Down Syndrome and Cardiorespiratory Training

By: Mujuthaba

I’m not aware of the percentage in the Maldives affected with Down’s syndrome. But I have seen ads regarding them on TV, and they were very touching. Please take some time to read this as this may help you to understand the syndrome more in a PT sense. On an average over one in eight hundred births are Down syndrome. Unlike normal individuals, Down syndrome is caused by an increase in an extra chromosome to the twenty first pair, from which gets its name ‘trisonomy-21’. This categorises this syndrome as a genetic disorder.

This common disorder is most prevalent in older women who get pregnant. One in thirty births by women over forty five bear a Down syndrome individual. With the age factor in bearing a Down syndrome child, the maternal parent is primarily responsible for the disorder, where only five to ten percent of the disorder occurs from the male parent. Therefore it may not be a good idea to delay the child bearing age. Since Maldivians have a tendency of getting a family at an early age, this syndrome may not be as common as in western nations. Anyhow this trend could be changing in the Maldives as more people wait to bear children in late life.

One of the main apparent defects of the Down syndrome individual is the mental and motor actions. Even though their action perceives them as being mentally retarded, not all of them are classified as severely retarded. There are many congenital (at birth) defects present in Down syndrome individuals. As a PT the main defects to be taken into consideration are the presence of bone deformations, shorter limbs, heart diseases, the presence of hypotonia, or the decreased strength/tone of muscles and also increased joint laxity (over flexibility).

Hypotonia decreases the function and movement of the limbs as to limit the amount of physical activity in Down syndrome individuals. Even though hypotonia is most prevalent in Down syndrome patients, it is also present in other diseases too. It has shown that this loss of motor functioning is due to the hypoplasia of the cerebellum of the brain, which occurs with age in normal populations.

With a very limited joint motor activity, the ‘active’ child looses his motivation to join in with their normal physically active peers. This trend continues throughout the childhood, unless an effort is made by their surrounding environment. A recent study states that the inactive lifestyle of Down syndrome individuals can be boosted by educating the care-takers of those individuals on the importance of physical activity. This states the importance of motivating the Down syndrome population by providing an active surrounding. Usually the Down syndrome individuals are kept at home by their families, without any involvement with the external active environments.

Unlike most of the normal population, Down syndrome individuals tend to gain weight with age, where the males tend to be overweight and the females obese. Increase in body fat is related to many of the chronic diseases. In inactive individuals the chronic diseases are more prevalent than physically active individuals. To decrease the risk of chronic diseases it is extremely important to take up a physical type of activity that would benefit in the long term. One of the best ways to stay away from chronic diseases is to adopt a cardiorespiratory exercise regimen. Cardiorespiratory fitness refers to the moderate to high prolonged activities which attributes to the efficient performance of the heart, blood vessels, blood, lungs and the contributing muscles during the activity.

It is crucial to investigate the benefits of a cardiorespiratory fitness regimen on Down syndrome patients. Various studies and papers have presented advantages of such a training program. One of these studies refers to the Down syndrome young individuals having a cardiorespiratory fitness level equal to normal individuals of thirty to forty years of age or individuals who have had a heart attack. This expresses the low functional capacity of the lungs, heart and the muscles.

In order to put the Down syndrome individuals on a cardiorespiratory fitness program it is extremely important to outweigh the medical complications that may affect the training. As Down syndrome patients have certain congenital heart disorders, muscle hypotonia, extreme joint laxity and valgus knee posture (inward knee posture), a cardiorespiratory program would be a challenge. Arguably benefits do occur with cardiorespiratory fitness prescription.

Different types of exercise regimens can be offered to Down syndrome patients, with reference from a specialised PT in the area. There are other physiological benefits that come out of endurance type of training for Down syndrome patients. One recent study published in 2006 showed that physical activity in Down syndrome patients increase the function of blood cells. This would conclude that physical activity would increase the oxygen carrying capacity of blood in this group. Another study conducted on Down syndrome individuals show that almost half of the cohort suffers from dementia with age. Dementia is usually the memory loss that occurs with old age or from diseases such as Alzheimer’s, which could affect Down syndrome patients. Six years later a study conducted in 2006 showed that physical activity can prevent the effect of dementia.

