Diabetes … what’s your type? - Natasha Eekhout (Paladin Biokineticists)

So you have diabetes… let’s not ‘sugar’ coat it. You’ve adjusted your sugar intake and you are changing your overall diet, but what about exercise? Yep these two go hand in hand, whether you are overweight (Type 2) or whether it was genetically passed on (Type 1).

In this day and age, Type 2 diabetes is most common, where our lives are made convenient with take-out meals and video games are more fun than socialising and kicking a ball outside. Type 2 diabetes occurs when the body is unable to use insulin properly or when the body doesn’t make enough insulin, thus making it hard for your body to metabolise sugar. Type 1 diabetes is usually genetic and occurs when the pancreas is unable to produce insulin.

So how do we fix this problem? Ok yes Type 1 diabetes cannot be cured whereas Type 2 can be prevented and managed completely. Although both Types are very different, they can both be approached the same way with healthy eating, lifestyle changes and most importantly physical activity.

Performing exercise sounds easy enough, however there are a few restrictions.  This is when our biokinetics qualifications intervene. Diabetes is a chronic condition and so with it comes a couple considerations to take into account when combining exercise, namely:

• Hypoglycaemia: sudden drops in blood sugar when physically exerted with symptoms such as shakiness, weakness, sweating, anxiety and visual disturbances
•  Hyperglycaemia: mostly a Type 1 concern, symptoms may include fatigue and increased thirst
• Blood glucose monitoring: nedds to be done before, after and during your physical activity
• Timing: Exercise isn’t recommended during periods of high insulin action as hypoglycaemia may result. Exercise in the morning and evening is dependable on the individual
•  Insulin injecting: avoid injecting into exercising limbs
• Supervision: is important and necessary to reduce risks
• Associated retinopathy: high intensity exercise can result in haemorrhaging and retinal detachment
• Thermoregulation: the body’s ability to regulate temperature is skewed
• Overweight: exercises need to be adjusted as to remove increased pressure on vulnerable joints

With all of these taken into consideration, we at Paladin and Associates Biokineticists have developed a specific program to improve your current diabetic condition, aimed to regulate your sugar levels, manage your weight and decrease your associated symptoms.

Feel free to drop us an email or give us a call, and let’s make life a little sweeter for you!

Natasha completed her BSc Sports Science undergraduate degree at The University of Johannesburg and her BHSc honours degree in Biokinetics at The University of the Witwatersrand. 

She has a passion for a variety of sports in particular soccer, tennis, running and kickboxing which have contributed to a strong interest in orthopaedic rehabilitation and working with athletes. Other areas of focus include diabetic and cardiac rehabilitation, as well as weight loss and a keen enthusiasm for working with children of all ages. 

Natasha can be contacted on 082 476 9727 or natashaeekhout@kinetics.co.za

Ergonomics in the workplace

From a Biokinetics perspective, empowering a patient with the knowledge to make good ergonomic and biomechanical decisions about their workplace setup results in fewer easily avoidable postural problems.

If one considers that for a standard 8-hour work day plus the associated travel, the workplace constitutes a good 40% of our lives on a day to day basis. Taking a little bit of time to set up our cars and desks goes a long way in productivity and comfort.

There a few “common sense” tips that we should adopt when spending significant amounts of time in static positions; especially when at a desk.

• ·      Adjust chair height so that your feet are flat on the floor so that your knees are at about 90 degrees, and in line with your hips.
• ·      Try and keep your wrists neutral so that they are not splaying outward or in a flexed position
• ·      Set your monitor so that your line of site is horizontal and around 500mm to 1000mm from your face.
• ·      Adjust your elbow height so that it is approximately in line with your keyboard height.
• ·      Center yourself around the “B” key of the keyboard. This is the centre of the keyboard.
• ·     Invest in a decent chair. Something that supports your all the way up and that the back of your head can touch!

When unsure, seek the assistance of a Biokineticist who is able to assist with your ergonomic setup.

Pounding the pavement – Can running do more harm than good?

You’ve been told that running sheds the pounds. Your Personal trainer has given you a running program to boost your goals but after the 3^rd week your knees are so sore that you look crippled when walking up stairs.

On the 3^rd kilometer of your track session, you become increasingly annoyed with the Kenyan guy who has lapped you for the 9^th time; not only because he is so unbelievably fast, but because you get a fright every time he zips past you.

