Interview with Okinyi Ayungo, CSCS

I have always had an appreciation for personal trainers and what they can do for the

Okinyi Ayungo, CSCS

individual in terms of overall health and well being.  I personally do some aspects of personal training as a coach. I had the opportunity to talk to a good friend of mine, Okinyi Ayungo, a rising young personal trainer, fitness educator and innovator (co-creator of the Functional Training Group Exclusive program) in the Maryland area who specializes in functional movement training.  Below is the e-mail interview:

(Me): Thanks for the interview.  First of all, tell everyone why you decided to become a personal trainer.  You obviously had many options in terms of employment.

(OA):  Thanks for giving me an opportunity to share with your readers.  I decided to become a personal trainer for two main reasons:  I love science and I want to help people.  Throughout most of my academic years, I was “told” (by parents, teachers, etc.) that I should consider going into medicine because I enjoyed the sciences.  However, I was always drawn to how the human body worked especially when it came to movement and sports.  In my quest to improve my own athletic interests, I began to learn as much as I could about the human body’s response to exercise.  Then, because I knew a lot about exercise, friends in college started asking me to design programs for them.  My first job was in biomedical research, but I also was a part-time personal trainer to help pay my student loans.  It was then that I realized how much of an impact I could have on people’s lives doing something that I truly enjoyed.  And the rest is history…

(Me):  Describe your philosophy of training.

(OA): I base the majority of my training on functional movments.  This means that we focus on improving the individual’s ability to perform some task (or series of tasks) outside of the gym that he/she needs or wants to become better at.  This could mean strengthening and stretching certain muscles to improve one’s tennis serve or golf swing; or it could mean improving strength and balance to be able to get off of the floor easier.  Whatever the goal of the individual, I always emphasize creating better, more efficient movement.  When people move better, they naturally become more active and get more joy out of life.  This makes them feel better.  When people feel better, then they are ready to make the positive behavioral changes that lead to looking better (the primary goal of the majority of personal training clients).  so you can say that my philosophy is:  Move Better, Feel Better, Look Better.

(Me): My big interest is in rehabilitation and prevention of injuries.  How do you accomplish this when working with your clients?

(OA): Proper screening and proper progression.  Every client does a health history questionnaire prior to any training.  If there are any unresolved injuries or pain, the individual must consult a medical professional before proceeding with training.  As part of my screening, I also conduct a Functional Movement Screen (FMS).  The FMS ranks and grades seven movement patterns that are important for normal function.  The FMS system identifies an individual’s limitations and asymmetries that could lead to injury.  This lets me know what corrective exercises need to be done before doing more aggressive training.

The other key to injury prevention is proper progression.  I start with mostly body weight movements to see how a client can control their own body in different positions before adding weight to a movement.  It’s always better to start off with a lighter resistance and progress in 5-10% increments once the exercise becomes comfortable for a given number of repetitions.  But the overarching premise is control.  If going up in weight compromises control of the movement, then that client is not ready to progress.

(Me): How do you incorporate stretching into your workouts?

(OA): Every workout begins with some dynamic flexibility (stretches that are only held for a few seconds in a rhythmic pattern) to warm-up the muscles, tendons and ligaments in the ranges of motion that we will be using during the workout.

For clients that need to focus on a particular flexibility issue, we will often stretch throughout the session.  For example, someone with short pectoralis (chest) muscles may do a brief stretch between each set of push-ups (or whatever chest exercise we are doing).

And at the end of the workout, we will do static stretching (holding the stretch for 20-30 seconds).  For clients with particular needs, we will do assisted contract-relax stretching or PNF stretching at the end of the workout.

(Me): Do you use a team approach, i.e., working with a massage therapist, chiropractor, etc., with some clients?

(OA): Yes, I have a physical therapist that I refer clients to that have musculoskeletal issues that are beyond my scope of practice.  For my clients whose main concern is weight loss or weight management, I have two nutritionists that I work with.  And for clients who are training for a specific goal that I do not have experience in (e.g. competitive bodybuilding) or may need/want other forms of specialized exercise (e.g. boxing), I will refer tham to someone in the network of other trainers and instructors with whom I have built relationships over the years.

