Filed under: Op-Ed
The American Academy of Orthopaedic Surgeons defines a stress fracture as a tiny crack in a bone that occurs when fatigued muscles lose their ability to absorb shock and then transfer stresses to the bone. Most stress fractures occur in the lower extremities, and more than half occur in the lower leg and foot.
A stress fracture is an overuse—sometimes referred to as chronic—injury, which means that it develops over a long period of time—from weeks to months. According to a 2011 systematic review published in Military Medicine, stress fracture incidence is high among U.S. military recruits, ranging anywhere from 3% for men to 9.2% for women.
Since it can take several weeks or months for a stress fracture to heal, the best approach is to avoid getting one. Here are some tips for prevention:
- Apply the progression principle of training—gradually increase your training intensity. Slowly incorporate higher-stress activities such as jumping and interval training into your workout. Setting incremental goals can be helpful in carrying out your training routine in a gradual way. And check out HPRC’s Physical Fitness Resources for more information on training and ways to avoid injury.
- Check your footwear and make sure it matches your training. Replace footwear that is old or worn.
- Pay attention to the surface where you train, since some are easier on the bones and joints of the lower extremities. For example, it is better to jog on softer surfaces such as rubber track or grass rather than on concrete. Also, it’s better to begin training on a flat surface and then progress to hills.
- Monitor your diet, specifically calcium and vitamin D intake, and read the National Institute of Health’s Dietary Supplement Fact Sheet on calcium. To learn more about nutrition take a look at HPRC’s Nutrition Resources.
HPRC has received a number of questions about whether dietary supplements—especially those used for bodybuilding and weight loss—could result in a positive result on military drug tests.
Military drug testing begins with urine, which is first screened and then followed by additional tests depending on the outcome of the screen. You can get extensive information about DoD’s drug policy and drug testing from the Drug Demand Reduction Program (DDRP), including military testing. And for answers about the potential effects of specific dietary supplements on drug screening tests, you can contact your service’s military drug-testing laboratory by phone or email at:
- U.S. Army, Fort Meade, MD – 301-677-7085 or USArmy.Meade.Medcomfirstname.lastname@example.org
- U.S. Army, Tripler AMC, HI – 808-433-5176 or email@example.com
- U.S. Navy, Great Lakes, IL – 847-688-2045, press 2 or ext 113, or NDSLGLfirstname.lastname@example.org
- U.S. Navy, San Diego, CA – 619-532-5180 or NDSLSDemail@example.com
- U.S. Navy, Jacksonville, FL – 904-542-7755, press 2 or ext 104, or DLJAX@med.navy.mil
- U.S. Air Force, Lackland AFB, TX – 210-292-3101 or firstname.lastname@example.org
Positive urinalysis results due to dietary supplement use can occur because products on the market may contain undeclared drug ingredients—that is, controlled substances that are not stated/listed on the product label. More information can be found in the FDA Consumer Update There you will also find information about how to get updates about products FDA has identified as tainted. There is no way to know if a particular supplement contains an undeclared drug without laboratory testing, but FDA does keep track of such products once identified through its MedWatch program.
The Department of Defense (DoD) currently has no formal policy on the use of dietary supplements and no list of either banned or safe supplements. For more on this topic, see Operation Supplement Safety’s (OPSS) FAQ “Is there an all-encompassing list of dietary supplements that are banned or illegal for use by military personnel?”
Kettlebells have been used in Europe for years in strength training, and now they’ve become a popular workout tool here in the United States too. The benefit of kettlebells is that they provide the user a wider range of motion than dumbbells do. Kettlebell workouts engage multiple muscle groups at once, making them a great option for getting a whole-body workout in a short time.
Interestingly, the January 26 edition of the New York Times Health Section reported on a Danish study that suggests kettlebell exercises are a promising musculoskeletal therapy for low-grade back and neck pain.
The study involved middle-aged women with low-grade back, shoulder, and neck pain who were randomly assigned to either a regular kettlebell workout or a general-exercise control group. The study did not include those with chronic pain.
According to the Times article, at the end of the study, the group that did the kettlebell exercises reported less pain, as well as improved strength in the trunk and core muscles, compared with the control group. Overall, the study showed exercising with kettlebells reduced lower-back pain by 57% and neck and shoulder pain by 46%.
