when compared with antihistamines, but more research is needed. (Malcolm B. Taw, et al., 2015)

Treating Allergies

  • Some individuals who choose acupuncture are seeking alternatives to standard treatment like medications, nasal sprays, and immunotherapy.
  • Others are looking for ways to enhance the effectiveness of medications already being taken, such as antihistamines or nasal sprays, or shorten how long or how frequently they are needed.
  • Initial treatment usually involves weekly or twice-weekly appointments over several weeks or months, depending on symptom severity.
  • This may be followed by annual treatments or on an as-needed basis. (American Academy of Medical Acupuncture. 2020)
  1. Most states require a license, certification, or registration to practice acupuncture, but these vary from state to state.
  2. Recommendations are for a practitioner who is certified by the National Certification Commission for Acupuncture and Oriental Medicine.
  3. A medical doctor who offers acupuncture.
  4. The American Academy of Medical Acupuncture has a list of acupuncturists who are also medical doctors.

Improperly administered acupuncture needles can cause serious side effects that range from infections, punctured organs, collapsed lungs, and injury to the central nervous system. (National Center for Complementary and Integrative Health. 2022) Before trying acupuncture, consult your primary healthcare provider, allergist, or integrative medicine specialist to make sure it’s a safe and viable option and the best way to integrate it into overall allergy care.


Fighting Inflammation Naturally


References

Feng, S., Han, M., Fan, Y., Yang, G., Liao, Z., Liao, W., & Li, H. (2015). Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. American journal of rhinology & allergy, 29(1), 57–62. doi.org/10.2500/ajra.2015.29.4116

Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., Dawson, D. E., Dykewicz, M. S., Hackell, J. M., Han, J. K., Ishman, S. L., Krouse, H. J., Malekzadeh, S., Mims, J. W., Omole, F. S., Reddy, W. D., Wallace, D. V., Walsh, S. A., Warren, B. E., Wilson, M. N., … Guideline Otolaryngology Development Group. AAO-HNSF (2015). Clinical practice guideline: Allergic rhinitis. Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 152(1 Suppl), S1–S43. doi.org/10.1177/0194599814561600

Hauswald, B., & Yarin, Y. M. (2014). Acupuncture in allergic rhinitis: A Mini-Review. Allergo journal international, 23(4), 115–119. doi.org/10.1007/s40629-014-0015-3

Chon, T. Y., & Lee, M. C. (2013). Acupuncture. Mayo Clinic proceedings, 88(10), 1141–1146. doi.org/10.1016/j.mayocp.2013.06.009

Taw, M. B., Reddy, W. D., Omole, F. S., & Seidman, M. D. (2015). Acupuncture and allergic rhinitis. Current opinion in otolaryngology & head and neck surgery, 23(3), 216–220. doi.org/10.1097/MOO.0000000000000161

American Academy of Medical Acupuncture. (2020). Acupuncture and Seasonal Allergies.

National Center for Complementary and Integrative Health. (2022). Acupuncture: What You Need To Know.

Functional Gastrointestinal Disorders: What You Need to Know

Functional Gastrointestinal Disorders: What You Need to Know

Individuals with digestive problems that cannot be diagnosed could be experiencing functional gastrointestinal disorders. Could understanding the types help in developing effective treatment plans?

Functional Gastrointestinal Disorders: What You Need to Know

Functional Gastrointestinal Disorders

Functional gastrointestinal disorders, or FGDs, are disorders of the digestive system in which the presence of structural or tissue abnormality cannot explain symptoms. Functional gastrointestinal disorders lack identifiable biomarkers and are diagnosed based on symptoms. (Christopher J. Black, et al., 2020)

Rome Criteria

FGDs used diagnoses of exclusion, meaning that they could only be diagnosed after organic/identifiable disease was ruled out. However, in 1988, a group of researchers and healthcare providers met to devise strict criteria for the diagnosis of the various types of FGDs. The criteria is known as the Rome Criteria. (Max J. Schmulson, Douglas A. Drossman. 2017)

