PT 360 March 2019

Getting you back to the life you want to live.


M arch 2019

In Touch


G ood L uck B ad L uck

old when attempting to stretch his hamstring and he didn’t quite get the instruction, pushing the heck down on my outer arm instead of my upper trap. I was hurt again 7 years ago in a car accident, and then last year, I picked up a heavy box, immediately put it back down, but shifted the weight to my right arm first. That was all it took to separate my shoulder — again. I was in PT myself for the early part of the year, digging in hard to get this thing settled and DONE once and for all and working all year on my upper body strength. Things were looking good. Then last week, I was in a car accident. I got T-boned at a great speed, and my car was totaled. What’s good about that? Well, I’ve been exercising all year, and I didn’t get that hurt. I know what to do a little too well to walk my way out of this now not very deep hole. I’m grateful. My wish for you is that you heed the little voice: The one that tells you to go for a walk, take a break because you really need it, or that this is the right thing FOR YOU, right now, convenient or not. Maybe turn up that little voice volume just a little bit; it’s usually trying to keep us on the good and healthy path. We’re just extra good at derailing it. Shelly Coffman

Through my now lengthy career, I find there are always life lessons that get pushed onto us, whether we are ready for them or not. I have said this many a time to patients in front of me, particularly patients that have been involved in an accident caused by someone else. Sometimes we need to be forced into taking care of an issue and taking care of ourselves when it gets so loud that it’s no longer possible to turn away from. Throughout the story, there are “bad” things that happen that later turn out to actually be “good” and then “bad” again later. The point of the story is that events are neither good nor bad, and there’s no good luck or bad luck. An “unlucky” event can bring about happiness, and something that comes easily may not have any benefit in the long run. At work, this has always led into a discussion of how sometimes, something bad isn’t so bad because the ultimate outcome is that the patient will come out stronger, more capable, and more knowledgeable about how to care for their body and optimize daily function going forward. What I do not anticipate time and time again is when it happens to me. Last year for me, was my janky shoulder. I was hurt on the job 20 years ago by a super strong 75 year There is a Chinese folk story that I love called A Blessing in Disguise.

I nvestigating the H ealth T rend T hat ' s A ll the R age

If each new year brings with it a new diet plan that promises the world to those who follow it, 2019 is shaping up to be the year of fasting. If you’ve missed the hype, fasting is quite a bit simpler than other nutrition trends like the keto diet or Weight Watchers program. Instead of counting calories or limiting sugars, you just don’t eat. Supporters argue that by putting your body into a “fasting state,” you can shed pounds and damaged internal tissue, increase your energy, promote cellular repair, lower bad cholesterol, and even protect against neurodegenerative diseases, like Alzheimer’s and Parkinson’s. Chances are you have a friend or loved one who’s tried out some form of fasting and discovered dramatic benefits. But before everyone starts skipping meals, it’s important to examine the research. Writer Julia Belluz at Vox splits the fasting trend into four categories. The first, “intermittent fasting,” cuts out or drastically limits your calorie intake intermittently. For example, thousands of people follow the popular “5:2 diet,” during which you eat normally on weekdays but consume less than 500 calories on Saturday and Sunday. Second is the “time-restricted feeding,”where you only eat during a four- to six-hour window each day — followers usually skip breakfast or dinner. The third category is “periodic fasts.” With this diet, extreme fasters abstain from food for several

–-Shelly Coffman

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fasting. As the thinking goes, the faulty cells die first during fasting, enabling the stem cells to start regenerating key tissues. The science backs up some of these claims, but there are a few issues regarding fasting research. Most of the research behind fasting

days, opting for calorie-free fluids instead. Finally, there is the “fasting mimicking diet,” which involves intaking highly limited, plant- based calories for several days each month. People who use this technique like it because they believe they get the benefits of fasting without missing out on key nutrients. The underlying philosophy behind fasting for weight loss is pretty self-evident — if you don’t eat for periods at a time, you’re bound to burn off some weight. But proponents say the diet’s success can be attributed to more complex factors as well. They argue that as the human race shifted from hunter-gatherers to world-conquering agriculturalists, we left our evolutionary path. Before crops existed, we weren’t wired to eat three square meals every single day. Instead, we made do with what we could find, often fasting for days at a time out of necessity. In addition, some researchers who advocate fasting point to the benefits it can offer regarding disease prevention and longevity. Autophagy, the process by which the body eliminates and replaces damaged cells, is believed to accelerate during intermittent

