Tips for Injury Prevention and Recovery with Dr. Blake Bohanan, DPT

Hey friends! In this episode, Dr. Blake Bohanan shares tips for preventing exercise-related injuries and best practices for recovering quickly should those injuries occur. He also shares about his journey into opening his own practice, Shift Performance PT, here in Knoxville, TN.

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Topics in this episode…

Why workout injuries are so common, especially this time of year. 

How to prevent common injuries from happening in the first place.

Best practices for recovering from exercise-related injuries

How the Shift Performance PT therapy model is different from traditional physical therapy.

Learn more about Shift Performance PT here.

Strength Training Benefits for Women with Cassidy Tipton, CPT

In today's episode, Certified Personal Trainer - Cassidy Tipton shares with us some of the many benefits of strength training for women's health. Whether you would consider yourself to be a beginner or an experienced athlete, Cassidy offers simple and practical tips for incorporating strength training into your everyday life.

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Alaina: Welcome back to the Health Forward Podcast. Today we have a special guest with us, Certified Personal Trainer Cassidy Tipton. Cassidy, welcome to the podcast! We are so happy to have you.

Cassidy: Hello. Thank you so much, Alaina, for having me. I'm so excited to be here.

Alaina: Yes - so I know you from our time working together at a local hospital here in Knoxville. We did that for a couple of years, but for people who don't know you, can you tell us a little more about yourself and your background?

Cassidy: Yes. Absolutely. So a little bit more about me. I kind of fell in love with strength training my sophomore summer of high school. I was one of those people while other girls were sitting there reading magazines like Vogue and Teen Spirit and all that stuff, I was sitting there reading magazines on, I don't know if you remember, the Oxygen magazine. I was a full subscriber to that. I loved it! I was engulfed in all of that. I loved the way those women looked - it was something so new to me. And so I was just taken in by that. I got started with strength training because I played softball in college and in high school, and so I needed to do strength training to help me get stronger with that. So that's where I fell in love with it. In college, I majored in exercise science, and it's funny because I literally changed my major four times when I was in college, and I always kept coming back to exercise science because that was what I truly loved. But other people are like, Oh, you know, you need to do this or that. Of course, I listened to them, but then I always came back to it. And so I did graduate from Carson Newman with an exercise science degree. Then after college, I started my first personal training gig, and I was there for about four years and loved every minute of it. During that time, I fell in love with lots of different types of strength training - working with different special populations of people, not just athletes, but people who were literally just wanting to better their lives, being able to do things with their grandkids. Then I received my ACE Personal Training certification as well as a CrossFit Level one certification. So I dabbled in CrossFit for a while and then also got my USAW Sports Performance certification, with which I competed nationally in Olympic lifting (fun fact for you guys)! So, I've kind of done all different spectrums of strength training.

Then, as Alaina said, we worked together at UT Medical Center - I loved it there! Now, I am currently not doing anything in the fitness realm and I miss it so much! Because of that, I had this strong pull to serve people in that aspect, so, I really started being active on my social media and just really pouring into people and serving people - showing them my workouts. I'm just trying to give that free stuff to people to help others since I don't do that anymore, but I miss it so much and I know that I have the tools and the background that I can help people with it So that is a little bit about me.

Alaina: Yeah, that's great! And you're a mama - you have a little girl. How old is she now?

Cassidy: She is two going on 20. It's like everybody else.

Alaina: I can't believe she's already two. When we stopped working together you had just had her!

Alaina: So, in today's episode, we're talking about strength training - specifically, as it relates to women's health. I think there's a lot of questions and stigma about women doing strength training. So, we are happy to listen to your expertise on this, both in your education and then in your life experience in it as well. So, can you tell us kind of an overview, what is strength training? Are there different types? What are those different types?

