(00:00:00) News and information broadcasts on Saturday are supported in part by Precision Tune with 19 Service locations in the Twin Cities area and good morning. It's five minutes past eleven o'clock and this is midday for Saturday the 13th of March 1993. I'm Jim Wagner glad you could be with us and we're pleased to welcome Kent Malcomson for our for our broadcast today. Mr. Malcomson is with Copeland physical therapy in the Twin Cities. He's a physical therapist and he's an expert in something called sports medicine and we'll find out in a minute what exactly that is what genre of medicine he's also the physical therapist for the Minnesota North Stars. They're still called that right? That's correct. Is it in the refrigerator for a few more weeks for a few more weeks? So if you have a questions about physical fitness conditioning how to prevent sports injuries particular types of exercise equipment. Give us a call. You can reach us a toll-free anywhere you receiving us at 28 and if you're calling from the Twin Cities area, there's a Twin Cities line. You can reach us on and that's two two seven six thousand. Once again the toll free number anywhere is one eight hundred to four hundred twenty eight Twenty Eight and Kent. Let's start out by defining sports medicine. That's a particular genre of general medicine. I presume. Yeah, it is. It's actually sports medicine is kind of a nebulous Concept in and of itself and that Sports Medicine entails a variety of specializations within the medical field involving Orthopedic Physicians Family Physicians internist physical therapist athletic trainers. So when somebody says that they're that they're interested in or want to go into sports medicine that really is kind of nondescript but generally entails working with athletic recreationally active populations what sorts of injuries are most prevalent at this time of year coming out of winter and going into spring each sport or activity that we see has kind of its types of injuries that are fairly Specific for those for instance with Hockey being real pronounce or prevalent right now with the high school tournament and whatnot shoulder injuries are fairly common with that all of the abuse and the banging that that gets but in a general sense, most of the injuries that we see involved in in athletics Recreation normally are of muscular ligamentous or muscular tendinous involving pull strange tears tendonitis has more of what's in the in the vein of an overuse type of injury. So how serious is that? It can be very serious in the ER in the initial stages. It can be something that would be just a nuisance that they get a little stiffer little achy, but if that goes unchecked or untreated or they don't direct any particular care for that problem, let's just let nature take its course it can get to the point where it becomes severe enough are limiting enough where they can't participate in their athletic activity anymore and oftentimes even creeps into being a problem with their daily activities. How would you avoid Something like that building yourself up slowly building up slowly is real important in with many of the conditioning programs are training programs. A lot of times. I'll talk about 10 to 15 percent increases in week. For instance. If you're a runner that you don't want to try and increase your mileage more than 10 15 percent per week because that's the kind of the time frame that those muscles need to adapt to that new level or intensity. So gradual progression also considerations for cross-training doing other types of exercises or activities that are different than the sport and that can incorporate both strengthening exercises as well as stretching. Can you give an example pick a sport and then choose choose the next as you think would be appropriate probably an example of ones that are done best in this regard would be football, you know, they have the scrimmages they have the practices that are on the field, but they're also in the weight room. One of the ones that probably is an example of the other end of the spectrum would be swimming in that especially at High Those were they maybe don't have the facilities or the the gym accessibility or the weight room so that they aren't doing the strengthening the stretching exercises out of the water. They're training for the sport by doing the sport. All right, if one gets some attention disorder titanosaur restrain other than not continuing with the activity. What's a good way to treat it? Well, we don't always recommend stopping the activity and that's one of the one of the misconceptions that if you have a problem that if you go to see a physician or physical therapist, they're going to tell you to stop doing that activity. It's much better to go with a restricted or modified level of that activity and try and still continue with the sport or the activity. But basically in caring for a problem kind of the principles of acute care, or what we call the ice, or the rice principles are good things to keep in mind and that's an acronym that I standing for ice, which applying cold to the area will help decrease swelling and inflammation see is compression that if you have any swelling using an Ace Wrap or some type of compressor Sleeve is helpful to minimize that and the E for elevation getting that part higher than your heart so that it can drain some of the fluid or some of the swelling out of it. If you did that. How long would you want to elevate it for usually about 10 to 15 minutes and many times. It's the best efficiency for that is to apply the cold pack in the compression and elevation all at the same time for 10 to 15 minutes every two to three hours. My guest is Kent Malcomson. He is with the Copeland physical therapy in the Twin Cities and he is also the physical therapist for the Minnesota North Stars and we're talking about physical fitness and conditioning how to avoid or how to treat sports injuries and we'll get into exercise equipment to in a while. If you would like to join us. You can reach us calling anywhere in Minnesota. You can reach us toll-free at 1-800-222-8477 free one eight hundred to four to Twenty Eight Twenty Eight. And if you calling from the Twin Cities area, you can also reach