How to Prevent Muscle Loss with Aging
Coach Amy explains how a combination of protein and resistance exercises together helps prevent age-related muscle loss and how blood flow restriction training can promote muscle building and strength while keeping joints safe.
What happens to muscles as we age?
As we age, we lose muscle. We refer to this process as sarcopenia, which leads to a significant decline in function and quality of life. But it is a process we have control over!
Aging muscles respond dramatically to exercise and proper nutrition. Together, they cause an increase in mass and strength.
Prevent age-related muscle loss with protein.
Load to the muscles is required to build mass (hypertrophy) and strength. First, we must have the building blocks available to grow the muscle. The building blocks are proteins, namely leucine, lysine, and methionine.
The best source of these building blocks is protein-rich foods. Supplements help provide additional support but do not replace food sources. Muscles require high quantities of protein from food sources, namely animal sources like eggs, chicken, beef, tuna, salmon, yogurt, and cheese.
In his book Outlive, Dr. Peter Attia, MD, explains why plant protein sources are less bioavailable than animal proteins. Check out this YouTube video interview where Dr. Attia explains the differences between animal and plant proteins.
Prevent age-related muscle loss with resistance exercises safe for your joints using blood flow restriction training.
When we have the right level of proteins circulating in our bloodstream, we can build muscle with resistance exercise training. But with normal age degeneration of the joints, this can be challenging because heavy lifting can cause injury to the joints and muscles. Enter BFRT!
Blood flow restriction training (BFRT) boosts hypertrophy and strength while minimizing joint stress.
Minimizing blood flow to your muscles tricks the neuromuscular system - that connection from your brain and spinal cord to your muscles - into thinking you are performing a high-intensity exercise. This trickery leads to a cascade of biochemical changes that promote muscle growth. It also stimulates bone, muscle, and tendon repair and boosts cardiovascular performance, but that's another article.
Move without age limits and move well with CoachAmyPT.
With protein building blocks and safe resistance loading for your joints, you can prevent age-related muscle loss and move well without age limits. Ask Coach Amy at your next appointment if BFRT will help you meet your wellness goals.
What are YOUR goals for 2024?
Treatment customized to your body. Your goals. Your future.
As we transition to a new calendar, I feel overwhelmed with gratitude for you, my patients - for your ongoing support and loyalty to CoachAmyPT and for trusting me with your wellness.
The new year is traditionally a time to reflect on last year's goals and create new ones. While I recommend evaluating and adjusting your goals throughout the year, the turnover to the next 365 days is a great time to do so, so let's give it a go!
Reflecting on 2023
Personal reflections.
My wellness goals for 2023 took an unexpected turn with the diagnosis of an autoimmune disorder and a torn meniscus. It meant jumping from one train track to another with a focus on learning how to manage my autoimmune disease and lots of rehab to recover from surgery. It required setting new goals, harnessing the same dedication and motivation I had for my original goals, and applying them to the new ones. And I'm still working on it because, as you’ve heard me say many times, “It is a process!”
Clinic reflections.
And what about the clinic? CoachAmyPT met many goals in 2023, including a remodel for a more functional layout and integration of high-intensity laser therapy into the treatment toolbox.
I earned my certification in advanced neurological dry-needling in the spring to enhance pelvic floor health and have helped both men and women with pelvic floor issues and endurance athletes with hip and back pain with these new techniques.
Oh, and then there is the successful launch of the new podcast, The Coach Amy and Coach Liz Show. While it is a podcast geared towards endurance athletes, several non-athletes have told us they love it and get something out of it, too. Have a listen wherever you get your podcasts.
Your reflections.
How did you do this year? Did you meet your goals for 2023? What would you change? Did CoachAmyPT help you? Share your testimonial with me - I’d love to hear it.
Looking Ahead to the New Year
Personal wellness goals.
My wellness goals for 2024 are to continue building strength, stay active, and get through the year injury-free. I'd also like to try the sport of gravel riding. It’s tempting to set a goal for a particular race, but instead, I will break down the year into quarters and set goals based on how my body reacts and progresses.
