article | StretchPilates.Fit

By Ben Benjamin, Ph.D. with Jeffrey Haggquist, D.O.

The field of massage therapy and bodywork encompasses a wide range of different styles and approaches. Each of us brings a unique combination of skills that we’ve found to be effective over years of study and practice — in areas ranging from sports medicine and orthopedic massage to relaxation massage, craniosacral therapy, and a variety of ancient healing arts. There are few experiences more exciting than finding a new modality or technique to add to your repertoire that dramatically improves your ability to help clients. Over the past couple of years, I’ve been exploring one such modality that has exceeded all my expectations: Active Isolated Stretching (AIS), a system developed over the course of the past 37 years by kinesiologist Aaron Mattes.

A Surprising Discovery

Discovering AIS has been the second major turning point in my professional career. The first came in the late 1970s.
At the time I was working quite successfully (running a small somatic therapy school, as well as a large private practice), using techniques focused almost entirely on muscles. I was operating on the assumption that most pain and injury problems could be traced back to muscular tension and imbalances. It came as a great shock to learn that the majority of chronic pain is actually caused by injuries to fibrous connective tissues (ligaments, joints, tendons, and fascia). When I first heard this, I was highly skeptical. I wasn’t convinced of the idea until I’d had it confirmed by direct experience, seeing Dr. James Cyriax’s therapies give lasting pain relief to people who hadn’t responded to any other therapies. Those people included me — receiving treatment for my own injuries eliminated the bac  and neck pain I’d felt for the previous 22 years (for which massage of the muscles had provided only partial relief)  Learning how to assess and treat connective tissue injuries caused a radical shift in my thinking. I eagerly shared what I’d learned with my clients and students, and saw many pain conditions that I had previously assumed to be permanent or beyond my expertise respond readily to the new types of treatment. Over the past 30 years, I’ve devoted much of my life to refining, practicing, teaching, and writing about these techniques. Recently I’ve again had cause to question my assumptions about which musculoskeletal problems are likely to be permanent, and which can be resolved. From my earlier study with Dr. Cyriax and my own work with clients, I came to believe that in the majority of cases, a combination of friction treatment, myofascial therapy, massage techniques, and/or exercise therapy could effectively relieve chronic pain, build strength, and improve range of motion. When these were not sufficient, I could usually trust that either injection therapy or surgery would be successful. However, there were still various conditions that I thought of as untreatable, including declines in flexibility due to aging, degenerative arthritis, or serious injury and muscular dysfunction due to progressive degenerative diseases such as multiple sclerosis (MS) or Parkinson’s disease. I’m happy to say that AIS has proven me wrong. As in the previous instance, I initially came to AIS with a great deal of skepticism, and was convinced only by direct experience. I’ve seen results in myself that I never thought possible: after receiving the work for just a few months, I achieved greater range of motion than I could ever remember having. Limitations that I’d attributed to the inevitable effects of aging simply disappeared. Moreover, once I received AIS training and began incorporating it into my work with clients, I started seeing remarkable changes — healing times for most softtissue injuries were cut in half, and some conditions that had been gradually worsening over time (including one individual’s MS symptoms) began to reverse course.
In this article, I’m going to outline the mechanisms of AIS, explain how and why it works, and discuss the
specific ways in which it complements massage therapy and supports healing. In the process, I will highlight a
variety of specific examples — including some surprising results I’ve seen in my clients, in myself, and in other
individuals I’ve encountered — that demonstrate the usefulness, versatility, and power of this approach.

How AIS Works

The AIS method differs from most other types of stretching and strengthening programs in several important respects. Listed below are seven defining characteristics of AIS techniques. Each is supported by established principles of human physiology. Note that although this method is called Active Isolated Stretching, it actually incorporates both stretching and strengthening in almost every maneuver. (Aaron Mattes has also developed a complementary program focused more heavily on strengthening, which is outside the scope of this article.)


Characteristics of AIS Stretches

1. Specificity
2. Active initiation
3. Incremental assists
4. Gentle motion
5. Brief duration
6. Multiple repetitions
7. Deep breathing

1. Specificity

AIS movements are precisely targeted to stretch individual muscles and parts of muscles, rather than larger muscle groups. (For instance, in contrast to a simple forward bend that provides a general stretch for all aspects of the hamstring muscles, AIS uses six different stretches to focus on different combinations of the medial, lateral, oblique, proximal, and distal fibers.) This enables the practitioner to independently evaluate — and then work to maximize — the flexibility of each section of the muscle. There are AIS protocols for every primary muscle in the body, amounting to more than 170 separate stretches. Using different combinations of these stretches, we can develop customized regimens tailored to the specific needs of any client.

2. Active Initiation

Although AIS stretches are supported and assisted by the practitioner, each movement is initiated by the client. This enhances the stretch, since contracting a muscle on one side of a joint causes the muscle on the opposite side to relax (a principle known as Sherrington’s Law of Reciprocal Inhibition), and that relaxation helps the muscle to stretch more efficiently. Moreover, having the muscles actively working helps to increase the temperature of the muscles and the fascia, which enhances flexibility even further.

3. Incremental Assists

At the end of the client’s active range of motion, the practitioner provides just enough assistance to push slightly beyond what the person could do on his or her own. In this way it’s possible to increase flexibility incrementally, typically adding two or three degrees with each repetition.

4. Gentle Motion

The movements involved in AIS are quite gentle, never approaching a muscle’s maximum sustainable force (i.e., the level of force that will cause that muscle to give out). Laboratory studies confirm that to avoid injury, it’s important to use 50% or less of the maximum force for the muscles being stretched.2 Gradual, gentle motion also helps to delay activation of the myotatic reflex (commonly referred to as the stretch reflex) — a defensive mechanism that is designed to prevent muscles from stretching too far or too fast. A movement that’s overly sudden or severe will cause the muscle being stretched to reflexively contract.

5. Brief Duration

The key to avoiding the stretch reflex altogether is to hold a stretch for only a short time — no more than two seconds. Traditionally, exercise specialists have recommended holding stretches for much longer periods of time, up to 60 seconds. (This is referred to as static stretching.) However, research has shown that such prolonged stretching initiates the stretch reflex, decreases blood flow within the tissue, and leads to a buildup of waste products, such as lactic acid, that contribute to muscle fatigue and soreness.3 When people stretch in this way, they’re working against themselves, causing a contraction of the very muscles they’re trying to lengthen (sort of like trying to drive a car with the parking brake on). As a result, the tendons and ligaments get stretched more than the muscles, which can lead to tendon irritation and even laxity, and thus predispose these structures to future injury.

6. Multiple Repetitions

Static stretching relies on a principle known as stress relaxation: when muscles and connective tissues are held at a constant length, they eventually fatigue, release, and lengthen. In addition to promoting muscle fatigue, this type of action is also relatively slow. AIS achieves results much more quickly by using 6 to 10 repetitions of shorter stretches. This method can help increase the range of motion in a particular area by as much as 60 degrees in a relatively short period of time.

7. Deep Breathing

Throughout an AIS session, the client coordinates his or her movements with regular, relaxed breathing. Deep breathing helps to increase the flow of oxygen to the muscles, decrease muscle fatigue, and encourage the release of muscle tension and fascial restrictions. It is important to avoid holding the breath. With oxygen available as fuel, muscles burn fatty acids and glucose (aerobic metabolism). Without sufficient oxygen, glucose gets converted to lactic acid (anaerobic metabolism), again leading to muscle fatigue and soreness.