For those with core-muscle instability or weak core muscles, kettlebells can be a great way to strengthen those muscles (back, abdominal, glutes, quads, hamstrings) and improve posture. However, along with exercise it is imperative to stretch the hamstrings, since this tends to be a major contributor to lower back pain or discomfort.
It’s important to start slow when using kettlebells and seek professional guidance. Like any other exercise equipment, if used improperly, kettlebells can cause serious injury, and their swinging motion can be difficult to control.
The Paleo Diet, also known as the Paleolithic or Caveman Diet, is based on the notion that by consuming what humans ate during the Paleolithic Era—wild animals, plants, eggs, tree nuts, vegetables, roots, fruits, and berries—we will be healthier, have lower disease risk, and live longer. Hunters/gatherers during that time had to rely on what was available and had no agriculture. But what are the implications of this type of diet for the athlete, let alone the average individual?
Foods that were grown and introduced after the Agricultural Revolution (roughly 10,000 years ago) are not allowed in the Paleo Diet. That means dairy and dairy products, grains, and legumes (beans, peas, and lentils) are excluded. Proponents of the Paleo Diet believe that we are “genetically programmed” to follow the diet of the hunters/gatherers. A specific book has been written for athletes who want to follow this diet, which accommodate athletes by allowing some carbohydrates: The authors present five stages of eating for the athlete to follow, based on the glycemic index (GI; how quickly food raises blood glucose levels). The stages are: (1) eating before exercise, (2) during exercise, (3) and 30 minutes after exercise, and (4) during post-exercise extended recovery and (5) long-term recovery. Low- to moderate-GI carbohydrates are recommended at least two hours prior to exercise. Sports drinks or high-GI carbohydrates are recommended for exercise lasting longer than 60 minutes. Immediately after exercise a recovery drink with carbohydrate and protein in a 4:1 to 5:1 ratio is recommended. Stage IV recovery foods (extended recovery) should be a 4:1 to 5:1 carbohydrate-to-protein ratio, with carbohydrates such as raisins, potatoes, sweet potatoes, and yams. Stage V recommends focusing on eating from the main Paleo Diet, with carbohydrates coming from fruits and vegetables. So one could argue that the Paleo Diet for Athletes is like most diets for athletes in that it requires carbohydrates. However, the Paleo Diet for Athletes is higher in protein and fat and lower in carbohydrates than what is recommended for athletes by most health professionals.
What we do know from scientific research is that carbohydrates provide the energy needed for endurance and resistance training, competitive athletic events, mental agility, and healthy living. Complex carbohydrates such as fruits, vegetables, whole-grain pasta, rice and grains, beans, and other legumes contribute to an overall healthy eating plan. By limiting consumption of some of these to only a brief time after exercise, the athlete runs the risk of not having enough fuel for the body, so the body will use protein for energy. Low-fat dairy products also contribute to a healthy lifestyle, providing much-needed calcium and vitamin D as well as probiotics. The Paleo Diet eliminates dairy entirely, even for athletes.
We also know from the scientific literature that during the post-exercise period, within roughly 30-45 minutes of exercise, eating a carbohydrate/protein snack, generally with a 3:1 carbohydrate-to-protein ratio, is essential to stimulate re-synthesis of muscle proteins and replenish glycogen (the storage form of carbohydrate). It doesn’t stop there: It is important to maintain glycogen levels in the muscle and liver to sustain all activities, especially over the course of several days. Eating high-carbohydrate snacks between training sessions is important to replenish glycogen stores. Carbohydrate intake recommendations for athletes are 6 to 10 g/kg body weight per day, or roughly 55% of daily calories from carbohydrates.
What’s the bottom line? Grains and dairy products are staples of modern-day society and provide essential nutrients to an overall healthy diet. By eliminating one or more food groups, you run the risk of missing important nutrients. And can we really eat as humans did during the Paleolithic era? Their life expectancy was about one quarter to one half of what ours is, and we benefit from research showing that eating a variety of foods over the course of time provides us with energy and the important vitamins and minerals needed to sustain us in daily activities and exercise.