Clinic goals.
And what about the clinic goals for 2024? CoachAmyPT will add blood flow restriction training (BFRT) for injury treatment and performance enhancement. And a refreshed and easier-to-navigate website is already in the works.
CoachAmyPT can help you!
What do you want to achieve in 2024? CoachAmyPT can help you with treatments that are customized to your body. Your goals. Your future.
I look forward to helping you move well in 2024 and beyond, whether for treating an acute or chronic injury, enhancing your recovery and performance, or helping you defy age-related musculoskeletal challenges.
Introducing Blood Flow Restriction Training (BFRT) to CoachAmyPT
Photo from Smart Tools: Smart Cuff 4.0
Increase strength, improve performance, and speed up recovery from injury or during training with Blood Flow Restriction Training (BFRT) at CoachAmyPT.
What is Blood Flow Restriction Training?
Coach Amy applies a pressure cuff to your extremities at a controlled and carefully prescribed occlusion pressure (measured with a Doppler ultrasound device). The pressure minimizes the blood flow to and from your muscles during customized physical therapy rehab protocol or performance training workouts.
How does Blood Flow Restriction work?
Minimizing blood flow to your muscles tricks the neuromuscular system - that connection from your brain and spinal cord to your muscles - into thinking you are performing a high-intensity exercise. This is through a series of biochemical reactions. I will share more in another post for those who like to geek out on the science.
What are the benefits of Blood Flow Restriction Training?
BFRT allows us to reap the same benefit of high-intensity training with less strain on the muscles, tendons, and joints. It also improves aerobic capacity with less stress in shorter amounts of time. This can support endurance training, enabling us to do more without the same strain/stress.
Blood flow Restriction Training is validated with scientific evidence to:
Increase strength
Increase muscle size/mass (hypertrophy) - even more so than high-intensity training.
Attenuate muscle atrophy
Promote recovery during training for sports performance
Improve cardiovascular function in all populations, including athletes and the aging
Aid in the rehabilitation of injury with faster outcomes
Enhance pre-surgical physical therapy (prehab)
Blood Flow Restriction Training is COMING SOON to CoachAmyPT
Coach Amy is taking level 1 and 2 certification courses for applying and using an FDA-approved BFRT device and will begin offering these services in January 2024 as an adjunct to physical therapy rehabilitation and performance enhancement. Stay tuned for more details!
Move past injury. Move toward success. Move without age limits. Move well.
Help, I can't see my appointments!
Screenshot once you’ve logged in to your account.
Help, I can’t see my appointments!
Can’t see your appointments? You are not alone, but rest assured they are there!
It’s a fact. Patients love the ability to schedule their appointments online. “It’s a great service.” The technology makes it easy for patients but also possible for small, privately owned healthcare practices to operate like a fully staffed front office. But, occasionally, an update to a platform can change how things look on both the business and patient end. This happened recently with our scheduling platform.
At first glance, it looks as though you may not have any appointments because the format has changed. Rest assured, your appointments are still there! The changes are not intuitive, so let us help you.
Follow these steps to see your scheduled appointments
Log into your account.
Locate your username/email. See the photo above.
Click the arrow next to your email address. A drop-down menu will appear. See the photo below.
Click on “Appointments.” You should be able to see all your upcoming and past appointments.
Still having trouble?
Please get in touch with Allison if you still can’t see your appointments.
Announcing a Podcast Hosted by Coach Amy with her Coach, Liz.
Cool looking album art.
Introducing a Podcast
Should you use ice or heat to treat an injury or for post-run recovery? How about a massage gun? What is recovery?
We answer these questions and more on The Coach Amy and Coach Liz Show, a podcast for endurance athletes from the perspective of two coaches, two athletes, and a physical therapist. And in the process, we share our experiences as athletes and patients - the good, the bad, and the ugly.
Not an endurance athlete? That’s okay; most active people will find many topics relevant.
Listen and Follow
The podcast goes live with the first three episodes on Sept. 20th. Until then, listen to the teaser trailer in iTunes or Spotify and follow us wherever you get your podcasts.
