Pilates is an exercise style that has grown significantly in the last 5-10 years and there are many good reasons for this.  It incorporates strength and stretching into almost all of the movements and is different than most other types of exercises in that it builds significant stability into your body – especially in your core – along with strength.

Exercises in Pilates can be slow and controlled or fast but they are all focused on quality of movement.  Any class that you go to should have an instructor who is watching all of the time and giving feedback on where your body is compensating around a weakness that you might have.

Common classes are mat-based but some of the fun of Pilates is the very cool/funky equipment that you may get on to stress your system and finds it’s weaknesses.  The name of some of the pieces is part of what adds to its “coolness”.  Things like the Reformer, the Trapeze, the Barrel, and the Cadillac!  Very cool!

Back to the serious stuff, some specific benefits of Pilates include:

• Improved posture
• Increased muscle tone
• Increased strength
• Increased Flexibility
• Improved overall mobility
• Increased focus on your breathing
• Improved circulation and decreased stress

As far as an adjunct to Physical Therapy, there are few better exercise styles.  Once your therapist has fixed specific dysfunctions in your system that were causing pain and gone through a progression of strength, stabilization and stretching exercises, Pilates is a natural next step.  It is a great way to stay strong or further progress your stability so that the chance of your pain coming back is very, very small.

If you cannot imagine how mere cornmeal can be turned into a tasty meal,then undoubtedly you have never eaten polenta prepared in an Italian kitchen. Once considered peasant food, polenta is now appearing in even the most elegant restaurants. Earlier in this century, polenta was a staple food eaten out of necessity, sometimes two or three times a day. Some families would dump a big mound of polenta onto a board, and everyone would sit around sharing it. It would be flavored with broth, a little sauce, vegetables or sausages. Polenta is still a staple in many homes in northern Italy today, particularly in the regions of Veneto, Piedmont, and Tuscany, although generally considered “home cooking” and not served for company.

Polenta has had a reputation for lengthy and extremely laborious cooking that originates in its Italian roots. Throughout history polenta was cooked over a wood fire in a central hearth or on a wood stove in a traditional curved bottom copper pot with a long handle called a paiolo. Copper was preferred as it conducts heat evenly, and the curved bottom of the pot exposed a greater portion of the cornmeal to the heat which insured there was no corners for the polenta to get stuck in and allowed for even cooking. The long handle of the pot kept the cook a comfortable distance from both the fire as well as the sputtering cornmeal. Constant stirring with a long-handled paddle, stick, or spoon was necessary to keep the polenta from burning. Today, there are very few of us that still cook over a wood fire, and our heavy bottomed cookware and modern stoves that have burners we can maintain at a constant low heat, allow us to let the polenta simmer away on its own with just occasional stirring to prevent lumps.

Polenta can be creamy, served soft with a scoop of sauce, or firm served as a side dish to grilled or roasted meats, or stirred into soups and stews to thicken and add flavor. Whatever way you choose to eat polenta, the basic principles of preparation remain the same. Although you now can buy instant polenta that can be prepared in under 5 minutes, or even precooked polenta ready to be sliced and fried or grilled, I find the effort it takes to prepare polenta the old fashioned way to be the best.

Basic Polenta Recipe

6 Cups Cold Water

1 Tablespoon Salt

1 Cup Cornmeal

3 Tablespoons Butter

2 Ounces Grated Parmesan Cheese

Bring the water to a boil in a medium saucepan. Add the salt and reduce the heat to medium low. As soon as the water begins to simmer, start pouring in the cornmeal in a thin stream, very slowly while stirring constantly with a wooden spoon to prevent lumps. Once all the cornmeal has been added, keep the water at a simmer, and stir frequently. It should take between 25-30 minutes to fully cook the polenta. Once cooked, the polenta should pull away from the sides of the pot easily. Just before it has completely cooked, stir in the butter and the cheese. Once your polenta is finished cooking, you can serve it the following ways:

Soft Polenta: Use polenta directly out of the pot, topped with sauce or vegetables as desired.

Firm Polenta: Once completely cooked, pour onto a wooden board or a greased baking sheet about 2 inches thick and allow to set. Cut into squares and serve as desired.

Grilled Polenta: Cut firm polenta into squares, brush with oil and grill lightly on both sides.

Fried Polenta: Cut the firm polenta into slices and fry in a few inches of hot oil until golden brown and crispy.

