Back to Fitness: Physical Therapy
By John Andersen
For this month’s column, I interviewed Daniel Freed-Pastor, one of the physical therapists from PT Plus Physical Therapy here in Crozet. Dan received his Doctor of PT from Columbia University and enjoys working and living here in Crozet and helping people achieve their fitness goals.
John Andersen: Okay, so this is the time of year when a lot of people are resolving to get back into shape. Since this column is called “Back to Fitness,” what would you say are the main things that limit people’s easy return to fitness?
Dan Freed-Pastor: We do a lot of education on this because a lot of the barriers to returning to fitness are usually a combination of physical and mental. We see a much better prognosis when people return to full activity after a period of injury or inactivity in a gradual manner and modify as they go. Being able to modify is key because a lot of times we can’t go right back into what we want to do, but rather need a “stepping stone” to help prepare our body to take the stress of the full activity we want to do. We call this “active rest.” Sounds like an oxymoron, but compared to full rest, where you stop doing everything, active rest is basically working around an injury, like cross-training. It’s like the person who has some shoulder pain and stops going to the gym altogether. They could be rehabbing the shoulder and continuing to go to the gym and avoiding aggravating exercises.
JA: I think a problem a lot of people get themselves into is following a somewhat rigid “back to fitness” program, like a couch-to-5k plan that says “do this on this day…” and so on. So, I’m hearing you say, “just be really, really flexible” if following a specific plan?
DFP: Yes, there is a big difference between pushing yourself and just not listening to your body and ignoring signs that things are headed in the wrong direction. Modification doesn’t mean you’re taking the easy road, just a different one that may be better for you.
JA: When I think of some initial “get off the couch” things that people do, I think of running, boot camp, and the gym. Can you name some exercises or activities that you think would be great for someone who is just starting to get back in shape?
DFP: When I look at any activity like running or boot camp, I picture the types of stresses that will go through their body and the most likely injuries they may incur if they do not prepare well enough. For things like running and boot camp, which may include jumping, I like to prep people with light impact activity, a lot of which we do on an agility ladder (side steps, side-to-side hops or diagonal shuffle) and preceding this with a good dynamic warm-up like high knees, butt kicks, body weight squat, skips. Statistically, PTs see the highest percentage of neck and back pain compared to other joints. I think the dynamic warm-up on agility ladder work would help, but I would also include some yoga moves like child’s pose, cat-cow and cobra pose to help make sure the spine is moving through the full range of motion. As far as strengthening to avoid injury for activities like running and cycling and boot camp, I would focus on glute strengthening and core control. We have a lot of exercises that we tailor to the individual person’s needs/issues.
JA: I know that most people don’t see you until they are injured and are prescribed physical therapy from their doctor. It seems most people are only doing PT exercises when something is injured. How can you get people motivated to do these when they are healthy?
DFP: Yes, this is a good point. I am just as guilty of this as other people are—only taking the time to do “corrective exercise” when you have a reminder, i.e. pain. I am not usually the person that spends 20 minutes stretching after working out at the gym or running because I go to the gym at 5 a.m. and I have only 45-50 minutes, so I want to get the most out of it. What I recommend to people is to incorporate corrective exercise like a stretch you know you need to do or side steps with a band around your ankles for glute strength into your circuit. If you like to keep moving while you work out, like me, you can use four stretches at 30-second holds and two minutes’ rest to recover for your next “working set” of whatever you are doing at the gym. If you are doing interval running, you may be able to stretch while you rest/recover/hydrate. This can sometimes take more planning, but you can potentially get the same workout and proactive stretching/strengthening in the same amount of time. We do actually see a lot of patients on “Direct Access,” which means they don’t need a prescription from their doctor, and is one of the reasons PT is now a doctoral degree, because we need to be able to screen patients and know when to refer them out when appropriate.
JA: Let’s talk about sitting. I’m a believer that a lot of our barriers to being fit people and barriers to easily getting back to fitness are from a life of sitting. If we didn’t have desk jobs and cars, and if we had to walk a mile to the water well, starting running would probably be a lot easier. Why is sitting so much bad for us and what are your recommendations to counter this?
DFP: Yes, I completely agree. Our muscles adaptively shorten to the positions we spend the most time in. Tight hip flexors and hamstrings from sitting all day are a good example. When I look at getting someone back to or into something like running, I look at the stresses the body needs to be able to manage and gradually introducing these to the body. I think I’ve heard you and Michelle talk about training and it being more about time on your feet than the distance you go. I think this is true for anyone starting running. When someone’s body is only taking the stress of standing for a short period of time (walking to their car, from their car to their desk, etc), it takes longer for them to adapt to the stress of running and they’re more likely to get injured if they ramp up too quickly. I usually recommend standing desks if necessary or, at the very least, getting up and walking to get a drink of water every 30 minutes throughout the day. Sometimes this means setting a timer on their watch, fitbit or phone, because I know how easy it is to get distracted with work and forget to get up.
JA: Let’s talk about that sensitive subject of extra weight. Let’s face it, significant extra weight is extra stress on the joints.
DFP: Yes, this is a sensitive subject and emphasized to varying degrees at PT. I always try to remind myself that although with some people it seems obvious that if they lost weight, it would help their injury, I don’t assume it will take care of the issue just by losing weight because there are few injuries that are solely caused by extra weight. With that said, for our joints that get injured from the increased load of extra body weight, i.e. lower back, hips, knees, and feet, just losing a small percentage of weight can significantly decreased the stress on these joints. The most inspiring stories I’ve seen are the people whose injury and subsequent rehab have been a wake up call and they actually make a lifestyle change, starting a gym/exercise program and losing weight as they finish PT.