If this sounds familiar, then you are not sufficiently conditioned to be running the distances you are attempting. You probably sound like a small elephant with flip flops on when you run because you actually lack the intrinsic lower limb strength to control the dynamic gait of running.

If you compare your lower leg and foot strength to that of a seasoned Comrades runner, you will more than likely find that they are able to do a lot more with their functional bodyweight than you can; such as a one legged squat and an unassisted one legged calf raise.

The best comparison of whether one is potentially doing more harm than good during exercise is the blister analogy. If you start lifting weights without gloves, your hands will blister. If you continue lifting weights and do not give the blisters time to become callous, then your hands will proceed to tear open and become injured.

The solution is common sense. Before you even start running; ensure that you have basic functional lower limb strength such as being able to do a one legged squat. A Biokineticist can assist with this and get you going. Once you start your running program, start with small distances and apply the 10% rule, running no more than 10% distance OR intensity each week.

If you slowly build up, you should see steady improvements over time until you are running comfortably without pain.

How much Exercise is enough? - Tony Paladin (Paladin Biokineticists)

According to the American College of Sports Medicine (ACSM) it is advised that adults should get at least 150 minutes of moderate-intensity cardiovascular exercise per week, train each muscle group 2 to 3 days a week, do 2 to 3 days per week of flexibility exercise and finally another 2 or 3 days per week of functional or neuromotor exercise.

A literal interpretation of this would amount to 9 days a week alongside a further 2.5 hours of cardio! Obviously as most of us are employed and in the bid to win the employee of the month wellness contest, training for 6 hours per day would get most of us fired…

As a general tip (unless we are training for a specific sports event), we should train for enjoyment purposes which will naturally enrich our health as a by-product. In practice, I find that people who train solely to maintain weight or because their doctor told them to, end up becoming bored and non compliant.

Although the guidelines of the ACSM are more or less accurate, we can definitely draw up our own little “cheat sheets” when it comes to exercise. The most honest way of doing this is to consider that the 4 types of exercise suggested (cardio, strength, flexibility and functional) are not mutually exclusive and do not need to be done independently of each other. Another way of looking at this is like eating yoghurt and muesli; whether your pour your yoghurt on top of your muesli or blend it into a smoothie, it’s still the same moosh inside your guts…

If we were to exchange the word “exercise” for “movement”, and try and free up around an hour per day to do this, the consumption of the ACSM’s guidelines seem a little more surmountable. In these 6ish hours per week, if we were to sprinkle a nice spread of cardio, strength, flexibility and functional into the mix, then surely the target becomes pretty easy to hit?

Taking this a step further and doing functional movements (balance), with good form, using free weights through a good range of motion, we have pretty much killed 3 birds with one stone! All we need to do is mop up the balance with a bit or cardio.

The most easily digestible recipe for the implementation of an exercise program is to book your exercise time slots into your diary, the same way that you would book a meeting.  The time of day is up to you but I would suggest booking time out and getting away from your home or office and turning your phone off in order to limit distraction.

Once this step has been done, it is relatively easy to populate your program with movement! Make sure that that around 50% of the movement is cardiovascular and the other 50% is a nice mix of strength, flexibility and function.

As we are all human and the dreaded “L” word gets in the way (Life), there are inevitably going to be weeks where we are unable to fit in our quota of sessions. My advice here is to make sure that you do not go more than 2 to 3 days without doing something; even if it just recreational (health depending). Once you allowed yourself to slip for more than 3 days, the pattern of inactivity tends to set in and we are more likely to be forgiving on ourselves to take another day off which will eventually become a week, which will eventually become a habit…

Obviously on the flip side of this is the potential of getting TOO MUCH exercise. If the body is getting insufficient rest or is being broken down faster than it is being built, it will begin to degrade. The quickest tester here is your health; if you are getting sick more than 2 to 3 times per year you are either overcooking the training or not getting to bed on time.

Tony’s Primary areas of focus include: Orthopaedic rehabilitation (mainly backs and knees). He works with regaining function in ACL reconstructions and total knee replacement patients.

Tony also has an interest in sport specific testing and training (primarily rowing, cycling, running and triathlon).

Tony is the Chairman of the Biokinetics Association of Southern Africa (Gauteng division).

