I just read a fascinating article, Metabolism Make-Over: Fact or Fiction?(Idea Fitness Journal, June 2011) by Dr. Len Kravitz, PhD, where he sifts through research about what affects our resting metabolic rate (RMR). RMR is the daily expenditure of energy we expend just by living. So the higher the RMR, the more calories you burn naturally.

The nuts and bolts  of his article come down to this: roughly 60% of our RMR is influenced by genetics, our activity levels, organ size, hormones etc. About 30% is due to effects of exercise, and 10% due to energy from food metabolism, digestion, etc.

He goes on to answer some important questions such as:

How much does RMR decrease from diet-ony interventions? RMR can be suppressed by up to 20% by dieting alone. Exercise will help offset this.

How is RMR affected by long term aerobic exercise? In the 16-month study he quoted subjects exercised 3-5 days/wk for 20-45min/session at moderate intensity. Females saw an average increase of 129 calories/day and males increased 174 calories per day.

How is RMR affected by long term participation in resistance exercise? Dr. Kravitz cited a 26-week study of sedentary 61-77 year old men and women. The study’s protocol involved 2 sets of 10 repetitions with 2 minutes rest between sets for an exercise program involving arms, abs, and legs. They trained at 65%-80% of their 1-repetition maximum. Participants increased their RMR by an average of 7% or about 100 calories/day.

How do you calculate your RMR?

Males: RMR= 10 x (weight in Kg) + 6.25 x (height in cm) – 5 x (age in years) + 5.

Females:RMR= 10 x (weight in Kg) + 6.25 x (height in cm) – 5 x (age in years) – 161.

1 Kg = 1 lb divided by 2.205.

1 cm = 1in x 2.54

These formulas  have a margin of error of about 10% due to genetics and other factors.

Does eating more frequently elevate RMR? Yes. If you refer back to the percentages above, 10% of your RMR is derived from the energy expenditure of eating and digesting food.

If you have questions about these studies or your RMR, I highly recommend you read this succinct, reader-friendly article! I’d love to hear your comments.

Just saw a patient today with foot pain. I noticed the non-painful foot has prominent hammertoes. After further testing I discovered she had a retroverted femur (a femur that is twisted into external rotation). I asked her to change her gait pattern to accommodate her retroverted femur. When she did, her hammertoes diminished. After I pointed this out I asked her to resume her old walking pattern and we both saw the hammertoes rear up again.

I believe that, in order for her to walk with what she believed to be a proper gait pattern, she used excessive force to swing through the leg while advancing it. She used her foot and toe dorsiflexors to achieve this, contributing to her hammertoes. Once we corrected her gait to reflect her femoral rotation, less effort was required and the toes remained relaxed.

We also found that this unloaded the opposite painful foot, which was compensating for the increased stress to the non-painful side. This will be an interesting case to follow!

Was just at a kids running fundraiser where pre-school through second graders ran around an 1/8 mile track as many times as they could to raise money for their school. It was so much fun! I couldn’t help but notice that every child ran with a forefoot strike pattern. This lends credibility to a new foot strike paradigm I’m using to help fix peoples’ foot and ankle pain.

I’ve been working with a woman with shoulder issues and she’s come a long way! No more pain and doing exceptionally well getting back into exercise. A few months ago, however, she developed burning biceps pain in both her arms. It was constant and didn’t seem to have a mechanical or neurological cause. This baffled us for quite a while.

Then we began talking about her diet. Specifically metabolic typing, which one of my other clients has been trying and who has discovered a great deal about foods that are affecting her diet and mood. Anyway, one of the things we learned was that the foods she craved the most, happened to be the worst for her. Once she cut those out, her weight dropped, energy went up, and she felt much better overall.

So I talked to my burning biceps girl about this and we discovered that her favorite foods were coffee and tomatoes. As an experiment, we decided to cut coffee out of her diet to see the effects, if any, on her burning biceps. She is now two weeks without burning! I have no idea as to the reason and the burning may come back but this is the longest stretch of time her arms have been burn-free. I thought this was fascinating. If you read my blog about gluten and carpal tunnel syndrome, then you’ll see how well this fits into my Threshold Phenomena theory.

I’d welcome your stories or comments!

I’ve been working with a client with bilateral carpal tunnel syndrome and, while we’ve knocked down quite a bit of her symptoms, some has remained. This has been perplexing me because, she has improved her mechanics significantly. Finally I talked to her about her diet. She is a very healthy eater however I spoke a little about foods that may be causing inflammation in her system. Gluten products, first and foremost, have a reputation as being inflammatory for many people. So she decided to experiment and cut them out of her diet. She just called to say her pain was significantly reduced as a result! I’m so happy for her.