What’s In It for Clients?

To consider combining a new skill with the work we already do, we need to know what specific, additional benefits it will bring for the clients we see. I’ve found that  AIS adds to the efficiency and effectiveness of bodywork in four different areas: general health enhancement; injury prevention; pain and injury treatment; and improvement of degenerative conditions.

General health enhancement

While many clients seek out massage therapy to help with particular pain or injury problems, these conditions are
often tied in with deeper health issues. For most clients I see, regaining full healthy functioning requires not just
healing a few isolated tissues, but helping to restore balance and resilience to the entire body. AIS can play a central
role in that process by enhancing flexibility, strength, and the overall health of both joints and soft tissues. It should come as no surprise that AIS improves flexibility; that’s the least we can expect from any stretching program. What’s remarkable is the amount of improvement it can bring, particularly for those who have experienced severe limitations due to aging, arthritis, or chronic injuries. I have always believed that as we age, our flexibility diminishes permanently. When I saw the range of motion in my own joints gradually decline (despite regular exercise and stretching), I attributed this to mild age-related arthritis that would probably continue to worsen over time. I was surprised and delighted to find that AIS could not only stop that decline, but even reverse it — I’ve seen flexibility return to my shoulders, neck, back, hips, thighs, and feet, and I have greater freedom and range of motion than I can ever remember having. For instance, I can now reach my lower scapula with my fingers from above and below, something I assumed I would never be able to do. At the same time I’ve grown progressively stronger, even building strength at the end of my range of motion, where we are all generally weakest. Overall, I feel about 20 years younger than I did when I began. Clients with whom I’ve done AIS work have shown similar striking changes.
In addition to working on muscles, AIS also helps to develop healthy joints. When the practitioner places repeated, gentle tension on the fibers contained in a joint structure at multiple angles, the fibers of the joint itself are exercised and strengthened. Joint sensitivity and irritation diminish and often disappear with this type of stretching, especially in the hands and feet. Another benefit is that by simultaneously stretching the muscle on one side of a joint and strengthening its counterpart on the other side, AIS creates a balance of muscular tone that leaves the joint stronger and more resilient. Furthermore, the gentle, repetitive motion improves the circulation of blood and nutrients, supporting the healthy growth and repair of all the surrounding soft tissues. It also improves the circulation and drainage of lymph, helping to eliminate waste products.

Injury prevention

As muscles become stronger and more flexible, they also become less vulnerable to injury. Increased strength allows them to absorb a greater amount of force, and increased flexibility allows them to lengthen further before becoming strained. Increased range of motion without muscle strength to control that new range of motion can be risky. AIS strengthens the muscles within an expanded range of motion, helping to ensure that the person will be able to function safely within that larger range. Equally important is the support that AIS provides for tendons, ligaments, and fascia. By placing repeated gentle stress on these structures, it helps to build their strength and integrity. And, when minor strains or tears do occur, continued AIS work helps to prevent the buildup of scar tissue — a major contributor to stiffness, inflexibility, chronic injury, and pain conditions.

Pain and injury treatment

Readers of my past articles will be familiar with the types of treatment plans I generally recommend for tendon and ligament injuries — involving some combination of rest, friction therapy, deep massage, and a few specific exercises for the client to do at home. For more than 30 years, I understood this to be the most effective and efficient path to recovery. I still believe this is true, with one caveat: adding AIS to the mix makes the healing progress much more rapidly. For instance, I recently treated a woman who had fairly severe tears in her sacroiliac ligaments, injuries that would generally take 6–8 weeks to heal. This time, in addition to my usual methods, I applied the AIS protocols for the hips, legs, and low back (a total of 58 separate movements). After three sessions over the course of a week and a half, this person was out of pain and functioning completely normally. In some cases, I’ve even found AIS alone to be sufficient for healing. Not only do these stretches seem to prevent adhesive scar tissue from forming, but they may also help break down adhesions that have already formed. One client with an injured infraspinatus tendon (one of the rotator cuff tendons) recovered fully with just two sessions of AIS. Typically I would expect it to take at least 10 sessions of friction therapy and massage for this type of injury to heal. One great advantage of AIS is that it enables therapists to treat structures that simply cannot be reached with the hands (such as the piriformis attachment to the sacrum). For years I had a nagging pain from one of the tiny ligaments deep in my foot that would come and go from time to time. No practitioner had been able to treat it successfully. Ever since I began having AIS work done on my feet, it has completely disappeared.

Improvement of degenerative conditions

In addition to enhancing my work with injuries, AIS has given me the skills to help an entirely new population of clients — people with serious neuromuscular conditions who don’t respond to the other forms of treatment I offer. When I first heard reports that AIS could reduce the symptoms associated with Parkinson’s, multiple sclerosis, muscular dystrophy, polio, and other debilitating diseases, I didn’t believe it. It still seems almost too good to be true, but I’ve seen it happen and the results are unmistakable. After I’d been using AIS for some time, I offered a free session to an acquaintance of mine with multiple sclerosis whose symptoms had been worsening for 12 years. Her mobility was quite limited: she was extremely unstable and shaky on her feet, and even had trouble moving around in bed. She had been in a wheelchair for three years. That initial session left her feeling energized, and she decided to try coming regularly as a client. Following her third treatment, she called me up to tell me that her ability to walk had significantly improved — she was able to use her feet normally (with a heel-to-toe walking action) for the first time in three years. After five treatments, she regained her ability to move her legs in bed. By the eighth treatment, her coordination had improved to the point where she could make crawling movements. She continues to be amazed at the progress she’s made with both stability and coordinated motion.

Talk to any experienced AIS practitioner, and you’ll hear many similar stories. I spoke with one woman who has Parkinson’s disease and uses AIS to stop her tremors. When she’s under stress the tremors tend to return, but after a few sessions they go away again, for months at a time. AIS achieves these impressive results partly by stimulating neurogenesis (the development of nerve tissues) and helping to create new neural pathways. Because the stretches are active, rather than passive, they reinforce the connections between the brain and the muscles.7 Furthermore, because the range of motion is gently increased at the end of each stretch, the muscles are continually moving into novel territory. Essentially, the brain-muscle connection keeps learning to do something new and different, which means new neural pathways are always being created.

Repetition of the stretches also promotes nerve development. Another relevant factor is the reduction of muscle spasticity. Spasticity, excessive tone in a muscle that leads it to involuntarily contract when it is stretched or lengthened, is a symptom common to both multiple sclerosis and Parkinson’s disease. It can vary in severity from mild muscle stiffness to severe, painful spasms. In many cases, AIS can effectively resolve spasms and lessen spasticity. In addition, some of the other effects that I mentioned earlier — promoting blood flow, nutrition delivery, waste elimination, and the general health of the muscles — are particularly helpful with degenerative neuromuscular diseases. AIS helps restore the supply of oxygen and nutrients to chronically contracted, blood-starved tissue. As a further benefit, the promotion of active, healthy muscle simultaneously promotes the health and growth of the surrounding nerves. Some of the most affected tissues in MS and Parkinson’s patients are the “two joint” muscles — muscles that act across more than one joint.9 These include the hamstrings and rectus femoris (hip and knee joints); gastrocnemius (knee and ankle joints); and the psoas (hip joint and multiple joints in the low back). With AIS, we can isolate and perform focused stretching on each of these muscles, working toward restoring normal posture and gait.