(Me): Of course, there is a big debate about health care reform these days.  I firmly believe that prevention of these chronic diseases would be the best answer to reducing the health care costs.  Do you thing that you have a role in the the health care community?

(OA): Absolutely.  The way I see it, the money that someone spends on personal training now will prevent them from having a much more costly coronary bypass surgery or a hip replacement in the future.  Not only that, but I think that we are just now beginning to understand the mental health benefits of exercise.  A few weeks ago, one client of ten years said to me, “Thank you for saving my life.”  I did not realize it, but when she came to me to start personal training, she was still mourning the loss of her mother.  She credits regular exercise with preventing her decline into major depression.  The funny thing is that her stated primary goal was to “look more toned”.  But by MOVING better, she started FEELING better.  And now she is one of my best LOOKING clients as well.

(Me): Any future exciting plans or announcements for your company?

(OA): I am working on a comprehensive on-line resource for functional training.  It will be a website dedicated to fitness for real-life.  It will be ready in early 2010. I will keep you posted.  But in the meantime, you may go to www.FDTtraining.com to get a feel for the type of fitness that I work towards for each of my clients.

Walk for the Cure Diabetes November 7th, 2009

Greetings!

I’m writing to you to ask for your support in a very special cause.

This year, Armstrong Podiatry & Sports Health, PLLC will be taking part in the Juvenile Diabetes Research Foundation’s Walk to Cure Diabetes along with a half-million other walkers across the country. Our goal: To raise $105 million to help fund research for a cure for type 1 diabetes and its complications.

Type 1, or juvenile, diabetes, is a devastating, often deadly disease that affects millions of people–a large and growing percentage of them children.

Many people think type 1 diabetes can be controlled by insulin. While insulin does keep people with type 1 diabetes alive, it is NOT a cure. Aside from the daily challenges of living with type 1 diabetes, there are many severe, often fatal, complications caused by the disease.

That’s the bad news… and yes, it’s pretty bad.

The good news, though, is that a cure for type 1 diabetes is within reach. In fact, JDRF funding and leadership is associated with most major scientific breakthroughs in type 1 diabetes research to date. And JDRF funds a major portion of all type 1 diabetes research worldwide, more than any other charity.

I’m writing to ask for your support because now more than ever, EACH of us can be a part of bringing about a cure. Each of us can make a real difference

Won’t you please give to JDRF as generously as you’re able?

Together, we can make the cure a reality.

Thank you,

Lloyd Kelsey Armstrong, D.P.M., CSCS

Please visit my Walk Web page if you would like to donate online or see how close we are to reaching our goal:

http://walk.jdrf.org/walker.cfm?id=87490253

Happiness and good health!

The real solution to the “healthcare crisis”

I might be opening a can of worms with this topic, but here we go……..

As a physician who will be affected by the healthcare changes  in the upcoming years (and at this point, who knows what they will be), I have taken an interest in the various ideas about restructuring health care in the U.S.  This issue is inextricably linked to the culture and character of America. 

The truth of the matter is that Americans strongly believes in choice, the free enterprise system, and of course, the “American Dream” (becoming successful through hard work and dedication).  This is why any system that forces people to equalize their healthcare coverage will be strongly resisted.  It removes the freedom of choice of health care coverage from the individual.  Also several reports that suggest that taxing the rich would be good way to give health care coverage to the poor also flies in the face of the “American Dream”.  It sounded good in Robin Hood, but not in real life.  Insurance companies also benefit from the free enterprise system, because they can set coverage and reimbursement rates according to schedules that generate profits for the companies.  In case you didn’t realize, reimbursement rates for physicians have decreased or remained the same in the past twenty years, despite everything else getting more expensive.

These strong beliefs of Americans also can be seen as a major factor in creating this “healthcare crisis”.  Our excess comsumption of items, because “we have the money to do so” and “because it is there”.   It definitely makes things easier in certain ways, but also makes us more unhealthy.  The elevator allows us to avoid the stairs.  The fast food restaurants (with excessive calories and unhealthy “additives”) allow us to eat quickly and “on the go”, instead of preparing a home cooked nutritious meal.  The car has allowed us to go five blocks to go the store to pick up some groceries, instead of walking. 

