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FAQs: Fitness/Sports Injuries

I am in good shape and work out daily. Some days, my aerobic workouts last as long as two hours. I also strength-train four days a week. My doctor says I am slightly anemic. But just slightly. However, I have been experiencing a feeling of wooziness and tingling in the extremities (hands, arms, cheeks) when I run -- no matter how fast I run. I usually don't experience the sensation until after the third mile. I often have to stop and walk. I usually can resume running shortly, and finish my run. Could this be connected to anemia? My doctor also mentioned hyperventilation. But she recommended an iron supplement and said to give it six weeks. In the mean time, I continue to have lousy runs. Any recommendations? Should I get additional blood work done? I also eat a number of foods/beverages with Nutrasweet.

Great work on all the exercise you're getting. When you work out everyday, anything that gets in the way of good performance can be very frustrating. You ask a number of inter-related questions regarding the relationship between blood counts, blood chemistries, and exercise tolerance. Maybe some general comments would be helpful.

First, the symptoms you describe -- wooziness and tingling during periods of exertion -- are not symptoms usually associated with anemia. Weakness, fatigue, lack of ambition, and in severe cases dizziness, or shortness of breath, are more typical (although they are not at all unique to anemia). And if it were anemia, you would expect the symptoms to be roughly proportional to the amount of exertion, which does not seem to be true in your case.

While it is true that hyperventilation is a common cause of tingling of the hands and face, hyperventilation typically occurs at rest: while reading, watching TV, or relaxing in bed.

So a look for other possible explanations might be warranted. One example is an alteration in blood chemistries, such as low potassium or calcium levels.

What should you do? Well, I am not aware of Nutrasweet causing these types of symptoms, but it is easy to find out. Just stop using it for a week or so, and see how you feel. And, as your doctor has pointed out, iron deficiency can be a cause of poor exercise tolerance, so taking iron supplements is definitely worth a try.

It seems reasonable for you to continue to work out, using common sense to stop and rest when you don't feel right. But continuing to search for a cause of your symptoms is also a good idea.

-- R. Jandl, 11/18/96, Category: fitness/sports injuries

I have a partially torn anterior cruciate ligament (ACL) in my right knee. Now, my left side of my body is feeling the effects. I have bursitis in my left hip and my left heel hurts. Is it reasonable to believe that a repair to my ACL is necessary?

The anterior cruciate ligament is familiar to many athletes. It is one of two cruciate ligaments (the other being "posterior") deep within the knee. It connects the thigh bone to the leg bone, and when torn can result in instability of the knee. The question of whether or not to surgically repair a torn or partially torn cruciate is controversial and will depend on a number of factors not the least of which is the person's level of competitive athletic activity and their commitment to long-term physical therapy for strengthening the leg. Often, by strengthening the muscles of the thigh, enough support is given to the knee that the pain, expense, and potential complications of surgery are not worth it.

As your question suggests, one problem can lead to another. With pain or instability in one leg, be it the ankle, knee, hip, or elsewhere, there is a strong tendency to favor that side. This puts a strain on the other side of the body which is now doing more work, and often throws off the posture or biomechanics of the normal side.

Pain from tendonitis, bursitis, back discomfort, or strains of other types are frequently seen in such situations. The best thing to do is try to minimize changes in how you walk, move, or exercise, in order to restore normal body mechanics. A physical therapist, trainer, or orthopedist may be able to show you where the problems are and recommend exercises to correct the problems or to develop strength and flexibility of the right muscle groups.

I suspect it may be hard to find a surgeon eager to operate on the anterior cruciate for reasons other than problems specific to the stability of the affected knee itself.

-- R. Jandl,9/25/96, Category: fitness/sports injuries

Six months ago, I kneeled and got back up. My right knee became red and swollen and hurt really badly for two days. It has not been the same since. It swells up for no reason, and feels as if there's fluid in it. It feels as if a knife is being stuck under the knee cap. Most of the time, I can't bend it or extend it without sharp pain. This happens almost every day. Could it be something serious?
-- SS

Problems that affect the knee come in many flavors, most of which involve some degree of pain. Many are minor, or are at least self-limited and do not require surgery or arthroscopy (the use of a lighted scope to visualize the inner knee joint and through which surgery may be performed).