Integrating AIS into a Massage Therapy Practice

AIS is probably best known in the context of professional sports (Aaron Mattes has worked with hundreds
of Olympic and professional athletes), but it’s equally valuable for combating the more commonplace physical limitations that we all develop as we go about our daily lives. As we grow older, most of us accept declines in our body’s functioning — such as a reduced range of motion, decreased strength and flexibility, and impaired coordination or fine motor skills — as an inevitable result of injuries and aging. It was a revelation for me to discover that through AIS, many of those declines can be successfully prevented or reversed. I am convinced that the majority of people who come for massage therapy could benefit from this work in one way or another, and I’ve started using it with most of my clients. Typically I combine AIS with other hands-on work, splitting the session in half — after 30–45 minutes of AIS, I’ll do 30 minutes of friction therapy and/or massage. The stretching leaves the body looser and more pliable, making the later work easier and more effective. I focus on the areas that need the most attention, working on both sides of the body to prevent any imbalances from developing. (AIS is almost always done on limited sections of the body, since performing the protocols for the entire body, from the neck down to the feet and toes, can take up to 4 or 5 hours.) In between sessions, I teach clients certain AIS stretching and exercise protocols that they can do on their own. That’s another benefit of this method: most of the techniques can be done on your own with the use of a 7- to 9-foot rope and a few weights. In this way, people can participate actively in their own healing, both in and out of the treatment room. The only thing better than a remarkably efficient and effective new treatment is one
that also leaves a client with a sense of empowerment and accomplishment for a job well done — and even a
little bit of sweat to show for it.

Ben E. Benjamin holds a Ph.D. in Sports Medicine and Education and is the founder of the Muscular Therapy Institute in Cambridge, Massachusetts. He is the author of many articles on working with injuries and chronic pain as well as
the widely used books in the field, Are You Tense?, Exercise Without Injury and Listen To Your Pain: Understanding,
Identifying and Treating Pain and Injury Problems, and is co-author of The Ethics of Touch. He has studied with the
British physician, James Cyriax, M.D., widely known for his pioneering work in orthopedic medicine. Dr. Benjamin
has been in private practice for over 40 years and has been publishing articles and teaching since 1986.
Jeffrey P. Haggquist, DO, is an osteopath who specializes in physiatry, a branch of medicine focused on restoring
optimal functioning and quality of life to people with physical impairments or disabilities. Dr. Haggquist completed
his residency training in physical medicine and rehabilitation at Temple University Hospital in Philadelphia, his
osteopathic internship at the University of Medicine and Dentistry of New Jersey, and his medical education at
Kansas City University of Medicine and Biosciences. Dr. Haggquist teaches widely on flexibility and neuromuscular
reeducation, and is a national specialist on Active Isolated Stretching. He has trained elite athletes in professional
baseball, football, soccer, and tennis, and collegiate track and field. He is the Medical Director of the Flexibility,
Sports and Rehabilitation Clinic located in Washington, DC. Prior to his medical training, he practiced as a neuromuscular
massage therapist for more than two decades



Haggquist, J.P. “Flexibility and Efficient Stretching: Its Use to Benefit Chronic Pain and Rehabilitation
Patients.” 2004.
Mattes, A.L. Active Isolated Stretching: The Mattes Method. Sarasota, FL: Aaron Mattes Therapy, 2000.
Mattes, A.L. “Flexible Fascia: How Active Isolated Stretching Combats Restricted Range of Motion.” Massage Magazine Issue 137, October 2007.
Stretching USA (official AIS web site):


1 Dr. Cyriax, author of a major text on orthopedic assessment and treatment, and now commonly known as the father of orthopedic medicine, was a teacher of mine in the late 1970s.
2 DeLee, J.C., D. Drez, and M.D. Miller, Eds. Orthopaedic Sports Medicine, 2nd ed. Philadelphia, PA: Saunders, 2003.
3 Mattes, A.L. Active Isolated Stretching: The Mattes Method. Sarasota, FL: Aaron L. Mattes, 2000, p. 1.
4 For more information on the effects of stretching tendons and ligaments, see Benjamin, B. Exercise Without Injury. Cambridge, MA: MTI, 1992.
5 Mattes, A.L. Active Isolated Stretching: The Mattes Method. Sarasota, FL: Aaron Mattes Therapy, 2000, p. 5.
6 Cyriax, James. 1982. Textbook of Orthopedic Medicine, Vol. 1, 8th Edition. London: Bailliere Tindall, pp. 16–19.
7 Mattes, A.L. Active Isolated Strengthening: The Mattes Method. Sarasota, FL: Aaron L. Mattes, 2006, pp. 5–6.
8 Extrapolated from van Praag, H., Shubert, T., Zhao, C., & Gage, F.H. (September 2005). “Exercise enhances learning and hippocampal neurogenesis in aged mice.” J. Neurosci. 25 (38): 8680–5.
9 Observations drawn from Dr. Haggquist’s clinical data.

This article was originally published by our friends at Authority Nutrition

Sarcopenia, also known as muscle loss, is a common condition that affects 10% of adults who are over 50 years old.

While it can decrease life expectancy and quality of life, there are actions you can take to prevent and even reverse the condition.

Although some of the causes of sarcopenia are a natural consequence of aging, others are preventable. In fact, a healthy diet and regular exercise can reverse sarcopenia, increasing lifespan and quality of life.

This article explains what causes sarcopenia, and lists many ways you can fight it.

What Is Sarcopenia?

Sarcopenia literally means “lack of flesh.” It’s a condition of age-associated muscle degeneration that becomes more common in people over the age of 50.

After middle age, adults lose 3% of their muscle strength every year, on average. This limits their ability to perform many routine activities.

Unfortunately, sarcopenia also shortens life expectancy in those it affects, compared to individuals with normal muscle strength.

Sarcopenia is caused by an imbalance between signals for muscle cell growth and signals for teardown. Cell growth processes are called “anabolism,” and cell teardown processes are called “catabolism”.

For example, growth hormones act with protein-destroying enzymes to keep muscle steady through a cycle of growth, stress or injury, destruction and then healing.

This cycle is always occurring, and when things are in balance, muscle keeps its strength over time.

However, during aging, the body becomes resistant to the normal growth signals, tipping the balance toward catabolism and muscle loss.

Summary: Your body normally keeps signals for growth and teardown in balance. As you age, your body becomes resistant to growth signals, resulting in muscle loss.

Four Factors That Accelerate Muscle Loss

Although aging is the most common cause of sarcopenia, other factors can also trigger an imbalance between muscle anabolism and catabolism.

1. Immobility, Including a Sedentary Lifestyle

Disuse of muscle is one of the strongest triggers of sarcopenia, leading to faster muscle loss and increasing weakness.

Bed rest or immobilization after an injury or illness leads to rapid loss of muscle.

Although less dramatic, two to three weeks of decreased walking and other regular activity is also enough to decrease muscle mass and strength (9).

Periods of decreased activity can become a vicious cycle. Muscle strength decreases, resulting in greater fatigue and making it more difficult to return to normal activity.

2. Unbalanced Diet

A diet providing insufficient calories and protein results in weight loss and diminished muscle mass.

Unfortunately, low-calorie and low-protein diets become more common with aging, due to changes in sense of taste, problems with the teeth, gums and swallowing, or increased difficulty shopping and cooking.