The Department of Defense (DoD) Combat Feeding Program (CFP) is responsible for all of the combat rations that feed service members and for the research, development, engineering, integration, and technical support of those rations. Their mission is to ensure that United States Warfighters are the best-fed in the world. It’s important that any new combat ration developed is fueled by the wants and needs of Warfighters themselves; they even field-test new rations to make sure that their requirements are being met. Items that pass their standards are then incorporated into ration menus so that they have a variety of nutritional meals to choose from.
The Meal, Ready to Eat™ (MRE™) is used by all military services to feed Warfighters during operations where food service facilities are not available. MREs are essential to military subsistence; they’re intended to provide a Warfighter’s sole sustenance for up to 21 days of deployment (in accordance with AR 40-25) and are still nutritionally adequate for longer periods if necessary. MREs™ are shelf stable for 36 months at 80˚F.
The Unitized Group Ration – Heat & Serve™ (UGR-H&S™) is designed to feed 50 Warfighters per module and is the first group meal consumed in early deployment, as soon as field kitchens (without refrigeration capability) are available. All components of the ration are pre-cooked and shelf stable for 18 months at 80˚F.
The UGR-A™ is also designed to feed 50 Warfighters per module and consists of high-quality group meals. The UGR-A™ is the only military operational ration that contains frozen food components. It’s based on a build to-order assembly process that requires refrigerated/ frozen storage and a field kitchen for preparation.
The UGR-B™ is used primarily by the Marine Corps to provide high-quality group rations that don’t require refrigeration and are quick and easy to prepare.
The UGR-Express™ (UGR-E™) is designed to provide a complete, hot meal for 18 Warfighters in remote locations where group field feeding wouldn’t be possible otherwise. It’s a compact, self-contained, self-heating module that doesn’t require cooks or a field kitchen for preparation. With the simple pull of a tab, the food is heated in 30-45 minutes and is served in trays to Warfighters like a cook-prepared meal.
The First Strike Ration® (FSR™) is a compact, eat-on-the-move assault ration intended to be consumed during initial assault by forward-deployed Warfighters. The FSR™ is shelf stable for 24 months at 80˚F and provides a new capability in that it is 50% lighter, smaller, and easier to prepare when compared to the MRE™.
The Meal, Cold Weather™ (MCW™) and Food Packet, Long Range Patrol™ (LRP™), which contain freeze-dehydrated entrees, are designed to meet the nutritional and operational needs for extreme cold environments, special operations, and long-range reconnaissance missions. They are shelf stable for 36 months at 80˚F.
The Modular Operational Ration Enhancement™ (MORE™) is an enhancement pack designed to augment operational rations with additional calories and nutrients when Warfighters are operating in extreme environments such as high altitude in cold or hot weather.
For more information on any of the above, please call (508)-233-4670 or visit the Army’s Natick Soldier Research website.
There’s probably no other body region people work on so hard to get results than the abs. The common goal of sporting a “six-pack” is why abdominal equipment machines make up the largest part of the commercial fitness industry. People are constantly searching for the key to the washboard stomach they desire, whether it’s the newest fad piece of equipment or traditional bodyweight-driven exercises.
Unfortunately, many of these abdominal exercises provide little improvement to the target musculature and inadvertently place the lumbar spine in a position that could lead to lower back pain and injury. Just a few examples of hip-flexor-dominant exercises that can place the exerciser at risk are supine leg lifts, supine leg lifts with partner-assisted push down (a partner pushes down on the raised legs while the exerciser attempts to decelerate leg movement), hanging leg lifts, leg levers (lying supine while maintaining feet six inches off floor), and leg levers with unilateral or “scissor” kicks are.
To understand why these movements are both inefficient and contraindicated, it’s important to have a basic understanding of the abdominal anatomy. The rectus abdominis, the primary “six-pack” muscle responsible for the flexion that occurs during a curl-up, extends from the pelvis to the lower sternum. It is not involved in moving the legs. The hip flexors are responsible for the leg movements in the exercises mentioned above, while the rectus abdominis and associated muscles attempt to stabilize the spine Without adequate stabilization, the strong pull of the hip flexors leads to a marked anterior tilt of the pelvis. The abs are often unable to maintain stability, and the strong pull of the hip flexors causes the pelvis to tilt, creating an increased curvature in the lower back that compresses the lumbar area. Over time, this can lead to back pain and injury.