There are three types of "itis", or inflammation, of the knee: bursitis, tendonitis, and arthritis. Any of these three are possible in your case. Although there are nuances in the management of each of these, the overall approach to treatment is similar. Rest the joint, apply ice after heavy use or injury, use anti-inflammatory medications, and consider cortisone injections, physical therapy, splinting, etc.

You ask if your symptoms could be something serious. While it would not be proper to try and diagnose your case, there are signs to look for that often indicate a need to see an orthopedic specialist. For the doctor, it is important to distinguish the three types of inflammation mentioned above, from intra-articular (within the joint) problems of the knee. If the knee locks at any time, so that for a moment or some minutes you cannot bend the knee, there may be a more serious problem such as a loose piece of cartilage or bone. If the knee suddenly gives out, that too is a worry as it may suggest joint instability from torn or stretched ligaments. Fluid collecting within the joint (and you may need a doctor to determine whether your swelling is within the joint or around the joint) may also indicate more serious problems, and may call for further evaluation to rule out different types of inflammatory arthritis.

-- R. Jandl,7/25/96, Category: fitness & sports injuries

What is a rotator cuff tear and how is it repaired?
-- BK

The rotator cuff is a structure made up of fibrous tendons from four muscles, all originating in the scapula, or shoulder blade. Tendons from these muscles fuse together to form a cuff, or sheath, that wraps around the shoulder joint and attaches to the humerous, or upper arm bone. For a great picture of what this looks like check out http://www.scoi.com/sholanat.htm. This structure is used to stabilize the shoulder joint and to provide "rotational" and upwards movement of the arm.

So here's a question: If you're the doctor, how do you know that there may be an injury to the rotator cuff? This is done by checking the function of the shoulder. If the person is unable to rotate the arm away from the front of his or her body, or is unable to raise it above shoulder level, without weakness or pain, you may well be looking at a rotator cuff problem. (Of course, additional elements of the history and examination come into play when making the diagnosis.)

As your question suggests, the rotator cuff may tear. This may be a slow, gradual process of deterioration, or may be sudden and complete. Tears are uncommon in people younger than the age of 40. Often, even in a complete tear, there is weakness and muscle atrophy, but not a lot of pain. Alternatively, pain may occur because of impingement on the cuff by nearby bone structures that cause friction, swelling of tissues, and tendon degradation.

The treatment of rotator cuff tears involves the use of anti-inflammatory medications and ice packs for acute episodes of pain. Unlike for routine tendonitis or bursitis, cortisone injections should not be used. Exercises such as "pendulum swinging" and "wall-climbing" are used to strengthen the muscles of the shoulder. Although surgery -- especially arthroscopy -- is frequently recommended, there is controversy as to whether this is any better than a more conservative approach. If this is a problem you are dealing with, you may want to seek opinions from a couple of different specialists. For more information about surgical treatment, check out http://www.scoi.com/cuffdise.htm.

-- R. Jandl,6/17/96, Category: fitness/sports injuries

I have tendonitis in my right arm and leg. My doctor said it is from calcium deposits. Does this mean that I have too much calcium and shouldn't take calcium supplements?
--AH

Calcium deposits actually do not cause tendonitis. Rather, tendonitis results in deposits of calcium. These deposits accumulate in areas of soft tissue (as opposed to hard bone) and are nonspecific results of chronic inflammation. However, once you have accumulated a substantial amount of calcium in, for example, a tendon or bursa, these deposits actually begin to contribute to the inflammation and pain, causing something of a vicious cycle.

Except for rare instances in which problems in calcium metabolism causes wide-spread soft-tissue calcifications, tendonitis-related calcium deposits are not due to high blood calcium levels. It's just that normal blood calcium precipitates out into the soft tissues in these inflamed areas. Unless one of these metabolic problems are present (and merely seeing tendon-related calcifications does not make that more likely) taking supplements will not make the situation worse.