Cassidy: Yes, for sure. So strength training (you can also call it Resistance Training) is basically when you are performing some type of physical exercise in which you are working your muscles against some type of opposing force. Now, that force can be something like weights, resistance bands, or gravity (as in just using your body weight). So there are so many modalities of strength training that you can use with the sole purpose of building strength and endurance. Often, when we think of types of strength training, we think of pull-downs, resistance bands, and dumbbells, but it is a totally different meaning inside of strength training that is more of a form of weight training. Then, as you said, you can do plyometrics, barbells, so many different modalities. But when it comes to specific types of strength training, there are seven different types of strength training. I do want to preface what I'm about to say by saying that it's important that we do try to find a program that is encompassing all seven types of strength training just to help get a very well-rounded program. I'll also mention that, women sometimes gear more towards one type and forget others, so be mindful of that. I'll run through these really quick.

So, the first one is going to be agile strength. When we think of this, we think of football players cutting back and forth. We think of things that are very explosive and agility-type movements. So that's gonna be things like shuffles, shuttle runs, and skaters. What's cool is that we can incorporate those types of movements even when we say, "heck, there's no way I can do shuttle runs or skaters", you can still do different versions of that type of training.

The second type is one that women tend to often veer toward - endurance strength. This is where we have the ability to move lighter loads for longer periods of time. So it's more like that 12 - 20 rep range. What's great with endurance strength is this is gonna help us increase the amount of time before we fatigue, while not only exercising but in everyday life. So endurance is so important just to help us as we age so that we can keep doing the things we enjoy. As I said, I do feel that a lot of women, especially when they're starting out with strength training and are worried about the weights and stick to more of the endurance area. There's nothing wrong with that because that is still great. We need that endurance for our muscles and to help us get stronger.

The third type is going to be our explosive strength. So basically, this is going to be your muscle's ability to exert its maximum amount of force in the shortest time possible. This is along the lines of Olympic lifting, box jumps, and burpees. This type of strength is really important as we age because we can build this strength faster than any other. This is especially helpful for elderly clients. For example, in explosive strength we think of the box jumps but we alter them and work on sitting to stand, but doing them explosively. Even with different variations, you can still get that explosive benefit.

Next is maximum strength. This is going to not really be for just the normal everyday average person just wanting to work out, and better their life. This is gonna be more for someone who is trying to lift a single rip at the heaviest amount of possible weight. So this is going to apply more to athletes. However, we can do a variation of this where we're doing higher weight and lower reps - like the 2 to 6 rep range. So we can still get the benefits of what maximum strength that way.

A couple more - next is speed strength. That's basically just how fast you are. You know, this is going to be more useful in sports, but it is good to help us improve how quickly we can react to something. Because as we age, our reaction is something that declines, so it is important that we still are able to react quickly, whether it's when driving or being aware of our surroundings.

Then there's something called starting strengths. Starting strength is what you would see in a track runner in starting position. They are trying to produce as much force or quickness as possible out of a standstill position. We use this same type of strength by sitting up and getting out of a chair. As we get older, we see we see a lot of people struggle to do this - rocking back and then trying to stand up. When we focus on starting strength with compound movements like squats, lunges, etc., it can help build that kind of strength.

Then last, but not least, is relative strength. This is the strength to weight ratio. So, pound-for-pound, how strong you are compared to someone else. So my husband is gonna laugh - my husband is a big man. He is like 230# and very strong, but when we were doing Olympic lifting and I was at my prime, pound-for-pound, I was technically stronger than him. He doesn't like for me to admit that to too many people because he is known for his strength and being very strong. Strength is important but like I said, those are just a lot of different types of strength training.

A great program is going to have a little mixture of kind of each of those types of strength training.

Alaina: So you mentioned this a little bit, especially talking about aging, but how do those things translate into kind of our everyday lives? Where can we see a lot of those benefits - both in our endurance, our ability to move, agility, and things like that as we age, but also from a health side of things?

