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What is Evidence-Based Practice and Why Is It Important?

What is Evidence Based Practice?

What is Evidence Based Practice (EBP) and why is it important? At Reset-Wellness we believe that our programs should be based on the best research out there. EBP is made up of 3 components that together make for the best outcomes.

  • Research.
    What does clinical evidence teach us? We use the SHA and the FMS to create programs that are grounded in evidence.
  • Clinical Expertise.
    Peter’s background and experience as a Physical Therapist is what sets us apart from most other personal trainers.
  • Client’s values and expectations
    If we don’t make a program that fits your needs, you will never achieve YOUR goals.

We combine the best evidence, and our 28 years of experience to create a programs for you, to reach your goals and satisfy your needs. By working together we will achieve the best outcomes possible. You will have to do the work, you will have to make the lifestyle changes, but we will guide you along the way and together we will #UpgradeYourLife

Source: What is Evidence-Based Practice and Why Is It Important?

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FITNESS TRENDS 2016

Reset Wellness is keeping up with the trends in Health and Fitness:

  • HIIT: part of every workout we do
  • Bodyweight training: we offer TRX
  • Outcomes: using FMS to identify your areas of improvement and then we re-assess to see if we accomplished our goals
  • Outdoor activities: when weather permits we train out door
  • Core Training: We incorporate core in to everything we do. It’s at the core of what we do.
  • #ACSMFitTrends

Source: WORLDWIDE SURVEY OF FITNESS TRENDS FOR 2016: 10th Anniversar… : ACSM’s Health & Fitness Journal

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Detox Waters

Try adding the below 5 naturally detoxifying ingredients to your water and take your detox game to the next level.

To detoxify means to remove toxins. Our bodies do a pretty good job of this already, and is why we have livers, colons and kidneys to filter and help remove our waste, but some people like to help the process along, especially when they’re feeling sick, bloated or low energy.

You can use a variety of sources to Detox. Different teas are a popular; Juicing; Eating only raw fruit and vegetables are other common detox routines. But the most safest and possibly best way to start a Detox is to drink lots of water. Our body is mostly water and staying hydrated can assist our body to cleanse toxins from our system

Lemon, Citrus, Cucumber are great additions to water to help detoxify.  Read more

Reset-Wellness Favorites

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You need more than HIIT

HIIT or low intensity, long duration training?

I have been reading more about HIIT versus Cardiac Output workouts.

This article on LinkedIn really made me think even more about this topic. I’m curious to see what others think on this topic? Here is another Great Article on this topic.

I think that HIIT is not enough. You can improve your recovery in between workouts, but building a solid cardio foundation with long duration, low intensity workouts. Not as sexy, but key to a more balanced approach to working out.

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Check out our Wellness Programs

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From Detox to Vacation Bootcamp

Whether you’re looking for weight loss, sport nutrition or healthy aging, we’ll coach you the whole way!  During detox week you spend a week with us at the Bed&Breakfast and we help you to re-boot your wellness.

Read more

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Is the Paleo Diet a Fraudulent Fad or the Healthiest Diet to Hit Mainstream? 

Paleo Diet

Came across this interesting article. The Paleo diet has been around for years. The popularity of Cross Fit brought this diet more into the mainstream. like many other diets there is no real credible research to show that it works.

paleo-burger

What do you think?

Source: Is the Paleo Diet a Fraudulent Fad or the Healthiest Diet to Hit Mainstream? Could It Be Both? | Peter de Smidt, PT, DPT, Cert. MDT,MTC,STC | LinkedIn

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Vacation bootcamp?

Five reasons why bootcamp could help with weight loss

Rather than slogging it out at the gym for months, attending a weight loss bootcamp has a number of benefits and will leave you feeling completely rejuvenated

The idea of focusing on nothing but health and fitness for 24 hours a day may seem a bit intense, but attending a Vacation Bootcamp is a brilliant way to kick-start a new exercise regime.