Now that you have the basics of polenta mastered, why not try a few recipes? One of my family favorites is soft polenta served with a tasty tomato sauce as shown in the photo below. Sprinkle on some freshly grated parmesan, and you have a hearty meal. You might try cooking polenta with greens as in the popular recipe Polenta Verde Calabrese. Add grilled sausages for a very tasty, filling meal. You can even use polenta in place of pasta in a lasagne-like dish, layered with sauce and cheese in Polenta Pasticciata. If you prefer a simpler polenta preparation, what could be better than grilled polenta and vegetables?

Old Calabrian Proverb: “If you want your polenta to taste good, only add the flour when the water is singing!”

Recipe compliments of Italian Food Forever

Yoga is a practice that focuses on stretching, breathing and meditation.  Many people are drawn to it because they want to work on relieving stress, get in shape, become more flexible, decrease pain and increase core strength.

There are different kinds of yoga:

• Hatha: One of the most popular types of yoga, hatha yoga is meant to achieve balance between the mind and body. It includes traditional yoga postures for all levels, and is often a general term used to describe a collection of yoga styles.
• Ashtanga and Power Yoga: This involves a fast-paced, flowing sequence of postures that gradually increase in difficulty.
• Forrest: A more contemporary type of yoga that makes you work up a sweat. It involves deep breathing, core strengtheners and holding postures for a longer time period. It is meant to purify and strengthen the body, along with promote the release of negative emotions and pain.
• Vinyasa: A gentle yoga practice in which breathing is synchronized with the poses.
• Bikram: A series of 26 poses are performed in a heated room (the temperature can be anywhere from 90-100 degrees F) to make your body sweat. The heat in the room is meant to increase your body’s flexibility, reduce the risk of injury and help you to detoxify.
• Kundalini: Kundalini yoga is meant to awaken a powerful energy that is located at the base of the spine. The energy, once released, is said to bring a great sense of well-being and awareness.
• Bharata: Bharata yoga helps to align the spine to increase mobility and improve posture.
• Ananda: Includes a series of gentle hatha yoga poses designed to send energy toward the brain to prepare the body for meditation. This type of yoga is meant to promote spiritual growth and self-awareness.
• Anusara: Meaning literally “to step into the current of divine will,” anusara is meant to promote awareness and well-being along with body alignment.
• Iyengar: This is a practice geared strongly toward bodily alignment. Poses are held for longer periods (as opposed to “flowing” from one into the other).
• Jivamukti: A physically intense yoga series that also involves chanting, meditation, and spiritual teachings.

I will typically refer people to yoga when I feel that flexibility, posture and stress are significant causes of their pain.  We have a number of staff members who do yoga regularly for both the flexibility and the strength aspects.  It is something that some people go to simply to have a time of peace in their day or week and that is a rare and precious thing these days!

No matter what the reason is that a person may go to yoga, my personal thought is that it is a wonderful practice and that it has many positive benefits for a person’s physical and psychological health.

Valentine’s Day is a time to show that special someone in your life how much you care, and what expresses that more than a well planned, elegant dinner for two? It is suggested that if you are setting the mood for love, that you should keep the meal light, the portions small, and surround yourself with scented flowers and candlelight. I have created two complete menus for Valentine’s Day, one for those who prefer seafood, and another for those who would rather have meat. You can of course mix the courses, and have a little of each. This menu utilizes many foods said to have aphrodiasic powers. So…….. set the mood, plan your dinner and tell the one you love, “Ti voglio bene”.

Seafood Menu

Meat Lovers Menu

Buon Appetito!
Deborah Mele 2010

Chi Mangia Bene, Mangia Italiano (Those Who Eat Well, Eat Italian)

Please visit: http://www.italianfoodforever.com/

Let’s start off with the answer to that question – it is both a small “Yes” and a big “No”.  Read on t0 learn more. . . .

Recently there was a story written about a research study done that showed that running shoes increase the torque on your knee joints even more than high heels do – wow!

The article was written by Rachel Rettner, with LiveScience.com, and was a good article – www.livescience.com/health/running-shoes-joint-strain-injury-100112.html.  The article it references is:

The effect of running shoes on lower extremity joint torques.  Kerrigan DC, Franz JR, Keenan GS, Dicharry J, Della Croce U, Wilder RP. PM R. 2009 Dec;1(12):1058-63.