Cassidy: So a couple of these are beneficial not only just for the everyday person, but especially for women. Number one is definitely going to be that these things are going to build and maintain our muscle mass. So, fun fact for you (well, fun/scary fact), as females our muscle mass decreases 3-8% per decade after the age of 30. This rate declines even more after you hit 60. Okay? And so what stinks about that is this is what leads to an increased risk for falls or the loss of independent living as we age. Strength training is the number one thing that can help slow that process down of losing muscle mass. It also protects our bone health. So as women, we know that we are a lot more susceptible than men to developing osteopenia and osteoporosis. So doing strenth training with any kind of external resistance or weights will help lower our risk for that. Also, if you do already have some form of osteopenia or osteoporosis, it's gonna help slow that process down. Unfortunately, you cannot reverse those factors, but you absolutely can slow it down. My grandmother is an example of this - she has osteoporosis pretty bad. I started helping her with strength training and the slowing down of the process has been huge. So great that when she's gone back to the doctor, there's been a couple of times it's only changed like a fraction, whereas before it was a very big decline each time she went back in my check. That's a big deal because I know a lot of people worry about that as they get older and I don't think that's a commonly known fact that strength training builds bone mass.

Also, for women, strength training is going to help support weight loss and weight management. So when we lift weights, it's going to help us burn more calories and stored energy or fat more efficiently. One way it does that is by increasing lean muscle mass. So we have all heard that muscle burns more energy at rest. Your BMR (basal metabolic rate) is the number of calories you would burn if you sat on the couch and watched Netflix all day. This number is higher if you have more muscle than fat. I think it's one lb. of muscle burns, 3% more than one lb. of fat. Muscle mass helps us to be efficient by increasing our metabolism and helping us burn more while we're literally doing nothing. So who doesn't want that?

Also, I am going to say this, I know that a big stigma around lifting weights for women is that a lot of women are scared that they're gonna get bulky. This is just a myth. The facts behind it are that the hormone testosterone is what makes that happen in the body and we have only about 10% of testosterone that men do. So there is physically no way that when we are lifting that we are going to get bulky as a man could.

We know that there are great benefits of strength training for everyone - better sleep, better energy, just more focus. It's going to help with blood markers like cholesterol and blood sugar. All those good things.

Another one that I think for women, especially and especially for moms is, it's gonna help increase our mental and emotional health., I know for me, working out is so much more than, than just how I look. But when I don't work out, within a few days, I can tell mentally. It is my one time that I can escape from everything else that's going on in my life and focus on me. It can help you have more mental clarity and give a good serotonin boost.

Alaina: Yeah, that's great. I think so many people don't know so many of those things. You know? They know that they'll feel better., but they don't really get down into knowing those details. So, I love that you shared that. I've talked a lot about how it helps from a hormonal health side with blood sugar and insulin sensitivity, but that mental-emotional component is so important too.

I think part of it, too, is that we feel stronger. When we're going to do a strength training workout, and we actually do it, not only are we physically stronger, but we walk away with more mental stamina as well, because it's like "I did that!", you know? So, I think that helps so much when you are facing chronic health issues or you are facing just normal life stress. It just gives you a little more confidence that you can manage things.

Cassidy: 100% agree with you for sure. Yeah, for me, it's just that feeling of going in and lifting just gives me that sense of accomplishment. I feel like if I can do this, then I can tackle anything, right?

Alaina: Exactly. So there are some common questions that come up when it comes to strength training. So I'm gonna ask you a few of those.

How many times per week? What is the goal when it comes to strength training versus overall exercise? We know the overall general recommendation of roughly 30 minutes a day, at least five days a week, but how much of that should be strength training?

Cassidy: Yes, so with strength training, it always depends on whether you are new to it as well as your goals. So if you are someone who is brand new to strength training, you've never done it before, and you're wanting to start off it is recommended that in conjunction with your cardio (75-250 minutes a week of moderate to high intensity) that you want to at least start with twice a week of a full-body workout - every other day type deal. You want to make sure you're hitting each major muscle group in that 10-15 rep range. Even if you are not new but say you just are wanting to maintain what you have, twice a week is what can give you results. You're not necessarily going to see the physique benefits at that frequency, but you're more going to see the benefits of improving your cholesterol, helping your joints, helping your bones, and those types of things. I