Rather than embarking on months of post-work gym sessions and morning runs, and getting gradual results, you can fully devote yourself to the cause. It’s like giving your car a full service and a new engine.

Read More

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The Squat Series

Squatting is a key exercise that should be part of everyone’s fitness routine. However, the squat can be limited die to a variety of factors and this can lead up injuries.

I use the Overhead Deep Squat as an assessment tool to see where in the dynamic chain we may find some issues: the thoracic spine; the hips, the ankle, the knee?

The Squat Series

I found a great series of 7 videos that tackles most of the common issues with the squat.

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How to Squat with back pain

If you have pain, or increased pain with your back squat, it might be time to modify your exercise program.

I like these variations to continue to squat, but reduce the pressure on the low back

You will not be able to lift as much weight, but its a good workout. It will also allow you to work on your squat depth.
As you start to feel better and want to return to squats: limit the ROM and use a Box Squat
If you can’t squat at all, try ome loaded step-ups to keep the quads going

Other links

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How To Squat With Knee Pain

👉 The Spanish squat was designed to treat patella tendinopathy but can be used for all lower extremity rehabilitation.

👉 The Spanish squat increases the tension within the lower extremities but does not increase the compressive force in the patella femoral joint.

👉 The increase in tension in the patella tendon due to the quadriceps contraction produces an analgesic effect on the tendon.

The analgesic effect reduces the inhibition of the muscle that occurs when there is a lot of pain.

👉 Seek the advice and treatment of a Physical Therapist if you have anterior knee pain

Spanish squat for anterior knee pain

How to perform the Spanish Squat

The Spanish Squat is used to generate strength in the lower extremities without “over loading” the anterior knee structures.  The exercise involves placing a non-elastic strap behind the knees of the patient and tying the strap to an immovable object. The patient leans back against the strap and squats down to a knee flexion of 70-90 degrees.  Their knees do NOT translate towards their toes and their shin bone should remain perpendicular to their ankle. The patient should keep their torso upright and not lean forward. The squat should be “held” at a level that is not extremely painful in the front of the knee.  The “pain” that the patient experiences should be due to the muscle fatigue in the thighs and buttocks. 

👉The eventual goal is to perform 45 second holds 5x several times per day.  There should be a reasonable amount of rest between squat/holds and can be as long as 2 minutes.

Research

Rudavsky, Cook. Physiotherapy management of patellar tendinopathy (jumper’s knee). J Physiother. 2014 Sep;60(3):122-9. doi: 10.1016/j.jphys.2014.06.022. Epub 2014 Aug 3.

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How to Train Your Hamstrings

Recent recent shows that Hip-extension exercise selectively activates the biceps femoris long head, and the knee-flexion exercises, like Nordic Curl exercise, preferentially recruits the semitendinosus.
So when you want to train the entire hamstring you need to pick exercises from both groups.

When you want to be specific with your exercises because of certain condition, you can do that.

  • For example for people after an ACL reconstruction with a hamstring graft, typically semitendinosus, you might want to go easy of knee flexion exercises early one to avoid a flare-up and then gradually add more exercises like the nordic curl.
  • Sprinters who pull their hammie, usually have biceps femoris issues. So start early on avoid to many hip extension exercises for the biceps and later on you want to really focus on that type of exercises

Good Extension based hamstring exercises

  • Stiff leg Deadlift
  • Hip extension kicks

Good Flexion based hamstring exercises

  • Nordic curl
  • Prone or seated leg curl

Research

Bourne MN, Williams MD, Opar DA, et alImpact of exercise selection on hamstring muscle activationBritish Journal of Sports Medicine 2017;51:1021-1028.

More Hamstring Articles

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What is Glute Amnesia

A study in 2013 showed that hip pain can reduce peak force in the glute max during activities like a bridge or hip extension. Hip impingement can be one of those conditions that causes the glutes to turn off

Some people have been trying to blame the hip flexors and too much sitting for this, but there is no good research to support the claim that tight, overactive hip flexors inhibit the glutes. Both can happen at the same time, but one is not causing the other. It’s more likely thta tight hip flexors and glute weakness are both the result of a back or hip problem.