Learn More
Visit our podcast landing page to learn more.
We are in this Together
Recommend us! Promote a healthy and positive experience in endurance sports by helping other endurance athletes discover this podcast. Not sure how? In the podcast trailer, click on the (…) and choose share.
Can I Run During an Injury and if not, When can I Return to Running After Injury or Surgery?
These are million-dollar questions! My answer is, "It depends."
A patient with patellar tendonitis, whom I instructed not to run, came into his appointment and said, "I feel great, and I ran seven miles two times last week." I lifted my head from my laptop, peered at him through my glasses, and gave him a grin and head nod of understanding while at the same time resisting the urge to roll my eyes back in my head.
As a runner who has experienced many injuries and surgeries, I empathized personally, but as a physical therapist, it is cringeworthy when a patient goes rogue.
Why rest from running or manage your return to running after an injury or surgery?
The musculoskeletal system, which includes bone, takes time to heal and strengthen progressively. When running, the structures must tolerate repetitively loading at least three times your body weight.
Several factors determine whether you can run during an injury or when you can return to running after an injury or surgery.
When and whether or not you should run depends on an injury's nature, severity, and chronicity. Does the injury involve bone or soft tissue like a tendon? Is the injury mild or severe? How long has it been present? Six months, three years, or two weeks?
Nature of the injury or Surgery.
If the injury involves tendons and ligaments, it can sometimes take longer than a fracture to heal. The rule of thumb for tissue repair is at least six weeks if you do all the right things! Some surgeries require six weeks of rest from running and high-impact sports, and others require six months or more. Runners undergoing surgery should always have post-operative physical therapy if they want to return to sport.
Severity of an Injury.
The more severe the injury, the longer it will take to return to running. For example, a grade III calf injury may need months of rest, while a grade I calf injury may only require a week of rest from running. Check out my article on Calf Strain and Pain.
Chronicity of an injury.
The longer an injury has festered, the longer it will take to return to running. This is a rule of thumb, and I find it is usually accurate. And why all runners should seek professional help if an injury does not subside within a week of rest and modification.
Signs, symptoms, and issues that indicate you need to rest from running or wait to return to running after an injury or surgery.
Poor biomechanics due to lack of stability, strength, or range of motion
Swelling/inflammation
Pain greater than a 3/10 during or after running
Poor Biomechanics
Many runners can feel when their run gait is “off” or when weakness or lack of mobility is present. Weakness and/or loss of range of motion is your body’s way of telling you that something is off - they are protective mechanisms. Pushing through a run in these circumstances will delay healing, worsen the injury, or even cause another injury!
Swelling and Inflammation
Swelling is a sign that the body is not okay. It is a red flag, a warning to stop running. Intermittent, mild swelling may be permitted with a return to run, but it means that you’ve done too much. Ensure you are working with a physical therapist to help you manage your back to run the program. Check out my article on Aiding and Controlling Inflammation.
Pain
Once again, it is a warning sign that something is not right. If unmedicated, your pain is greater than a 3/10 on a pain scale where 0 is no pain, and 10 is emergency room pain, then you should not run. Do not take pain medication to run. Pain is a fascinating and multi-faceted topic, and your physical therapist can help you navigate when it is okay to have some pain. Check out my article: Pain and Injury Doesn’t Mean You Have to Quit.
Resting from running impacts our mental health. Acknowledging and addressing our mental headspace is just as important.
Following my patient’s admission to running, an explanation ensued, "I don't drink, I don't smoke, and I don't do drugs. I run." Running releases serotonin, which makes us feel good, and it is a mental escape, a muse. Taking it away from us for too long can mess with us physically, emotionally, and mentally. Fear of losing fitness comes at a close second to the effect on our headspace.
Acknowledge this aspect and work with your physical therapist to manage it with modifications and alternatives for running.
Modifications in running during injury and returning to running programs after injury are not one size fits all! It is personal and individual.