Tony can be contacted on 011 028 1128 or tonypaladin@kinetics.co.za. 

In case of an emergency, he can be contacted on 082 921 6776.

Why sleep is such an important factor in weight management - Michelle Smit (Paladin Biokineticists)

Ever wondered why you are constantly hungry and craving unhealthy calorie loaded foods, the day after a restless night’s sleep? The answer is actually quite simple. Increased evidence shows that sleep has a direct influence on eating behaviours. Excess body weight, poor diet quality and increased food intake, are all associated with short sleep duration, poor sleep quality and later bed times.  There may also be bidirectional effects between weight gain and increased sleep, such as insufficient sleep causing weight gain and obesity, and obesity in turn causing insufficient sleep, hence creating a setting for a vicious cycle.

The relationship between sleep and weight gain is complex and involves the hormones leptin and ghrelin. Leptin, which is produced in fat cells, is responsible for the satisfied feeling experienced after a meal; thus signalling to the body that sufficient food has been ingested. Ghrelin, which is produced in the stomach and pancreas, does exactly the opposite and signals to the brain that it is time to eat. The body regulates leptin and ghrelin during periods of sleep.

Thus inadequate sleep leads to high levels of ghrelin in the body, and constant hunger. It furthermore causes low levels of leptin in the body, leading to an unsatisfied feeling, even after a meal. Adequate sleep helps the body maintain proper levels of these hormones. It is thus evident that sleep has a direct influence on eating patterns.

So how many hours of sleep is sufficient? Research shows that between 7 and 9 hours of sleep is needed for optimal brain function, but between 8 and 10 hours is needed for optimal weight management.

The moral of the story is that for optimal weight management sleep is just as important as exercise and a balanced diet, so pull those pillows closer and enjoy a good nap.   

Michelle obtained her degree in human movement sciences at the University of Potchefstroom and her BSc honours degree in Biokinetics at the University of Zululand. 

She has a keen interest in orthopaedic rehabilitation, particularly the shoulder joint, as well as chronic disease managemen/ rehabilitation and enjoys working with people of all ages. 

She enjoys netball and swimming and working with athletes on any level. 

Michelle can be contacted on 084 579 3174 or michellesmit@kinetics.co.za

Biokinetics to master your pirouettes - Melissa Biffi (Paladin Biokineticists)

Just like any other sport, dancing is very taxing on the body, because of the long hours of training and we are constantly pushing our bodies to achieve more and more every time. Although pushing your body can certainly provide you with results, at the same time it may result in injuries. Therefore it is extremely important to find a balance and identify weaknesses that can be strengthened, enabling you to work harder and push yourself without obtaining injuries.

Often with dances they realise their weaknesses too late, which will result in long term rehabilitation in order to correct these injuries. Therefore it is of vital importance that individuals address their weaknesses before the injuries occur. It is believed that supervised training and focusing on key areas can allow a dancer to build the strength needed and still allow their bodies to recover from a strenuous dance class, without the risk of developing overuse or repetitive injuries. This is done by using different physical activity in order to rest dance-specific muscles which will allow the body to adapt, as it gives the nervous system a rest from the usual dance specific movements.

The use of Biokinetics is a great way to help professional and aspiring dancers to improve fitness, flexibility, and strength and help with injury recovery. That being said, no amount of Biokinetics can replace your dancing classes, the only way to master pirouettes is to practice them. However this needs to be done with the right combination of supervised training, resulting in increases in strength and control, thus your improvements should be progressively more noticeable from class to class setting you apart from the rest.

A Biokineticist can identify weaknesses and risk factors that could result in dance injuries and give you tailor-made physical training as well as education on conditioning principles, which could be applied directly to improve your dance technique. While not being strictly ‘exercise’, if your budget and schedule allows, you’d be good to make time for some additional therapies to improve your body’s recovery such as Sports massage, Yoga and Pilates depending on the specific needs of your body.

Sports massage can help maintain the body in a number of specific ways. General conditioning, preventing injuries and loss of mobility, restore mobility to injured muscle tissue, boost performance and extend the overall life of your sporting career.

Yoga is perfect for building core muscle and general flexibility too. Having to focus on your balance whilst barefoot also helps to awaken and strengthen the intrinsic foot muscles which are so important for strong feet.