us on our Twin Cities line. That's two two seven six. And we'll be going to the phones in just a minute, but one other area I'd like to like you to comment on concerning young children. We consider young children to be very active in burning up a lot of calories and so on should they be involved in a formal exercise program or do they get enough exercise as it is? I think they're a couple of thoughts on that. And and one of the things that I usually recommend is that I think the the child has to want to participate or be interested in an activity. If you're trying to force them into a particular activity or sport just for the sake of getting that exercise often times if they don't approach it with the right mindset that can lead to some problems and things but generally speaking as they run around and do their activities. It's you know, that's good exercise quote unquote, but a lot of times you miss developing or isolating right defying particular areas that could use extra help with strengthening or stretching should they be encouraged? Encourage. Yeah, given the opportunity to and I think that you know most kids with a lot of the idolization that they have their Sports Heroes and things that they're probably going to choose some activity or sport to be involved with but you know, I think having them have the opportunity to make the decision to do that's important too. Okay, can't let's go to the phones. Good morning. You're on Minnesota Public Radio. Where are you calling from Baldwin Wisconsin high. Go ahead, (00:07:25) please. Hi. I'm 87. I was involved in an accident and I had a closed head injury from us and the the results of it was similar to my is my heaven has stroked. My left side is paralyzed. Hmm, and I'm trying to come out of that little better trying to figure out exactly what I should do to deal with that. I'm wanting to know what would be a good reading material or a good place for me to go to read about the best way to handle this. (00:07:56) Well, one of the things with with a closed head injury or really any kind. Injury where we're talking about central nervous system and that would be either brain or spinal cord injuries is that it's a very complicated very long recovery process. And those are tissues that are delicate enough that oftentimes we expect not to have full recovery or function. So I think one of the things is to make sure that you're getting good advice and input from Healthcare professionals from your physicians physical therapists that specialize with Rehabilitation and that would be primarily with you know, a Rehab Clinic where they where they specialized in stroke or head injuries because one of the things that that you need to do is realize it takes a long time to reconnect or retrain those muscles on what they need to do. The injury itself happens often times very very quickly, but the long-term effect in recovery process often times as months and years how much of a factor is age age is definitely a factor primarily because of of In and just General Health and viability of the tissue that injuries that occur as were younger that usually we rebound quicker from and recover more quickly from because the tissue has better circulation Better Health to it. Okay, let's go back to the phones. Good morning. You're on. Midday. Where are you calling (00:09:16) from Minneapolis? I have two questions for you one. I'm I've heard that water is the best liquid to replenish fluids after exercising and not fruit juice not pop. I wonder if you could explain that phenomenon and then the second one and if it's true or not and then the second one is if you could explain the target heart range, I've been told that there's a sort of a formula where you subtract your age (00:09:44) from 2 to write right? Let's take the first one with the with fluids. One of the things that happens is we exercise is that we sweat and as we sweat that changes what we call the electrolyte levels or some of the balances and concentrations of different. And minerals that are in our systems and if we get too dehydrated that that change in concentration is what results in this becoming excessively fatigued and running into problems with heat exhaustion and kind of hitting the wall and having some problems with continuing activities. So replenishing fluids is very important water generally is considered to be the best one. You'll hear a lot about different athletic drinks and sports drinks that have some of the electrolytes in them. But the thing to keep in mind is that it takes our bodies a while to process those and to get them into the system. And really the best thing to do would be to hit the water General recommendations are to have about 12 ounces or so of water 30 minutes or so before your activity so that you can kind of hydrate before the exercise and tend to minimize some of the dehydration. What about sugar drinks? The sugar drinks are sometimes tough to process for the stomach is the sugar sits in the stomach and some people have problems with getting cramps and just not feeling well trying. Drink those type of fluids during an activity, especially if it's a prolonged activity there. If you're out training for marathons or out on a long bike rides things like that. So water is probably the best thing to use as a source of rehydration while you're exercising. OK the second point he wanted to know about the target heart rate formula target heart rates important when we talk about aerobic activity in particular if I go out and I want to do an exercise and I'm running or biking or working out the benefits of aerobic exercise with regard to improving the health of your cardiovascular system and weight reduction are all based on aerobic levels of exercise and we have this concept of aerobics being turn on the jazzy music and jump up and down and dance around and really aerobics is generic and that it's any exercise or activity where you get your heart rate to predetermine levels, and that's where this formula comes in and there are a couple ways to compute it but the one that's probably used most often is to take 220 and Your age and that value that you come up with is called your predicted maximal heart rate. If I were to put somebody on a treadmill