All these examples and more lead to the chronic diseases we see today, such as hypertension, diabetes, and the like.  We would have a lot less visits to the doctor’s office, if we committed ourselves to a healthier lifestyle. 

That is why I try to communicate PREVENTION  for my patients, through many different facets, such as nutrition, stretching, and physical fitness.  I am selling several nutritional products on my website (www.armstrongpodnsportshealth.com) by the company Emugenix, and I will be launching a personalized nutrition program that radically changes your eating habits and keeps them that way,  in the next month or two.  I am still working on my e-book on stretching which should be available by the end of the year. Furthermore, I am working on developing some conditioning camps for the fall of this year.  I believe a doctor should do more than just treat the injury, we should direct the patient how to prevent them. 

Happiness and good health!

Interview with Dr. Robert Schleip

 

I had the opportunity to interview the preeminent researcher in the fascinating world of FASCIA, Dr. Robert Schleip from Germany.  He has singlehandedly changed the way I,and many others should treat patients with soft tissue injuries, particularly plantar fasciitis (heel pain).  Fascia is a continuous web of tissue that surrounds the bones, ligaments, tendons and muscles of the ENTIRE body!  Its all-encompassing nature, highlights the fact that it has a major impact on injuries and prevention and also the interconnection of the entire body.  Below is the e-mail interview:

(Me) I have been fascinated by your work.  What type of response have you been getting here in the U.S.?

(RS) There has been an avalanche of interest from the US, yet also Canada.  Not only in our work but in the new field of fascia research in general.  Most interest comes from manual therapists, yet also from sports medicine people, yoga instructors, manual art specialists, and others.

(Me) Tell my audience about your background.  I believe it is important that the scientific and medical community works hand and hand

(RS) I have been a bodyworker since three decades.  Mainly as a practitioner and instructor of the Rolfing method, yet also as a Feldenkrais teacher.  Based on my frustration with a pseudo-scientific foundation of my work, I began to enter the field of academic science myself, first as an avid reader and participant of conferences, and then 6 yrs ago I became an active laboratory scientist myself.  Together with a small team of colleagues at the University of Ulm in Germany, and in combination with my PhD dissertation, I could show that normal fasciae, i.e., the dense muscular connective tissues, have active contractile properties.  This was awarded with Vladimir Janda Award in 2006 and has stimulated several further studies since then.  I was also involved in organizing the first International Fascia Research Congress, at Harvard Medical School in Boston in 2007, which was a hugh success.  It was booked out months in advance and received an enthusiastic coverage in the scientific media; and soon we’ll be having the 2nd such congress in Amsterdam.

And you are right: I strongly agree that scientists and health care practitioners should work closer together.  Yet this is exactly what is currently happening in the field of fascia research.  The current excitement that everybody feels in this field is not only because the cinderella effect, in which the tissue which was most neglected in orthopedic research in the last few decades is achieving an almost superstar position since that first Harvard congress.  Moreover, that excitement, which has some qualities of  a gold digger’s rush, is largely colored by the interdisciplinary mixture of the people entering this field and the mutual cooperation of clinicians, researchers, movement therapists, nutritionists, and many others.

(Me) Tell us the results of your studies in regards to contractile cells in fascia (myofibroblasts).

(RS) Pathological fascia such as Frozen Shoulder or hypertrophic scars contain so-called myofibroblasts, which are connective tissue cells with smooth muscle like contractile properties.  These tend to densify and to contract the fascial matrix.  What we did is look for the presence of such cell in normal human fasciae.  Basically we found such contractile cells in all fascial tissues that we looked at, although at different cellular densities.  Additionally we suspended pieces of fascia in an organ bath environment and stimulated them wth specific cytokines or with mechanostimulation.  Here we could show, that many of the fascial pieces could actively contract and relax in a smooth muscle like manner.  This finding may have implications of understanding many conditions and therapies which involve hypo-trophic or hypertrophic fasciae. Possibly manual therapies, yet also stretching or yoga or Pilates practices, may be targeting the active ability of fascial tissues to regulate their tonicity independently of the muscular tone.

(Me) Tell me the results of your studies of fascia in regards to water content.