doesn’t examine its effect on weight loss, and most of it comes from animal trials, not human trials. Though there are a few human trials on fasting that show it can improve health, they have very small sample sizes, and there is not enough data to be conclusive. It’s worth noting that fasting to lose weight can be an extremely difficult strategy to stick to, and according to one literature review, as many as 40 percent of fasters drop out of the diet. Furthermore, at least one study indicates that fasting is not superior to the average calorie-counting diets. In short, fasting is promising, but the data is inconclusive. It may help you live longer and fight off disease, but it is also notoriously

tricky. The average dieter is just as well off with regular calorie counting, especially if you’re not looking to get too intense with your diet plan. Before you start skipping dinner every day, visit your doctor. If they say fasting is right for you, go for it. Just because the jury is still out doesn’t mean you can’t reap the benefits of the trend — just go into it with a healthy attitude, be safe, and understand that fasting is not magic.

K eep T his O ff Y our B reakfast T able S ugary C ereals A re N o B etter T han C andy

the combination of puffed rice and a lack of proteinmeans you won’t feel full until you’ve overindulged. By eating twice the recommended serving (about two cups), you’ve consumed the same amount of sugar found in one can of soda. Honey Smacks is the worst of the two because it contains hydrogenated vegetable oil —one of the unhealthiest food-based oils you can consume. This type of oil keeps the cereal shelf-stable for longer, but the American Heart Association points to it as a major dietary cause of heart disease. Many other cereals are just as bad, including Kellogg’s Froot Loops and General Mills Trix. These two cereals hide behind the guise of“fruit,”which many people associate with better nutrition. But you won’t find balanced nutrition in either of these cereals. Froot Loops is just under 50 percent sugar by weight, andTrix is just under 40 percent. Both cereals also contain artificial food dyes and flavorings. Trix also contains corn syrup, which has been linked to the rising rates of obesity and type 2 diabetes. When you eat 10 grams of sugar in any form— which is in just one cup of Trix—or more, depending on the cereal, you can expect a spike in blood sugar. A blood sugar spike early in the morning can often translate to low energy later in the day. Over time, a diet high in sugar can lead to insulin resistance, which can lead to the development of type 2 diabetes.

It’s no secret that most breakfast cereals are loaded with sugar and

carbs. Starting your day with a hefty bowl will inevitably give you a sugar high that crashes into a haze of fatigue not long after. What’s worse, however, is that some cereals are even more unhealthy than you might realize. Do you remember the old Reese’s Puffs slogan:“Candy?! For breakfast?” Reality isn’t far off.

Kellogg’s Honey Smacks and Post Golden Crisp are two of the biggest offenders when it comes to sugar content. By weight, Honey Smacks and Golden Crisp are more than 50 percent sugar. That’s more sugar than your average cake or cookie. And there isn’t much more nutritional value to make up for the excess sugar. These puffed rice cereals contain less than two grams of protein and one gram of fiber per serving, which is remarkably low. For reference, Honey Smacks lists 1 1/4 cups as a serving, while Golden Crisp considers 3/4 cup a serving. That said, most people don’t measure out food based on the recommended serving size. With these two cereals,

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3 W ays to H onor I nternational W omen ' s D ay

avenues for women to express themselves is a great way for your company to take a step forward in fostering gender equality. J oin the C onversation Regardless of your gender, March 8 is the

On March 8, people around the world will honor International Women’s Day. Adopted by the United Nations in 1975, the holiday is meant to highlight the immeasurable accomplishments of women throughout history and draw attention to the ongoing struggle for global gender equality. International Women’s Day is celebrated differently around the world. Some nations, like Nepal, give all their citizens the day off. Most countries, however, including the United States, treat it as a normal day, at least officially. Even though we don’t have the day off, there are many ways for everyone to honor International Women’s Day this year. Here are a few of them. T alk A bout the W omen W ho I nspire Y ou Frommajor innovators, like Ada Lovelace, the world’s first computer programmer, tomegalithic literary icons, like Maya Angelou, women throughout history have shaped howwe live our lives. Whether you’re inspired by famous historical figures or the women in your own life, take the time to talk about that influence. Which women helped get you where you are today?What female leaders do you look up to?What are some lessons you’ve learned from them? M ake R oom for C onversation in the W orkplace Many of the challenges women face globally happen in the workplace. If you think your company has room for improvement in its treatment of women, now is a great time to do something about it. Even if you believe your company treats women and men equally, there’s no harm in empowering your colleagues to talk to give their opinions. If you’re an employer, this couldmean giving women in your workplace an avenue to discuss issues, air grievances, andmake suggestions. If you’re an employee, consider asking for such a forum. In either case, providing both public and anonymous