or on a bike into a stress test that is have them doing increasing amounts of exercise and activity to a point where they just couldn't continue anymore. That's about where we'd guess that heart rate would be going and with most people that's going to be up into the 180s one 70s as we get older that number obviously goes down now that's a fairly intense level and so obviously we don't want to be exercising at that rate aerobic levels are typically considered to be anywhere between 60 and 80% of that type of that predicted maximum heart rate. So your target heart rate is figured out by taking 220 minus your age and then taking 60 to 80 percent of that 60 percent is a good good level for people to use as they're just starting to work on an exercise program many people be surprised how quickly they can achieve that 60% and it's a good level to use for starting out working out to work on weight. Troll improving cardiovascular fitness most people probably use between 70 and 80% for their levels. So the way to do it the target heart range is to take the Number 220 subtract your age and then take 60 to 80% of that. That's correct. All right. My guest is Kent Malcomson a physical therapist and good morning. You're on midday and Minnesota Public Radio. (00:13:22) Hello. (00:13:22) Hi, go ahead with your question, (00:13:23) please. Thanks. I'm calling from Saint Paul. I'm a I'm 38 years old and I've always been in pretty good health and I'm a cyclist and last year. I was probably doing about a hundred miles a week and I started having problems with my knees and I went to a sports doctor and I have flat feet so he gave me some exercises to do and then also suggested that I get some Orthotics if I still had problems. Well, I started still a pretty having problems going upstairs and things like that not severe pain or anything, but I went and got some Orthotics and I'm having even more more problems for and Talk to the physical therapist. We're going to try a couple things. I guess. My question is typically is this something that a person has to deal with the rest of their life or with some patients are usually able to come up with some therapies that (00:14:11) work. Well actually the answer your question is both. I'm making a few assumptions here in from what you've told me thinking that your problem is sounds like it's related to the front part of your leg around your kneecap and it's a problem that's fairly common in the general population about half of us have trouble with it at some point in time or another and it falls into a whole Myriad of diagnosis is chondromalacia patella femoral syndrome runner's knee, but basically we're talking about is something going on with Annie that's creating some irritation underneath that kneecap surface cycling has an advantage in that it's a relatively low impact exercise. And so it minimizes some of that pounding force on the knee and the Orthotics. They I think certainly the if you have flat feet, that's one of the Local factors that can make that problem worse, but it certainly much more of a factor when you're involved with pounding weight-bearing activities like running and so the cycling may or may not be a situation where the Orthotics would be terribly helpful more important with that kind of a front of the knee pain and problems with going up and down stairs or having it bent for a long time or kneeling squatting those types of things would be to make sure that your seat height is adjusted correctly and most people if they make a mistake, it's too low when you have your seat adjusted properly and you get to the bottom of the Revolution and if your have the ball of your foot on your pedal, you should have about a 15 degree or so bend in your knee or another way to check that quick is to slide your heel to the pedal and at that point the leg should be fairly straight. If the seats too low typically you end up putting a lot more pressure on the backside of that kneecap and when you combine that with any terrain or going up a lot of heels or selecting gears that are too high or too hard to Pedal it puts a tremendous. Then this amount of load underneath that kneecap. And so those are some suggestions on what you might want to do to correct the cycling or minimize stress on it from a cycling standpoint, but General concerns with flexibility of the hamstrings and the calf muscles are very big part of that problem as well. So I take keep at it with the therapist and a lot of times they'll have some specific exercise programs for you to work on for that problem as far as overall exercises. How does cycling compared with say swimming and jogging and just walking? Cycling Compares quite favorably because of the non-impact status. The one of the disadvantages of cycling is that it does use primarily just to lower extremities or the legs and the way our bodies are built is that our legs are more capable of doing heavier intensity longer time types of functions. That's why considerations of NordicTrack or doing walking or jogging. We're using the heavy hands or something where you hang onto and getting the arms involved makes it a much more efficient aerobic exercise because the arms are relatively light intensity quickly fatiguing type of muscles. And so when we incorporate them into the exercise that does a much better job of loading up our cardiovascular system and kind of getting things turned on to improve our cardiovascular efficiency. So jogging then would be a nice overall one as far as aerobic benefits. Yeah, the downside of it is again the pounding in some people's joints knees and particular can't take That so sometimes you have to vary it a little bit 23 past 11:00 and good morning. You're on with the Kent Malcomson. Go ahead please with your (00:17:36) question. Hi. Good morning. I'm calling from Brookings South Dakota. Hi, I'm a little over 52 years old now and I have a few comments and maybe a question just with respect to the last question on biking as compared to other things. I bike last winter not this one but a year ago because I had a foot problem so I couldn't run one of the side effects was I got a soft butt out of that one and it took quite a few months of running to get hardened up again once once