
	The Renkens Center Newsletter Voume 2; Issue 3 "Great changes may not happen right away, but with effort even the difficult may become easy."

Omega-3s Revisited

In the first installment of my newsletter, I wrote about omega-3 fatty acids and their numerous health benefits. Since then I have had further discussions on the topic with several patients. I would like to take this opportunity to both review the benefits as well as clarify a few important points pertaining to this "good" fat.

First things first. Fat comes in many different forms. The different forms have different effects on our health. Most people have heard of the terms, "saturated, "monounsaturated", "polyunsaturated", and "trans" when it comes to fats. A few key points in regards to these terms follows:

Trans fats are terrible. Avoid them completely. They show up in cookies, French fries, crackers, and most margarines. "Hydogenated" and "Partially Hydrogenated" are words to be fearful when reading nutritional facts on foods you eat.
Not all saturated fats are bad. Saturated fat intake should not be overdone, of course, but some forms (coconut) are not bad for you.
Fat found in nuts and olive oil is monounsaturated. This is good and heart healthy.
Polyunsaturated fats come in two forms on their own: omega-6s and omega-3s.

It is this last bullet point I would like to expand upon. The problem in most people's diets is they get far too little omega-3 and far too much omega-6. If you recall from the previous article, I referenced research that showed an average person consuming the typical Western diet gets between 25:1 and 30:1 ratio of omega-6 to omega-3. Most people get their omega-6s from highly refined and processed vegetable oils - namely soybean, corn, sunflower, and safflower. The problem with these oils is they lack the natural health-promoting antioxidants. Why? Because if they are left in their natural state, they shorten the shelf life of many of the foods that Americans eat too much of. Most nutritionists that are worth reading consider the ideal intake ratio to be more towards 1:1 omega-6 to omega-3.

Why is this omega-6 : omega-3 so important? High ratios of -6 to -3 are associated with breast and prostate cancer risk, increased risk of heart disease and increased risk of inflammatory and autoimmune diseases. When our omega-6 fat intake exceeds our omega-3 fat, our levels of COX-2 enzymes go up. COX-2 enzymes create inflammation. So high omega-6 intake coupled with low omega-3 intake equals higher levels of inflammation. Inflammation has recently been stated to be the common link between heart attacks, cancer, Alzeimer's, diabetes, arthritis, obesity, and other diseases.

Now that it has been established that we should be both increasing our omega-3s AND decreasing our omega-6s, you may be asking yourself, "What exactly do omega-3s do and where do I get them?" For starters, as stated above, omega-3 fatty acids are anti-inflammatory. This makes them a critical component towards all of us achieving optimal health. These good fats also support circulation and transport oxygen to our tissues. They also help lower blood pressure and prevent blood clots by acting as a blood thinner - only without the side effects of statins and aspirin. Omega-3s are also very effective in improving insulin and glucose metabolism, making them beneficial for diabetics. Last, but not least, omega-3s are also being studied for their positive effects on depression, behavior, and cognitive thinking.

While natural sources of omega-3s are found naturally in healthy, wild fish such as salmon, sardines, herring and mackerel, they can also be found in sources such as flaxseed and walnuts. However, in these sources, it is in the form of ALA (alpha-linolenic acid) which brings me to an important point of distinction. There are three different omega-3s. One is ALA - the kind found in flaxseed. The other two are DHA and EPA. While ALA is an essential fatty acid (the body cannot make it by itself), it is DHA and EPA that are more important to the body. EPA is not technically essential because our bodies make it from ALA, although conversion is not efficient (sometimes as low as 3%) and rates vary, based on many factors. However, DHA conversion from ALA is so poor that some authorities think it should be classified as "conditionally essential" (Maher).

It is for these reasons why EPA and DHA should be provided by both fatty fish in the diet several times a week and a quality omega-3 supplement. A pure omega-3 supplement supplies these "ready made" forms of fat (EPA / DHA) that are so critically important to our health.

Mobility - Stability
Part I: Stretch? Don't Stretch?

While there continues to be no real clinical evidence of static stretching being beneficial and even more that shows stretching done at the wrong time can be harmful, I continue to get looks of amazement when I ask patients to stop stretching. I would bet cash money that there is a similar look on many faces reading this now. "Josh, you mean to tell me I should never stretch?!" I am not saying never, but I do think it is overdone, done at the wrong times, and done in instances where it is actually doing more harm than good. Blindly increasing one's range of motion rationalized by the belief that it is beneficial is shortsighted and can be problematic. I see examples of this every single day. I read about how "everything needs to be stretched", and see it in no matter what gym I am in. I see people trying themselves to "stretch pain away" and still other helpless victims being stretched by their trainer. Seeing this always leaves me shaking my head. There they are on the floor with red face, face all contorted in pain, and holding their breath while the trainer pushes, twists, and pulls them further against their body's protective mechanism.