FGDs

A comprehensive list as described by the Rome III criteria (Ami D. Sperber et al., 2021)

Functional Esophageal Disorders

  • Functional heartburn
  • Functional chest pain believed to be of esophageal origin
  • Functional dysphagia
  • Globus

Functional Gastroduodenal Disorders

  • Unspecified excessive belching
  • Functional dyspepsia – includes postprandial distress syndrome and epigastric pain syndrome.
  • Chronic idiopathic nausea
  • Aerophagia
  • Functional vomiting
  • Cyclic vomiting syndrome
  • Rumination syndrome in adults

Functional Bowel Disorders

  • Irritable bowel syndrome – IBS
  • Functional constipation
  • Functional diarrhea
  • Unspecified functional bowel disorder

Functional Abdominal Pain Syndrome

  • Functional abdominal pain – FAP

Functional Gallbladder and Sphincter of Oddi Disorders

  • Functional gallbladder disorder
  • Functional biliary Sphincter of Oddi disorder
  • Functional pancreatic Sphincter of Oddi disorder

Functional Anorectal Disorders

  • Functional fecal incontinence
  • Functional Anorectal Pain – includes chronic proctalgia, Levator ani syndrome, unspecified functional anorectal pain, and proctalgia fugax.
  • Functional Defecation Disorders – include dyssynergic defecation and inadequate defecatory propulsion.

Childhood Functional GI Disorders

Infant/Toddler (Jeffrey S. Hyams et al., 2016)

  • Infant colic
  • Functional constipation
  • Functional diarrhea
  • Cyclic vomiting syndrome
  • Infant regurgitation
  • Infant rumination syndrome
  • Infant dyschezia

Childhood Functional GI Disorders:

Child/Adolescent

  • Vomiting and Aerophagia – cyclic vomiting syndrome, adolescent rumination syndrome, and aerophagia
  • Abdominal Pain-Related Functional GI Disorders include:
  1. functional dyspepsia
  2. IBS
  3. Abdominal migraine
  4. Childhood functional abdominal pain
  5. Childhood functional abdominal pain syndrome
  • Constipation – functional constipation
  • Incontinence – nonretentive fecal incontinence

Diagnosis

Although the Rome criteria allow the diagnosis of FGDs to be symptom-based, a healthcare provider may still run standard diagnostic tests to rule out other diseases or look for structural problems resulting in symptoms.

Treatment

Although no visible signs of disease or structural problems may be identified as causing the symptoms, it does not mean that they are not treatable and manageable. For individuals who suspect they may have or have been diagnosed with a functional gastrointestinal disorder, it will be essential to work with a healthcare provider on a working treatment plan. Treatment options can include: (Asma Fikree, Peter Byrne. 2021)

  • Physical therapy
  • Nutritional and dietary adjustments
  • Stress management
  • Psychotherapy
  • Medication
  • Biofeedback

Eating Right To Feel Better


References

Black, C. J., Drossman, D. A., Talley, N. J., Ruddy, J., & Ford, A. C. (2020). Functional gastrointestinal disorders: advances in understanding and management. Lancet (London, England), 396(10263), 1664–1674. doi.org/10.1016/S0140-6736(20)32115-2

Schmulson, M. J., & Drossman, D. A. (2017). What Is New in Rome IV. Journal of neurogastroenterology and motility, 23(2), 151–163. doi.org/10.5056/jnm16214

Sperber, A. D., Bangdiwala, S. I., Drossman, D. A., Ghoshal, U. C., Simren, M., Tack, J., Whitehead, W. E., Dumitrascu, D. L., Fang, X., Fukudo, S., Kellow, J., Okeke, E., Quigley, E. M. M., Schmulson, M., Whorwell, P., Archampong, T., Adibi, P., Andresen, V., Benninga, M. A., Bonaz, B., … Palsson, O. S. (2021). Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology, 160(1), 99–114.e3. doi.org/10.1053/j.gastro.2020.04.014