Weight training is essential for all dances. For dancing boy a strength training program is beneficial as it helps in preparing for partnering. For ballet girls, you’d need specific advice on weight training, as you want to maintain long, lean muscles and not build bulk like a bodybuilder ,also keeping  in mind there may be some forms of exercise that could be great for you and not-so-great for others.

Finding your personal recipe for dancing success might take some experimental research, but a combination of dancing and other forms of exercise is highly recommended if you want to take your dancing to the next level. 

Melissa Biffi obtained her BCom Sports Management Degree at the University of Johannesburg and completed her Honours in Biokinetics at the University of Witwatersrand.

She has a special interest in dancing and other sports such as soccer and hockey, which lead to her interest in orthopaedic rehabilitation, particularly knee rehabilitation.

Melissa is also very passionate about working with children in specific areas such as rehabilitation and development of individuals from very young ages all the way through to adolescents.

Melissa can be contacted on 082 822 9677 or melissabiffi@kinetics.co.za

Ages and Phases of Growth, does it make a difference on training?

Ages and Phases of Growth, does it make a difference on training?

Here are couple facts for all you coaches to take into consideration, when training your young athletes of all shapes and sizes.

Age definitely has an effect on the form of training performed. Each individual will progress through the different phases of growth at different periods throughout adolescence.

In order for a coach to design an effective program for young athletes, it is essential for the coach to understand their athletes’ individual strengths and limitations. This is due to the fact that the working capacity of athletes differs significantly. The coach needs to consider individual differences such as stage of development, training background and experience, health status, recovery rate between sessions & competitions and gender differences. It is vitally important for coaches to cater for the individual needs of each athlete. It is recommended that coaches pay more attention to anatomical age, biological age and athletic age as children of the same chronological age can differ by several years in their anatomical maturation.

So what’s the difference between all these different forms of ages?

• Anatomical age: this refers to anatomical growth of an individual such as infancy, crawling, walking, prepuberty, puberty, adolescence and maturity, thus explaining why some kids develop faster than others and may therefore pick up skills faster.
• Biological age: is the physiological development of organs and systems that determine physiological potential. This type of development is invisible to a coach and could lead to misjudgement of potential.
• Athletic age: is drawn up by national and international federations, and classifies the eligibility at which an athlete can compete.

It has been shown that physiological characteristics and trainability of prepubertal adolescents is different to that of adults, particularly the anaerobic processes which are still poorly developed and the trainability to change this status is limited. In most young athletes, aerobic pathways are genetically determined, not significantly influenced by training programs prior to the athlete’s peak growth phase.
One of the greatest potentials for improvement exists, however, in the area of coordination. Focusing on teaching skills and neuromuscular coordination has the capacity to improve the young athlete's efficiency and therefore improve performance.

It is good to practice for training programs to be structured in an attempt to reflect these considerations and focus on the attainment of the skill and not totally highlight attempting to change physiological status.

Puberty is characterised by the increase in bone growth:

Gender

Average age

Range

Females	9 years	7.5 – 13 years
Males	11.5 years	10.5 – 15 years

More than 50% of children fall outside of the accepted norms.

Height development precedes the development of muscle mass by about one year. During this phase, muscle strength can be improved slightly. No heavy weights or major repetitions should be included in the training program until full bone maturation has occurred.

Young athletes who are “tall for their age” often lack the muscular development to match their skeletal development and are often relatively weak, prone to imbalances and developmental injuries. Great attention should be paid to such athletes when considering them for selection in senior teams. Although they may be the same size or bigger, perhaps even stronger than some of the older athletes, they still may not be able to handle the heavier training load of the senior teams.

As has already been mentioned, children develop at different rates. The growth rates of bones, muscles, organs and nervous systems are different and these developments largely dictate their physiological and performance capabilities. This is why a training program should consider individual training potential. Therefore, a progressive program with no abrupt increases in intensity and a large amount of variety, greatly increases training efficiency thus reducing the chance of injury.

Development of the young athlete is divided into 4 stages:

1. Initiation: 6 – 10 years; Athletes are gradually introduced into sport training
2. Athletic Formation: 11 – 14 years; Athletes develop their talents
3. Specialisation: 15 – 18 years; Athletes choose their sport and the position they would like to play
4. High performance: 19+ years 

Coaches often try applying stages 3 and 4 too early in an athlete’s life, taking the principle of specificity and applying it with no regard to the athlete’s background or level of development. Examples of this are quite commonly noted in athletes that have recently matriculated and perhaps competed on a junior national or provincial team, who have been invited back to coach u14’s at their school.