With mild injuries, sometimes running can continue, albeit modified in volume, intensity, and perhaps surface, while you heal. When it comes to a back-to-run program or continuing to run while managing an injury, finding the right recipe can be complicated: it takes practice, finesse, and patience. It's an art as much as a science, and an experienced physical therapist specializing in running can help.
Your physical therapist will continually test you to ensure you meet benchmarks for return to run and, when you meet them, will set you up with a back-to-run protocol. That protocol will consider how much time you’ve rested from running, your specific injury or surgery, your running experience, and your tolerance.
Invest in your running future.
My patellar tendonitis patient was lucky. Most runners that do this rouge testing don't fare as well and end up setting back their healing and their return to run. Pay attention to the signs and symptoms that should stop your run, and seek professional help for managing your rest, modification from, and return to run; it is an investment in your running future!
Stop injuries before they occur!
Learn the top five training errors that lead to injuries in runners in this blog post.
How to treat Delayed Onset Muscle Soreness
You know that feeling of sore muscles after a strenuous strength workout? There is a name for that! It’s called DOMS, and Coach Amy has some advice for what to do when this happens.
What is DOMS?
Delayed Onset Muscle Soreness (DOMS) occurs 12-24 hours after a workout. It is okay and normal to experience mild-moderate cases of DOMS, especially with certain kinds of exercises. Do not confuse DOMS with pain due to injury, which occurs almost immediately. If you suspect an injury, click on the button below.
How do I treat DOMS?
Resting the affected muscle groups, dynamic movement, and cross-training are the best medicine in mild to moderate cases.
DOMS Treatment List
relative rest
dynamic mobility
moist heat
compression socks/sleeve
Kinesio Tape (applied for lymph drainage)
cupping
light massage/myofascial release
proper hydration and nutrition
Reduce the intensity and duration of exercise for 1-2 days following intense DOMS-inducing exercise. Resting the areas of the body experiencing DOMS allows proper recovery so you can resume training quicker. You can exercise less affected body parts during this time and perform gentle dynamic movement of affected areas.
In severe cases of DOMS, Tylenol can help with pain. It is not an anti-inflammatory. Taking Tylenol with certain prescription medications or in the case of certain medical conditions can be contraindicated. Always check with your doctor first if you are uncertain.
What NOT to do when experiencing DOMS.
Successful training relies on a normal inflammatory repair process. If you hamper that inflammatory process with ice and NSAIDs, you could negatively impact your overall training response. Deep tissue treatments and stretching during early DOMS can also delay healing and cause injury.
During the DOMS, avoid the following:
stretching
NSAIDs (non steroidal anti-inflammatories e.g. ibuprofen)
Ice and ice baths
deep tissue massage
percussion massage
deep tissue treatment devices like scrapers, dense foam rollers
If you do not recover from DOMS within 24 hours of onset, talk to your physical therapist, coach, or personal trainer so they can help you modify and navigate the recovery process successfully.
DOMS happens. Honor it and know what to do so you can resume training safely.
Massage Guns: Do or Don't?
"Should I use a percussion device or massage gun?"
That is an excellent question; unfortunately, many patients and athletes assume devices they see at race expos, post-race recovery tents, or in magazine articles are safe and don't question it.
My answer is no; you should not use a percussive device or massage gun. Before you discard yours or ignore my answer and go ahead and use it anyway - yes, I know who you are - please hear me out.
The reason I do not recommend the use of percussive devices or massage guns is that the risks outweigh the benefits. Unlike vibrating massage heads or foam rollers, these devices create a downward force into the body's tissue like a jackhammer, and the smaller the head(s), the more concentrated the power. This hammering force can cause damage, sometimes severe.
Unfortunately, athletes, in particular, associate "pain" with stretching or massage as beneficial. "It hurts, so it must be working." That is rarely the case. It is difficult for injured or sore athletes to discern when it is acceptable to feel discomfort with a self-treatment method like a massage gun.
Risks of using a massage gun
Safely using a percussive or massage gun requires a thorough command of human anatomy. Besides a general knowledge of where the claves, glutes, and hamstrings reside, most athletes and patients are unaware of the location of nerves, blood vessels, lymph nodes, bursae, organs, tendons, or ligaments. Improper device placement over these structures can cause severe damage.