In order to see positive results for the individuals it is extremely important to construct a well structured exercise program. In walk/jog program studies, it showed cardiorespiratory fitness improvements and an increase in performing capabilities in Down syndrome individuals. As exercise requires specific movements, it is extremely important to instruct the individual on the exact technique of the exercise mode. It is necessary to make the individual understand the specific movements, or alternatively the exercise could be kept at a basic level to make the individual motivated in the beginning phase. Down syndrome patients should be referred to a medical practitioner for medical clearance prior to prescribing an exercise program. This is important in defining the medical complications of the Down syndrome patient, which may have occurred with birth or with age.

It is extremely important to engage these special populations into physical activity that they are so strange to. This will improve their quality of life, motivation in life and engagement in the society. Most of all be an inspiration for the rest of us. It is our responsibility to see that they live a normal life.

Ladies, Secure Those Breasts

By: Mujuthaba

Atleast 50% of women who undergo a training session complains of breast pain. It is so common to come across this if you are a personal trainer involved with female athletes or individuals involved in a running regimen. It is important for us to get into this and to know why this happens and how this can be prevented.

Breasts are made up of mainly fat tissue, except the nipples which contains muscle fibers that respond to cold and other stimulations. Therefore, clear your minds that the breast is not a muscle group. Since the breasts are not made up of muscle tissues, resistance training of any kind would not help in toning the breasts at all. Breasts lie on the chest muscles (Pectoralis Major and Minor) from where they are held in place by connective tissues known as ‘Cooper’s ligaments’.

Breast pain is mainly caused by strain on the Cooper’s ligaments that try to keep the breasts in place. Bouncing breasts causes the ligaments to loose its ability to hold them in place, hence irreversibly sagging the breasts. Until recently, exercise physiologists had little knowledge and understanding on the effect of breast on training. Modern biomechanics equipment had given an insight on the movement of the breasts during running. From this it is known that with every step the breasts bounce 9cm independent from the body. The breasts also bounce to a figure of eight, up and down, in and out. This makes the strain on unsecured breasts more. These latest studies were conducted by Dr. Joanne Scurr from University of Portsmouth.

Initially the bouncing causes discomfort and pain, and eventually sagging. This would be in contradiction with the training, which is supposed to make the client feel good and look good. There are two solutions for strained breasts. Either take a medication or use a good sports bra. If you intend to use the medication, which doesn’t work for 50% of the people; and for the people which it works, they had to cope with the side effects. So it is always sensible to use a good sports bra, which is effective in securing the breasts and no side effects. The most effective sports bra in the market is designed to reduce the breasts from bouncing by 78%.

Follow these guidelines when you run to shop for a sports bra:

- Should give support from above, below and the sides of the breast

- Should be made of material that is firm, mostly non-elastic, non-abrasive and has good absorptive ability

- Straps should be non-stretch, criss-crossed or Y shaped at the back

- Should have no seams or ridges in the nipple area and no fasteners or hooks

- Should be individually fitted and must be comfortable at rest and during vigorous training

It is important to note that to strain the Cooper’s ligaments, size doesn’t matter. Even a smaller A-cup size breasts could have the effects of strain as an FF-cup sized breasts. So this is for the whole female population to consider. I hope this helps out to those women out there who are skeptical about a sports bra. Make sure the next time you start your training, you secure those breasts.

Being Old is no License to Chill, but to Thrill

By: Mujuthaba

Well, obviously you are not over sixty are you? It is so scarce as to see any of us get into the internet to search for information on getting fit through physical activity. Can you imagine anyone over 60 getting into the internet to search for this information? Don’t think so. So if you are reading this, pass the message and information to the senior citizen/s at home.

Do you know the much media attracted 100-year-old Arthur Winston from Los Angeles? Learn about his life a bit, you may be inspired. "I'm going to keep active. I can't afford to just sit down. I wouldn't do that. I don't drink and I don't smoke, so I feel alright," this was what he said upon his retirement after 72 years at work. Being old doesn’t mean its time to sit on a chair and listen to the oldies music waiting for your end to come; especially when you can live as a 30 year old at 80.

As we cross the 50 year mark, the body looses muscle mass at a pace of 0.4% per year. This is the main reason the normal population gets frail; muscle wasting follows muscle imbalances leading to challenges in holding the normal body posture. To prevent muscle wasting, the only thing that can be done is to stay active.