perfect time to tune in to the larger conversation surrounding gender inequality, if you haven’t already. This couldmean attendingmeetings or demonstrations in your town, reading works that capture the female struggle for equality, such as Roxane Gay’s“DifficultWomen,”or seeking out blogs and social media accounts fromgender equality activists online. International Women’s Day is about appreciating the contributions of women to society and envisioning a more equal world for the future. However, you decide to celebrate women this March, keep inmind that nomatter who you are or where you come from, we all have the power to change our world for the better.

H omemade C orned B eef



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2 quarts water 1 cup kosher salt

1. In a large stockpot,

combine water, garlic, and all herbs and spices to make brine. Cook over high heat until salt and sugar are fully dissolved. Remove from heat and stir in ice. 2. Once water temp reaches 45 F, place brisket in a 2-gallon zip-close bag, pour in brine to cover, lay flat in a large container, and store in fridge. 3. Brine for 10 days, checking daily to make sure brisket is fully submerged and brine is stirred. rinse under cool water. In a large pot, cover brisket, onion, carrot, and celery with water. Bring to a boil, then reduce heat to low and gently simmer for 2 1/2–3 hours. 5. Remove, slice across the grain, and serve. 4. After 10 days, remove brisket from brine and

1/2 cup brown sugar 2 tablespoons saltpeter (potassium nitrate) 1 cinnamon stick, broken into large pieces 1 teaspoon mustard seeds 1 teaspoon whole black peppercorns 8 whole allspice berries 12 whole juniper berries 2 bay leaves, crumbled 1/2 teaspoon ground ginger 1 5-pound beef brisket, trimmed 1 small onion, quartered 1 large carrot, coarsely chopped 1 stalk celery, coarsely chopped 8 cloves garlic 2 pounds ice

T ake A B reak !

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1215 SE 8th Ave., Ste. D Portland, OR 97214

Good Luck Bad Luck The Skinny on Fasting Diets Page 1 Candy? For Breakfast? Page 2 3 Ways to Honor International Women's Day Homemade Corned Beef Page 3 When Should You Heat or Ice an Injury? Page 4 I nside T his I ssue

F ire and I ce W hen S hould Y ou H eat or I ce an I njury ?

When it comes to relieving pain, everyone has an opinion. Your mommight suggest taking pills and a nap, while your neighbor swears it’s best to walk it off. Meanwhile, yearly advancements offer more options—and opinions— for patients seeking relief. Among the plethora of available treatments, two remain constant —heat and ice. However, many people don’t knowwhich to use, and unfortunately, the wrong decision canmake your pain or injury worse. If you are unsure which method is best for you, here’s the answer to your heating or icing dilemma. Heat: These treatments can come in several forms, such as creams, pads, and wraps. Many medical professionals suggest using heat treatment for 30 minutes to four hours, depending on what is needed to fully relax the muscle. Heat often works best for chronic pain because it supports blood flow and loosens your

decreases swelling. This is the opposite of the muscle relaxation you need for chronic pain relief. Eventually, heating treatments can be worked into a healing plan, but ice is a quick solution to a small problem. As withmost treatments, what works for one personmay not work for another. If icing an injury feels best for you and you see improvement, continue icing away your pain. Additionally, some patients find relief while rotating between cooling and heating. Regardless of your preferred method, it’s best to seek professional guidance in order to find a viable long-term solution.

muscles. Heat treatments can also be used to relieve stress and tension, but you should never use heat on an open wound or fresh injury. Ice: Cooling treatments can also be found in creamor wrap form, but a bag of peas or ice from your freezer will work just as well. Ice should be used for short periods throughout the day. Icing treatments are best for bruised wounds andminor injuries because the cold can reduce the swelling in your blood vessels— the cause of bruising—and expedite your healing process. However, icing your chronic pain can be detrimental due to the stiffening reaction that

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