This speaks to, what I call, the Threshold Phenomena of pain. I believe we all have thresholds, above which, we experience pain. There are a variety of potential stressors pushing us to that threshold. Some are mechanical, others dietary, still others are psychological. I’m sure there are other stressors such as hormones but body mechanics, diet, and psychology seem to be the biggest three I encounter. Each one of these stressors plays a part in our overall health. Sometimes one or two are responsible for pushing us past the threshold of pain while the third is almost non-existent. Each of us balances these stressors differently.

For this girl it was mechanics and diet. I’ve seen others who are entirely psychological. To me this reinforces the need to understand the musculoskeletal system even more so I can rule out mechanical diagnoses contributing to pain. Once this is done, we can look to other stressors, like gluten, to solve the problem.

I’d love to hear your comments!

Well, just finished the first Fixing You seminar for fitness professionals and it went very well! Had a great group to work with with varied backgrounds! It’s very exciting to see the lights go on when someone gets a concept. I have to admit, the seminar is PACKED with new information most attendees hadn’t heard before but they did a great job! Thanks to all who attended!

I’m now looking into Columbus, OH for a clinic later this year. Anyone have a suggestion about another city that would be good?

Just read an interesting article in Wall Street Journal. It talked about how more complicated spine surgeries for stenosis are on the rise in spite of lack of evidence as to their effectiveness. I can’t really speak about whether or not more complicated surgeries are warranted. I’m sure in some cases they are.

What I thought was interesting was that the physicians described spinal stenosis as a result of “normal wear and tear”. I would tend to disagree with this comment. I say this because pain associated with stenosis can be eliminated with proper conservative treatment. This doesn’t mean, however, that the stenosis is decreased–just the pain.

In my mind though, this means that the stenosis and the associated pain are separate. Therefore could it be that the stenosis may result from the same functional deficits that give rise to its associated pain? In other words, could the stenosis be a symptom of functional problems–just like the pain? And if this is the case, normal wear and tear would not result in stenosis. Instead abnormal wear and tear would–which means it can be avoided.

It would be interesting to see if stenosis can be reversed (or at least the progression halted) using the same treatment principles that would eliminate the associated pain. Has a study like this ever been tried? Not to my knowledge. I’d love to work with a physician who is up to the task though.

Any thoughts from readers out there? What is your experience with spinal stenosis?

I just finished treating a woman with chronic SI joint pain. She had been a dancer years ago and whose training had created abnormal movement patterns that led to her pain. Her foot strike pattern seemed to be the place to begin helping her as her pain was primarily triggered when standing or walking. I filled her in on my recent hypothesis regarding foot strike patterns and how hers deviated from, what I feel to be, a healthy strike pattern. Once we experimented with changing her standing/walking habits, her pain was immediately reduced. After one week of practice it was completely gone.

This makes me appreciate the essential connections between foot strike patterns and the rest of the body. Although changing how we walk may feel unnatural, it often feels better if done correctly. Now we’ll see if we can help her bunions!

I just read a great article by Gina Kolata from the New York Times. It talked about the fact that no one is really sure how foot orthotics work-but that they do most of the times. Also that many doctors have different approaches to casting orthoses. And that when it comes down to it, there really isn’t a lot of scientific evidence to support using supports.

I think one of the reasons why we don’t have clear evidence is that we don’t fully understand how the foot is supposed to work in the first place. There are many bones, muscles, and ligaments in the foot and ankle which makes it difficult to study function. And when we talk about function, we don’t really know what that is. For the past few decades, correct foot function assumed that we must heel strike when walking or running. With the barefoot movement gaining ground, that basic assumption is being challenged.

In terms of my own experience treating foot problems, I tend to agree with the barefoot movement to a degree. I believe we should not be heel striking as much as we do. I’m testing my theories on foot pain patients and the results have been very encouraging.

That’s not to say orthotics are useless–many people benefit from them. I cast for them myself. However now that I have, what I believe to be, a better understanding of foot function, I consider using orthotics as a last resort. I’m actually talking a lot of people out of them–or I should say treating them out of them. Although I have more research to do, I feel I’m onto a better approach to treating feet and therefore knees, hips, and backs.

So, way to go, Gina! I’m on board with the fact that we don’t really have good evidence for the use of foot orthoses. And I even think we may not need them nearly as much as we think we do.