As we all get old, a number of chronic (long lasting) diseases prevail. Such as heart complications, diabetes, hypertension…etc. Exercise has been proven to decrease the risk of chronic diseases as we age. The latest ACSM (American College of Sports Medicine) physical activity guidelines require a minimum of 30 minutes of moderate intensity exercise for five days every week. This latest change also includes a 2-3 strength training session for both the elderly and normal population.

Aerobic type training is known to increase the cardiorespiratory (collective lung and heart function) fitness and cardiovascular (collective heart and blood vessel function) fitness. This type of training is long duration with a low intensity and lasts for a minimum of 20-30 minutes. As an old individual, this would be a requirement to keep the fitness of the lungs, heart and blood vessels on hand. Aerobic training is also essential to loose fat, which, as we age, starts accumulating in the muscle (intramuscular fat) in conjunction with visceral and subcutaneous fat. An aerobic training can be such activities as cleaning the house, running after your grandchildren or even going dancing. It doesn’t need to be a gym based activity.

Since muscle wasting is an issue in the elderly population, it is extremely important to incorporate strength training into your life as you age. Strength training doesn’t mean you will be bulking up on steroids waiting to be a Hulk look alike at 70. Strength training is essential to retain the muscle mass, that otherwise would be wasted as we age. This type of training also decreases intramuscular and subcutaneous fat, increasing muscle and bone mass. Increase in bone mass retains the bone strength, preventing it being subject to fractures or breaking easily. ACSM recommends a minimum of 10-15 repetitions of 10 strength training exercises per week for the elderly.

Maintaining muscle mass means retaining your posture with increased muscle tone and increased muscular strength, eventually preventing falls and ability to be active with healthy aging. It is also extremely important to be doing a strength training program while you are young, which would help you throughout the aging process (which may in time be absent).

If you are an elderly person, instead of sitting around, make a change and start being active. Changes in the body will be experienced at no time and you will start to feel young again. Time never runs out when you are into exercising and it’s never too late to start.

Delayed Onset Muscle Soreness: Masgulha-keun

By: Mujuthaba

Theodore Hough in 1904 wrote about the delayed painful response that developed after an untrained skeletal muscle was introduced to an exercise. This was named Delayed Onset Muscle Soreness (DOMS), or delayed muscle soreness in plain terms. In Dhivehi its commonly named as ‘masgulha-keun’. This although was a familiar pain to many people starting extensive training programs, up to date no solid answer has been formulated, as to why the delayed muscle soreness occurs 24-48 hours after the exercise.

Due to this uncomfortable episode of pain experienced by athletes most of the research is based on various cures for the post-training pain. Delayed muscle soreness has been known to be created due to the lengthening phase of a muscle contraction (eg: effect of a lowering action on the biceps during biceps curl) rather than the shortening phase (eg: effect of a lifting action on the biceps during biceps curl).

Previously lactic acid was blamed for delayed muscle soreness after exercise. Lactic acid is an end product of extensive physical activity, and the main reason why we get tired. Research has shown that (excessive amounts of) lactic acid clearance takes place right after exercise, and clears off from the body in 24 hours. This would contradict the fact that delayed muscle soreness is at its peak 48 hours after exercise, as no excessive lactic acid would remain in the body to cause that pain. So lactic acid doesn’t cause delayed muscle soreness.

Lengthening phase of a muscle contraction (eccentric contraction) causes the muscle to stretch, and is known to damage the muscle at a microscopic level. Biopsies (surgical removal of muscle fiber to study the fiber) and electron microscopy taken after an eccentric phase exercise has demonstrated that there in fact is extensive muscle damage due to this type of training. Since delayed muscle soreness is created overall by eccentric contractions, researchers had linked delayed muscle soreness with inflammation. Inflammation in Dhivehi is termed as ‘dhulhavun’, but since the scale of this is very small, the ‘dhulha’ may not be felt externally as such. Inflammation is the process by which the body reacts to repair any damages to the body. Therefore many researchers headed towards finding more answers connecting delayed muscle soreness to inflammation.

Many conventional methods have been studied to relieve ‘the inflammation’, with no actual effect on delayed muscle soreness. One such study, which was done using cold water immersions to relieve inflammation which did not have an effect on exercise induced delayed muscle soreness. Although some of the studies have shown that there in fact is a relationship with inflammation and eccentric contraction muscle damage.