Interestingly, soft tissue calcium deposits can be seen in many other situations, such as within certain glands, tumors, joints, or breast tissue. Sometimes their presence suggests the possibility of an underlying disease. For example, certain patterns of calcification seen during mammography of the breast may suggest the presence of a malignancy. At other times, or in other organs, similar calcifications may be perfectly benign.

-- R. Jandl, 5/20/96, Category: fitness

What causes charlie-horses? I seem to get them when I'm sleeping; they tend to be pretty painful. What can I do to prevent them?
-- KC

Charlie-horses are muscle cramps. They commonly affect the major calf muscle (the "gastrocnemius") and occasionally the smaller muscles of the foot. They very often occur at night, awakening sleepers in a very unpleasant way. Although it is commonly believed that an electrolyte problem (e.g., low potassium) or a buildup of lactic acid is to blame, this is actually only very rarely the case.

Nocturnal muscle cramps seem to be related to the position of the lower leg while sleeping -- essentially with the toe pointed. In this position, the calf and feet muscles are in their most shortened, and therefore most vulnerable position. This can somehow trigger sudden contraction, causing cramping and severe calf pain. You can often see or feel the hardened muscles.

Rarely reflective of serious underlying disease, nocturnal muscle cramps can nonetheless be extremely uncomfortable and bothersome. Prevention includes stretching exercises, and attempts to change leg position while sleeping (easier said than done!). The way to deal with a charlie-horse is to stretch the muscle as soon as you can, in order to break the spasm. This can be done by "heel-pointing" (i.e., extending your toes and foot upward) or jumping out of bed to stand on the leg which will stretch the calf muscle more forcefully. Gently massaging the calf can help, especially afterwards to keep it from recurring. More persistent cramps should be treated with heat. Passively and slowly stretching the contracting muscle often helps (e.g., gently pulling the foot towards your head using your hands).

For many years quinine sulfate was used to treat nocturnal leg cramps, with variable results. Recently, studies have been done which indicate that for many people high dosages must be used to be effective. Unfortunately, there are potential side-effects including nausea, vomiting, hearing loss, visual impairment, cardiac problems and platelet abnormalities.

-- C. Ebelke, 1/17/96, Category: Fitness/Sports Injuries

I would like to know why I have shin splints, and how do I get rid of them???? Please HELP!!!!!!! -- JM

Shin Splints! Well, the bottom line is that our current understanding of what causes them is a big mystery. (Somewhere in the bad-humors-trying-to-get-out-of-your-body-and- causing-pain-as-a-result realm.)

OK, OK, they HURT! and there is no doubt that they are a potentially debilitating problem. Current theories as to their cause are largely theoretical, as whatever is really happening occurs at a microscopic level and does not leave much in the way of anatomic or physiologic clues. Microscopic muscle tears, areas of bone stress, and areas of inflammation have all been proposed as possible causes. There is one area of agreement though, and that is that other, potentially serious causes of pain in the frontal (or, tibial) area of the calf must be excluded in anyone who presents with this symptom.

Shin splints, by definition, occur as a result of repetitive impact-related activities such as walking, running, or jumping. Most commonly, they seem to be related to changes in activity, either switching from one type to another (for example from bicycling to running) or to increasing the duration, distance, or intensity of an ongoing activity. Sometimes changing footgear, equipment or terrain seems to be related to their onset.

