Progress or Plateaus

Most people will encounter plateaus at some point during a consistent training program. Learn more about what plateaus are and what to do when they arise in this article written by Jeff Gilliam, PhD, PT and published on physicaltherapist.com. For more questions call us 619-756-7500!

 

So often we see such great progress as we begin our weight loss program, pushing onward to our goal at a jackrabbit pace, only to be met with a discouraging plateau. When plateaus are experienced, our first response should be, “Am I doing everything possible to encourage my progress? Am I following through with the program as it’s been designed”??? If our answer is “Yes!” then our next question should be, what has happened to slow my progress, and what can I do to ensure continued progress toward my goal?

During weight loss programs, momentary plateaus are an absolute. Plateaus occur as the body loses weight and no longer requires the same amount of calories to run its basic bodily functions and daily activities. No longer are you carrying around 10, 20, or 30 extra pounds during daily activities, which means fewer calories are being expended now, than when you started the program. Also, whenever you go on a caloric restricted diet, your body becomes very efficient in running its basic bodily functions, and requires fewer calories for the Resting Metabolic Rate (RMR). Lastly, during weight loss programs, typically 25% of the weight loss is from lean body mass, while approximately 75% is from fat. The likelihood of muscle loss is increased when resistance training does not accompany a weight loss program. Maintaining muscle is a key to ensuring that the RMR continues to expend energy at a high rate, subsequently burning calories at a level that will allow for continued weight loss.

When plateaus arise, modifications in your program will be necessary to ensure ongoing progress. Increases in your exercise intensity/time are often required, and a close examination of your food choices may be necessary. In order to offset this trend, it may be necessary to increase your exercise output (an increase in exercise time and/or intensity) making sure resistance training is a part of your routine. Additionally, making sure your protein intakes are optimal will spare lean body mass loss during caloric restriction. The importance of protein in a weight loss program is highlighted by a recent study which found when subjects on an ad lib diet increased their protein intake to 30%, they ate 441 fewer calories each day, lost more weight, and experienced greater feelings of satiety than the lower protein group. Remember at your current weight you’re expending fewer calories at rest than when you started your weight loss journey, which means you must continue to make better food choices to encourage your body to continue to lose excess body fat.

These changes should cause your body to increase its fat burning capacity and is often affective in “recharging” the system and renewing weight loss at an acceptable level. During times in which you experience a plateau in your weight loss, strategic shifts toward better food choices and avoiding those occasional food temptations will allow you to realize ongoing progress. The use of daily exercise to boost your metabolism has been shown to be helpful in offsetting a depression in the RMR.

Remember: Plateaus are only momentary pauses in our progress that will soon be relinquished by making the appropriate adjustments in our dietary and exercise regimens.

Rehabilitation With a Personal Trainer vs. Physical Therapy

When tackling your fitness goals, its important to know your body. Are you looking to improve your fitness level or do you have some injury or pain that you need to heal? Your fitness goals will determine whether you see a personal trainer or a physical therapist. Learn the difference between training with both from this article posted on Livestrong.com and written by Nick Ng. For more questions, call our studio at 619-756-7500!

Rehabilitation With a Personal Trainer vs. Physical Therapy
Personal trainer. Photo Credit Creatas Images/Creatas/Getty Images

Personal fitness trainers design exercise programs and help their clients execute them to maintain or improve health, while physical therapists diagnose, treat and manage pain, injuries and diseases. Fitness trainers often encounter clients with existing difficulties, such as severe back pain and diabetes, and plan activities that blur the line between fitness and medicine. When a problem is beyond their expertise, trainers must refer clients to a proper rehabilitation professional, such as a physical therapist.

Therapist Education and Qualifications

Rehabilitation With a Personal Trainer vs. Physical Therapy
Physical therapist. Photo Credit Jupiterimages/Creatas/Getty Images

Physical therapists must have at least a master’s degree in physical therapy, kinesiology, sports medicine or a similar field. If your bachelor’s degree is not exercise related, you need to complete prerequisites as mandated by a university before applying for the physical therapy program. Physical therapists must also be licensed by the state they practice in, pass the National Physical Therapy Examination and fulfill state requirements such as jurisprudence exams, according to the Bureau of Labor Statistics. They must also take continuing education courses to keep their practice updated to maintain their license.