Hyams, J. S., Di Lorenzo, C., Saps, M., Shulman, R. J., Staiano, A., & van Tilburg, M. (2016). Functional Disorders: Children and Adolescents. Gastroenterology, S0016-5085(16)00181-5. Advance online publication. doi.org/10.1053/j.gastro.2016.02.015

Fikree, A., & Byrne, P. (2021). Management of functional gastrointestinal disorders. Clinical medicine (London, England), 21(1), 44–52. doi.org/10.7861/clinmed.2020-0980

Your Pelvic Health: A Guide To Pelvic Floor Physical Therapy

Your Pelvic Health: A Guide To Pelvic Floor Physical Therapy

For individuals experiencing pelvis pain symptoms and associated problems, can integrating pelvic floor physical therapy exercises help with treatment and prevention?

Your Pelvic Health: A Guide To Pelvic Floor Physical Therapy

Pelvic Floor Physical Therapy

When the muscles fail to function correctly, individuals can experience symptoms like:

  1. Painful intercourse
  2. Prolapse – when an organ or tissue drops or shifts out of place.
  3. Urinary incontinence
  4. Constipation problems
  5. These conditions are common in pregnant individuals or older women.

These symptoms can be treated with pelvic floor physical therapy to alleviate discomfort. Pelvic floor physical therapy can help women and individuals with vaginas:

  • Alleviate issues like painful sex, urinary leakage, and prolapse.
  • In physical therapy, individuals work on breathing, relaxation, and lengthening and strengthening techniques to train their muscles to function optimally.

Causes of Pelvic Floor Issues

Pelvic floor dysfunction tends to happen with age, during pregnancy, or in combination with events like the postpartum period and menopause, which can lower hormone levels.

  • Individuals who are pregnant are especially prone to pelvic floor issues but might not know they have a problem.
  • The pregnancy weight of a uterus can pressure and strain the muscles.
  • Vaginal childbirth can also stretch or weaken the muscles. (Ilaria Soave, et al., 2019)

Symptoms

Symptoms can include: (Columbia Surgery. 2022)

  • Pain in the pelvis region
  • Back pain
  • Painful urination
  • Constipation
  • Urinary leakage or incontinence
  • Stool leakage or incontinence
  • Painful intercourse
  • If left untreated, these symptoms can worsen over time.

Pelvic Floor Physical Therapy

An individual will meet with a specialist to discuss symptoms and undergo a physical examination that includes:

  1. Pelvic floor exam.
  2. Evaluation of posture, mobility, and core strength.
  3. Once the initial exams and evaluation are complete, the practitioner will go over pelvic floor exercises and provide a treatment plan.
  4. Recommended exercises vary based on symptoms but focus on relaxing, stretching, and/or strengthening muscles.

Muscle Relaxation

  • To relax the muscles, a therapist may recommend breathing exercises.
  • For pregnant individuals, this means timing breaths with contractions.
  • For individuals experiencing constipation, breathing exercises can help the body relax and reduce strain.

Stretching Muscles

  • Stretching can help relieve muscle tightness and stiffness.
  • A therapist may help stretch the pelvic floor through various therapy modalities.
  • This type of physical therapy can help loosen tight muscles or help gently reset dislocated organs back into place.

Strengthening Muscles

  • After the pelvic floor is loose and relaxed, the focus typically switches to strengthening the muscles.
  • Strength work may target abdominal muscles or the pelvic floor muscles themselves.

With time, commitment, and targeted treatment, individuals can use pelvic floor physical therapy to loosen tissues, strengthen muscles, and restore function.


Spinal Decompression In Depth


References

U.S. Food and Drug Administration. (2019). Pelvic organ prolapse (pop).