The more serious causes of this type of pain include stress fractures and compartment syndromes. The first is a type of fracture which is often not seen on a regular X-ray at first, but may be diagnosed by follow up X-rays which show evidence of new bone growth in the area of the fracture (even though the original hair-line stress fracture may still not be evident.) Although this is not a serious kind of fracture from the point of view of bone deformity or the like, left untreated it can cause long term pain and put undue stresses on other bones and joints as a result of being favored. The second, potentially more serious condition which may need to be excluded is compartment syndrome. This occurs when muscle swelling or trauma causes enough of a buildup of pressure in one of the spaces in the lower leg that the blood vessels in that closed space become compressed and can no longer nourish the structures they serve. This can be either an acute condition, in which case it may be a medical emergency with immediate decompression necessary in order to prevent permanent damage, or it can be a more chronic condition. Finally, other problems which should be excluded when considering shin splints include pre-existing anatomic abnormalities of the foot or leg.

Once a diagnosis of plain-old (Ha!) shin splints has been made, a variety of treatments can been tried. The one that seems to work the best is complete avoidance of the activity that brought them on in the first place. Usually one or at most two weeks of such rest is sufficient to effect resolution. That may even mean taking time off from work or sports. Once the pain has completely subsided, gradual resumption of the suspected offending activity, starting off at about half of the previous level of intensity can be tried. Over the next one to two months, working back up to the previous level can be attempted. To minimize the chance of recurrence, other protective techniques should be considered including adequate warm up and cool down periods incorporating stretching exercises, running or walking on softer surfaces, and the use of footgear appropriate to the activity - with good cushioning for the heel and insole. The most common cause of recurrence is too rapid a return to the previously offending level of activity. If you're careful and persistent, the problem should eventually go away.

-- B. Kopynec, 2/18/96, Category: Fitness/Sports Injuries

Other than rest, what is the best way to treat patella ligament tendonitis (jumper's knee)?
-- RP

No doubt about it, rest is the best and most important part of treatment for any kind of tendonitis. Thinking about the causes of tendonitis helps to understand why rest is so important.

Basically the problem has to do with excessive, and often unaccustomed, exercise and stress. This causes micro trauma to the tendon fibers by pulling them away from the bone where they normally attach. In addition, there can be inflammation to the bursas, which are small lubricating sacs right at the juncture of the tendon and the bony insertions, and the tendon sheaths, which are fibrous tunnels the tendons travel through to help guide the tendon. Unless the area is put to rest those little traumatized fibers never have a chance to heal. Unfortunately, we often have to use the areas involved in the activities of daily living and that will often prolong the problem. Occasionally we will recommend immobilizing a joint with a splint or even a cast to help the healing process.

There are other ways to help healing. Certainly ice packing a fresh injury or adding hot packs a few days later can relieve the pain and discomfort. Topical lineaments available over the counter will also provide some relief. Using one of the popular anti-inflammatory agents like aspirin, ibuprofen, or naprosyn will also speed recovery. In severe cases, the tendon area can be injected with corticosteroids. We generally avoid doing that too often as it can lead to weakening and possible rupture of the tendon. Another trick is to get your friendly physical therapist involved. They will sometimes use an ultrasound device to deliver deep heat into the inflamed tissue which can be very beneficial. Rarely, surgery is indicated for very difficult situations. So, unfortunately, if your patella tendon is inflamed, you may have to stay off the basketball court just a little longer.

-- A. Calhoun, 1/29/96, Category: Fitness/Sports Injuries

I have been diagnosed with inflamed tendons in the back of the knees. Physical therapists have given me stretching exercises to do. It helps. I bicycle almost every day. Is it possible that the inflammation is caused by some improper technique in my cycling? I ride both mountain and road bikes. I've taken anti-inflammatories and they help but I don't like taking them and when I stop the inflammation comes back anyway.

There can be several causes of pain in the back of the knees, as there are a number of important structures in this area, including tendons. If you have been performing your stretching exercises regularly and you incorporate a warm up routine prior to any serious cycling, there may be some other problem causing your pain.

Therapeutic stretching and exercise takes time before one reaches maximum benefit. Since you have experienced some positive results from this intervention, it sounds like there is hope and perhaps perseverance is all that is required at this point. If you'd like greater reassurance on the benefits of stretching, an excellent reference you might peruse is Brad Appleton's page "Stretching & Flexibility" at http://www.cs.huji.ac.il/papers/rma/stretching_toc.html#SEC4.