(RS) We repeated and extended some earlier experiments from a group in Montreal, which showed that when a ligament or other fascial tissue is being stretched isometrically, that is yields and looses some of its original stiffness by the well-known feature of creep or viscoelastic relaxation.  We could show that this yielding or temporary softening is due to a loss of tissue water from the ground substance; i.e. that some water is squeezed out of the tissue, like in squeezing a wet towel or sponge.  When one then gives the tissue a sufficiently long resting period, it sucks up again with water and regains its original stiffness.  Yet quite surprisingly, if the previous stretch was strong enough and the resting period long enough, then the tissues in our experiments filled up to a state of supercompensation, where they filled with more water than they had lost during the stretch and in which they ganied the state of “strain hardening”.  This means that they ended up being stiffer than before, for about 1 or 2 hours after the original stretch.

It seems like the stiffness and elasticity of fascial tissues depends to a very large degree on the regulations of their water content.  Water makes up about two thirds of the volume of fascial tissues.  And most of that biological water seems to be in a bound state, in which the water molecules are arranged in an organized fashion similar to a liquid crystal, or like the surface tension that allows a spider to move on top of a water pond.  Aging tends to go along with a loss of hydration in tendons, and degradation of the normal water molecule coating around the elastin fibers.  It seems like the dynamic changes of the various water content and water binding properties of fascial tissues have a very profound effect on our bodies; and that many practices like massage, sports activities, or stretching are influencing those properties.  We now have the technology, e.g. with modern magnetic resonance imaging, to study those changes in water molecules, and I can’t wait to see the results of some of those studies in relation to specific preconditioning practices in sports, or in manual therapies. 

(Me) As a podiatrist, I am interested in this information in regards to plantar fasciitis or more precisely, plantar fasciosis.  Do you think stretching should be a first-line treatment for this condition?

(RS) Yes, in my Rolfing practice, which I still maintain two days a week I find that the plantar fascia in those people is not only thicker, but is seems to be also much drier and less elastic.  One can often palpate some rope-like or ribbon-like dry strands in the sole.  These feel similar to the rat fascia in our lab after they have been exposed to air for several minutes.  So I think stretching is most likely a very good treatment.  However, the stretching should not be done with the intention of stretch the collagen fibers inside, but to squeeze out the fluid contents of the tissue similar like in squeezing a sponge or a wet towel, such that it will soak up with new water molecules immediately afterwards.  If done slowly and repeatedly one will find that dense tissues like the plantar fascia can regain their original youthful juiciness and elasticity. 

(Me) I have used massage therapy (myofascial release) for stubborn cases of plantar fasciosis.  Do you think this would be a good first-line treatment? 

(RS) Yes, absolutely.  But is takes several months of fascial tissues to change their morphology, muscles can do that much faster.  So it may take some patience to yield a complete healing response from the plantar fascia. 

(Me) Any exciting new research results you can share with us?

(RS) Yes, we found strong indications that acute back pain is generated in a large proportion of the cases by microinjuries in the lumbar fasciae.  In many cases, the discs are not the causal factor for the pain, yet the lumbar fascia shows signs of injuries, inflammation, scarring and adhesions.  And this fascia is densely innervated not only with mechanoreceptors which are important for proprioception, but also with free nerve endings which can drive the central nervous system mad and lead to chronic long term pain syndrome.

(Me) Thank you for your time and I hope to meet you in the near future

(RS) It’s been a pleasure, hope to see you maybe at the next fascia congress in Amsterdam this October.

I know it a little technical, but I feel Dr. Schleip’s work is so important, because it  gives a legitimacy to massage therapy and similar manual therapies.  Feel free to send a line for clarification or for any questions you may have.

Happiness and good health!

Stretching: Vital to health

I had the opportunity to meet some members of the community where my office is located earlier this month.  I really enjoyed talking to them about certain foot problems and ways to stay healthy.  My talk was quite popular; it was called, “Stretching is for Everyone”.  Here is a summary of my talk.  I hope to give this whole topic a full explanation, along with a potential e-book in the future.  For now, enjoy!

 

WHY DO WE STRETCH?

WHAT DO WE STRETCH?

HOW DO WE STRETCH?

 

WHY?

 

 

 

 

WE ARE NOT GETTING ANY YOUNGER!