To help prevent sarcopenia, scientists recommend consuming 25–30 grams of protein at each meal (10).

3. Inflammation

After injury or illness, inflammation sends signals to the body to tear down and then rebuild the damaged groups of cells.

Chronic or long-term diseases can also result in inflammation that disrupts the normal balance of teardown and healing, resulting in muscle loss.

For example, a study of patients with long-term inflammation resulting from chronic obstructive pulmonary disease (COPD) also showed that patients had decreased muscle mass.

Examples of other diseases that cause long-term inflammation include rheumatoid arthritis, inflammatory bowel diseases like Crohn’s disease or ulcerative colitis, lupus, vasculitis, severe burns and chronic infections like tuberculosis.

A study of 11,249 older adults found that blood levels of C-reactive protein, an indicator of inflammation, strongly predicted sarcopenia.

4. Severe Stress

Sarcopenia is also more common in a number of other health conditions that increase stress on the body.

For example, people with chronic liver disease, and up to 20% of people with chronic heart failure, experience sarcopenia.

In chronic kidney disease, stress on the body and decreased activity lead to muscle loss.

Cancer and cancer treatments also place great stress on the body, resulting in sarcopenia.

Summary: In addition to aging, sarcopenia is accelerated by low physical activity, insufficient calorie and protein intake, inflammation and stress.

How to Tell If You Have Sarcopenia

The signs of sarcopenia are the result of diminished muscle strength.

Early signs of sarcopenia include feeling physically weaker over time, and having more difficulty than usual lifting familiar objects.

A hand-grip-strength test has been used to help diagnose sarcopenia in studies, and may be used in some clinics.

Decreased strength might show itself in other ways too, including walking more slowly, becoming exhausted more easily and having less interest in being active.

Losing weight without trying can also be a sign of sarcopenia.

However, these signs can also occur in other medical conditions. Yet if you experience one or more of these and can’t explain why, talk to a health professional.

Summary: Noticeable loss of strength or stamina and unintentional weight loss are signs of multiple diseases, including sarcopenia. If you are experiencing any of these without a good reason, talk to your doctor.

Exercise Can Reverse Sarcopenia

The strongest way to fight sarcopenia is to keep your muscles active.

Combinations of aerobic exercise, resistance training and balance training can prevent and even reverse muscle loss. At least two to four exercise sessions weekly may be required to achieve these benefits.

All types of exercise are beneficial, but some more than others.

1. Resistance Training

Resistance training includes weightlifting, pulling against resistance bands or moving part of the body against gravity.

When you perform resistance exercise, the tension on your muscle fibers results in growth signals that lead to increased strength. Resistance exercise also increases the actions of growth-promoting hormones.

These signals combine to cause muscle cells to grow and repair themselves, both by making new proteins and by turning on special muscle stem cells called “satellite cells,” which reinforce existing muscle.

Thanks to this process, resistance exercise is the most direct way to increase muscle mass and prevent its loss.

A study of 57 adults aged 65–94 showed that performing resistance exercises three times per week increased muscle strength over 12 weeks.

In this study, exercises included leg presses and extending the knees against resistance on a weight machine.

2. Fitness Training

Sustained exercise that raises your heart rate, including aerobic exercise and endurance training, can also control sarcopenia.

Most studies of aerobic exercise for the treatment or prevention of sarcopenia have also included resistance and flexibility training as part of a combination exercise program.

These combinations have been consistently shown to prevent and reverse sarcopenia, although it is often unclear whether aerobic exercise without resistance training would be as beneficial.

One study examined the effects of aerobic exercise without resistance training in 439 women over 50 years of age.

The study found that five days per week of cycling, jogging or hiking increased muscle mass. Women started with 15 minutes of these activities per day, increasing to 45 minutes over 12 months.

3. Walking

Walking can also prevent and even reverse sarcopenia, and it’s an activity most people can do for free, anywhere they live.

A study of 227 Japanese adults over 65 years old found that six months of walking increased muscle mass, particularly in those who had low muscle mass (27).

The distance each participant walked was different, but they were encouraged to increase their total daily distance by 10% each month.

Another study of 879 adults over age 60 found that faster walkers were less likely to have sarcopenia.

Summary: Exercise is the most effective way to reverse sarcopenia. Resistance training is best to increase muscle mass and strength. However, combination exercise programs and walking also fight sarcopenia.

Four Nutrients That Fight Sarcopenia

If you’re deficient in calories, protein or certain vitamins and minerals, you may be at higher risk of muscle loss.

However, even if you aren’t deficient, getting higher doses of some key nutrients can promote muscle growth or enhance the benefits of exercise.

1. Protein

Getting protein in your diet directly signals your muscle tissue to build and strengthen.

As people age, their muscles become more resistant to this signal, so they need to consume more protein to increase muscle growth.

One study found that when 33 men over age 70 consumed a meal containing at least 35 grams of protein, their muscle growth increased.

Another study found that a group of younger men only required 20 grams of protein per meal to stimulate growth.

A third study got seven men over the age of 65 to take daily 15-gram supplements of essential amino acids, the smaller building blocks of protein, which resulted in muscle growth.

The amino acid leucine is particularly important for regulating muscle growth. Rich sources of leucine include whey protein, meat, fish and eggs, as well as soy protein isolate.

2. Vitamin D

Vitamin D deficiency is related to sarcopenia, although the reasons why are not entirely understood.

Taking vitamin D supplements can increase muscle strength and reduce the risk of falling. These benefits have not been seen in all studies, possibly because some research volunteers may have already been getting enough vitamin D.

The best dose of vitamin D for preventing sarcopenia is currently unclear. Taking up to 100% of the Recommended Dietary Allowance (RDA) is safe, but may not be necessary if you already get enough vitamin D from sunlight or fortified foods.

3. Omega-3 Fatty Acids

No matter how old you are, consuming omega-3 fatty acids via seafood or supplements will increase your muscle growth.

A study of 45 women found that a daily 2-gram fish oil supplement combined with resistance training increased muscle strength more than resistance training without fish oil.

Part of this benefit may be due to the anti-inflammatory benefits of omega-3 fatty acids. However, research has suggested that omega-3s might also signal muscle growth directly.

4. Creatine

Creatine is a small protein normally made in the liver. Although your body makes enough to prevent you from becoming deficient, creatine in the diet from meat or as a supplement may benefit your muscle growth.

A group of several studies investigated how taking a daily 5-gram creatine supplement affected 357 adults with an average age of 64.

When participants took the creatine, they got more benefits from resistance training compared to when they performed resistance training with no creatine.

Creatine is probably not beneficial for sarcopenia if used alone, without exercise.

Summary: Protein, vitamin D, creatine and omega-3 fatty acids like those in fish oil can all improve muscle growth in response to exercise.

The Bottom Line

Sarcopenia, the loss of muscle mass and strength, becomes more common with age and can decrease lifespan and quality of life.

Eating enough calories and high-quality protein can slow down the rate of muscle loss. Omega-3 and creatine supplements may also help fight sarcopenia.

Nevertheless, exercising is the most effective way to prevent and reverse sarcopenia.

Resistance exercises appear to be particularly effective, including using resistance bands, lifting weights or doing calisthenics like squats, push-ups and sit-ups.

However, even simple exercises like walking can slow your rate of muscle loss. At the end of the day, the most important thing is to get active.