There are other causes of pain in this area though, some common, such as a Baker's cyst, and some rare, such as aneurysms of the popliteal artery. If you've been doing stretches and warm-ups for some time now, and the problem persists, I would recommend that you seek a follow-up examination with the health care provider who made your initial diagnosis, or that you consider evaluation by a physician with special training in sports medicine. Your question about improper cycling technique might be best addressed in this manner. You might also ask your physical therapists if any of them would be willing to observe you, especially since most physical therapy departments have a stationary cycle which you could use to demonstrate your current technique.

-- B. Kopynec, 1/19/96, Category: Fitness/Sports Injuries

What can I do in the winter to decrease the effects of exercise-induced asthma? I have used certain inhalers in the past and found them effective. But is there a more holistic way of prevention?
-- MJ

Exercise induced asthma is simply asthma that is brought on by exercise. In some folks, cold air makes things even worse because of the irritating effects of cold air on the bronchial tubes. Trying to find a good way to cope with the situation can be tough. If the cold air bothers your asthma be sure to use a scarf over your mouth to warm the air a bit. Another technique when you are out exercising is to breath in through your nose and exhale out through your mouth. It takes a little practice but you'll find that the nose does a good job of warming the air before it hits your lungs. Dryness is another irritant to the bronchial tubes, and in cold weather, dryness and dehydration become more of a problem. Therefore, it's important to drink lots of extra fluids in the cold to avoid dehydration.

Sometimes you may have to bite the bullet and exercise inside in really cold weather. If you have a pool available swimming is a terrific sport for exercise asthma because the increased humidity is very beneficial to the lungs and reduces bronchospasm.

Other remedies that have been touted for asthma include acupuncture, ephedra (or Ma-huang, an herb containing ephedrine which acts to dilate bronchial tubes), and qigong (popular in China where movement, meditation and breath regulation are used to enhance the flow of qi, or "vital life energy"). Other approaches include homeopathy, and neural therapy (where injections of anesthetics are used to restore normal cell electrical activity).

However, don't give up on your inhalers if you need them, and if they work without side-effects. Most people find that using them before exercise can prevent or reduce the severity of an asthma attack. Certain inhalers, containing the medication chromolyn, are particularly beneficial for exercise induced asthma.

-- A. Calhoun, R. Jandl, 1/18/96, Category: Fitness/Sports Injuries

To control arthritis in my knees I take ibuprofen, double-strength, 400 mg three times a day. It seems so much. What better anti-inflammatory drug in smaller doses would be as useful with less side effects. I am a senior, otherwise in good health.
-- AA

The dosage of ibuprofen you are currently taking is not unreasonable to use in controlling the pain of inflammation due to arthritis. There are, of course, many other anti-inflammatory medications available by prescription which could be used. Some examples include Naprosyn, Feldene, Voltaren, Relafen, and myriad others. It turns out that most of these prescription medications are pretty comparable in terms of effectiveness. However, people may respond differently to each of these medications, and it is usually determined by your individual situation which medication will work best for you, as well as a little bit of trial and error. Some, such as Relafen, may have a lower incidence of gastrointestinal side-effects, a common problem with all of these medications. Some people do very well with over-the-counter ibuprofen. For others, it is not very effective and the prescription strength drugs are better. Ibuprofen is usually very well tolerated when taken with food.

Basically, if the lower strength over-the-counter drugs work and are free of side-effects, use them. If they don't work, or if you get side-effects, consult your doctor about an alternate medication. Keep in mind there are also many topical preparations you can take for arthritic pains. For example, capsaicin, a hot pepper extract available over-the-counter, can be effective in diminishing arthritis pain. No medication, particularly over the long-term, is without its risks; being familiar with the potential side-effects, drug interactions, or effects on other medical problems is important.

Another question to consider here is that of your diagnosis. Having significant arthritis at a young age is uncommon. Consider having your knee evaluated if you are experiencing significant or chronic pain.