Trainer Education and Qualifications

Rehabilitation With a Personal Trainer vs. Physical Therapy
Sports Medicine is a degree for therapists. Photo Credit Hemera Technologies/AbleStock.com/Getty Images

The profession of personal training does not have an educational standard and is self-regulated. Trainers can have a master’s degree in biomechanics with five years of experience working at a clinical and athletic setting, or simply a weekend certification with no experience. However, personal trainers should have a minimum of a bachelor’s degree in exercise science or a related field as well as an accredited certification that extends their academic knowledge, such as PTA Global or the National Academy of Sports Medicine. They should also be CPR and first-aid certified.

Scope of Practice

Rehabilitation With a Personal Trainer vs. Physical Therapy
Physical therapists works with injured patients. Photo Credit Hemera Technologies/AbleStock.com/Getty Images

Physical therapists diagnose, treat and rehabilitate patients who have an injury or disease that limits their movement. Their job is to help patients move independently, alleviate pain and prevent disability. They often work with patients with joint and muscle pain, multiple sclerosis, arthritis, cerebral palsy, stroke, spina bifida and post-surgical conditions.

Besides designing exercise programs, personal trainers also coach clients to a healthier and more active lifestyle, help prevent injuries and help clients follow through with their physician’s or physical therapist’s advice. They also screen movement patterns to ensure that clients can move well without pain or severe limitations. Trainers may not recommend diets or supplements, unless they are registered dietitians.

Expert Insight

Rehabilitation With a Personal Trainer vs. Physical Therapy
Personal trainer with client at gym. Photo Credit Chris Clinton/Digital Vision/Getty Images

A personal trainer may perform the work of a physical therapist only if he is a licensed physical therapists also. This hybrid professional may work with a patient with back pain and a high school football player who wishes to gain muscle size and speed.

Some personal training certification agencies provide a clinical exercise certification for trainers who have little or no experience or qualifications in the rehabilitation field. When in doubt, choose a physical therapist over a personal trainer for rehabilitation services.

The Effects of Pronation Distortion Syndrome and Solutions for Injury Prevention

Issues starting at the foot and ankle can cause distress to other regions of the body. Read this article by Scott Lucett, MS, NASM-CPT, PES, CES who is a Senior Research Director for the National Academy of Sports Medicine for great insight on this topic! Then come see us at San Diego Sports Physical Therapy for great exercises. 619-756-7500

Dysfunction at the foot and ankle complex can lead to a variety of musculoskeletal issues in other regions of the kinetic chain that can eventually lead to injury. In this article, we’ll review the common postural distortion pattern, Pronation Distortion Syndrome, its effects on the kinetic chain, and corrective solutions to decrease injury risk.

Introduction

Pronation distortion syndrome is characterized by excessive foot pronation (flat feet) with concomitant knee internal rotation and adduction (“knock-kneed”). This lower extremity distortion pattern can lead to a chain reaction of muscle imbalances throughout the kinetic chain, leading to foot and ankle, knee, hip and low back pain.

It has been shown that excessive pronation of the foot during weight bearing causes altered alignment of the tibia, femur, and pelvic girdle (Figure 1) and can lead to internal rotation stresses at the lower extremity and pelvis, which may lead to increased strain on soft tissues (Achilles tendon, plantar fascia, patella tendon, IT-band) and compressive forces on the joints (subtalar joint, patellofemoral joint, tibiofemoral joint, iliofemoral joint, and sacroiliac joint), which can become symptomatic (1,2). The lumbo-pelvic-hip complex alignment has been shown by Khamis to be directly affected by bilateral hyperpronation of the feet. Hyperpronation of the feet induced anterior pelvic tilt of the lumbo-pelvic-hip complex (3). The addition of 2-3 degrees of foot pronation lead to a 20-30% increase in pelvic alignment while standing and 50-75% increase in anterior pelvic tilt during walking (3). Since anterior pelvic tilt has been correlated with increased lumbar curvature, the change in foot alignment might also influence lumbar spine position (4). Furthermore, an asymmetrical change in foot alignment (as might occur from a unilateral ankle sprain) may cause asymmetrical lower extremity, pelvic, and lumbar alignment, which might enhance symptoms or dysfunction. An understanding of this distortion pattern and its affects throughout the kinetic chain becomes particularly important for recreational runners and walkers as the accompanying stressors to the soft tissues and joints can lead to Achilles tendonitis, plantar fasciitis, IT-band syndrome, and low back pain.