NEUROKINETIC THERAPY or NKT has been called the missing link. It’s an innovative approach to manual muscle testing based on the premise that when an individual experiences injury certain muscles shut down or become inhibited forcing other muscles to take over and become overworked.

The practitioner will teach the client the specific release and show how to strengthen the underworking muscle. The client needs to participate in the “homework” given by the practitioner to make the testing results fully integrate into their system thus keeping pain away and strengthening weakness. is proud to offer NKT through Kristen Wallner, our certified NKT therapist.

It generally takes three sessions of NKT to resolve a specific issue. Sessions are 1 hour in length, except the first which can be up to 1 and a half hours to take into account patient history. Sessions are $75 but we are currently offering a three session package for $199. Sign up today.

Find out more at

Body Core

Why is your Core so important?

Your core consists of :

    • Deep abdominal muscles (Transverse muscle, Looks and acts like a corset)
    • Oblique muscles
    • Lower abs (Pelvic floor muscles)
    • multifidus (deep low back muscles)

These muscles, in theory, should support your back and keep your body in proper alignment, so your back muscles have support to hold you upright.

Weakness and lack of strength pull your neck out of alignment and then your body starts pulling all your back muscles tighter because your upper body starts leaning forward.

Your Core also supports strong leg and arm movement.

If your core is not strong and fired it can cause pain not only in back and neck, also shoulders, arms, hands knee and hip pain, foot and ankle pain (Planter fasciitis and the like).

Lack of Core strength, lack of strength in general causes a lot of PAIN!

If you you would like an assessment of your Core strength get in touch today!

Neuroscience and fasting

Neuroscience Reveals What Fasting Does To The Brain (And Why Big Pharma and the Food Industry Won’t Study It)

by ideapod | May 8, 2017 | Mind & Brain |

I came across this TEDx talk given by Mark Mattson, the current Chief of the Laboratory of Neuroscience at the National Institute on Aging. It presents some fascinating details about fasting and why it isn’t as popular as it should be.
Many research studies are showing its benefits. This article by Authority Nutrition highlights 10 evidence-based health benefits of fasting that studies have found. These include weight loss, lower blood pressure and reduced cholesterol.
But the real interesting question is, why won’t the pharmaceutical industry study it?

Here is a transcript of a section of Mark Mattson’s talk which hints at these questions:

“Why is it that the normal diet is three meals a day plus snacks? It isn’t that it’s the healthiest eating pattern, now that’s my opinion but I think there is a lot of evidence to support that. There are a lot of pressures to have that eating pattern, there’s a lot of money involved. The food industry — are they going to make money from skipping breakfast like I did today? No, they’re going to lose money. If people fast, the food industry loses money. What about the pharmaceutical industries? What if people do some intermittent fasting, exercise periodically and are very healthy, is the pharmaceutical industry going to make any money on healthy people?”

Please watch and share so we can raise questions about our eating habits and how we can become more healthy.

To further back up the benefits of fasting, here is a quote from an author from The Power of Ideas who tried intermittent fasting for one month:

“Intermittent fasting has now become my way of life. It feels damn good and I find myself being clear and focused. My energy levels have sky rocketed. I used to always get that afternoon slump when I felt tired at about 3 PM, but I don’t experience this anymore.

Eating has also come to be an experience that’s enjoyed, rather than just food to scoff down as fast as I can. This has made it easy to keep intermittent fasting going.

Also, after a couple weeks, I decided to try exercising (running and weights) as soon as I woke up on an empty stomach. I thought I would feel light headed and faint from working out on an empty stomach, but the truth is, I had more grit and energy.

Research has found that there’s major perks to doing this: apparently it’s meant to supercharge your body’s fat-burning potential.”

Watermelon Agua Fresca Recipe

Are you in need of a refreshing drink to cool down with this summer? You’ve got to try this fruity, sparkling Watermelon Agua Fresca.

Agua fresca, or “fresh water,” is a popular drink in Mexico and throughout Central America. They’re made by combining water with sugar and fruits to create a sweet and tasty beverage. My version uses cooling benefit-rich watermelon and honey to keep it free from refined sugars. When mixed with sparkling water, the result is a fizzy beverage you’ll want to drink all summer long.

Start by blending the watermelon, raw honey and fresh lime juice in a blender until the watermelon is smooth. Mix in the Pellegrino before pouring.

Garnish the drink with lime slices or mint leaves before serving.

Make a big batch of this Watermelon Agua Fresca to keep in the refrigerator for hot nights or for serving at barbecues.

Watermelon Agua Fresca Recipe

Total Time: 5 minutes
Serves: 8


  • 4 cups watermelon, cut into pieces
  • ½ cup water
  • ½ tablespoon raw honey
  • ½ tablespoon fresh lime juice
  • ½ cup sparkling water


  1. Blend watermelon, water, honey and lime juice in a blender.
  2. Stir in Pellegrino just prior to serving.
  3. Garnish with lime slices and mint leaves if desired.
7 Habits That May Actually Change The Brain
I cover health, medicine, psychology and neuroscience.  

The brain is by far our most precious organ–others are good, too, but they all pale in comparison to the mighty brain. Because the brain works so hard around the clock (even while we’re sleeping), it uses an extraordinary amount of energy, and requires a certain amount of nutritional support to keep it going. It’s high-maintenance, in other words. But there may be misconceptions about what keeps a brain healthy–for instance, there’s little evidence that omega-3 supplements or green smoothies would do anything above and beyond generally good nutrition. So what does science actually tell us can help our brains? Here’s what we know as of now.


Physical activity is pretty clearly linked to brain health and cognitive function. People who exercise appear to have greater brain volume, better thinking and memory skills, and even reduced risk of dementia. A recent study in the journal Neurology found that older people who vigorously exercise have cognitive test scores that place them at the equivalent of 10 years younger. It’s not totally clear why this is, but it’s likely due to the increased blood flow to the brain that comes from physical activity. Exercise is also thought to help generate new neurons in the hippocampus, the brain area where learning and memory “live,” and which is known to lose volume with age, depression and Alzheimer’s disease. The one stark exception to the exercise rule is impact sports like football, which has been shown again and again to be linked to brain damage and dementia, since even low-level impacts can accrue over time. The same is true for soccer headers.

Starting an exercise routine earlier in life is likely the best way to go, and the effects more pronounced the younger one begins. More research will be needed, but in the meantime, enough research has shown exercise to be beneficial to the brain that it’s pretty hard not to at least acknowledge it (even if we don’t do it as much as we should).

Foods and Spices

The brain is a massive energy suck–it uses glucose way out of proportion to the rest of the body. In fact, it requires about 20% of the body’s energy resources, even though its volume is just a tiny percentage. This is justifiable since thinking, learning, remembering and controlling the body are all huge jobs. But the source and quantity of the sugar matter: Eating highly processed carbs, which break down very quickly, leads to the famous spike-and-crash of blood sugar (which your brain certainly feels). But eating whole, unprocessed foods leads to a slow, steady rise, and a more constant source of energy–and it makes the brain much happier.

 Beyond giving energy, dietary sugar (especially too much of it) also appears to affect how plastic the brain is, or how capable of change. A study last year, for instance, found that rats fed fructose water after brain injury had seriously impaired recovery. “Our findings suggest that fructose disrupts plasticity—the creation of fresh pathways between brain cells that occurs when we learn or experience something new,” said study author UCLA study author Fernando Gomez-Pinilla, whose work has also shown that sugar impairs cognitive function in healthy animals. Interestingly, omega-3 fatty acids appear to reverse some of this damage. And in humans, fatty fish has been linked to cognition, presumably because the fats in it make the cells of the brain more permeable. Omega-3 capsules, however, have not been shown to do much good.