I solve the foot problem. Anyway, my main comment is that I feel that an awful lot of attention and money is spent on people young people that are involved in sports and then of course people in their 20s and 30s that are involved in Personal Sports and not enough attention is being paid to long-term effects of doing various kinds of exercises that those of us in the general population who aren't involved in any sport But realize that we have to sweat to live sure maybe doing and then coming around to a specific item. (00:18:52) Well, go ahead and get your question, please (00:18:54) sir. Here it comes. I have recently come to the quest point where I've decided that I've got to make a choice between starving myself to maintain a certain running speed or give it up Jog and then eat a little more so that I can maintain a certain amount of strength. In other words. I've had to make it make a compromise between strength and in weightlifting which I do for an exercise three days a week or speed and jogging which Do on the other three days a week? (00:19:30) Sure. Well, I think you know what you something question kind of falls into a good area that that as we as we get old, we have to realize that we can still be in very good shape but a 52-year old body isn't the same thing as a 25 year old body, even if you've done a good job of keeping it in shape and doing things and so one of the things with athletes is that they have to realize is to structure goals that are appropriate for what they want to do and what they want to accomplish for instance a runner who is 52 years old might not be running the same types of times they were when they were 25 30 years old, but they may have to restructure some of their goals or some of their activities to say that I want to still be competitive with in that age group and it may mean that sometimes change or that you have to do things a little differently diet or exercise wise now than you did 10 20 years ago. So a lot of that's personal preference in kind of selecting what your goals are and what you want to do the other thing I want to And briefly when you talked about doing the biking and and getting a getting a soft butt out of the deal is it brings up a good point that different types of activities will work different muscles. And if you have that's the whole idea of cross-training and then if you do more exclusively one type of exercise, you can strengthen and get certain muscles in very good shape, but it may not do a very good job of addressing other muscles. What about exercise and diet. If you're on a diet you're constantly dieting is it is it more difficult to maintain your strength and maintain a schedule it is especially if you get two extremes, I think that's one of the one of the big controversies that as you read articles and information on diet and exercise is that there's a fairly big swing as to what the importance of prioritization of those are some some articles will say that exercise is perhaps 80% of weight loss and weight control and diet 20 others will put much more emphasis on the diet component of it and I think what we're realizing, is that the Processes is so complex that died in itself that there's many factions within dieting and that you don't have to so much diet as you do look at what you're eating. You know, it's not just simply reducing your intake but taking a look at cutting down on the fats and and you know eating healthier which may not necessarily mean eating less and then exercise trying to maintain some level of activity that does your target heart rate for 20 to 30 minutes three to four times a week. Well, that's another Point. What about exercising every day. Can you exercise too much? Sure. Absolutely, especially if the intensity of the exercise is quite High when you exercise and use a muscle essentially what you do is to on a microscopic level kind of tear it down and break it down and the body's response to that is okay. We're going to be ready for next time and they try to go through a rebuilding process and get stronger and if you're working Not quite heavily and quite intensely that rebuilding process takes anywhere from 24 to 48 hours and sometimes longer if you've really overdone it. And so if you exercise too often you end up getting stuck in kind of this cycle where you were you tear the muscle down, but don't allow enough time to rebound sufficiently to get stronger and you stay at kind of the same strength levels. So giving yourself an off day or people that do go to the gym. If you watch them, they might be doing upper body routines Monday Wednesday Friday and lower body Tuesday Thursday Saturday so that they're still giving that breakup or that day off in between. Let's go back to the phones. Good morning. You're on Minnesota Public Radio. (00:23:06) Good morning. I'm calling from Lino Lakes. Hi, I'm 40 and I've been exercising for about a year and a half with Denise Austin. She's an exercise physiologist on ESPN and she does a fitness program, but I think you know, it's maybe 22 minutes total when you add the commercials and things right but every day there's the warm-up and then some aerobic and working. Body parts, but I'm not finding that I'm reducing very much. Is that too short a (00:23:33) Time? The time frame is sounds right. But the thing that I would ask you is is again with the all idea of the target heart rate in the aerobic component of it. I mean many people will go out and they'll do these exercise routines or they'll ride the bike and they said Gee I'm working out three times a week four times a week and I just don't seem to be getting anywhere number one oftentimes. It takes our muscles and our bodies a while to understand what we're trying to do in accomplish and and many times weight loss programs or goals that you might establish, you know, or take several months to achieve those but the other thing is that you need to be checking that target heart rate because even though you're doing these exercise programs, if you're not getting your heart rate up into those target heart rate levels, it's going to be relatively ineffective program for doing weight reduction toning. You'll still get some benefit of using the muscle and doing some exercise