Others suggest that sitting restricts the blood flow to the glutes. Not very likely, we have been build better than that!!! And again, no research to support it.

What research DOES show is that pain can cause certain muscles to be less effective. Its been done for knee pain and VMO “weakness” and Freeman and McGill did a study where they induced knee pain and tested muscles before and after. Research has also shown that this weakness, which is more a neural inhibition, can continue after the pain has been resolved!!

What do the glutes do?The gluteal muscles as a whole are responsible for:

  • Hip extension
  • Hip abduction
  • Hip external rotation and internal rotation
  • Raising the body up from a forwardly displaced position (think deadlift)
  • Lifting the body out of the stooped position (think squat)
  • Femoral, patellar and tibial alignment (knee pain? check the butt!)
  • Stabilizing the lower back and sacroiliac joint via its attachment into the thoracolumbar fascia (Back pain? check the butt!)
  • Keeps the pelvis level for walking and running

This is quite a list and therefore there are a lot of hip strengthening exercises. The hips are not always weak, but more likely inhibited and forgot how and when to turn on and off.

But they can feel and present as weak and we need to activate them. The Hip Thrust is a great exercise to get glutes going

Research:

Freeman, Mascia A, McGill S.Clin Biomech (Bristol, Avon). 2013 Feb;28(2):171-7.  doi: 10.1016/j.clinbiomech.2012.11.014. Epub 2012 Dec 20. Arthrogenic neuromusculature inhibition: a foundational investigation of existence in the hip joint.

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Bloodflow Restriction training to reduce pain

What is Blood Flow Restriction (BFR) training

Blood Flow Restriction (BFR) training has long been used to build strength and hypertrophy without using high intensity resistance. For those people that can not lift the typically heavier weights needed to build strength or muscle mass due to injury, surgery status, or immobilization BFR is used to get similar results but lifting much less lower weights.

BFR is a safe and effective adjunct to low intensity resistance exercise (LIRE) or aerobic exercise that increases muscle mass, improves aerobic capacity, and aids in repair and regrowth of tissues.

Dr. Pieter L. de Smidt, PT, DPT

BFR can reduce pain

Recent studies now show that BFR can also reduce pain. Rodrigues et al showed that BFR was effective in improving muscle strength, mass, function and health-related quality of life in patients with Rheumatoid Arthritis (RA).

Giles et al showed that BFR had a 93% greater reduction in pain with activities of daily living for patients with patello-femoral (anterior knee) pain.

Research

(1) Rodrigues et al. (2019). Low-load resistance training with blood flow restriction increases muscle function, mass and functionality in women with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2019 Apr 29. doi: 10.1002/acr.23911

(2) Giles et al. Quadriceps strengthening with and without blood flow restriction in the treatment of patellofemoral pain: a double-blind randomised trial. Br J Sports Med. 2017 Dec;51(23):1688-1694. doi: 10.1136/bjsports-2016-096329. Epub 2017 May 12.

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What Is Blood Flow Restriction

Getting Popular

Blood flow restriction training is getting more and more popular in rehab setting and in the gyms. With good reason, as there is a substantial amount of research coming out that shows the benefit of BFR to improve strength and hypertrophy.

Research on Hypertrophy

With traditional workouts you need to load the muscles at least at 65% of their 1 Rep max. So if you can curl 50# maximally, you need to work with 33# to gain hypertrophy. Research on Blood  Flow Restriction shows that you can get the same results with loads as low as 20-30%, so with 10-15# dumbbells!

How does it work?

  • Blood flow restriction training does not break down the muscle like traditional resistance exercise because the loads are so light: So less Muscle damage!
  • But BFR creates huge amounts of protein synthesis due to the hormonal responses the body has to BFR training: So more Muscle growth!