Now, depending on your goals and depending on if you are really wanting to change your physique, or maybe you have a specific sports goal, then I would say you need to start ramping up the days that you are in the gym doing your strength training. So I would say you need to be in the gym doing more of like a 4-5 day a week type thing and doing more of what's called a split in your workout. Maybe one day you come to the gym and do an upper-body routine. The next day you do lower-body. Then the next day you rest and then repeat the process. You could get even more specific and focus on only two muscle groups at a time, such as the chest and triceps. Then the next day would be back and biceps... next day legs, or something like that. And then obviously there's some abdominal work in there a couple of days a week too but that is just going to depend on your goal.

So, for example, when I was training for Olympic lifting, I was in the gym six days a week, two hours a day. And there is no way that I would do that right now because I don't have the time and that's not my goal. Now in the gym, I usually try to get some sort of strength training workout four days a week, and I'm doing more of a split style. I also really like doing more of a full-body workout to like more of a CrossFit type style workout, where I'm in my strength and my cardio kind of together. It's important that you are doing the right amount of days and everything, but the main thing is that you find something that you enjoy, because if you don't enjoy it, you're not going to do it and you're not going to show up.

So even if it's something that maybe is not ideal, who cares? The main thing is that you're there and that you're showing up. So whether it's Pilates, Barre, CrossFit, or just weightlifting, find what you enjoy and mix it up. Consistency is where you will get the results.

Alaina: Yes, I love that, and I love that you mentioned those different kinds of workouts. I think that's confusing for people. Sometimes they think strength training only means using machines or only using a barbell. You can incorporate strength training and a HIIT workout. You can incorporate strength training in Barre, Pilates - all that stuff. So, just like you said in the beginning, it depends on what your goals are for that and what you will stick to.

So, a couple of other questions? What would you recommend for someone who says, "Okay, I've tried strength training a few times, and every time I do it, I get very sore, and then I can't do it for three or four more days, and then I kind of just stop".

Cassidy: Absolutely. So, that's a great question. So what I would tell that person or what I would want to look at first is going to be some of their lifestyle factors. So with strength training, you know that is just one piece of the puzzle. But if they if that person is not getting enough sleep, if they're not getting 7 to 9 hours of sleep, if they are not drinking enough water, if they are not fueling their body properly - especially enough protein and carbs to sustain that can be an issue. We also want to make sure that there is a good balance of fuel for the workout. Carbs are glycogen for our muscles and they are going to replenish and refuel our muscles after we work out. If they aren't eating within the first two hours after their workout, let's try throwing in a protein shake. How strength training works is that we do not get the benefits of strength training when we are doing the strength training. It's during our recovery process. So, if we are not going through that recovery process, then yes, we're going to be sore all the time. And so how it works is when we're working out, we create these tiny, small, little micro-tears in our muscles and our body, when we are at rest it goes through something called protein synthesis to repair our muscles. That requires both glycogen and protein. So if we are not giving our body enough protein there's no way we can repair properly. That often leads to injury and it can lead to chronic soreness.

Also, are they sleeping? Stretching? Stressed? When our cortisol is elevated, it can lead to injury, and it can lead to soreness because our body is not going to be able to go through that inflammation process of cleaning all that out and just repairing our muscles and everything. Also, making sure that we're drinking lots of water, you could even throw in some electrolytes in your water as well. One of my tried and true methods for soreness is foam rolling. So on your off-days, foam rolling your muscles will help get out that lactic acid build-up out and help your muscles go through that process of cleaning all the stuff out.

Alaina: Gotcha. That makes a lot of sense. I think that's a huge missing piece - the recovery. People think, "I did my work out - I'm done - I'm going to go on with my day", and then they don't give any thought to that recovery. So follow-up to that is, would you say, within 30 minutes or within an hour? What's that time frame that we need to make sure we're getting that good protein, protein, and carbs, but definitely protein?