In its conclusion, the article states:

“The findings at the knee suggest relatively greater pressures at anatomical sites that are typically more prone to knee osteoarthritis, the medial and patellofemoral compartments. It is important to note the limitations of these findings and of current 3-dimensional gait analysis in general, that only resultant joint torques were assessed. It is unknown to what extent actual joint contact forces could be affected by compliance that a shoe might provide, a potentially valuable design characteristic that may offset the observed increases in joint torques.”

The study had 37 women and 31 men who ran at least 15 miles/ week, recreationally.  The comparison was of barefoot running versus running with a typical modern running shoe and measured the torque at the knee, hip and ankle joints.  It also measured the amount of bodyweight force created, using a foreplate under the treadmill (basically a scale under the treadmill).

The author, Rettner, states:  “The researchers found an increase in the torque for the knees, hips and ankles when the participants were wearing running shoes as compared with when they were running barefoot.”

Specifically, they saw a 38 percent increase in torque in areas of the knee where osteoarthritis develops.  This was greater than what is created while wearing high heeled shoes, which showed a 20-26 percent increase.

Even though the increased force can lead to damage in the joint, it is not recommended that you stop wearing your running shoes.  Today’s running shoes absorb shock very well from the hard running surfaces that people run on today and that is a significant issue.  They also support the foot and help to prevent things like shin splints.

A key question at this point, obviously, is whether running and running shoes are “good” for you or not.  There are significant benefits from running, specifically – cardiovascular, weight, emotion, balance, bone strength, and on and on.  It should be recognized that there is increased stress on your joints with running – and now apparently specifically from running shoes and I think it is interesting that the higher heel of a running shoe impacts your joints negatively.  Having said this, you shouldn’t stop running and, as the article says, you shouldn’t ditch those shoes – like most things in life, they some positive effects as well as some potential negatives. . . .

There was a recent article written in the NY Times about Physical Therapy which I thought brought up some very interesting issues and I thought I would share my view on it with everyone.  The article spoke of the worthiness of therapy, how much of it is evidence-based and how some parts of it are “Voo Doo”.  The title of the article is “Treat Me, But No Tricks Please” and was written by Gina Kolata.  The link is: http://www.nytimes.com/2010/01/07/health/nutrition/07best.html.

One of the most significant points that it speaks about is how classic (what I would call low-level and old fashioned Physical Therapy)  is not very beneficial.  Therapy such as this is primarily focused on modalities such as Ultrasound, Heat, Electrical Stimulation and Ice and is considered “Voo Doo” by many physicians.  It does not focus on what is causing the symptoms and  how to decrease these symptoms.  Most pain, muscle spasms (”knots” in a muscle) and limitations of motion are due to limitations in the mobility of a joint or overworking of specific muscles.  If you fix the underlying “drivers” of a person’s pain, the inflammation, pain, muscle spasms, etc all go away.

The author of the article makes some interesting comments on the use of modalities.  A quote from the article:

When I’ve gone to physical therapy, the treatments I’ve had — ice and heat, massage, ultrasound — always seemed like a waste of time. I usually went once or twice before stopping.

My doctor at the Hospital for Special Surgery in New York, Joseph Feinberg, seems to share my opinion. “Very often, I think the hot packs, cold packs, ultrasound and electrostimulation are unnecessary,” he said, adding, “For sure, in many cases these modalities are a waste of time.”

I agree thoroughly with most parts of this article, including where we need to have more evidence to back up what we do in therapy.  Unfortunately, there is a definite side of therapy that is difficult to measure and “prove” in a research study.  This side  is significant, however, in why patients get long-term improvement with treatment.  The American Physical Therapy Association wrote a response to the article listed above (link is:  http://www.apta.org/AM/Template.cfm?Section=Letters1&CONTENTID=67938&TEMPLATE=/CM/ContentDisplay.cfm) and they make a fantastic statement in the response that I’d like to share:

But evidence alone cannot heal a patient. With the best available evidence at hand, a health care provider must use their evaluative skills, clinical judgment and assessment of a patient’s needs to develop a plan of care.

Evidence is essential, but it must be combined with a health care provider’s unique knowledge and understanding of an individual patient.

Physical Therapy, just like much of medicine including Orthopedic Surgery, is a combination of science and art.  A good therapist will treat their patient keeping these two things in mind.  Therapists who simply focus all of their treatment on exercise are basically glorified Personal Trainers and clinics that recommend every patient be treated with heat, cold, electrical stimulation and ultrasound are places that give Therapy a bad name.  A great PT clinic finds the source of a person’s pain and treats the source. Taking it one step further, a great PT will teach the patient how to treat themselves with specific exercises for strength and flexibility which will address postural issues that a person may have.  And, only if needed, the use of modalities to settle inflammation down along with everything else.