Sartori, D. V. B., Kawano, P. R., Yamamoto, H. A., Guerra, R., Pajolli, P. R., & Amaro, J. L. (2021). Pelvic floor muscle strength is correlated with sexual function. Investigative and clinical urology, 62(1), 79–84. doi.org/10.4111/icu.20190248

Raizada, V., & Mittal, R. K. (2008). Pelvic floor anatomy and applied physiology. Gastroenterology clinics of North America, 37(3), 493–vii. doi.org/10.1016/j.gtc.2008.06.003

Soave, I., Scarani, S., Mallozzi, M., Nobili, F., Marci, R., & Caserta, D. (2019). Pelvic floor muscle training for prevention and treatment of urinary incontinence during pregnancy and after childbirth and its effect on urinary system and supportive structures assessed by objective measurement techniques. Archives of gynecology and obstetrics, 299(3), 609–623. doi.org/10.1007/s00404-018-5036-6

Columbia Surgery. (2022). Pelvic floor disorders: frequently asked questions.

Creating an Effective Workout with the FITT Principle

Creating an Effective Workout with the FITT Principle

For individuals trying to get into a regular fitness regimen, could using the FITT Principle help structure exercise, track progress, and achieve fitness goals?

Creating an Effective Workout with the FITT Principle

FITT Principle

The FITT principle is a set of guidelines for adjusting, revising, and improving exercise workouts. FITT is an acronym for:

  • Frequency
  • Intensity
  • Time
  • Type of exercise
  • Individuals take these elements to create and adjust workouts that fit their goals and fitness levels.

For example, this could be a workout of 3 to 5 days combined with low, medium, and high-intensity exercises for 30 to 60 minutes each session that incorporates cardio and strength training. Focusing on these details and progressing over time helps create an effective program.

Frequency

Workout frequency and how often the individual is going to exercise is the first thing to look at.

  • Frequency depends on various factors, including the type of workout being done, how hard the workout is, fitness levels, and exercise goals.
  • General exercise guidelines developed by the American College of Sports Medicine offer recommendations. (Carol Ewing Garber, et al., 2011)

Cardiovascular Workouts

  • Cardio workouts are usually scheduled more often.
  • Depending on goals, guidelines recommend moderate cardio exercise five or more days a week or intense cardio three days a week to improve health.
  • Individuals can adjust the exercise intensity level easily on a treadmill to provide excellent and convenient cardiovascular workouts.
  • Individuals who want to lose weight may want to work up to more workouts gradually.
  • However, more is not always better, and recovery time is essential. (Pete McCall. 2018)

Strength Training

  • The recommended frequency for strength training is two to three non-consecutive days a week. (National Strength and Conditioning Association. 2017)
  • Individuals should have at least one to two days of rest and recovery between sessions.
  • Workout frequency will often depend on the type of training sessions being performed as well as health goals.
  • For example, individuals want to work on each muscle group at least two times a week if their goal is to build muscle. (Brad J. Schoenfeld, Dan Ogborn, James W. Krieger. 2016)
  • For individuals following a split routine, like upper body one day and lower body the next, workouts can be more frequent than total body workouts.

Intensity

Workout intensity involves how hard the individual is pushing themselves during exercise. How it is increased or decreased depends on the type of workout. (Carol Ewing Garber, et al., 2011)

Cardiovascular Workouts

For cardio, individuals will monitor workout intensity by:

  • Heart rate
  • Perceived exertion
  • Talk test
  • Heart rate monitor
  • A combination of these measures.
  1. The general recommendation is to work at a moderate intensity for steady workouts.
  2. Interval training is done at a higher intensity for a shorter period.
  3. It’s recommended to mix up low, medium, and high-intensity cardio exercises to stimulate different energy systems and prevent overtraining. (Nathan Cardoos. 2015)

Strength Training

  • Individual intensity comprises the amount of weight being lifted and the number of reps and sets done.
  • The intensity can change based on health goals.
  1. Beginners looking to build stability, endurance, and muscle are recommended to use a lighter weight and do fewer sets with high repetitions – for example, two or three sets of 12 to 20 reps.
  2. Individuals wanting to grow muscle are recommended to do more sets with a moderate amount of reps – for example, four sets of 10 to 12 reps each.
  3. Individuals who want to build strength are recommended to use heavy weights and do more sets with fewer reps – for example, five sets of three reps each.
  4. Building muscle can be done with a wide range of repetitions and weights. (Brad J. Schoenfeld, Dan Ogborn, James W. Krieger. 2016)

Time

The next element of the plan is how long the exercise will be during each session. Exercise length depends on individual fitness level and the type of workout being done.