There’s mixed evidence that plant-derived antioxidants can improve cognitive function, at least in isolation. While some studies haven’t found an effect, others have suggested that compounds in foods like cocoa and blueberries may do some good. (Not surprisingly, Mars Inc. has funded a lot of research in this area, and even markets a high-potency cocoa mix, CocoaVia, for cognitive health.) And finally, turmeric, a key component of curry, if used regularly, has been linked to reduced incidence of Alzheimer’s disease, presumably for its antioxidant and anti-inflammatory properties.

In general though, researchers are split on whether eating just one thing will cut it–for instance, adding blueberries to an otherwise mediocre diet probably won’t do much. But a diet low in sugar and high in whole foods, healthy fats and as many colorful fruits and veggies as you can take in is cumulatively one of the best things you can do for your brain.

Vitamins and Minerals

Though there’s little evidence that multi-vitamins do us much good, there are certain vitamins that the brain needs to function. Vitamin B12 is one of the ones critical for the function of the central nervous system, and whose deficiency can lead to cognitive symptoms like memory loss. Vitamin D is also critical for brain health–and while there’s no causal link, low levels have been linked to cognitive decline. Iron is another that the brain needs to function well (especially for women who are menstruating) since it carries oxygen. But as always, although supplements are certainly necessary for certain people, getting your nutrients from food appears to be the most efficient way to take them in and absorb them.


This is a funny one. Many coffee lovers know instinctively that coffee does something very good for their brains in the morning, and indeed our cognition seems a little fuzzy without it. But coffee does appear to effect some real change: Not only does it keeps us alert, by blocking adenosine receptors, but coffee consumption has also been linked to reduced risk of depression, and even of Alzheimer’s and Parkinson’s diseases. This is partly because, like cocoa, compounds in coffee improve vascular health, and may also help repair cellular damage by acting as antioxidants.


This connection is fascinating, because although there are thousands of years of anecdotal evidence that meditation can help a person psychologically, and perhaps neurologically, the scientific evidence for meditation’s effects on the brain has really just exploded in the last five or 10 years. Meditation has been linked to increased brain volume in certain areas of the cerebral cortex, along with less volume in the brain’s amygdala, which controls fear and anxiety. It’s also been linked to reduced activity in the brain’s default mode network (DMN), which is active when our minds are wandering about from thought to thought, which are typically negative and distressing. Meditation also seems to lead to changes to the white matter tracks connecting different regions of the brain, and to improved attention and concentration.

Education/Mental Activity

Staying mentally active over the course of a lifetime, starting with education, is tied to cognitive health–which explains why crosswords and Sudoku are thought to help cognition. Mental activity may or may not keep a brain from developing disease (like Alzheimer’s), but it certainly seems to be linked to fewer symptoms, since it fortifies us with what’s known as cognitive reserves. “It is not that the cognitive activity stops amyloid beta production or neurofibrillary tangle development or spread,” David Knopman of the Mayo Clinic told me recently, “but rather that higher cognitive activity endows the brain with a greater ability to endure the effects of brain pathologies compared to a person with lower cognitive engagement throughout life.”


The brain does an awful lot of work while we’re sleeping–in fact, it really never sleeps. It’s always consolidating memories and pruning unnecessary connections. Sleep deprivation, and just a little of it, takes a toll on our cognitive health. It’s linked to worse cognitive function, and poorer attention, learning and creative thinking. The more sleep debt you accrue, the longer it takes to undo it. Sleeping for about seven hours per night seems to be a good target to aim for.

*  *  *

The bottom line is that doing as many of these things as you can is good for your brain; but if you can’t do them all every day, don’t beat yourself up. If you don’t do any, just integrating a couple will very likely help. And your brain may appreciate it more than you think.

Running shoe mistakes

Even seasoned runners sometimes make these blunders.

By Amanda Furrer

FRIDAY, JUNE 16, 2017, 11:57 AM

Whether you’re just getting into this whole running thing, or you’ve been doing it your entire life, shoe shopping can be tricky. The technology is constantly changing, there are new advances in foams and other materials every year, and styles change often enough that sticking with one line—or even one brand—doesn’t always make sense. So we asked running shoe experts, Eric Sach, Ken Larscheid, and Carson Caprara, what the most common buying gaffes runners tend to make are when they’re sole searching—and what to do instead. (And once you learn how to shop, check out the Runner’s World 2017 Spring Shoe Guide for our thoughts on the latest models.)

You’re not getting your foot properly measured.

“One of the most common errors beginner runners make when they walk into a shoe store is not getting their foot measured by a store associate,” says Eric Sach, owner of The Balanced Athlete in Renton, Washington. At a shoe store, associates use the Brannock device, which measures the heel-to-toe length as well as foot width and arch length. Sach finds that most people ignore arch length, which is measurement from your heel to the ball of your foot, the area where your foot flexes. “All shoes are designed to flex at one spot, just as your foot is designed to flex at one spot,” says Sach. “It’s best to match those two flexing points together.”

You’re confusing volume with width.

“Shoe volume is the measurement of the space inside the shoe,” says Sach, who has 27 years of experience. Most people tend to ask Sach for a wider shoe when there’s not enough volume. The trick is to measure the space in between the top eyelets with your fingers.

“When you tie the laces, the shoe should be snug—not too tight and not too loose—and you should have two fingers between the eyelets,” says Sach. Three fingers mean there’s not enough volume and the fit is too tight. One finger is when there’s too much volume and therefore, the fit is too loose. And two fingers—you guessed it—should be just right. Knowing you’re wearing a shoe with the correct volume will save you from common foot injuries, such as the dreaded plantar fasciitis.

You’re afraid of increasing your shoe size.

Sach recommends getting your foot measured every time you need a new pair of shoes. On several occasions, he will get customers who find their “normal” shoe size a little too snug before getting their feet measured. “Feet generally don’t get shorter,” says Sach. “The tiny muscles in your feet support your body every day, causing your feet to ‘grow’ because these muscles stretch and don’t come back—unless you run barefoot or perform foot strengthening exercises.”

Consider the difference in sizes between shoes: a half size is only an eighth of an inch difference; a whole size is about the width of a shoelace, almost a quarter-inch. “It’s very tiny,” says Sach. “However, all the time, people say they’re going to trip over it.” Going up half a size—or even a full size—will make a world of difference in comfort, but shouldn’t cause your friends to tease you about wearing “clown shoes.”

You give into peer pressure.

According to Sach, the most important elements to consider when buying shoes are the three F’s: fit, feel, and function.

But when people bring along a friend during shoe shopping, sometimes their friends will cloud their judgment by commenting on how the shoe is the wrong color or they make the wearer’s feet look too big. Even if it feels like they’re walking on air, wearers will usually go with their friends’ opinions and opt out. Sometimes new runners will fall back on what their friend is wearing, as well. But there isn’t one shoe that fits all. While you may value your friend’s advice in the fitting room, when it comes to running shoes, it’s more about feel than looks.

You’re using the wrong kind of shoe reviews.

It’s all too easy to believe that “when something works for you, everyone [else] should have the same exact thing,” says Sach. And that is the shoe buyer’s downfall when it comes to relying on crow-sourced shoe reviews.