 

 

The elasticity of connective tissue fibers (tendons, fascia, muscles) tend to deteriorate and shorten

This tendency is accelerated by inactivity (IF YOU DON’T USE IT, YOU LOSE IT)

 

 

 

 

 

This shortening will:

Change the way you stand (posture)

Change the way you move (stride length)

Change the energy you have (decrease circulation to tense muscle)

Change your overall health (elevate your blood pressure)

 

 

 

WHAT?

 

NORMAL VS. ABNORMAL POSTURE

Abnormal posture is typical of Western society due to sedentary lifestyle and poor choice of shoegear

 

 

 

 

 

OUR SEDENTARY LIFESTYLE

Causes our hamstring muscles to tighten because we sit on them all day!

This can lead to a posture called lordosis

 

 

 

 

 

OUR POOR CHOICE OF SHOEGEAR

Majority of our shoes has a heel elevation

If you wear them long enough, you will get a tight, shortened Achilles tendon complex

 

If you don’t use it, you lose it!

 

Practically everyone has a tight Achilles tendon complex

 

 

 

Can lead to bunions and hammertoes

Can lead to tightening and contracture of hip flexor muscles

 

 

 

 

THE 3 MUSCLE GROUPS I BELIEVE ARE THE MOST IMPORTANT TO STRETCH IN THE LOWER EXTREMITY:

Achilles tendon complex

Hip flexors

Hamstrings

 

 

HOW?

 

Goal of stretching is to restore muscle to their normal length and beyond

Gentle stretching is the most effective way: 30-40% of maximum perceived stretch OR until you feel the tension disappear

Aim for about 60 seconds of stretching three times for each muscle group

 

Can be done anytime; suggest in the morning and again at night

No warm up necessary (Isn’t body temperature warm enough for your muscles?)

 

 

 

 

 

 

Common foot and ankle injuries

I am planning to do several talks to local shoe stores to inform the staff about certain common foot and ankle injuries and how to approach them. Here is a handout of what I talk about:

PLANTAR FASCIOSIS
• Arguably the most common foot complaint
• When first seeing a podiatrist, it has progressed from fasciitis to fasciosis
• Fasciitis is an inflammatory condition of the fascia on the bottom of the foot
• Fasciosis is collagen degeneration with no inflammatory cells present
• Seen in all types of people, but common thread is usually a sudden increase in activity; pain after a period of rest that goes away after 5-10minutes and at the end of the day
• Treatment involves: rest, supportive shoegear in conjunction with therapy that causes an inflammatory response, i.e., aggressive stretching, self-massage, injection (cortisone/anesthesia mixture or just anesthesia)
• Orthotic therapy maintains the healed/healing plantar fascia, along with prevention of any biomechanical abnormalities that caused the condition

ACHILLES TENDONOSIS
• Has become common, especially for individuals who have worn high-heeled shoegear for a long period of time and want to start wearing flatter shoes
• When first seeing a podiatrist, it has progressed from tendonitis to tendonosis
• Tendonitis is an inflammatory condition of the tendon about ¾ inch from the back of the heel bone
• Tendonosis is collagen degeneration with no inflammatory cells present
• Pain is present after a period of rest that goes away after 5-10 minutes and with increased activity
• Treatment involves: rest, supportive shoegear in conjunction with therapy that causes an inflammatory response, i.e., Alfredsson stretching protocol, aggressive cross friction massage
• Orthotic therapy maintains the healed/healing Achilles tendon and may incorporate a heel lift to decrease stress upon it

CAPSULITIS
• A condition mostly due to biomechanical abnormalities
• It is an inflammatory condition of the capsule (sheath surrounding the joint with nerve and artery supply)
• Pain usually in the ball of the foot, is mild in the morning, but increases as the day continues and is usually sharp in nature with no radiation.
• Mostly like to compensatory overload of the second metatarsalphalangeal joint, due to inadequate functioning of the first ray (i.e., too short, too long, too stiff, etc.)
• Treatment, involves rest, supportive shoegear and use of adequate orthotic therapy that restore normalcy to the first ray joint.

Happiness and good health!

Children & Foot Health

I just went to a children’s health fair and wrote some handouts for the parents.  I will post one of the handouts here, which is pretty general, but I will get in further detail as time goes on.  I am a big proponent of healthy feet in children, because that sets the stage for healthy feet as an adult! 

·        Organized and unorganized sports are a great way to improve the cardiovascular system, the musculoskeletal system, coordination, and develop self-confidence and self-discipline

·        The unfortunate trend towards specialization of children in sports at a younger and younger age, lends itself towards the potential of overuse injuries; this is due to constant pressure upon a certain set of muscles, ligaments and stress upon the bones

·        Growth plates of bones don’t close until about 13-15 years old in girls and 15-17 years old in boys, so they are more suspectible to injury than tendons and ligaments

 

SOLUTIONS

·        Allow children to play many different sports and activities; this will benefit overall coordination and decrease risk of overuse injuries.

·        Simple movement patterns and proper technique are important part of prevention, especially for children younger than ten years old

·        Stretching and proper strengthening exercises are vital for growing children as the muscles and tendons will become tight as the bone lengthens

Happiness and good health!

Overuse Injuries: An Introduction

Injuries have always played a part in any physical fitness activity.  That sore shoulder after playing softball during the summer or that painful heel after running twelve miles during the weekend are prime examples of injuries.  These injuries can be due to a number of factors:  training mistakes (“doing too much too soon”), muscle-tendon imbalances, improper shoegear, abnormal biomechanics (the functional motion of the body), anatomic malalignment and nutritional factors, to name a few.  With the continuous presentation of any or all of these factors upon the body in explosive (throwing a ball) or repetitive (running long distance) activities, anyone can and will get injured

How does this happen?  All these factors lead to a wear and tear of the body’s tendons (fibers which connect muscle to bone), ligaments (fibers which connect bone to bone at a joint), muscle, skin, bones, fascia and joints from the explosive and repetitive nature of the body’s motion.  By applying these forces upon the body, the body reacts by breaking down.  Let’s take the classic model of an unfolded paper clip.

By bending the paper clip back and forth upon itself, you are applying a loading  and unloading force upon it.  This can be seen in individuals that has “soreness” in the shoulder, foot, etc., after an activity.  If you continue  to apply the same force ad infinitum, eventually the paper clip will break apart.  This is when the injuries are called, “overuse injuries”.

The breakdown of the body is seen by the process of inflammation, a complex response defined by pain, redness, swelling, heat and lack of function.  Initially, the inflammation is acute with increasing signs of these characteristics, but with overuse injuries, the inflammation is chronic or longstanding.  Why?  Acute inflammation usually takes about two to three weeks before the pain, swelling, etc., disappears, but in overuse injuries, the inflammation is still present, but not as obvious as the acute variety.  Chronic inflammation leads to a weakening and/or destruction of tendons, ligaments or bones.  This is mostly seen as scarring in the soft tissue, making it more prone to reinjury.  That is why it is so important to rest any injury in the acute phase, before it becomes detrimental to overall health and fitness.  And furthermore, it can avoid THAT visit to the doctor!  It is the chronic inflammatory injuries that I specialize in, and will discuss treatment plans and modalities, along with preventative measures in future entries.  that may be of benefit to any injured individual, primarily in the foot and ankle.  Of course, the best way to get treatment for your condition is to see a medical professional!  Feel free to contact me if you have any questions at armstrongpodnsportshealth@verizon.net

Happiness and good health!

Hello world!

My name is Dr. L Kelsey Armstrong, and I am the owner of Armstrong Podiatry & Sports Health, PLLC.  My love of teaching my patients about various foot and ankle conditions, combined with my knowledge of exercise training prompted me to start this blog.   Here is an excerpt from my website(www.armstrongpodnsportshealth.com) explaining my credentials…

Dr. L Kelsey Armstrong, DPM, CSCS

A graduate of Temple University School of Podiatric Medicine, Dr. Armstrong is one of the few podiatric physicians who is certified in Strength and Conditioning Science by the National Strength and Conditioning Association (NSCA).  A native of Toronto, Canada, Dr. Armstrong has treated athletes and non-athletes in Canada and the U.S. for over nine years, focusing on getting individuals moving as quickly as possible, by nonsurgical means.  Dr. Armstrong is also a certified USATF Level I coach and official, and spends his spare time coaching high school and post-collegiate track and field athletes.     

 

I am looking forward to lively interaction with all of you in the near future.  Thanks