Cardiovascular Workouts

The exercise guidelines suggest 30 to 60 minutes of cardio, but workout duration will depend on fitness level and type of exercise. ((Carol Ewing Garber, et al., 2011)

  • Beginners are recommended to start with a 15- to 20-minute workout.
  • Individuals with some workout experience and are doing steady-state cardio, like jogging or using a cardio machine, might exercise for 30 to 60 minutes.
  • For individuals doing interval training and working at very high intensity, the workout will be shorter, around 10 to 15 minutes of high-intensity interval training.
  • Having a variety of workouts of different intensities and durations will provide a solid, balanced cardiovascular program.

Strength Training

  • How long an individual strength trains will depend on the type of workout and schedule.
  • A total body workout can take over an hour.
  • A split routine can take less time by working fewer muscle groups in one session.

Type

The type of exercise you do is the last part of the FIIT principle.
It is easy to manipulate to avoid overuse injuries or weight loss plateaus.

Cardiovascular Workouts

  • Cardio is easy to adjust and change because any activity that increases heart rate counts.
  1. Walking, dancing, running, cycling, swimming, and using an elliptical trainer are a few activities that can be incorporated.
  2. Having multiple cardio activities is recommended to reduce burnout and keep workouts fresh.

Strength Training

  • Strength training workouts can also be varied.
  • They include any exercise where some type of resistance  –  bands, dumbbells, machines, etc. are used to work the muscles.
  • Bodyweight exercises can also be considered a form of strength training.
  • Strength workouts can be changed from total body training to adding, for example, supersets or pyramid training.
  • Incorporating new exercises for each body area is another way to vary the type of workouts.
  • Spending a few weeks working on functional strength movements, then switching to hypertrophy or strength-based training.
  • Each modality includes various alternative types of strength-based exercises.

Using FITT

The FITT principle outlines how to adjust workout programs to achieve better results. It also helps figure out how to change workouts to avoid burnout, overuse injuries, and plateaus.

For example, walking three times a week for 30 minutes at a moderate pace is recommended for a beginner to start out with. After a few weeks, the body adapts to the workout. This results in burning fewer calories, burnout, or weight management efforts, and goals are put on hold. This is where the FITT principles come in. For example, a change-up could include:

  • Changing frequency by adding another day of walking or jogging.
  • Changing intensity by walking faster, adding more challenging terrain like a hill, or jogging at certain intervals.
  • Walking for a longer time each workout day.
  • Changing the type of workout by swapping one or more of the walk sessions for cycling or aerobics.
  1. Even just changing one element can make a big difference in the workout and how the body responds to exercise.
  2. It’s important to change things up regularly to keep the body healthy and mind engaged.

Injury Prevention

One of the best things about using FITT is that it allows individuals to monitor the length and intensity of their workouts. When individuals work out too frequently or don’t get enough rest, they run the risk of overuse injuries, burnout, and muscle strains. The FITT principle encourages adding variety to workouts. When following this practice, it allows the body to rest and recover properly. Because individuals are not working the same muscle groups over and over again, better results are achieved.


Fighting Inflammation Naturally


References

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., Nieman, D. C., Swain, D. P., & American College of Sports Medicine (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and science in sports and exercise, 43(7), 1334–1359. doi.org/10.1249/MSS.0b013e318213fefb

McCall Pete. 8 reasons to take a rest day. (2018) American Council on Exercise.

National Strength and Conditioning Association. (2017) Determination of resistance training frequency.

Schoenfeld, B. J., Ogborn, D., & Krieger, J. W. (2016). Effects of Resistance Training Frequency on Measures of Muscle Hypertrophy: A Systematic Review and Meta-Analysis. Sports medicine (Auckland, N.Z.), 46(11), 1689–1697. doi.org/10.1007/s40279-016-0543-8

Cardoos, Nathan MD. Overtraining Syndrome. (May/June 2015). Current Sports Medicine Reports 14(3):p 157-158. DOI: 10.1249/JSR.0000000000000145

Gaining Posture Awareness Through Low Back Curve Exercises

Gaining Posture Awareness Through Low Back Curve Exercises

For individuals trying to achieve healthy posture, could using posture awareness training be effective in treatment and prevention?