How familiar is the reviewer with the range of shoes on the market? What type of foot does the reviewer have? Is the reviewer actually a runner? Ask yourself if the review is published by a reliable source: Is it the kind of site that aggregates enough info to help runners choose or are they just telling you what to buy? Lookout for biased reviews, as well, where brands sponsor the writer if they review their product. (The Runner’s World shoe finder tool helps you find the right shoe, with ratings you can trust.)

You wear your shoes too long.

Most running shoes have a lifespan of between 300 and 500 miles, but many runners either don’t keep track of mileage. That, or they throw caution to the wind and wear out their pair.

Wearing out shoes can lead to injury. According to Ken Larscheid, owner of Running Lab in Pinckney, Michigan, a tell-tale sign for replacing your pair is when you get unusual aches and pains in certain areas. “A lot of people who come in and feel pain or soreness don’t even question the age of their shoes,” says Larscheid. “What we suggest at the store is overlapping them a little bit.”

Introducing a new pair before your current pair wears out will help you ease into new shoes as you ease out of your old ones. Other indicators to start changing out include worn, smooth grooves at the bottom of your shoes and uneven foam on one side of the shoe, meaning the sole is no longer level.

You’re avoiding specialty stores.

Larscheid says that many beginners are overeager about getting started or are unwilling to spend the money for the best pair. Instead of going to a running shoe store where they can get their foot analyzed by experts, new runners tend to buy whatever shoes they see—for cheaper prices—at department stores, or order online.

Gait analysis and identifying specific needs of the wearer—is this shoe for endurance or cross training?—are considerations new runners may overlook if they avoid the specialty store and seek shoes elsewhere.

And although people think they’re saving money, they’re potentially setting themselves up for buying pair after pair of the wrong kind of shoe, and spending more money out of dissatisfaction. At a running store, you’ll have more options and experts at your fingertips. If the shoe fits, think of it as an investment and safeguard against future injuries. Running stores also typically have the varying widths that department stores won’t always carry.

You forget that it’s only a tool.

“One mistake runners can make is searching for a shoe as a prescription to help fix how they run or to help them run a certain kind of way,” says Carson Caprara, Brooks Director of Footwear Product Line Management. “Instead, runners should look for the shoe that works best for how their body wants to move and provides them with the experience they want out on the run.” Remember: the power doesn’t lie in the shoe, it lies in you.

Don’t overdo it with the self-massage tool.

Despite the foam roller’s popularity, it “shouldn’t be considered the silver bullet for at-home therapy,” says Richard Hansen, a Boulder, Colorado-based sports chiropractor. Hansen, who treats recreational runners as well as Olympians, warns that incorrect use may cause muscle damage.Doug Perkins, a physical therapist and certified strength and conditioning specialist also based in Boulder, agrees: “Runners should understand why, when and how foam rolling should be used before getting started.”Here are 10 mistakes these experts recommend against, as well as suggestions for safe and effective foam rolling:

Foam Rolling Without Reducing Adhesions First

Why it’s bad: Perkins warns that foam rolling won’t be as effective if you don’t properly address and reduce your adhesions—also known as knots—beforehand.

What to do instead: Adhesions can be addressed using the foam roller itself: just place it under the pressure point and press your weight down until you feel the tension ease. Or, if the tightened area is small and more localized, a targeted tool—like a massage ball, tennis ball or lacrosse ball—can do the trick. Once the knots are loosened, lengthen out the muscle by gently rolling it across the foam roller for about 30 to 90 seconds.

Waiting to Foam Roll Until After Exercise

Why it’s bad: While Perkins notes that the research is still mixed on the ideal time to roll, he recommends both pre- and postworkout sessions. The reason: jumping straight into a workout without proper tune ups can put you at risk for pulling on those adhesions and making pain worse. Plus, prerun foam rolling lengthens out your muscles, which can help improve your performance.

What to do instead: Set aside an extra five to ten minutes before your workout to reduce any adhesions and then roll out your muscles per the above.

Foam Rolling for More Than 20 Minutes

Why it’s bad: If you feel you need more than 20 minutes of foam rolling to work out the kinks, “you’re probably suffering from a deeper, underlying issue that foam rolling won’t fix,” Perkins says. Hansen agrees: “It’s better to underwork tissue than overwork it,”  as excessively rolling a trouble area can increase injuries.

What to do instead: Limit rolling to 30 to 90 seconds per muscle group, with 10 seconds of stretching in between each roll. You can repeat this cycle up to three times on each body area.

Using a Roller That’s Too Firm

Why it’s bad: If you’re new to foam rolling, using a rock hard, textured roller can compress the tissue too much and cause unnecessary pain—and even bruising, warns Perkins.

What to do instead: Rookies should opt for a softer, even-surfaced roller. As your muscle tissue becomes used to the pressure, you can gradually work your way up to a firmer roller.

Rolling out Your Lower Back

Why it’s bad: Perkins explains that your lower back is more vulnerable than your upper back; rolling it can put too much pressure on the bony part of your spine and end up increasing—rather than alleviating—your back pain.

What to do instead: If you’re experiencing chronic back pain, the problem is likely radiating from a point lower down, like your hips or hamstrings. Rolling out these muscles may help alleviate the back pain, but Perkins advises runners who are unsure of the cause to consult a medical professional for a proper diagnosis.

Improperly Rolling Your IT Band

Why it’s bad: Rotating on your side, stacking your feet on top of each other and rolling out your IT band will compress it against the femur and likely cause extreme pain. “The average person is doing this because they think they should, but they’re actually smashing the muscle against the bone,” says Perkins.

What to do instead: Once you’re rotated on your side with your feet stacked, bring your top leg to the floor and place weight on it to relieve pressure from our IT band. You can also relieve pressure by placing your hand on the floor too.

Rolling Over Knee Caps

Why it’s bad: Rolling straight down from your quad to your calf without breaking can crush the bony attachment in your knee, warns Perkins.

What to do instead: Pay attention when you’re rolling so that the roller doesn’t slip onto danger areas.

Foam Rolling to Treat Injuries

Why it’s bad: Rolling an injured area can aggravate damaged muscle tissue, particularly in the first few days after an injury.

What to do instead: Keep the foam roller off of the sensitive area until the pain subsides. And remember: the foam roller should be just one piece of your recovery process, not your only “go-to” technique, advises Hansen.

Only Rolling on Days You Run

Why it’s bad: Exercise isn’t the only thing tightening up your muscles. Sitting for prolonged periods of time—like most of us do at work—can decrease your range of motion, says Perkins. You may notice this tightness when completing everyday activities, like bending down to tie your shoe.

What to do instead: Keep yourself consistent and limber by setting a routine time to foam roll, whether you run that day or not.

Not Understanding Why You’re Foam Rolling

Why it’s bad: The most fundamental foam rolling mistake a person can make, says Perkins, is not properly understanding why she or he is foam rolling—and not making sure that the foam roller is the right tool. Simply rolling out muscles because that’s what you always do, or because you’ve seen other people do it, is an easy path to accidental injury.