Where do the cuffs go?

The cuffs should be placed either at the upper arm, or at the upper thigh.
Cuff pressure should be 4-5 on a scale of 10 (maximum pressure you can handle) for the upper body and 6-7 on a scale of 10 for the lower body. Always be on the low side. More pressure does not create better results!
If your Therapist or Trainer uses Doppler, its even safer and more accurate!

What Exercises should I do?

Results has also shown that there is a systemic effect: people that used BFR just for upper body exercises, gained lower body strength too. You can basically use any type of exercises, from bike or treadmill to dumbbell or barbell activities. The 30/15/15/15 protocol is what appears the most in the literature. So you perform 4 sets, the first one with a weight that you can lift for 30 reps and then 3 sets with 15 reps each. Rest only 30 seconds in between. If you can not complete all the reps, reduce the weight next session!

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How to do Bulgarian Split Squat

The Bulgarian split squat isn’t an all-around better exercise than the barbell back squat, but if you incorporate it into your plan intelligently, it can help improve your leg development while reducing your risk of injury and muscle imbalances.

Benefits

💪It’s a unilateral exercise, so we can reduce differences between left and right
💪We can work on anterior hip mobility
💪Also develops lower quadrant stability at same time. You engage lower body and your core for a functional workout.

Muscles Worked

✔Quads
✔Glutes
✔Adductors
Calves and core are involved for stability, which make this a good exercise for patients with back, hip,knee and ankle problems.

How to perform a split squat

There are three key parts to the Bulgarian split squat:
You balance on one foot, with your rear foot on a bench or box.
Your back stays more or less straight throughout the whole movement.
You usually hold dumbbells to add weight, instead of using a barbell.

Single leg squat versus the Bulgarian Split Squat

The Bulgarian split squat has a greater range of motion than the single-leg squat, but it’s also harder to maintain your balance with heavy weights. And because balancing is easier with the single-leg squat, that means it’s also easier to use a barbell instead of dumbbells.

Bulgarian Split Squat versus. Lunges

Functionally speaking, the main differences between the lunge and the Bulgarian split squat are the lunge engages the rear leg more, and uses a shorter range of motion.

The lunge also requires even more balance than the Bulgarian split squat, making it less newbie friendly. Even advanced lifters generally can’t use as much weight on lunges, either.

All in all, though, lunges and Bulgarian split squats are very comparable. Use whichever one feels more comfortable to you.

Videos

Bulgarian Split Squat:
Barbell Split Squat
Lunges
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How to Bent Over Row

Rowing Is One Of My Favorite Exercises

Rowing for back, neck and shoulder problems

Rowing exercises might be the exercise Inused the most in the clinic
I use it for patients with back pain to stabilize the torso. I use it for shoulder patients to stabilize the scapula and I use it for neck patients to improve posture

Many of my patients need to improve engagement of the posterior chain and the bent over row does just that. Perfectly! It’s a compound exercise that involves many muscles, multiple joints and is functional.

Key for any rowing variation is to first “set the back” engage your core and back muscles and pull your shoulder blades back and down. Now you have a stable base to pull from.

If you do a single DB row, make sure to pull back and up. Not straight up.

Barbell rowing can be done with palms up or down. With palms up you get more help from your biceps.

Landmine rowing can be done with both arms, or as a single variation and can be fine tuned to work different parts of your back, depending on where you place your feet.

rowing is a must exercise for most of my patients and should be part of all your back and pulling days.

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How To Improve Thoracic Mobility

Here is a good way to use foam roller

Here is a good progression to improve thoracic extension with a foam roll

  1. Foam rolling
    Start by lying on your back with a foam roll under your back.
    Place your hands on your stomach and then slowly roll forward and back across your back using your legs. If you find an area that is more tender or tight, progress to step 2 below and do 1 set of 10 and progress as tolerated
  2. Arching over a foam roll
  3. Head supported
    1. Arms overhead
    2. Holding a weight
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