ANKLE PAIN

The Pain

Ankle pain is a common problem for people who are active, whether it is from hiking, running, playing basketball or any number of fun weekend sports.  This pain typically comes from several different sources in your ankle – tendons, ligaments and cartilage being the most common.

The Causes

The most common problem to cause ankle pain is what is called a lateral ankle sprain and it is mostly typically caused by “turning” your ankle from landing funny while jumping  or from running and hitting an uneven part of the pavement.  This problem effects the anterior talofibular ligament – the one on the front/lateral part of the ankle bone – and the injury is classified by a “grade” – I, II or III.  The higher the number, the worse the sprain / injury.

You can also have ankle pain from inflammation in the tendons around the ankle, called tendonitis, and this can effect the inside or outside part of the ankle.  This problem is usually from overuse of the muscles in the lower leg which have their tendons extending down into the ankle.

The last common cause of ankle pain is arthritis.  This is a breakdown of the cartilage inside the joint and causes swelling and pain from the inflammation that is caused.  This problem is not normally caused by trauma – it develops gradually over time.  Pain, swelling, stiffness and warmth are common to this condition.

The Treatment

1.)   Sprains

a.     The initial treatment for a sprain is RICE – Rest, Ice, Compression and Elevation.  Rest allows the tissues to heal; Ice helps to decrease the inflammation, swelling and pain; compression helps to decrease the swelling; and Elevation also helps to decrease swelling by using gravity to pull the swelling out of the joint and toward the heart, where it is re-absorbed back into the system.

b.     As far as Physical Therapy goes, there are multiple things that are done in treatment at a facility like ours.  These include:

i.     Joint mobilizations to make sure the joint is moving correctly again after the injury and soft tissue mobilization if there are muscle spasms present after the injury.

ii.     Taping to the ankle.  There are a number of possible tapings that can be done.  The first is a classic stabilization taping for the ankle to “lock” the ankle in place and prevent reinjury.  The second is a taping geared toward the lateral malleolous (the outside ankle bone) which is focused on repositioning it in the proper place to allow it to function normally.   Finally, a taping can be done to help decrease the swelling in the ankle.

iii.     A therapist make treat an ankle sprain with modalities such as electrical stimulation to help decrease the swelling and compression units to help push the swelling out of the ankle.

iv.     Exercises to help strengthen the muscles around the joint and to retrain balance so they don’t re-injure themselves.  We find that the most common cause of recurrent ankle sprains is not a weakness problem – it is that the joint was never retrained correctly to stop another sprain before it happens.  We do a lot of balance / proprioceptive training with ankle patients.

2.)   Tendonitis

a.     The key for treatment here is to stop the overuse of the muscles/tendons that caused them to get irritated in the first place.  All of the tendons in the ankle have muscles that are located in the lower leg.  The tendons have their lower attachment in the foot and control the foot and ankle movements.  The place to start, then, is to decrease the work done at the foot/ankle.  Two easy ways to do this are to use arch supports / orthotics to help the feet (primarily the arch) and an ankle brace to support the ankle.

b.     Once you have stopped the overworking of the muscles and tendons, it is a good idea to ice, rest for a short time if needed and use anti-inflammatory medicine such as Ibuprofen if your doctor okays it.

c.     Physical Therapy treatment for this is geared toward joint and soft tissue mobilization to make sure that the joints and muscles are working properly, along with orthotic fabrication, taping of the foot (to support the arch) or ankle (to reposition the lateral malleolus) and, when needed, modalities such as ultrasound to decrease the inflammation.  (Clinics such as ours rarely use modalities for things like this but it is a common treatment approach for many PT clinics.)

d.     Lastly, it is a good idea to do stretches of the calf muscle to make sure that it is not limiting motion at the ankle and placing increased stress on the foot and ankle tissues.

3.)   Arthritis

a.     The best treatment for arthritis is rest, arch supports / orthotics and anti-inflammatory medicine if your doctor okays it.

b.     Surgery is a last-resort option if the arthritis gets too bad.  The typical surgical procedures for this are arthroscopic surgery to “clean” out the joint, or an ankle replacement.  Replacements are normally not done unless a person has significant difficulty with walking or has extreme pain.