Assessment

When assessing for pronation distortion syndrome, both static and dynamic assessments can be done. When performing either a static or dynamic assessment, have the individual take their shoes off and make sure you have the ability to see their knees as well. During a static assessment, from an anterior and posterior view, look to see if the arches of their feet are flattened and/or their feet are turned out. When performing a dynamic assessment, such as the overhead squat, look to see if the feet flatten and/or turn out and if the knees adduct and internally rotate (knee valgus). These compensations can also be assessed both from an anterior and posterior view. For many, it’s easier to see excessive foot pronation from a posterior view in comparison to an anterior assessment, so assessing in both positions can help in confirming your findings.

Corrective Exercise Strategies for Pronation Distortion Syndrome

Functionally tightened muscles that have been associated with pronation distortion syndrome include the peroneals, gastrocnemius, soleus, IT-band, hamstring, adductor complex, and tensor fascia latae (TFL). Functionally weakened or inhibited areas include the posterior tibialis, anterior tibialis, gluteus medius and gluteus maximus. Following NASM’s Corrective Exercise Continuum programming strategy can help address these muscle imbalances that may be contributing to the distortion pattern (5). First, inhibit the muscles that may be tight/overactive via self-myofascial release. Key regions that should be addressed would include the peroneals, gastrocnemius/soleus, IT-band/TFL, bicep femoris and adductor complex.

The next step is to lengthen the tight muscles via static stretching. Key muscles to stretch include the gastrocnemius/soleus, TFL, bicep femoris and adductor complex. Hold each stretch for a minimum of 30 seconds perform 1-2 sets of each stretch.

Once the overactive muscles have been addressed, activate the underactive muscles. Key areas to target with isolated strengthening are the anterior tibialis via resisted dorsiflexion, posterior tibialis via a single-leg calf raise, gluteus medius via wall slides and gluteus maximus via floor bridges. Perform 1-2 sets of 10-15 repetitions.

Finally, perform an integrated exercise to improve muscle synergy to enhance neuromuscular efficiency and overall movement quality. An example integration exercise would include a multiplanar single-leg balance reach while maintaining neutral foot and knee alignment. Perform 1-2 sets of 10-15 repetitions.

Summary

Pronation distortion syndrome is a common lower extremity postural distortion pattern that can lead to other movement dysfunction patterns throughout the kinetic and ultimately injury. By incorporating static and dynamic assessments of the foot and ankle complex can help to identify this distortion pattern. Once identified, following a systematic corrective exercise strategy can help to improve functionality and movement quality, leading to decreased risk of injury.

References

Powers, C.M. (2003). The influence of altered lower-extremity kinematics on patellofemoral joint dysfunction: a theoretical perspective. Journal of Orthopedic & Sports Physical Therapy, 33:639-46.
Powers, C.M., Chen, P.Y., Reischl, S.F., & Perry, J. (2002). Comparison of foot pronation and lower extremity rotation in persons with and without patellofemoral pain. Foot & Ankle International, 23:634-40.
Khamis, S., & Yizhar, Z. (2007). Effect of feet hyperpronation on pelvic alignment in a standing position. Gait Posture, 25:127-34.
Levine, D., & Whittle, M.W. (1996). The effects of pelvic movement on lumbar lordosis in the standing position. Journal of Orthopedic & Sports Physical Therapy, 24:130-5.
Clark, M. C., & Lucett, S. C. (2011). NASM Essentials of Corrective Exercise Training. Baltimore, MD: Lippincott, Williams and Wilkins.
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