in maintaining the health of that but for for an exercise in the standpoint of weight reduction and toning and making those types of improvements the Heart rate is really the critical issue know that you're doing enough. What do you think overall of exercise programs that come over TV? I think they've gotten a lot better and that's true for I think most of our exercise programs and that used to be gosh. You've got a you know, feel the burn, you know get intense with this and I think they've done a much better job of incorporating different aspects of the programs of spending more time with the warming up with with doing the aerobic levels and trying to emphasize target heart rates and allowing for some variability of that intensity based on the person's age and their level of fitness and health and then also incorporating cool down and stretching at the end. Those are all very important aspects. I think generally they've done a pretty good job with that Kent Malcomson is our guest on midday today. He is with the Copeland with Copeland physical therapy in the Twin Cities and he's an experts in sports medicine and he's also the physical therapist for the Minnesota North Stars and let's go back to the phone is good morning. You're on Minnesota Public Radio. (00:25:39) Hello. Well, I'm trying to follow up some of your ideas in relation. To specialized exercise for people with a special problems such as I happen to have let's call it Advanced stage overweight and recently some sort of a arrhythmia atrial fibrillation. So I'm curious about getting let's say getting in shape and how to take that into account cardiologist said just stay with walking but I think he's very conservative. How does one deal with this kind of a situation taking into account these recommendations for target heart rate and what you can do to get in shape Beyond just (00:26:25) walking. Well, you already mentioned one word that makes me feel a whole lot more comfortable about that and that's cardiologist. I think that General recommendations are that if anybody is between 35 and 40 or older and is looking to begin or start some type of an exercise program and have not been particularly active. For several years is to have a thorough General physical before you start an exercise program. You mentioned the atrial fibrillation. That's a particular heart condition. And there are many things that can turn up on those evaluations and doing stress testing that may necessitate modifications of an exercise program that certain types of exercises might be better for you than others certain guidelines may have to be enforced for you as far as target heart range Etc and certainly walking swimming stationary biking those are probably three of the easiest things to begin with that can be used for exercise programs that are relatively non-stressful on our joints, but can be fairly efficient and you may need to just start off with a very very basic very light walking program in progress from there. And because of the heart condition may have to establish more longer-term goals and expect to see changes or results may be over six months rather than somebody might be looking at three months, but I think the fact that you've Cardiologist working with you on this is very important and certainly that'll be an excellent source of information for you and helping to structure an exercise program. Overall how good of an exercise is walking? I've heard it appraised quite a bit walking is very good. You have to again the the target heart rate is important. You have to be able to check and know that you are walking at an intensity or a pace that's brisk enough to get to accelerate your heart rate. You can improve the efficiency of that by utilizing the heavy hands are getting the arms more involved into it. And that's some of what we've seen the popularity of the of the race walking as you see people cruising around the Lakes like that and you know, they get a lot of snares and Giggles because they're moving so funny and got things going in directions that we didn't think we could move it but it's a very good way to do it. However still does require some attention to preparation for the activity in the thing that in race Walker's that I've seen or people that do walking more extensively as an exercise is that the calf muscles are very very important to make sure that Flexible enough strangely enough, you need to have better flexibility for walking as an exercise in your calf muscles, then you do for running and so making sure that you're paying attention to doing the calf stretch where you lean against a tree or against the wall and or feeling that pull in your calf is very important to make sure that you're getting that muscle stretched out. This is midday for Saturday and we're taking your calls. Good morning. What's your question? (00:29:10) Hi, I'm calling from Bloomington, Minnesota. Hi. Hi, I'm 45 years old and I've been jogging for about 12 years 15 to 20 miles a week and last summer. I developed pain on the bottoms of both feet and I've never had problems before and I've changed shoes twice since then, but the pain is still there bottoms of both (00:29:32) feet. Does it seem to be that it's more towards the base of the toes or more I can the arch itself (00:29:39) it mostly in the heel but also all the way up to the balls of the feet behind the toes (00:29:45) okay with it being more in that area. I would tend to suspect more it being involving some of the planner fashion the foot many times some of the injuries that we have our overuse injuries. And that means that the amount of flexibility or strength that we have for that activity doesn't quite match with the demand of the exercise is and these are problems that might show up over the course of weeks months or years of doing that particular activity with Runners and foot problems plantar fasciitis our heel spurs or something that usually are long term developing types of problems and certainly getting an evaluation by a podiatrist or an orthopedic physician that specializes in foot problems might be helpful in determining what exactly are diagnosis or problem is, but making sure that That your shoe is supporting your foot adequately enough and