Massage guns on injured and inflamed connective tissue can further damage the structure and increase inflammation. For example, use on a torn ligament, like an ankle sprain, could injure it further.
There are many examples of patients in my clinic who improperly used a massage gun to treat their soreness, pain, or injury. Below are four cases.
Case #1
A patient attempted to treat his groin pain, in this case, psoas tendonitis, and placed the gun in the area where the femoral nerve, artery, and vein reside. Not only is it contraindicated to use the device on the injured, inflamed psoas tendon, but the risk for vessel and nerve damage was high in this area.
Case #2
A patient tried to treat his pectoral muscle strain and aimed the device in his armpit on a large bundle of nerves called the brachial plexus. Damage to these nerves could cause temporary or permanent disability to the entire arm/hand.
Case #3
A patient attempted to treat her knee pain and aimed the device at the painful spot but didn't realize that what "hurt so good" was the peroneal nerve. Damage to this nerve could cause foot drop - or lack of the ability to lift the foot.
Case #4
A patient tried to treat her sore "glute" with the massage gun but didn't realize she aimed it at a bursa (a fluid-like sack) in the same area. Because this was my initial visit with her, it is hard to know if she was suffering from bursitis before using the gun or afterward, but in either case, her injury and pain were worse.
Dangers and contraindications for massage gun use
While rare, a percussive massage tool can sometimes cause severe or life-threatening injuries, including fractures or joint damage, deep vein thrombosis, and rhabdomyolysis.
Using a percussive massage gun can cause a fracture in persons with osteopenia or osteoporosis. Never use a massage gun at the site of a fracture - even a stress fracture. If you suspect a fracture go to the emergency room or an orthopedic urgent care center.
Deep vein thrombosis is a rare but life-threatening condition, especially for post-surgical patients. It tends to show up as calf pain and soreness. A massage gun on that sore calf could dislodge the blood clot and cause a pulmonary embolism and death. If you are experiencing symptoms consistent with a blood clot, go to the emergency room.
Rhabdomyolysis is a severe and potentially life-threatening condition. Endurance sports athletes are particularly at risk of acute exercise-induced rhabdomyolysis (AER), which can occur after profound overexertion, such as after a long run, ride, or race. Endurance athletes using percussion massage to treat delayed onset muscle soreness after an endurance event or training session may be at a higher risk.
There is a case in the literature of a patient who suffered a case of severe rhabdomyolysis after percussion massage: Chen, J., Zhang, F., Chen, H., & Pan, H. (2021). Rhabdomyolysis After the Use of Percussion Massage Gun: A Case Report. Physical Therapy, 101(1). https://doi.org/10.1093/ptj/pzaa199
Not ready to throw your massage gun in the trash?
Limited research supports that a percussion device can help with increased mobility when used on healthy tissue and when operated by a healthcare professional. The risks outweigh the benefits, but if patients and athletes insist on using them, I recommend scheduling an appointment with a physical therapist to learn how to use them safely.
While your health is serious business, we can also take a minute to laugh about the massage gun. Check out comedian Tom Papa’s bit about these “weapons-grade jackhammer massage guns.” Tom Papa: What A Day!
Alternatives to achieve mobility
Physical therapists, patients, and athletes have many safer alternatives to achieve mobility. Subscribe to Coach Amy Says to receive upcoming posts on how to achieve mobility and why Coach Amy does not recommend stretching as well as other tips on injury prevention, wellness, and performance.
Coach Amy discusses massage guns and all things endurance sport with Coach Liz in their podcast, The Coach Amy and Coach Liz Show. Coming soon to Apple Podcasts, Google Podcasts, and Spotify.
Treating Migraines with Neurological Dry Needling
What is a migraine, and what causes them?
Migraine headaches are a genetic neurological disease. Multiple factors can trigger migraines, such as hormones, stress, lack of sleep, alcohol, caffeine, food allergies, overuse of medications, smell, light, and dehydration.