-- C. Ebelke, 12/29/95, Category: Fitness/Sports Injuries

I have a pain which feels like a bruise under my arch on my left foot. I also have a feeling like a strained muscle in my left calf. Both symptoms are about a month old. Should I be concerned?

There are many causes of foot and leg pains that meet your description. Among them are heel spurs, various types of arthritis, and tendonitis. One of the more common is something called plantar fascititis, which is an inflammation of the connecting tissue that supports the arch of the foot. Typically, plantar fascitis causes pain in the arch of the foot, which is quite bad when you first try to stand getting out of bed in the morning. After moving about the pain will get better, but with any sustained walking or standing, it becomes worse again. It is a frustrating problem that often lasts for many months.

To help figure out what may have caused your symptoms you should think about any changes in the type, frequency, or intensity of any activities you've been involved in (e.g., running, racquet sports, skiing, etc.), any new footwear, or any other changes which may have affected your foot and calf. These changes in activity or weight-bearing can cause inflammation and pain to set in. Although the symptoms are usually self-limited, it may take many weeks or months.

The treatment of fascitis, tendonitis, and some types of arthritis are similar initially. You can use ice (with a barrier, like a washcloth, to avoid excessive cold to the skin) or heat to the affected area, whichever provides the greatest relief. Resting the body part in question is common sense, but not often adhered to as people get frustrated with their temporary limitations and want to continue business as usual. Usually an anti-inflammatory drug such as ibuprofen can be of help as well.

Should these conservative measures not prove effective, many further measures are available ranging from orthotic devices and stronger anti-inflammatory medication, to exercises and physical therapy. These are only general guidelines, however. Be sure and have your foot and leg examined to rule out more serious problems such as stress fractures, phlebitis, and others.

-- C. Ebelke, 12/30/95, Category: Fitness/Sports Injuries

About two months ago, I jumped off of a 100-ft. cliff into a river and really screwed up my back. I thought it would get better with time, but it hasn't really. I was just wondering what kind of approach I should take in getting it fixed. Thank You.

There are numerous approaches you can take to address your back pain. The most important thing is to get a good initial medical evaluation to rule out major structural problems or diseases of the back and spine. After that, the focus is on pain management and improving your back's flexibility and range of motion. These can be attempted - and hopefully accomplished - in a variety of ways.

A common part of initial therapy is the use of anti-inflammatory drugs (e.g., ibuprofen) as well as muscle relaxants if indicated. Ice massage or moist heat, depending on the circumstances, can be very helpful. Gentle exercises may be recommended after the initial pain is under control, but at first rest is usually indicated. Interestingly, a recent study suggests that those who forced themselves to remain active in spite of their pain tended to do better in the long run. In either case, what is important is to respect your own limits by paying close attention to the signals your body is sending you regarding pain, stiffness, etc.

The hardest thing on the back is sitting -- it's much better to be standing upright or lying flat on a firm surface. If insufficient progress is made, physical therapy can often be of great value. Yoga is also an excellent choice for maintaining the back's strength and flexibility, as well as dealing with the stress that often accompanies pain. Alternative therapies such as acupuncture, biofeedback and relaxation/ stress reduction techniques are often worthy of consideration in difficult cases.

-- C. Ebelke, 10/11/95
Category: Fitness/Sports Injuries

I'm 24 years old and I suffer from aching knees, very frequently. What might be the reason?
-- YG, Sovemia

There are many reasons why knees ache. In someone in their twenties there are a number of considerations including tendonitis (an inflammation of the tendons that connect muscle to bone), problems with torn or worn cartilage (the hard lubricating surfaces inside the knee), and problems left-over from previous injuries such as a sprained knee, broken leg, chronic tendonitis, and so forth. There are also a variety of arthritic conditions that could be affecting your joints that should be ruled-out.

More serious problems of the knees are suggested if the knee spontaneously gives out, if there is a catching sensation when you bend the knee, or if the knee temporarily locks up. Also, if the whole joint is swollen and red, that is a real concern.

Persistent knee problems that are not readily resolved taking acetaminophen, ibuprofen, or other over the counter remedies, require a visit to the doctor.

-- R. Jandl, 10/14/95
Category: Fitness/Sports Injuries

I was in a car accident and injured my low back (L4-L5 and L5-S1 disks). It's been 18 months now, but my activity is still severely restricted. Even a 15-minute walk will leave me in pain for several days. All the doctors have said is to exercise as much as possible.

What are my options? I'm afraid that if I exercise through the pain that something will get damaged or my leg will start going numb again (besides the discomfort caused by pain).

Chronic back pain can be very, very difficult to deal with. It is also very common -- unfortunately, you are in good company. The options available to you are quite varied, and the details of your MRI or CT scan findings, the physical exam findings, the medications you've tried, your occupation, and other aspects of your physical conditioning and medical history become very important in coming up with a plan.

If surgical options have been excluded, and medical therapy exhausted, then other options can be looked at. They might include physical therapy treatments and exercises, consultation with a physiatrist (an MD with special training in physical medicine and rehabilitation) or Doctor of Osteopathy (doctors who have training in conventional medicine but who also are skilled in physical manipulation techniques). The basic idea behind all of these approaches is to maximize flexibility, movement, and strength, while minimizing pain. Ongoing severe pain triggered by routine activities may require further investigation. A good relationship with, and confidence in, your doctor(s) is very important. As you are probably now aware, your emotional state is also key to the healing process. If you are feeling depressed, fearful of further aggravations, or uneasy with your diagnosis and treatment, the pain may become more difficult to tolerate. If this is a factor, counseling with an individual or program dedicated to helping people cope with chronic pain can be a real life-saver. Finally, if you are feeling even more adventurous, alternative medicine techniques such as accupuncture can also be helpful. Good luck!

-- R. Jandl, 10/4/95
Category: Fitness/Sports Injuries

How can I calculate my body fat as a percentage of total weight?

There are really two ways to answer your question. The first is by determining your ideal body weight, recognizing that if you are above the normal range, it is because you are carrying too much fat. The second, is to actually measure your body fat as a percentage of total weight.

To help with the first question, check out the table of ideal body weights.

If you actually want to measure your percent body fat, you must use special techniques such as the ones listed below:

Underwater weighing (the displacement of water by your body) is considered to be the most accurate. There are a limited number of places that have the equipment to do this.

Skin fold thickness can be used to assess body fat using calipers. A set of good calipers and a person trained in taking measurements is required.

Other methods include bioelectric impedance analysis, dual energy x-ray absorptiometry, near infra-red interactance, and other imaging techniques -- all requiring special instruments and personnel.

These techniques are not available in many doctor's offices, but you may find them at health clinics or clubs.

-- L. Hill Einbinder, 12/6/95
Category: Fitness/Sports Injuries

I understand the FDA has approved an anti-obesity drug. Is it Leptin? And how is it available to the public? By prescription?

Leptin is a newly discovered hormone produced by the body, which appears to provide an internal signal to eat less and exercise more ....... at least in mice. It is not clear that overweight humans would benefit from additional leptin. In fact, contrary to expectations, researchers have found high levels of leptin in some overweight research subjects. (Perhaps overweight people with high leptin levels may not be responding to leptin appropriately.) In any case, more research needs to be done to assess the role of leptin in the human body. It is not currently available as a weight control drug for human use.

-- L. Hill Einbinder, 12/6/95
Category: Fitness/Sports Injuries

I want to start exercising again, after a long lapse. However, I'm young and used to exercise regularly, so I think I may be able to get back into shape fairly quickly. My goals are to lose weight and lower health risks. I want to include strength training as part of my routine (10 lb dumbbells?), but have never used weights before. Can you give me some guidelines as to how many reps, how much weight how often, how many sets (what are they--do I rest in between sets, do I do another exercise between sets?, etc.) Also, should I do a couple months of aerobics before I begin strength training, or do I start off doing both together, etc.? I'd appreciate any basic information and/or routines you may have to get me started.