Summary

While ankle problems are fairly common, treatment is very straight forward and people typically improve well in the long run.  The key is to make sure to get early treatment – a good rule is that the faster you get in to therapy, the faster you get better and get out of therapy!

Photo: Flckr

Is your work out being effected by pain on the outside of your knee? You could be suffering from Iliotibial band (ITB) syndrome which is the most common cause of lateral knee pain among athletes. The ITB is a thick band of tissue that acts as a strong cable that starts at your hip and runs down the side of your leg and inserts onto the outside of the knee.

Source: Frank Netter

ITB syndrome develops as a result of inflammation of the tissue surrounding the ITB and usually affects athletes who are involved in sports that require continuous running or repetitive knee flexion and extension. This condition is, therefore, most common in long-distance runners and cyclists.

There are many causes of ITB syndrome, some of them include biomechanical factors such as foot over pronation (feet rotate too far inward on impact), pelvic asymmetry’s,  leg length differences, muscle imbalances and tightness of the muscles that insert onto the ITB. Training can play a major factor in the development of ITB syndrome and common culprits include: excessive hill running (especially downhill), running frequently on cambered running surfaces, high weekly mileage and interval training.

Treatment for ITB syndrome usually is conservative. Often physical therapy intervention can be avoided with a good self treatment program. Initially you should reduce the training load and intensity of your work outs. This may include decreasing weekly mileage, avoid activity that requires repeated knee flexion and extension, incorporate alternative cardiovascular workouts such as swimming during this time. Ice treatments should be employed after workouts using either a cold pack applied to the area for 10-15 minutes or using ice massage, which involves rubbing ice over the inflamed area for 3-5 minutes or until the area is numb.

One of the most important components of the self treatment program is consistently stretching the tight muscles that directly affect the ITB. These include the gluteals, piriformis, and lateral hip/leg musculature.

This is just a quick summary of problems and common treatments of lateral knee pain caused by the ITB.  If simple self treatment doesn’t work, we suggest seeing a Physical Therapist.  They can perform joint mobilizations and soft tissue mobilizations to normalize the system and take the stress off of the ITB along with showing you stretches that decrease the pull on the ITB and, when needed, use modalities to help decrease the inflammation in the area.

Chicken With Savory Orange Sauce

In my recent quest for recipes that are both healthy and delicious I have been making a lot of poultry recipes, which as you know if you follow IFF is one of my favorite foods. I chose chicken thighs for this recipe as they are less expensive than chicken breasts yet have a lot of flavor and remain moist when cooked, but you could use chicken breasts if you prefer. I wanted to create an orange sauce using marmalade, but was initially concerned that most marmalades contain such high quantities of sugar but I stumbled across a Smucker’s sugar free brand that had only 10 calories per tablespoon. This brand also had a fresh, clean orange flavor and I found it worked out perfectly in this recipe. I made this dish twice now, and after tweaking the ingredients just a bit, I love how it turned out and know I’ll make it many times in the future. This dish actually keeps well, and I found that even when slowly reheated the next day, the chicken stayed moist and tender.

Serves 4

by Deborah Mele

8 Boneless, Skinless Chicken Thighs

2 Tablespoons Olive Oil

Salt & Pepper

1 1/2 Cups Chicken Broth

3/4 Cup Sugar Free Orange Marmalade

2 Teaspoons Dijon Mustard

1 Tablespoon Red Wine Vinegar

2 Teaspoons Cornstarch

1 Sweet Red Pepper, Cored, Seeded And Diced

2 Cloves Garlic, Peeled & Minced

3 Tablespoons Chopped Fresh Parsley

Trim the thighs of any excess fat. Season with salt and pepper. Heat the oil in a large, heavy skillet and brown the thighs well on both sides over medium heat, about 7 to 8 minutes. Remove the thighs to a plate and cover. Cook the garlic and diced pepper in the same pan for 3 or 4 minutes. Add the chicken broth, marmalade and mustard and mix well. Bring to a boil and cook until the sauce has reduced by about 1/3 volume. Stir together the vinegar and cornstarch and whisk this into the broth mixture and cook until thickened. Season with salt and pepper. Reduce the heat to a simmer and return the chicken to the pan. Cook over low heat until the thighs are cooked through, about 15 minutes. Place the thighs onto a platter and spoon the sauce on top. Sprinkle with chopped parsley and serve immediately.

Buon Appetito!

Deborah Mele 2009

Compliments of: Italian Food Forever