Such individuals are no doubt phenomenal athletes and potentially great coaches but by trying to enforce “results-based” training on youngsters spells potential disaster.

In an attempt to produce competitive, highly specific performance routines in young athletes, the coach often exposes the child to training that is too specific for their developmental level. This results in drop out because there is no solid performance base that the athlete can work from.This approach to training can lead to unilateral, narrow development of muscles and organs

• It has the potential of disturbing the natural physical development and biological harmony in the young athlete’s bodies, which are essential for physical efficiency, athletic performance and development of a healthy individual.
• Injury, overuse and over training can result in the long term.
• It can interfere with the child’s ability to develop social relationships due to the many hours of intensive training.

   

    The 4 stages of athletic development

    a. Initiation Stage: 6 - 10 Years Olds

Children in the initiation stage should participate in low-intensity training programs, in which the emphasis is placed on having fun. Most young children are not capable of coping with the physical and psychological demands of high intensity training or organised competitions. Training programs for these young athletes should focus on overall athletic development and not sport specific development.

The body is growing at a rapid rate and larger muscle groups are more developed than smaller ones. The cardio respitory system is developing, and aerobic capacity is adequate for most activities. 

Anaerobic capacities are limited at this stage as children have low tolerance to lactic acid accumulation. Body tissues are still cartilaginous and bones are still calcifying.

Attention span is short at this age, and children are action oriented, thus they cannot sit and listen for long periods of time. It is especially important for training at this stage to be varied and creative. Participation and fun should be emphasised over winning.

The following guildelines will help in developing training programs that are suitable for athletes at this stage:

• Emphasise multilateral development by introducing a wide variety of skills and exercises including running, jumping, catching, throwing, batting, balancing and rolling.
• Provide each child with enough time to adequately develop skills and equal playing time in games and activities.
• Positively reinforce children who are committed and self-disciplined. Reinforce improvements in skill development.
• Encourage children to develop flexibility, co-ordination and balance.
• Encourage children to develop various motor abilities in low-intensity environments.
• Select a suitable number of repetitions for each skill, and encourage children to perform technique correctly.
• Modify the equipment and playing environment to a suitable level.
• Design drills, games and activities so children have opportunities for maximum active participation.
• Simplify or modify rules so children understand games.
• Encourage children to participate in drills that develop attention control to prepare them for the greater demands of training and competition that occur in the athletic formation stage of development.
• Emphasise the importance of ethics and fair play.
• Make sure sports are fun.
• Encourage participation in as many sports as possible.

b. Athletic Formation: 11 - 14 Years Old

It is appropriate to moderatley increase the intensity of training during the athletic formation stage of development. Although most athletes are still vulnerable to injuries, their bodies and capacities are rapidly developing. Their cardio respiratory system continues to develop, and tolerance of lactic acid accumulation is gradually improving. 

It is important to understand that variances in performances may be the result of differences in growth. Some athletes may be experiencing a rapid growth spurt, which can explain why they lack co-ordination during particular drills. As a result emphasise developing skills and motor abilites, and not performance and winning.

The following guidelines will help the coach develop training programs that are appropriate for the athletic formation stage:

• Encourage participation in a variety of exercises from the specific sport and from other sports, which will help them to improve their multilateral base and prepare them for competition in their selected sport. Progressively increase the volume and intensity of training.
• Design drills that introduce athletes to fundamental tactics and strategies, and reinforce skill development.
• Help athletes refine and automate the basic skills they learned during the initiation stage and learn skills that are a little more complex.
• Emphasise improving flexibility, co-ordination and balance.
• Emphasise ethics and fair play during training sessions and competitions.
• Provide all children with opportunities to participate at a challenging level.
• Introduce the athletes to exercises that develop general strength. The foundation for future strength and power gains should begin at this stage. Emphasise developing the core sections of the body, in particular the hips, lower back and abdomen, as well as muscles at the extremities, i.e. shoulder joints, arms and legs. Most exercise should involve bodyweight and light equipment, such as medicine balls, gym balls and light dumbbells and barbells.
• Continue developing aerobic capacity. A solid endurance base will enable athletes to cope more effectively with the demands of training and competition during the specialisation stage.
• Introduce athletes to moderate anaerobic training. This will help them adapt to high intensity aerobic training, which takes on greater importance in most sports during the specialisation stage. Athletes should not compete in events that place excessive stress on the anaerobic lactic acid energy system.
• Avoid regular competitions that place too much stress on the body anatomically.This includes events with high risk shock impacts such as triple jump.
• To improve concentration, introduce athletes to more complex drills. Encourage them to develop strategies for self-regulation and visualisation. Introduce formalised mental training.
• Introduce athletes to a variety of competitive situations that allow them to apply various techniques and tactics. Young athletes like to compete; however it is important to de-emphasise winning. Structure competitions to reinforce skill development.
• Provide time for play and socialising with peers.

c. Specialisation: 15 - 18 Years Old

Athletes in the specialisation stage are capable of tolerating greater training and competition demands than in earlier stages. The most significant changes in training take place during this stage. Athletes who have been participating more exercises aimed specifically at high-performance development in one sport.

Closely monitor the volume and intensity of training to ensure that athletes improve dramatically with little risk of injury. Thus the coach can move from a teaching to a coaching (training) role. 

The following guidelines will help in developing programs for athletes in the specialisation stage:

• Closely monitor the development of athletes during this stage. They will develop strategies for coping with the increases in physiological and psychological demands of training and competition. They are also vulnerable to experiencing physical and psychological difficulties from over training. It is VERY important that the coach keeps a look out for this: it usually tends to manifest itself in moodiness, frustration and crying (even in 17 year old boys!)
• Check for progressive improvements in the dominant motor abilities for the sport such as power, anaerobic capacity, specific coordination and dynamic flexibility.
• Increase the training volume for specific exercises and drills to facilitate a performance improvement.
• Increase training intensity more rapidly than the volume, although still increase volume progressively. Prepare athletes to perform a particular skill, exercise, or drill with the appropriate rhythm and speed. Training should closely simulate the actions that take place during competitions.
• Involve athletes in the decision-making process whenever possible.
• Continue to emphasise multilateral training, particularly during the preseason. However, it is more important to emphasise specificity and to use training methods and techniques that will develop sport specific efficiency, particularly during the competitive season.
• Encourage athletes to become familiar with the theoretical aspects of training.
• Emphasise using the muscles that athletes primarily use when performing technical skills. Strength development should start to reflect the specific needs of the sport. Athletes who are weight training can start performing exercises that require fewer repetitions and a heavier weight. Avoid maximum strength training, in which athletes perform fewer than four repetitions of an exercise.
• Make developing the aerobic capacity a high priority for all athletes.
• Progressively increase the volume and intensity of anaerobic training. Athletes are now capable of coping with lactic acid accumulation.
• Perfect the technique of the sport. Select specific exercises that will ensure the athletes are performing the skills in a manner that is biomechanically correct and physiologically efficient. 
• Improve individual and team tactics. Select drills that are interesting, challenging and stimulating and that require quick decisions, fast actions, prolonged concentration and high levels of motivation from athletes.
• Increase the number of competitions progressively, so by the end of the stage athletes are competing as frequently as senior level competitors.
• Athletes should practice mental training. Structure drills and exercises that develop concentration, attentional control, positive thinking, self-regulation, visualisation, and motivation to enhance sport specific performance.

d. High Performance: 19 Years and Older

A well-designed training plan based on sound principle of long-term development will lead to high performance. Exceptional performance results that athletes achieved during the initiation, athletic formation or specialisation stages do not correlate with high performance results as a senior competitor. There are many books written about the preparation of elite athletes ad so this will not be discussed here.

Tony’s Primary areas of focus include: Orthopaedic rehabilitation (mainly backs and knees). He works with regaining function in ACL reconstructions and total knee replacement patients.

Tony also has an interest in sport specific testing and training (primarily rowing, cycling, running and triathlon).

Tony is the Chairman of the Biokinetics Association of Southern Africa (Gauteng division).

Tony can be contacted on 011 028 1128 or tonypaladin@kinetics.co.za. 

In case of an emergency, he can be contacted on 082 921 6776.