Cassidy: So they call it "The window of gains". It is within an hour of your workout is typically what they're recommending, and they usually say you want a complete source of protein. They have done a lot of studies saying that the most quickly digested form of protein is going to be like an isolate or whey protein, but or any type of isolate type protein. So that's going to be something from like a protein shake. Now I know a lot of people might be sensitive to whey protein, so I mean any type of protein shake you could do, and I think that's going to get to your muscles a little bit quicker than a piece of chicken would. Now, if you come straight home from your workout and eat a well-rounded meal, that's still going to be fantastic for you. Sure, it just might not be quite as bioavailable as quickly.

Alaina: Now, what about collagen? Where does that come in because it's not an isolate?

Cassidy: So yes, to make a full, complete protein there have to be 21 essential amino acids in that protein. I think that collagen doesn't have every one of them - I think it's like 19 or something. So collagen is something that you could definitely put in your post-workout shake because it has great benefits, but it wouldn't be something that I would just put in water. It's not going to be sufficient by itself. Yes, but that's a great question.

That kind of brings me to the other point is the complete protein. So there's a lot of sources of proteins that are considered proteins, but are not full, complete proteins. It is important that after our workouts were looking for something with a complete protein, so that's gonna be found mostly in animal sources, right? So just be conscious of that.

Alaina: Cool. Okay, well, are there any resources that you would recommend for people? Maybe who are just starting out their new to strength training? Would you suggest they get a trainer? Are there programs they can do at home?

Cassidy: Yes. So my two favorite resources are going to be ACSM.org and then acefitness.org. That is who I got my personal training certification from, so both of those are the two I trust the most. They are the gold standard when it comes to health and specifically fitness and working out. They do a lot of studies, and they're just they are kind of the cream of the crop. I know specifically, ACEFitness has lots of blogs you can literally type in, "strength training for beginner" and there are thousands of articles that come up that have workout programs in it.

Another thing you can do is getting a personal trainer. I think that's a great idea as well. On those two websites, you can search their database for personal trainers in your area that are certified through them.

Alaina: Great! So if people would like to follow you online where you've been sharing a lot of your workouts and some tips, where can they find you?

Cassidy: Yes, So, on Instagram, they can find me at cass_tipton.

Alaina: I'll put all of that in the show notes so that people can easily find you and then also those two resources as well. Well, thanks so much for spending some of your day with us and sharing all this information with us. It was so helpful!

Cassidy: Yes, you're so welcome! Thank you so much for allowing me to do this and just share some stuff that I love.

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018 - How I Supported My Body Through Insulin Resistance

Hi friends! In last week’s episode we talked about ways to keep our blood sugar levels stable and why that is something that we need to be paying attention to (If you haven’t listened to that episode yet, hit pause and go do that real quick, so that we are all on the same page!). In that episode, I mention Insulin Resistance as something that can cause blood sugar imbalance, and that it is becoming more and more common.

Insulin Resistance occurs when our cells are no longer sensitive to insulin. Insulin is a hormone produced by the beta cells in our pancreas to help allow our cells to utilize glucose. In last week’s episode, I gave the analogy of insulin being like a key that opens the door for glucose to go into our cells - and in someone with Insulin Resistance, it’s like that key just stops working. 

There are a few different theories as to why this happens. Sometimes it can be due to an overproduction of insulin caused by a continual release of glucose into the bloodstream. This is often, but not always, due to lifestyle and dietary choices. When we eat mostly carbohydrates - especially simple carbohydrates that break down very quickly into glucose - then our pancreas is continually releasing insulin as well. When this happens chronically, over time our cells simply become so desensitized to the glucose, that they stop functioning properly and can’t utilize the glucose as they should. Therefore we end up with high levels of both glucose and insulin in the bloodstream and our cells don’t get the energy that they need to function well.

 Another cause of Insulin Resistance, that research is showing as more and more prominent, is that chronically high levels of inflammation in the body actually cause damage to the insulin receptors on the cells. So, in this case, it’s not so much that the cells are desensitized and can’t respond to the insulin, it’s that they are actually damaged and can’t respond to the insulin. Although this is a different root cause, it results in the same issue of high levels of glucose and insulin in the bloodstream.