Injury to the neck muscles, joints, and nerves can cause migraine-like symptoms and trigger a migraine in sensitive individuals. We refer to problems with this area of the body as cervicogenic.
What is a cervicogenic headache?
Cervicogenic issues may arise from a sports injury, whiplash, arthritis, pinched nerve, muscle strain, or poor posture.
Dry needling can treat most cervicogenic headaches and help individuals with the migraine headaches they trigger.
How does neurological dry needling help treat headaches?
Studies show that the trigeminal nerve is overstimulated and inflamed in cervicogenic and migraine headaches. Integrative Dry Needling System (IDNS) techniques can help reduce the inflammation of this nerve and its many branches, thereby decreasing the frequency and intensity of migraine headaches.
How can Coach Amy help you with your headaches?
Coach Amy is certified in IDNS. She treats the neuromuscular and biomechanical causes of both types of headaches with the following:
patient education
dry needling
manual therapy techniques like active release
joint mobilization
posture and biomechanics training
“After the first treatment, the results were life-changing. For six months I had woken up with a headache, but these immediately disappeared. For over a year, I often canceled plans because I could not leave home, but now I can plan because I know I won’t be stuck in bed with a headache. In the past five months, I have only had 3-4 migraines, which are less severe. Dry needling with Coach Amy has been central to my recovery.”
While dry needling will not cure migraine headaches, it may help decrease the frequency and intensity, especially those triggered by cervicogenic issues.
Schedule an appointment with Coach Amy to evaluate if neurological dry needling and physical therapy can help minimize your migraines and improve your quality of life.
The Science Behind High-Intensity Laser Therapy (HILT)
How does high-intensity laser therapy (HILT) help heal various musculoskeletal injuries?
Remember introductory high school science class? Does photosynthesis ring a bell? How about mitochondria and ATP? These concepts are foundational in understanding the science behind HILT. But don't worry if you don't remember! I will explain.
Boosts Cellular Energy
When your body is recovering from an injury, the cells (e.g., muscles and nerves) require energy to build and repair. HILT boosts that cellular energy and activity.
Let's take out a virtual microscope and zoom in on a slice of quadriceps (thigh) muscle. Zoom in further; you will see bundles of skeletal muscle cells that comprise the thigh muscle. Zoom in once more, and inside those muscle cells are mitochondria. These are kidney bean-shaped organelles responsible for creating energy (ATP). See the drawing above.
HILT penetrates the skin and travels deep into the quadricep muscle cells. It stimulates their mitochondria to generate more ATP (energy), so the cell can be more active, allowing them to create the building blocks that repair the muscle; this is just an example of a muscle cell. HILT also increases energy production in other connective tissue cells, including nerves, ligaments, and tendons, in the same way.
Aids in the Transport of Nutrients
Cellular repair requires energy, but we also want to remove waste products caused by the injury and bring needed nutrients to the area so the cells can build new, healthy tissue. HILT dilates blood vessels, increasing blood supply which transports nutrients required for cellular repair, and removes waste products released by the injured tissue.
Enhances Cellular Mobility
Injuries, disease processes, and conditions like frozen shoulder and, often, surgery cause scar tissue to develop; tissue fibers become cross-linked and stiff, interfering with mobility and, ultimately, function. HILT helps release the cross-linked fibers. The result? Muscle, capsular, and ligament relaxation.
HILT is one treatment method and does not stand alone.
HILT is a powerful addition to a well-rounded arsenal of treatment methods, such as manual therapy, dry needling, and applied functional exercises—along with Coach Amy's ongoing evaluation methods based on principles of biomechanics. No treatment offers an effective long-term solution without pinpointing the root cause.
Do you have more questions about HILT?
High-Intensity Laser Therapy FAQs cover everything from what to expect during treatment, how many sessions you may need, how to prepare, and more.
Coach Amy breaks down what HILT is and isn’t in this article: Introducing High-Intensity Laser Therapy at CoachAmyPT.
HILT helps treat conditions from head to toe, including pain syndromes, nerve and joint problems, and muscle and tendon damage. Coach Amy will explain it in an upcoming article: Conditions HILT Helps Treat.