changing shoes often enough is important with Runners most of the shoes that that we have in the cushioning and shock absorption with them is good for anywhere from about 300 to 500 miles and in somebody that does a lot of running that may mean that that shoe is has lost a significant amount of its support and shock absorption over the course of four to six months and the shoe may look fine, but it's not doing the job in supporting the foot anymore. What should you look for in issue and you have to pay triple digits to get it shoes can be terribly expensive and cost you well over $100, but that doesn't necessarily mean that it's the shoe for you or that it's the best shoe. I know that many of the running magazines in their spring issues in particular and in March and April have evaluations of running shoes and that's always a helpful source to look at and getting an idea of what type of shoe you might want to get. There are a lot of considerations for What type of mileage you run what your body size is what terrain you're running on and what your foot shape is somebody who's got a pronated or a flat foot might need a shoe. That's got a lot more arch support in it than somebody who's got a higher Arch and so taking all those things into mind and and also getting some feedback from somebody that's got some expertise in that and a lot of the the running shoe stores. I'm you know, I'm not an expert on all the shoes. They come out so fast and furious and have all new things all the time that it's hard to keep up on it, but going to someplace like Marathon Sports or GBS sports or any of the places where they specialize with the running that you can get some very good feedback on on what your shoe selection might be. We'll get back to the phones with the Kent Malcomson after I tell you about a new service for public radio listeners. It's now in operation the public radio music Source, it will enable you to call an 800 number with questions about any records or compact discs and you Then order them for home delivery if you want the proceeds from the sales will help support this Minnesota Public Radio Station the number FYI. He might want to write it down. The music Source number is 1-877-560-4440 is Kent Malcomson of Copeland physical therapy in the Twin Cities. He is a physical therapist taking your calls answering your questions will go back to the phone. Good morning. You're on Minnesota Public Radio. (00:33:00) Good morning. I'm calling from West Central Minnesota. Hi, and I've got I would like him to address stress fracture in the foot and also a severe ankle strain when you are using the wrap is the Ace Wrap better than the preformed wrap that you can buy. And also have you are you acquainted with muscle massage therapy if you use that? I'll hang up and listen. (00:33:30) Okay, thank you with regards to stress fractures. They are again fall into that overuse category of injuries. It's something that results from repetitive trauma and pounding to an area of the bone that has become weakened. It's not a fracture in the sense of the bone actually breaking and taking an x-ray and seeing a lot of deformity with it. And in fact many stress fractures cannot be seen on an X-ray the Physicians will do a specialized test called a bone scan in which they inject a Dye or special radioactive isotope into which has an affinity for areas of bone that are undergoing growth and then they take an x-ray later and it shows up as a hot spot and with a stress fracture the mode of treatment is basically it has to heal and even though it's not a broken bone in the sense of what we can see on an X-ray. It still has to go through that same healing process that a boned would and so Usually that means that you need to discontinue the pounding types of activities for the better part of four to six weeks. Sometimes they require casting or mobilization sometimes not but then we have to take a look at why did that's for more? Why did that start and oftentimes? It's related to a mismatch of the function of that foot or that leg to the activity level with respect to flexibility strength training. And so it usually requires some change in what you've done up to that point with your preparation and activities with regard to the ankle sprain question. A straps have a disadvantage in that they're only as good as the expertise of the person that's applying them the pull on types of wraps are much more convenient and apply maybe a little bit better distribution of pressure. Ace wraps typically have to be wrapped about every three to four hours if you are using them because they do have a tendency to slip and slide and lose some of their compression and then with regard to muscle. Therapy or massage techniques that something is a physical therapist that you know that we do quite a bit of that as part of our overall bag of tricks that we have in treating different types of problems certainly massage therapists have more specific expertise and utilization of that as a treatment technique but massage therapy can be very helpful for muscles that are our tents or what we call hyper tonus that they're in spasm or knotted up the can also be very effective as a post exercise or activity technique for helping to wash some of the metabolites in the lactic acid out of the muscle so it can be a very helpful technique as part of treatment or a post exercise activity any suggestions on what to do after exercise should one sit should one keep a little bit active for should one wait before eating. After exercise is generally a good idea to try and continue to have a cool-down phase and this does a couple of things if we're exercising especially a fairly intense levels are heart rate is up there. It's pushing blood through our system to the muscles to the brain. If suddenly we stop exercising then we lose some of the efficiency of that circulation from the muscles Contracting and relaxing and now it puts all the onus and responsibility on the heart to make sure that blood is getting circulated effectively through our bodies and if we suddenly stopped exercising this is what can sometimes could tribute to some of the lightheaded dizzy kind of feeling and so it's a good idea to try and if you've been running to go