As a general rule of thumb, if you’re unable to maintain a stable spine position, or if you have a history of lower back pain or injury, these exercises should not be performed. There are other abdominal exercises that you can use to train more efficiently and more safely.
Even the most novice exerciser will be familiar with this common abdominal exercise: the bent-knee abdominal curl-up, or “crunch.” It has replaced the traditional sit-up as a staple in abdominal training due to its ability to recruit the abs without excessive hip-flexor activity. By varying hand placement—across the chest, behind the head, or extended overhead—the difficulty of the movement can be increased.
Crunches with a stability ball
A popular method to increase the difficulty of crunches is to perform them with a stability ball. Therapists have used stability ball training for years, and they are now becoming a common sight in gyms, as well. By reducing stability, the ball forces the exerciser to use his or her core-stabilizing muscles to maintain position, increasing the challenge to the abs. The result is a significantly greater amount of abdominal activity when compared with regular crunches.
A method of ab training not used often is the standing crunch, in which you flex and rotate your torso in various ways from a standing position. During the high to low “wood-chop,” for example, the rectus abdominis and oblique muscles are active during both the downward and upward phases. With rotation, emphasis is concentrated on the obliques. These exercises also have more “real-world” functional relevance, as they mimic everyday movements. In addition, various types of resistance—such as medicine balls, cables, resistance bands, and cords—can be used to make these exercises more difficult.
It’s important to be aware that many common abdominal exercises are not only ineffective but, more important, can place stress on the lower back. Try one of the safer alternatives above, focusing on correct form. The right abdominal training can benefit your trunk muscle strength and endurance, increase core stability, and improve functional movement—and can also start you on your way towards developing your “six-pack” abs.
Have you ever had one of those days that never seemed to go well, from the minute you heard the alarm clock go off? Maybe you didn’t have time for breakfast, forgot your laptop at home, lost your temper when someone cut you off on your way to work, replied to an e-mail in a way you really wished you hadn’t, ate poorly all day, couldn't concentrate at work, and then couldn't find the energy to go the gym?
Ask yourself how you slept the night before. One factor that can contribute to bad days is lack of sleep. Not getting enough sleep is all too common in the military and across the country—it’s often looked at as the price you pay to get ahead. Some sacrifice sleep for social activities at night—web surfing, e-mailing, watching TV, playing video games, or one more drink out with buddies—which further worsens the issue.
Bottom line: Not getting enough sleep is pervasive throughout all ranks and has major negative impact on your health, relationships, and career. The effects of sleep loss affect performance in much the same way that alcohol intoxication does. So coming to work deprived of sleep is rather like coming to work drunk. Your interactions with others and your job performance suffer—which has a huge impact on safety. Losing sleep isn’t sustainable for the long run.
But the damage doesn’t stop there. In fact, sleep loss has a ripple effect throughout virtually every aspect of health and wellness, including your physical, emotional, social, family, and spiritual well-being (see the five program components of Comprehensive Soldier Fitness here). It increases your risk of disease and harms your social relationships and possibly your professional reputation.
Sleep deprivation can be a byproduct of mission demands, of course. In the military, sleep loss is sometimes used on the battlefield as a weapon, wearing the enemy down through non-stop engagement. The problem is that this strategy affects our own Warfighters, too. Senior leaders are cautious in employing this tactic, and it’s used only for specific, organized, orchestrated periods of time, allowing for a full rest and recovery before massive errors occur that can cost lives.
Where many of us go wrong is thinking this type of sleep schedule is normal and maintaining it post-deployment. Most people aren’t able to tell when their state of mind—alertness, mood, concentration—has been compromised by lack of sleep until gross errors are made.
I believe sleep is the single most vital wellness function we do every single 24-hour period, and yet it requires no treadmills, no weights to be lifted, no personal trainers, and not even special clothes. It has dramatic implications for your entire body and sets you up for optimization everywhere else. Sleep is commonly overlooked at the doctor's office because physicians (including myself) don't understand exactly how it works, and in fact, there is no standardized medical test to see if you are getting enough sleep. But that’s no reason to ignore the health treasures afforded to those who get a great night's sleep on a regular basis.