The other method of explaining delayed muscle soreness is the affect of free radicals on muscles during exercise. The free radicals are byproducts of extensive training and stress. Most notably free radicals are linked to aging. These free radicals are said to increase in number during exercise to create muscle damage at extensive levels. Although, similar to the effect of anti-inflammatory drugs in preventing delayed muscle soreness, there is little effect on delayed muscle soreness from anti-oxidants such as vitamin-C and some fruit juices.

Further methods for reducing muscle soreness

There have been further studies done using various other means and methods. Most of the methods and means used had negative effects on muscle soreness. Such methods include using sensory-level high-volt pulsed electrical current on the muscles, dietary intake of carbohydrates before exercise, static magnetic therapy and combining aqua exercises in training. Neutral effects have also been shown in studies. One such study has been done on effect of massage or soft tissue therapy, with positive and negative effects on muscle soreness. Other studies with positive outcomes have been done, such as studies on hydration during exercise, yoga, protease or protein supplementation and vibration training before exercise.

Muscle soreness after training has been highlights of many researchers as it creates a lot of discomfort in professional athletes, as well as people starting exercise programs for the first time. Research still continues towards opening new doors into further research in this area. For the time being, I would say it is a response by the body to adapt to the new training. Therefore let the muscle get its rest for the three days of delayed muscle soreness that you experience.

Bibliography:

Close, G.L., Ashton, T., McArdle, A., & MacLaren, D.P.M. (2005) The emerging role of free radicals in delayed onset muscle soreness and contraction-induced muscle injury. Comparative Biochemistry and Physiology - Part A: Molecular & Integrative Physiology, 142(3), 257-266.

Davis, J.M., Murphy, E.A., Carmichael, M.D., Zielinski, M.R., Groschwitz, C.M., Brown, A.S., Gangemi, J.D., Ghaffar, A., & Mayer, E.P. (2006) Curcumin effect of inflammation and performance recovery following eccentric exercise-induced muscle damage. American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 292(6), 2168-2173.

Powers, S.K., & Howley, E.T. (2004) Exercise physiology: Theory and application to fitness and performance. (5^th Ed.) McGraw-Hill, New York, NY

Braun, W.A., Flynn, M.G., Armstrong, W.J., & Jacks, D.E. (2005) The effects of chondroitin sulfate supplementation on indices of muscle damage induced by eccentric arm exercise. Journal of Sports Medicine & Physical Fitness, 45(4), 553-560.

Yu, J.G., Malm, C., & Thornell, L.E. (2002) Eccentric contractions leading to DOMS do not cause loss of desmin nor fibre necrosis in human muscle. Histochemistry and Cell Biology, 118(1), 29-34.

Colgan, M. (1993) Optimum sports nutrition: Your competitive edge. Advanced Research Press, Ronkonkoma, NY

Close, G.L., Ashton, T., Cable, T., Doran, D., & MacLaren, D.P.M. (2004) Eccentric exercise, isokinetic muscle torque and delayed onset muscle soreness: The role of reactive oxygen. European Journal of Applied Physiology, 91(5-6), 615-621.

Connolly, D.A.J., Lauzon, C., Agnew, J., Dunn, M., & Reed, B. (2006) The effects of vitamin C supplementation on symptoms of delayed onset muscle soreness. Journal of Sports Medicine & Physical Fitness, 46(3), 462-467.

Tourville, T., Connolly, D., & Reed, B. (2006) Effects of sensory-level high-volt pulsed electrical current on delayed-onset muscle soreness. Journal of Sports Sciences, 24(9), 941.

Close, G.L., Ashton, T., Cable, T., Noyes, C., McArdle, F., & MacLaren, D.P.M. (2005) Effects of dietary carbohydrate on delayed onset muscle soreness and reactive oxygen species after contraction induced muscle damage. British Journal of Sports Medicine, 39(12), 948-953.

Mikesky, A.E., & Hayden, M.W. (2007) Effect of static magnetic therapy on recovery from delayed onset muscle soreness. Physical Therapy in Sport, 6(4), 188-194.

Junichiro, T., Keiji, I., & Junichiro, A. (2006) Effect of aqua exercise on recovery of lower limb muscles after downhill running. Journal of Sports Sciences, 24(8), 835.

Moraska, A. (2007) Therapist education impacts the massage effect on postrace muscle recovery. Medicine & Science in Sport & Exercise, 39(1), 34-37.

Zainuddin, Z., Newton, M., Sacco, P., Nosaka, K. (2005) Effects of massage on delayed-onset muscle soreness, swelling, and recovery of muscle function. Journal of Athletic Training, 40(3), 174-180.