ahead and continue walking for a little while and kind of cool down do some stretching do some calisthenics and that's typically a European technique that they do a lot of post exercise activity. All right. We'll go back to the phones. Good morning. You're on Minnesota Public Radio. (00:37:18) Good morning. I'm calling from northern Minnesota. Hi there. I have a couple of questions you did State and is widely agreed upon that person should have a couple of rest days a week. Does this mean total Couch Potato rest is one of my questions another one. Does this also apply to stretching or should stretching be done daily. And my third one is Every Spring, although I've been a very active during the winter months cross country skiing for five days a week and swimming. When I start walking more extensively the muscle in the front of my shin gets extremely tender and I'm just wondering if that is perhaps because of improper walking technique or shoes or (00:38:14) what let's take that the walking question first there. It's something that is painfully obvious to people that are doing running and walking and Hiking early season that particular muscle is one in the front of your leg called the anterior tibialis and in normal walking. It doesn't have a whole lot of work to do basically all that muscle does is just lower your foot to the ground when you are running or brisk walking it now has to perform that function under a much accelerated timeframe and the demand and activity on that muscle becomes a lot more than it is just with regular walking and this is one of the problems that falls into the category of kind of what we call it. Average term of shin splints. I kind of cringe when I hear shin splints because as a therapist, I there about five or six different specific problems that are fall into that category. And each of them have kind of some unique aspects to the particular muscles or tendons that are involved and what we need to do treatment-wise and what the patient needs to work on for stretching and strengthening. So I think the fact that you notice that in the spring is Not Unusual it's typically a that particular muscle as a fairly short-lived soreness that normally after a couple weeks of being into that particular activity the muscle regained some strength and control and generally feels better with respect to the day off with stretching and strengthening that's apples and oranges many people think that when they do a good exercise program that they're accomplishing both for stretching and strengthening and that and that's just not the case exercises for strengthen our one thing exercises for stretching or another and with the strength. Exercises typically it is a good idea to do the day off in between. But again, it depends on the intensity activity. If you're not working at all that hard it may be perfectly fine to do that every day, or maybe do a weightlifting on Monday Wednesday Friday and aerobics on Tuesday Thursday Saturday so that you're getting a different type of exercise even though you're exercising every day stretching is something that you can't go wrong by doing too much with at least not very often where you can go wrong on stretching is trying to go too hard and that when a muscles only going to stretch out at a certain rate and the best way to stretch it if you have a tight muscle is to do stretch it daily spend about five or six minutes working on that muscle holding a moderate comfortable stretch for anywhere from 15 to 30 seconds relaxing for a few seconds and just spend that five six minutes repeating that stretch. What about the couch potato? Couch Potato ensure feels good on some days and sometimes you do need to do a day off especially for the people that are having a training regimen for either biking synturion races or running marathons. If you look at a lot of those training schedules, they actually do incorporate days off and days rest because the body does need to chance to kind of catch up from some of those extremes of intensity. If you just listen to your body will your body tell you what it needs or doesn't need if you need to exercise or and you need to rest. What should you look for for the most part bodies give us a pretty good Clues as to what we need to do or how we need to take care of it. Unfortunately a lot of times we don't do a very good job of listening to it. But for instance if you have a if you're running and you have a sore muscle the body will give you some ideas to how Intense or how significant that problem is by what it does over the next few minutes a muscle. So stiff and hasn't been warmed up adequately perhaps you may feel some pulling her some tightness, but over the course of the next few minutes of running. It seems to go away and dissipates. I like to use or use an analogy of a stoplight with with my athletes for my patients and then if they're doing something and it feels fine. That's the green light if they have a problem that's a yellow light and now the next few minutes, we'll tell them whether that lights going to go green or red if that tends to dissipate and go away. Let's find a continued still monitor your body's reaction and symptoms if it doesn't go away or continues to get worse. That's a red light. That's an indication that there's something going on there that the body just just doesn't like that and it needs to be discontinued and get that checked into physical therapist can to Malcomson is our guest for the next 10 minutes or so. We'll go back to the phones. Good morning your question, (00:42:41) please hi. Good morning. I'm calling from Savage Minnesota and I'm 50 years old. I've been running for Half that time three to five about three times a week and my question is is I think I'm routinely getting up right around my target heart rate. Is there a risk there? I guess with the frequency. I'm working out. I don't see it. I see that's where I need to be as a comfort zone appreciate some advice on that say for the long (00:43:16) term. Well, it sounds just fine again when we talk about exercising for Health weight cardiovascular benefits doing that exercise three to four times a week doing it with the duration of at least 15 to 20 minutes. And that's at the target heart