On average, we spend 20-25 years of our lives sleeping, and five to seven of those are spent the critical dream periods known as "Rapid Eye Movement." REM periods occur at regular intervals throughout a night of good rest (when not impaired by alcohol, caffeine, or other drugs). Unfortunately, many of us look at this time as wasted, yet it can be some of the most glorious "unconscious" time to improve our health!
During REM periods, your brainwave patterns register signals much like those produced when you are awake and concentrating. During sleep you also secrete hormones that repair tissue and renew microscopic damages to cells and organs before they develop into bigger problems. In fact, you actually concentrate and focus for several hours throughout a good night's rest as you repair your body! Your brain, the center of all health, is exercising while you lie quietly in dreamland! When you destroy the quality of your REM sleep, the result is poor performance, inattention, obesity, hormonal imbalances, poor appetite, lack of normal growth, high blood pressure, poor interpersonal skills, no energy for the gym, possibly diabetes, and more.
Getting enough sleep means you are more likely to live longer, experience less disease, retain information better, perform better, and get more out of your workouts. You will be more patient with others, less demanding and prone to anger, and able to optimize all aspects of human performance, including your family relationships. For more about getting enough sleep, visit the HPRC’s Sleep Optimization page. Don't overlook the simplicity of a good night's rest.
In order to reach your optimal performance level and minimize injury, you should incorporate aerobic, anaerobic, and strength training into your training program, and also give your body time to adapt as you work towards your fitness goals. Just last month, the American College of Sports Medicine (ACSM) published its new guidelines for exercise professionals, the first update since 1998. (Warning: ACSM publications tend to be a bit technical, but they have great information for the motivated reader.) Among other things, it emphasizes the need for diversity.
Aerobic exercise strengthens your heart muscles and improves your heart’s ability to pump blood as needed when you are active. Some examples of aerobic exercise are walking, running, cycling, fitness classes, and any other type of activity that requires movement of your large, lower body muscles. This type of exercise can help reduce your risk of cardiovascular diseases, lower your resting heart rate, and improve your breathing, and your tolerance to more vigorous exercise.
With anaerobic training, you will see significant increases in your muscular strength and speed. Basically, anaerobic exercise involves exercising at such a rate that your bloodstream can’t get enough oxygen to your muscles to meet the demands. It can be achieved with any activity that produces brief spurts of high-intensity activity, including sprinting and sports such as football, basketball, and soccer. Weight lifting and interval training can also provide anaerobic exercise. This type of exercise helps your body become better at higher levels of exercise with less fatigue.
The third key component to a complete exercise program is strength training, such as using weights or resistance equipment. Not only can it enable you to increase your strength and muscle size, it can help you build stronger muscles that will enable you to lift heavier loads. However, you need to plan your strength exercises so that they maintain the mobility and stability of your muscles as well as build size and strength. Your muscles need to maintain or increase their range of motion to help prevent injury. The ACSM also has recommendations on how to ramp up your strength training.
The final link in the fitness chain is flexibility. Long debated by the exercise community, flexibility exercises have earned new respect by way of a “Position Stand” just released this year by the American College of Sports Medicine (ACSM). It summarizes the value of flexibility exercises as improving range of motion and stable posture (the ability to keep your body in a stable, balanced position). The report covers the various methods of stretching that can be incorporated into a complete training program. The ACSM’s June 2011 press release includes an excellent summary of these new guidelines—which cover all aspects of exercise—as well as a link to the complete document.
If you incorporate all four of these types of exercise into your training program, you will have a healthy heart and lungs and more endurance (aerobic exercise), speed and power (anaerobic), and range of motion (flexibility training). And by diversifying your exercise regimen, you will feel fresher and be less likely to become bored. Best of all, you will be on your way to Human Performance Optimization!
When my own husband returned from deployment, I was thrilled but anxious as I stood on the airstrip waiting for his helicopter to arrive. I thought about all of the birthdays, holidays, and special events he had missed during his time away. I wondered what it would be like to share a home with him again after I had become so independent.
This is an experience felt at some point by most military families, and it has a name: “boundary ambiguity.” