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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.

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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.

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Does blood-flow restriction training work, and who can it help?

Blood-flow restriction training has almost as many applications and names as it has uses.  From: https://www.elitecme.com/resource-center/rehabilitation-therapy/blood-flow-restriction-training-does-it-work/

Some call it occlusion training; others, hypoxic training. Bands, cuffs, and even ACE bandages have been used in attempting to utilize the benefits of the training for a number of desired outcomes.

Yet just about everyone agrees on one point – the practice is gaining popularity due to its effectiveness.

First things first: no matter what name you choose to use, let’s clarify how it works. People, for any number of reasons, may be unable to lift heavier weights or do extensive strength training for a period of time. Whether it’s an injury or another condition, blood-flow restriction training allows the patient to lift lighter weights while receiving benefits similar to people lifting heavier. 

“They can gain strength and hypertrophy without having to work at a particularly high intensity,” explained Pieter de Smidt, PT, DPT, Cert. MDT, MTC, who is the president and owner of Reset-Wellness Physical Therapy in Houston, TX. “That makes it ideal for physical therapy patients.”

De Smidt’s explanation is as follows: the accepted standard is that in order to gain strength or hypertrophy, a person must be able to lift weights that are at least 65 percent of the person’s maximum capacity for that exercise. For example, if you can lift 100 pounds, you must lift at least 65 pounds in order to see tangible benefits in added strength. 

Of course, for people coming off of recent injury or surgery, this is an impossible task. It becomes challenging for the physical therapist to allow these patients to strengthen themselves because of the reduced capacity for exercise and lifting. “I can’t make you work hard enough for the body to adapt,” explained de Smidt.

With blood-flow restriction training (BFRT), however, that same patient who is unable to lift 65 pounds while recovering or while injured can suddenly see benefits while lifting only, say, 20-25 pounds. 

How? Say you want to work your upper body. You wrap a pressure cuff or similar restrictive instrument around the upper portion of that limb, reducing the ability of blood to flow out of the working muscle. When properly performing blood-flow restriction training, blood is able to enter the muscle via arterial flow, but the veins are restricted so that blood is partially prevented from leaving the working muscle. 

“That’s the ideal scenario for repairing the tissues,” de Smidt explained. “But by lifting lighter weights, you’re not providing any mechanical stress or doing mechanical damage to your muscles. Everything you do goes toward growth.

It’s a great way to gain that strength safely, while slowly progressing toward your ability to lift those weights normally. It’s a temporary solution – you don’t need to be doing it forever, just until you’ve safely regained strength and the patient is able to lift heavier items again.”

De Smidt was originally attracted to blood-flow restriction training not only by its ability to create hypertrophy, but by the potential for utilizing the training for prevention in a passive state. “If I restrict your blood flow without anything else,” he explained, “while you’re, say, in a cast, you will not lose your muscle mass or strength if you do this training during immobilization. Otherwise, strength loss and atrophy can occur very quickly.”

Post-injury, post-surgical, post-immobilization – they’re all strong indicators for the potential benefits of blood-flow restriction training. “It works for anyone who has a reason why they’re unable to perform typical, high-intensity exercises can benefit,” said de Smidt. “But it can also be used in your athletic population.”

De Smidt outlined a pair of uses for BFRT in athletes – in-season training, when coaches and trainers are leery of players hitting the weights too hard, or use it as the finishing touch at the end of the workout to maximize the benefit of strength training. “You can reduce the mechanical stress component,” de Smidth said of the first example.

Contraindications

De Smidt cautioned against using the method with post-surgical patients before consulting with the surgeon. It’s also important to account for any cardiovascular restrictions, such as hypertension, before proceeding with blood-flow restriction training. PTs should avoid utilizing BFRT in areas with open wounds or impacted by lymphedema. ANy area with clotting risks or limbs with a dialysis port should also be avoided.

Benefits

Years ago, patients would undergo surgery for vascular necrosis of the hip. These patients were too young for a total hip replacement, so the chosen procedure would require six months non-weight bearing, It’s easy to imagine the atrophy and loss of strength that would take place over that time.