What to do instead: Clearly outline your fitness goals before foam rolling. Are you trying to improve performance, facilitate recovery, prevent injury, or do you have another goal in mind? Next, make sure the foam roller is the most effective tool for the job. Perkins notes that other techniques like stretching or massage therapy may be more appropriate. If you feel you can’t properly and safely determine your needs, it’s time to seek professional advice.

knee injury can be helped with exercise

Story at-a-glance

  • Meniscal tears are present in 35 percent of people over 50 and anterior cruciate ligament ruptures occur between 100,000 and 200,000 per year
  • Rehabilitation programs and exercise may offer you the same results as surgical repair depending upon several factors
  • Strong rehabilitation programs also improve strength and stability of the joint, potentially reducing future injury

The knee is the mostly commonly injured joint by athletes, accounting for 2.5 million sports-related injuries seen in the emergency department annually. Meniscal tears occur in 35 percent of people over the age of 50.

Ruptures of the anterior cruciate ligament (ACL), important to stabilizing your knee, occur in 100,000 to 200,000 people each year. Knee injuries may be treated by a wide range of clinicians, from orthopedic surgeons to internal medicine physicians or Physical Medicine and Rehabilitation Specialists.

Your knee may suffer from an acute or traumatic injury or, through overuse, you may experience degenerative changes to your meniscus. How you treat these injuries may have an impact on your ability to return to your normal activities, and whether you experience degenerative arthritis in the future.

A recent randomized control trial demonstrated the effectiveness of using a structured exercise program to rehabilitate your knee either prior to surgical repair, or in many cases, instead of a surgical repair.

To take full advantage of rehabilitation it’s important to understand how the knee works and what key factors are evaluated to determine which option is best for your unique situation.

Anatomy of Your Knee and Meniscal Tears

Three bones meet at your knee to form the joint that is the largest and considered the most complicated joint in your body. Although your knee is a hinge joint, it must not only bend and be flexible to allow walking but also stable to allow you to stand stationary.

Between your thigh bone (femur) and shin bone (tibia) are two wedge shaped pieces of cartilage. The function of these tough and rubbery pieces are to cushion the two bones and keep them from rubbing against each other. These pieces are called your meniscus.

The menisci have blood supply to the outer edges but this supply rapidly declines as you move further toward the center of the cartilage located directly between the two large bones. Your menisci can tear in a number of different ways from either an acute injury or from degenerative changes over time.

The number of surgeries done each year to repair a meniscus tear has been on the rise. Recent findings in the American Journal of Sports Medicine demonstrated that meniscus repairs increased 100 percent between 2005 and 2011.

Additionally the research demonstrated that patient pain may not have been related to the meniscal tear in the first place.

The researchers found patients experienced pain relief despite the fact that the tear did not heal after surgery. The lack of healing was discovered during a follow-up arthroscopy. What did appear to relieve pain and improve function was immobilization and physical therapy.

Study Demonstrates Effect of Exercise Versus Surgery

Two studies demonstrated the effectiveness of using a structured physical therapy program to either eliminate the need for surgical repair or to improve outcomes when therapy was done prior to surgery.

In the first study, researchers followed participants for five years with minimal follow up loss. The study participants had suffered an ACL injury. The researchers found that results between those who had surgical repair and those who were treated with rehabilitation alone were near identical.

Another study released in 2016 followed participants for two years who had suffered a meniscal tear in their knee. Again researchers found exercise and rehabilitation in middle-aged patients with knee damage was as effective as a meniscal surgical repair, which is an outpatient procedure.

Researchers estimate that 2 million people worldwide undergo arthroscopic surgery every year. But in their review of the literature, researchers did not discover benefits to the patient. This prompted scientists from Denmark and Norway to undertake this two-year study.

In this study, researchers identified 140 patients who had a meniscal tear, the majority of whom were without any osteoarthritic changes to the knee. Half underwent an intensive 12-week exercise program and the other half had arthroscopic surgery and given a home rehabilitation program.

No clinical difference between the two groups was found as it related to their ability to do daily activities, participate in sports or pain levels. Thirteen of the participants who were in the exercise-only group opted to have arthroscopic surgery during the study, but didn’t experience any additional benefits.

Additional Benefits of Exercise Versus Surgery

Arthroscopic surgery is considered a low risk procedure. The most common serious side effects are deep vein thrombosis, infection and pulmonary embolism, occurring only 0.4 percent of the time.

However low risk this procedure may be, surgical repair increases medical costs, insurance costs and doesn’t appear to produce superior results. On the other hand, a strong rehabilitation exercise program does produce increased strength in the large muscles supporting the knee joint.

In the most recent study, researchers tested the quadriceps (thigh) muscles of the participants at baseline, three months and 12 months.

They found the individuals who underwent rehabilitation not only experienced similar results to those who had arthroscopic surgery, but also exhibited increased strength. The authors, quoted in Science Daily, said:

“Supervised exercise therapy showed positive effects over surgery in improving thigh muscle strength, at least in the short term.

Our results should encourage clinicians and middle aged patients with degenerative meniscal tear and no radiographic evidence of osteoarthritis to consider supervised structured exercise therapy as a treatment option.”

Strength improvements were demonstrated in the first 12 months of the study, but were not evaluated during the remainder of the study. Improved strength in the knee joint may reduce your potential for further injury and may also improve your ability to perform daily activities.

A placebo effect happens when you think you’re being treated with something, but the medication you’re given doesn’t have any physiological effect. This video describes what may be happening in your brain when you take a placebo. To gain approval by the U.S. Food and Drug Administration (FDA) a medication must prove it is more effective than a fake drug or placebo. However, when approving medical devices or surgical procedures for treatments, this proof is not required.

In 2002, research published in the New England Journal of Medicine proved the results people experienced from arthroscopic surgery for osteoarthritis were no better than those results you would expect from a placebo.

In another trial, conducted with 146 patients who experienced a meniscal tear without osteoarthritis, researchers found that a sham surgical procedure had the same results as those who underwent a meniscal repair. The study evaluated the participants over a 12-month period and found no significant difference between the groups.

The study proving the placebo effect in arthroscopic surgeries for osteoarthritis occurred in 2002. Unfortunately, to date this information has not changed the number of arthroscopies performed, costing insurance companies and individuals over $3 billion each year for a procedure that produces results individuals may experience with physical therapy and rehabilitation alone.

Consider These Important Factors Before Surgery

If you would like to consider a surgical option for your injury there are several factors that may improve or reduce the likelihood of a successful outcome.

Functional Changes

While you may have changes to your meniscus on an MRI, if you don’t exhibit pain or functional changes to your gait, surgical repair is likely not necessary. Sports medicine physicians use a “duck walk” to evaluate the impact knee injuries have on your stability and strength. Squat and walk like a duck. If you aren’t able because of knee pain or weakness, consider a rehabilitation program to improve your joint strength and reduce pain.


Your weight is a significant factor in determining the potential success of a surgical repair. For instance, research has found significant changes in the curvature of your knee joint within the first three months after injury with an increased body mass. The results found those who underwent surgery experienced greater flattening of the knee joint than those who used rehabilitation without surgical intervention when their body mass index was higher.

Size and Placement of the Tear

The reduced blood supply to the meniscus in the center of the knee increases the likelihood any surgical repair will not heal or will fail. The size of the tear and the placement — whether in the center of the meniscus or along the outer edges with greater blood supply — impacts the decision about surgery.

Repair of the meniscus has a greater success rate in younger patients with peripheral tears near the capsular attachment that are either horizontal or longitudinal. Even in these cases, success depends on compliance with post-operative exercise and rehabilitation, including non-weight bearing and bracing.