Gaining Posture Awareness Through Low Back Curve Exercises

Posture Awareness

Spinal curves help support the body’s weight, movement, and balance. Five areas include the neck, upper back, lower back, sacrum, and coccyx. The bottom of the spine or sacrum rests between the two hip bones that comprise the pelvis. Because of this location, the movements made with the pelvis significantly affect the spine. (Ibrahim Alkatout, et al., 2021) When the pelvis moves, the spine moves.

  • Posture-related back pain and associated symptoms are often caused by a weakened strength and flexibility ratio between the opposing muscle groups that hold the body upright.
  • Achieving healthy posture requires technique and consistent practice for maintaining a healthy pelvis and low back curve. (DeokJu Kim, et al., 2015)
  • Finding the low back curve and exploring how it responds when moving the pelvis is important to effective posture awareness training.

Lower Back Curve Awareness Exercise

One important thing to do to increase postural awareness is to become aware of the low back curve. (Arkadiusz Łukaz Żurawski, et al., 2020)

Sit On a Firm Chair or Stool

  • So that the weight is planted into the seat in a balanced way.

Hold Onto the Arms of the Chair

  • If the chair doesn’t have arms, hold onto the edge of a desk/workstation or the sides of the chair seat.
  • This will support the back when moving the pelvis.
  • Maintaining core abdominal strength is key to preventing back injury. (Erika Zemková, Ludmila Zapletalová. 2021)

Movement

  • Tilt the pelvis forward.
  • In this position, notice the slightly exaggerated arch in the lower back and the increase in lower back muscle tension.
  • A moderate amount of this increase and exaggeration is normal.

Relax Back to the Start Position

Sitting upright with the hip bones/top of the pelvis directly above the bottom.

  • Next, tilt the pelvis back.
  • The abs may have to work hard to support this position
  • Use your hands against the chair for support.
  • Check the lumbar curve area, noticing if it has flattened out.
  • Notice the tension in the back muscles.
  • Is it a little looser? This is normal.

Relax Back to the Start Position

  • Sitting upright.
  • Repeat the sequence again.
  • This time, when in the forward position, pause briefly and slide a hand between the lower back and the back of the chair or the wall.
  • When in the backward position, there will be little to no space between the lower back and the seatback or wall.

Problems

  • If there are problems moving the pelvis back and forth, imagine a basket or bowl of fruit.
  • The pelvis has a round shape and is open at the top, like a bowl or basket.
  • Imagine the fruit is placed toward the front of the bowl, and the weight brings the bowl/pelvis forward.
  • To go back, imagine the fruits are placed toward the back.
  • The weight causes the bowl to roll backward.
  • This may help to get the rhythm of the movement.

This posture awareness exercise can be used as a posture muscle builder by doing it with the back against the wall.

  • A more challenging position for this exercise is standing against a wall.
  • Keep the heels against the baseboard to really work the abs.
  • Start with sitting and gradually to standing.

Foot Motion and Posture


References

Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 27(6), 1791–1794. doi.org/10.1589/jpts.27.1791

Alkatout, I., Wedel, T., Pape, J., Possover, M., & Dhanawat, J. (2021). Review: Pelvic nerves - from anatomy and physiology to clinical applications. Translational neuroscience, 12(1), 362–378. doi.org/10.1515/tnsci-2020-0184

Żurawski, A. Ł., Kiebzak, W. P., Kowalski, I. M., Śliwiński, G., & Śliwiński, Z. (2020). Evaluation of the association between postural control and sagittal curvature of the spine. PloS one, 15(10), e0241228. doi.org/10.1371/journal.pone.0241228

Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International journal of environmental research and public health, 18(10), 5400. doi.org/10.3390/ijerph18105400