“Initially, we started those patients on a passive protocol, followed by an aerobic protocol, and finally strength training,” de Smidt recalled. “Using BFRT, we saw significant differences in the strength loss as opposed to in the past.

“That’s how I got into this – they were immobilized, they weren’t allowed to do many exercises because of that initial fragility. This allowed us, for a few weeks, to get ahead of the atrophy. Slowly, we made the patients more and more active, and it was nice to see how BFRT helped in that process.”

PTs, OTs, certified athletic trainers, and personal trainers can all benefit by utilizing BFRT similarly with their patient populations. “As long as [the professionals] know how to use it, it can be very effective.”

De Smidt cautioned that each session shouldn’t exceed 10-20 minutes, and that this strategy should not be used as a primary strength-building approach. “If you’re healthy, and able, the research shows you should be lifting heavier weights to gain strength and hypertrophy,” he urged. “Once, twice a week in a healthy person, this can provide a different kind of stimulus because you fatigue much more quickly. You can use it as the finishing touch to a regular workout.”  

BFRT is great for strength training, hypertrophy, aerobic endurance – it can be used to increase a patient’s VO2 max in a short amount of time – and can be performed actively or passively. But by using it at the beginning of a session, de Smidt says you can reduce the patient’s pain, expanding their capacity for exercise throughout the session. After injury, the patient can start day one, while post-surgical patients tend to wait 1-2 weeks before starting through a slow progression. 

Lastly, a few safety precautions: de Smidt says the gold standard is usage of a Doppler to determine lymph occlusion pressure. “Say, at 200, we have no more pulse shown, we work at about 50 percent of that. We don’t want maximum occlusion –the key is doing this safely to maximize its potential.

With several decades of research behind the method, de Smidt says BFRT should likely be used more liberally within the clinical setting, but some practitioners have concerns about safety…

If you would like to learn more from de Smidt himself, sign up for one of his seminars by following this link.

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Crossfit Movements-Clean

Lots of people ask me about different crossfit style exercises. Sometimes they feel intinmidated to go to a crossfit box, other times they want to learn on their own. I’m not a crossfit coach, but I help patients that have pain with lifting weights, or have pain and want to return to lifting weights.

The official crossfit website has a lot of information. Today, we will look at the clean. Often I find people that have difficulty with the front rack position, due to limited upper back mobility and/or limited flexibility of the lats.

A great way to start with this movement is using dumbells, before a straight bar. Click here to see a detailed description

Then you can progress to the barbell clean.

A variation that can be used is the hang clean, where you dont start with the barbell on the ground, which is great if the actual lift off the ground causes you difficulty.

The clean is typically combined with the jerk.

What is difference between the “clean” and the “power clean”?

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Glute Self Release

So many people approach me and ask pain in their glute area. This pain can come for the low back, the hip, the SI joint and from any of the muscles in that region.

Foam rolling and lacrosse balls may or may not work. I like using the Accumobility ball. I do not sell them, nor do I get paid for this post. I just like how they work. Period.

Look at this video and shoot me your questions: https://player.vimeo.com/video/204910867

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What Is Blood Flow Restriction

Getting Popular
Not just for patients, also for athletes
Improve strength, gain mucle mass and increase endurance

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!

Do you want to try Blood Flow Restriction Training?

If you have never tried it, book a session and let me work with you. We have different cuffs, from different vendors and you can see which one you like the best. Email me with questions

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How To

In this series we review popular exercises and show you the proper form, why you should do these exercises and when you should look for an alternative exercise

How To Perform a Hip Thrust

The Hip Thrust exercises has become a lot more popular and for good good reason. For function and overall lower extremity development, you also need to train the backside of the legs, the posterior chain.

Read More Here

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.

Read More Here

How to Improve Thoracic Mobility

The Foam Roller can be used to improve thoracic mobility, esepcially to improve extension which a lot of use due to our forward bend posture.

Read More

How to train your hamstrings

The hamstring is is made of 2 groups, the semis and the biceps femoris. Each responds to different type of exercises.