Thanks for your help!

Your question is an excellent one. First of all, to improve overall health and to reduce your long-term health risks, begin with an exercise program which includes an aerobic exercise you enjoy for 30 minutes or more a day, three times a week. The options, to name a few, could include walking, hiking, swimming, rollerblading, low-impact aerobics, tennis, or cycling. The most important part of your exercise program is to participate in activities that you enjoy, and will continue to do regularly, as maintaining your motivation over time is what really matters. This should be the foundation upon which your strength training is built.

I would suggest that your first goal be to get out and exercise 3 times weekly for 30 minutes at a time. Once you have achieved this goal, and feel you can maintain it consistently, then consider adding strength training to your regimen. The best advice in terms of starting a strength training program is to work with a fitness instructor at a local club or gym. Word of mouth may help you find someone who is good, and who will help you to develop a personal program. There is just too much variability from person to person to make more specific recommendations.

Certainly, if you have any potential health problems or questions, get them checked out before you dive in to a rigorous program. Good luck!

-- L. Hill Einbinder, 11/29/95
Category: Fitness/Sports Injuries

I am a 35-year-old male and have had pimples on my forehead, scalp, shoulders, upper back, and chest for 10 years. Not full-blown acne, but small pimples that never seem to get worse or go away. I've seen several dermatologists, who recommend topical antibiotics (which do work, some of the time), and other treatments. I've seen an endocrinologist, a nutritionist, an allergist, and an immunologist. They all give up. However, I've been lifting weights strenuously in the gym for over 10 years, and I understand taking hormones to increase bulk can lead to acne in these areas. I wonder if I am generating these hormones (weight lifting can do that) and if perhaps there might be a hormone therapy solution. Thanks.
-- DS

After researching the literature on your question I found the following: There are some studies which demonstrate an increase in testosterone production among male and female weightlifters undergoing "heavy resistance" training. However, other studies have shown no increase or a decrease in testosterone depending on the type of exercise and when the testosterone was measured.

One case study was published which describes a 21-year-old male patient who presented with acne due to anabolic steroid use during weight training. After stopping the use of anabolic steroids, the acne healed. And, of course, we know that anabolic steroids are a cause of acne.

First recommendation: If using anabolic steroids or any other "bodybuilding enhancers" that might possibly have steroids in them, stop using them and see of the acne responds to the absence of steroids.

Secondly: Test your own hypothesis regarding the relationship between bodybuilding and the acne by stopping the bodybuilding and seeing if the acne subsides.

To my knowledge, there are no hormone treatments used to treat acne in bodybuilders.

-- L. Hill Einbinder, 10/12/95
Category: Fitness/Sports Injuries

How fast can you safely lose weight?

The rule of thumb is, generally, no more than 1-2 pounds per week. If this doesn't sound like much to you, remember it takes a long time to put that weight on--it's not going to be shed over night. Consider this, 2 pounds weight loss per week over a year's time is 104 pounds!

A weight loss of one pound per week is equivalent to reducing your caloric intake and/or increasing your exercise or energy expenditure by 3500 calories per week. This averages out to 500 calories per day.

Here are some reasons why this is a reasonable goal to stick to:

-- L. Hill Einbinder
Category: Fitness/Sports Injuries

How do I know if I eat too much fat?


Here's a calculation you can use to determine whether your diet is too high in fat.
1) Calculate the amount of calories you generally consume in a day.
2) Divide that number by 3. (Only one third of your caloric intake should come from fat.)
3) Divide that number by 9. (There are nine calories per gram of fat.)

The final number will indicate the number of grams of fat you are consuming. The number of grams of fat you have just calculated indicates the number of grams of fat your intake should be limited to.

EXAMPLE:
If I consume 1800 calories daily:
1800 calories / 3 = 600 calories from fat
600 calories / 9 calories per gram of fat = 66 grams of fat
I should limit my fat intake to less than 66 grams of fat!

-- L. Hill Einbinder

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