rate that your exercise routine May certainly be longer than that if we incorporate warmup time stretching time, and then at the end cooldown time, somebody may have an exercise program or running that they do for half an hour an hour two hours. But we know that there's a minimum time for the aerobic benefit and that's that that you know, 15 minutes or so. You can do longer than that and that would be some personal goals as far as how much beyond that you went. But I think it sounds like you're you're doing just fine and you mention the comfort zone that it's something that you seem to be into a routine with and it sounds like you're doing just fine a lot of people belong to health clubs. What should you look for when you're considering that what kinds of exercise equipment or facilities are the most important? It's actually I think a lot of the health clubs are fairly competitive with each other as far as the types of equipment that they have. One of the big issues is the availability of that equipment in that you get to a health club. That's a very popular one and you have to sign up for using that stair stepper a 30 minutes from now. So having a health club where you have some reasonable time frames of accessibility of equipment is I think important but the types of things that most health clubs have that I think are good to look for with with variety of exercise or certainly the complement of Nautilus or Eagle Equipment for doing more of the isolated muscle strengthening weight training types of things. But then also the aerobic equipment as far as the different types of exercise bikes fit runs lifecycles you bees which is upper body or gone there, which is basically a bike for using the arms the stair steppers treadmills, all of those are Are very viable useful pieces of equipment for doing aerobic exercise. Okay. Let's get another question. Good morning. You're on. (00:45:29) Midday. Good morning. I'm calling from Pine City. I'm 39 and a real big Honker. I weigh about 400 pounds and my doctor suggested I get a Nordic Track and use it and a couple of questions. If I may one is as it seems it's taking me forever to get used to the NordicTrack to just be comfortable. I'm not talking so much about getting tired out on it as much as I am just feeling comfortable on the machine. It took me a while before I wasn't like falling off and getting coordinated it and now I just can't keep up a movement for very long. And as I say, I'm not really getting exhausted but it's hard to I guess be coordinated for more than about seven eight minutes and to feel like I'm just up there moving along. The other thing is that I find when I'm done with it, especially if I'm watching when I even thought I wind up with such a tremendous amount of energy sometimes for a day or so afterwards that I'm somewhat uncomfortable with it. And I don't know that that's an indication of a problem or if because of my very low activity level. I'm just not used to having energy and it's and I'm uncomfortable with it. (00:46:48) Sure. I think there's going to be some changes in that you notice with your energy level and how you feel that that especially if you're you know being at that weight and trying to get into an exercise program that your body is going to go through an awful lot of changes as you try and get into an exercise program and try and lose some weight. NordicTrack is a very good piece of aerobic exercise equipment. But the thing is that you have to have that coordination to be able to use that certainly somebody that's done cross country skiing in the past is going to be much more comfortable on that piece of equipment and used to doing that. One of the things I suggest for patients is to break up the And get on the piece of equipment and just do the leg component and and have that be part of your exercise routine and then do just the arm component because first before you get into a fairly complicated multi limb exercise like that, you need to train those muscles to work in a coordinated fashion and it sounds like that to begin with that. You're just asking too many different things to do stuff. They're not used to doing and not getting the benefit out of it. So I'd break it up and work with just the leg part the work just the arm part get comfortable with those and then try and integrate the movements. Okay. I think we have time for one more quick question and answer. Good morning. You're on. Midday. Go ahead, please (00:48:02) I'm going from st. Paul and I have two young children. And so I often do the exercise videos at home on TV and my four-year-old daughter likes to watch and sometimes participate but she gets frustrated easily. Is there a children's video exercise to do you recommend (00:48:18) I'm not specifically familiar with children's exercise videos. Certainly, most of the public libraries would be a source. We could take a look at those or a lot of the bookstores that would carry those. I can't really speak to one particular that I would recommend. I think it's just good that she enjoys doing it because at that age they're doing a lot of things and trying to get muscles coordinated and skills. And even the fact that she's in there trying to do things certainly should be, you know, some encouragement and praise from you that she's in there trying to work away at it and work on those. So I just encourage you to do that and shop around a little bit. I don't have a particular recommendation for you for a video though. Okay. Thank you for the call. Thanks to all those who called over the past to 50 minutes or so for those who didn't get through. We apologize, but we will have Kent back with us and take some more calls didn't get one call on the North Stars. No, I'd probably just as well as it's a little sentimental for me right now. So I suspect so thank you for coming by Jim. Thanks very much. It was a pleasure Kent Malcomson is with Copeland physical therapy in the Twin Cities. He's a physical therapist and an expert in It's medicine and he's also as we mentioned a physical therapist for the Minnesota North Stars. This is mid date on Minnesota Public Radio. I'm Jim Wagner time is five minutes before twelve. Midday on Saturday is sponsored in part by the Oriental.