Read More

How to Squat with knee pain

If you have knee pain, especially pain on the anterior (front) of the knee, give this exercise a try

Read More

How to squat with back pain

If your back is hurting, sometimes you need to alter your leg workout.

Read more

How to Bench Press

Follow these 4 steps to safely perform the bench press. If you have pain with Bench press this post also shows you some alternatives.

Read More

How to do a pull-up

We have videos to show you step-by-step how to master the pull-up

Read More

Coming soon

How to deadlift

How to Squat

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How can exercise help chronic pain?

Answer:

Although resting for short periods can help with pain, too much rest may actually make it worse and put you at greater risk of injury. Research has shown that regular exercise can ease pain long term by improving muscle tone, strength, and flexibility. Exercise may also cause a release of endorphins, the body’s natural painkillers. Some exercises are easier for certain chronic pain sufferers to do than others. Try swimming, biking, walking, rowing, and yoga.

Finding the right exercise for YOU is most important. Not every person with low back pain responds to one type of exercise. Not every person with rotatorcuff problems needs to do the same exercise. The “right” exercise is very individual. However, it has to be an exercise you enjoy!

For people suffering from pain, their initial response is to avoid activity and seek rest. And yet exercise therapy is often prescribed as a treatment option to manage pain. There are known benefits of exercise and regular physical activity. CDC lists following as the benefits of physical activity: controls weight, reduces risk of cardiovascular disease and metabolic disease, reduces risk of some cancers, strengthens bones and muscles, improves mental health and mood, improves ability to perform daily activities and prevent falls, and increases chances of living longer. Exercises and physical activity not only have benefits in healthy individual but also has proven benefits in people with pain and injuries

Aerobic exercise/endurance training and resistive exercise/strength training are two different types of exercises which can be aquatic or land-based. Pain control is achieved differently with different types of exercises.

Prescribing appropriate intensity and frequency of exercise is important in achieving the desired effects of hypoalgesia and therefore you want to seek out a professional who understands pain and will take the time to evaluate you and who will listen to your concerns and most importantly answers your questions about pain.

Research?

An immediate local mechanical hypoaglesic response has been shown to specific exercises of cervical spine in patients having neck pain for at least 3 months. Specific exercises included (1) cranio-cervical flexion with 10 second contraction for 10 repetitions with 10 second hold in between, and (2) cervical flexion endurance exercise of head lift in supine was performed for 3 sets of 10 reps at 12RM with 30 second rest in between sets (each rep lasted for 3 second with 2 second interval between reps).

A systemic review done by Hayden et al, concluded that supervised exercise therapy which consists of stretching and strengthening, and is individually designed improves pain and function in chronic nonspecific back pain.

Martin et al designed an exercise program which has shown to be an effective management for fibromyalgia in short term. Exercise program included aerobic training, flexibility exercises and strength training.

  • Thorén P, Floras JS, Hoffmann P, Seals DR. Endorphins and exercise: physiological mechanisms and clinical implications. Medicine & science in sports & exercise. 1990 Aug. 22(4): 417-428
  • Koltyn KF, Brellenthin AG, Cook DB, Sehgal N, Hillard C. Mechanisms of exercise-induced hypoalgesia. The Journal of Pain. 2014 Dec 31;15(12):1294-304.
  • O’Leary S, Falla D, Hodges PW, Jull G, Vicenzino B. Specific therapeutic exercise of the neck induces immediate local hypoalgesia. The Journal of Pain. 2007 Nov 30;8(11):832-9.
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Back pain? Want to lift?

This might vary from person to person

Everyone is different. Your pain is not the same as someone else’s pain. If you have pain, get a qualified Healthcare Provider that understands lifting weights to help you stay active 

If you have back pain you don’t have to stop lifting, but you may have to adjust your program. Find an exercise and a volume that you can safely perform.

Gradually increase your programming. Most of us get in trouble by doing too much too soon

Pieter de Smidt, PT, DPT, Cert. MDT, MTC
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