Three questions I ask myself before I implement anything into my own program or the program of anyone I am working with are the following:
1. Is it sensible?
2. Is it safe?
3. Is it practical?
When considering stretching to increase mobility and range of motion (ROM), it is the first two questions that need to be strongly considered.

First of all, you can't "stretch away pain." The majority of the time where the pain is, is not where the problem is. Take for example, hamstring tightness. There are several things that can contribute to tightness - or perceived tightness - in the hamstrings. One cause could be adhesions in the hamstrings themselves. In this case, stretching is not going to resolve the problem (the adhesions). Stretching in this instance would be analogous to trying to stretch out a knot in a rubber band. The knot will not go away by stretching the rubber band. Rather, the knot will get tighter! Another cause could be inhibited glutes. The glutes don't function like they should in extension and lateral rotation, so the hamstrings and low back extensors end up becoming overused, leading to chronic tightness and strains. I would get angry and tight too if I had to do my job and someone else's. Still another cause could be neural tension. It is alarming how often people are encouraged to stretch their hamstrings in response to an insidious onset of posterior thigh and buttock pain, often coupled with a nagging low back problem. In probably 90% of cases, provocative testing will indicate pain is being driven by neural tension, which needs to be addressed with strategies different than stretching.

The next point to consider is the low back. While mobility is a requirement for certain areas of the body, the low back is NOT one of them. There is a documented negative correlation with more flexibility in the low back and higher subsequent back troubles (Hodges, et al). The low back is one of the areas that needs stability. I alluded to this point in a previous newsletter when differentiating between lumbar (low back) and thoracic spine mobility. We want motion to occur in the hips and thoracic spine; not the lumbar spine. Hypermobile joints in the low back without precisely controlled strength leave us unstable and vulnerable to injury. Stretching the primary and secondary stabilizers (muscles and ligaments) in this area will do nothing more than ensure that one's back continues to hurt. Several studies show that static stretching of the spine ligaments can cause muscle spasms and actually diminish the protective stretch reflex we all innately possess (Hodges). Adhesions need to be addressed properly to restore normal ROM (Active Release Techniques), stabilizing muscles need to be working (Muscle Activation), and motor control and posture needs to be retrained. Yes, in most instances, stretching of the low back needs to be stopped.

When can stretching be a good thing? Let me get this out of the way. I believe when there is an obvious right / left asymmetry in the body and stretching is properly implemented in the overall performance program, it can be a small part of the solution. But then why stretch both sides? To pass the time? To create more instability on one side of your body creating even more stress and resultant compensation? Furthermore, even after stretching, a system of checks and balances should be performed to ensure stability if there is a new-found ROM. Remember this: flexibility without control is useless!

It is quite obvious by now where I stand. I believe in optimizing mobility and improving ROM. I also believe in optimizing stability at the joints that need it. Stretching, for many, is done to lengthen muscle in a passive sense. Yet there is little evidence that this occurs or is even a potent mechanism. After all, muscle by definition is elastic. Stretching of the muscles (increasing their length) can be attempted, but any results will be slow to appear. For this reason, I favor a more dynamic mobility warmup (studies suggest that pre-stretching modulates the stretch receptors to inhibit subsequent performance), performing resistance exercises through their full ROM, eccentric quasi-isometrics near the end of workouts, and consistent work on the foam roller over stretching any day. After all, these four strategies are all done actively while a lot of times static stretching is done passively. In a perfect world, all of this is complemented and enhanced with regular soft tissue work done by a skilled professional.

Big News For The Renkens Center!

I am proud to announce that this summer I will be expanding and moving to a new location. The new digs will be in the newly built Bedford Commons on Bedford Avenue here in Green Hills (one street behind my current location in The Boardroom). In addition to the work many of you are accustomed to, the newly designed space will better accommodate corrective and performance training.

The new space will neighbor Golf In The Now, owned by top-level golf instructor, Jim Williams, out of Windermere, FL. Golf In The Now will provide indoor golf instruction, swing analysis, and more! With two hitting bays, a contoured putting area, and the latest in golf technology, Jim will bring a unique golf experience to the heart of Green Hills.

During the next few months, I will keep you updated on the latest developments. Look for more in newsletters to come, including the exact date of the move!

"Change strengthens us. Change is a challenge and an opportunity; not a threat."