As we know, inflammation in the body is caused by so many different things - inflammatory foods like sugar, artificial and highly processed foods, food colorings and dyes, infections in the body, dysbiosis in the gut, chronic stress, lack of sleep, and so much more. Now research is showing that having high levels of this inflammation is actually doing damage to our bodies on a cellular level.

I actually experienced this myself several years ago when I went looking for answers to my hormone imbalance issues. My labs came back that I had both Insulin Resistance and PCOS. It really surprised both me and my physician, because I didn’t really have any of the other symptoms that, at that time, were thought to accompany IR and PCOS, but as I would come to find out later, my body was very inflamed. I had really poor gut health - dysbiosis and leaky gut, a candida overgrowth, endometriosis (which is an inflammatory disease), years of low-level chronic stress, and a long history of not eating well or really caring for my body well at all. I just didn’t know what I didn’t know! And for me personally, my genetics mixed with all of those things created a perfect storm for IR and then a cascade of hormone imbalance as a result. Thankfully, both insulin resistance and chronic inflammation are things that can be positively affected by lifestyle change, and with the blessing of my physician, that’s exactly what I did. She asked me to come back in 6 months to recheck my levels and thankfully, my insulin levels were back within the normal range and my cycles had also returned to normal intervals, as well. 

If you are struggling with Insulin Resistance or suspect that something is imbalanced with your blood sugar levels or hormones, I strongly encourage you to work with a physician and get some lab work done. Depending on your practitioner, you may need to specifically request that they check your insulin levels, as that isn’t always part of routine lab work. 

As far as how to manage, and possibly reverse Insulin Resistance with lifestyle changes, all of the tips that I shared in last week’s episode apply here as well. Things like eating balanced meals at regular intervals, regular exercise, getting quality sleep, and managing and reducing your stress levels will all help to stabilize the amount of glucose in your bloodstream and lower inflammation. 

There are a few specific recommendations that I would add for someone looking to manage IR though. Your key focus is going to be on reducing inflammation in your body and helping your body to become sensitive to insulin again. This is very important so that you don’t progress further into prediabetes and Type 2 diabetes. 

Be sure to always have a protein and fat with every meal and snack and try to reduce your intake of carbohydrates overall. 

Some people call this a low-carb diet. There are also paleo and keto diets that are similar in nature, but overall I’m just talking about when you look at your plate, or the portions of what you are eating, having carbs only account for about 30-40% of your food.

Eliminate simple, processed carbs altogether.

You need carbs, but you do not need simple carbs full of inflammation-raising ingredients. Stick to high fiber veggies, some nutrient-rich root veggies like sweet potatoes, and whole forms of non-gluten grains like brown rice or quinoa. 

Engage in strength-training exercises at least 2x per week.

We’re not talking about anything crazy here, but research has shown that doing bodyweight and added weight exercises helps to increase our cell’s sensitivity to insulin. You can click here to find a few of my favorite online strength training workouts to do at home or there are tons of classes at your local gym if you’d rather have some personal instruction and work out with other people. 

Add anti-inflammatory herbs and supplements to your diet.

• Make sure you are taking a good whole-food vitamin to fill in any nutrient gaps.

• Supplement with extra vitamin D and magnesium, if needed. Both can help to increase insulin sensitivity. 

• Cook with turmeric, ginger, and garlic which can all help to lower inflammation levels and they’re delicious! You can also get or make teas with inflammation lowering ingredients, too!

Work with a professional for more support.

While Insulin Resistance can be reversible, it isn’t always easy. It takes concentrated effort and some research, but it is so worth it! If you feel like it’s too overwhelming for you or you would just like personalized support as you make changes to your lifestyle, reach out to someone that can help. This is something that personally I am passionate about and have done a lot of research on, so I would love to work with you one-on-one if you feel you need more support. Click here to schedule a free 30-min initial session with me!

I hope that you have learned something from my story that is encouraging to you and that these tips help you see that there are things you can do to help heal your body!