Heymanson, N., & Hiskins, B. (2006) Delayed onset muscle soreness and soft tissue therapy-What makes good research. Sport Exercise Dynamics, 10, 8.

Hart, J.M., Swanik, C.B., & Tierney, R.T. (2005) Effects of sport massage on limb girth and discomfort associated with eccentric exercise. Journal of Athletic Training, 40(3), 181-185.

Cleary, M.A., Sitler, M.R., & Kendrick, Z.V. (2006) Dehydration and symptoms of delayed-onset muscle soreness in normothermic men. Journal of Athletic Training, 41(1), 31.

Cleary, M.A., Sweeney, L.A., Kendrick, Z.V., & Sitler, M.R. (2005) Dehydration and symptoms of delayed onset muscle soreness in hyperthermic males. Journal of Athletic Training, 40(4), 288.

Boyle, Colleen A., Sayers, S.P., Jensen, B.E., Headley, S.A., & Manos, T.M. (2004) The effects of yoga training and a single bout of yoga on delayed onset muscle soreness in the lower extremity. Journal of Strength and Conditioning Research, 18(4), 723.

My shins are hurting: Can I call it Shin Splints?

By: Mujuthaba

Usually the term referred to anterior lower leg pain (shin pain) by physical trainers (PTs) is 'Shin Splints'. Is this an appropriate term to refer to shin pain, or is this term collective?

I personally have experienced 'shin splints' in the days I did my running. There were times when I had to stop running after 3-kms in a 10km run, just because of the stinging pain in the shins. Although after a minute or two of walking phased out the pain. I knew something was going on in my shins, and it was not pleasant. During my days as a PT for MNDF, 'Shin Splints' was the major cause of unpleasantness and injury for the servicemen I trained. Since this is such a common injury in recreational and competitive runners, I thought it would be a good to share the causes of the collective term 'Shin Splints'.

Shin pain in runners is mainly caused by three major factors:

1- Stress Fractures: This is caused due to over-training, in which case applying a lot of stress on the bone. The strain on the bone causes stress fractures, which gives rise to extreme pain, normally in the most anterior bone of the lower leg, the tibia. To avoid stress fractures, it is best not to over-train and to avoid running on hard surfaces.
Diagnosis &Treatment: Increased pain while jumping action or continuous pain at night and while at rest are symptoms of stress fracture. Rest is the best treatment. You can still exercise by means of swimming, cycling or water running. Stress fractures are usually microscopic, and may not show on normal x-rays. Generally they are visible on MRI and CT scans.

2- Inflammation: This could either be the inflammation at the insertions (to the bone) of the lower leg muscles, or inflammation of the outer-most layer of the lower leg bones (periostitis). Again, avoid over-training, running on hard surfaces and also use an appropriate shoe for running.
Diagnosis & Treatment: If shin pain subsides after a warm up or after five minutes into your 5km run, then the pain is probably due to periostitis. Ice therapy, appropriate rest, deep massage therapy and an anti-inflammatory drug to deviate inflammation may help. Visible on MRI scans.

3- Compartment Syndrome: A very complicated issue for runners. There are ten muscles that cover around the two bones of the lower leg. These muscles are grouped into four muscle compartments, where each is surrounded by a sheath or fascia. Compartment syndrome is caused when this fascia looses its ability to stretch with the muscle/s it surround. This applies a lot of pressure on the fascia (which doesn't stretch), causing pain, numbness at the feet and sometimes lower leg hernias. Main cause of the fibrosis (hardening) of the fascia is from over-use followed by inflammation. The affected compartment to this syndrome is normally subject to the form in which the runner uses his/her foot (biomechanics).
Diagnosis & Treatment: If compartment syndrome is present, the pain during running would not subside, but it will get worse. This pain will disappear only after a couple of minutes rest. Treatment is usually by means of training reduction and deep massage therapy. If this treatment fails, surgery could be the only option (fasciotomy).

I hope this helps you to categorize the type of ‘Shin Splints’ you are associated with currently. It may not be that you have just one cause listed above; there could be two or all three present.

As you can see, it is extremely important to avoid over-training your legs (or any body part for that matter) as this is the main reason for the three causes of lower leg pain.

Bibliography:

Brukner, P. & Khan, K. (2005) Clinical Sports Medicine (2^nd Ed.) McGraw-Hill, NY.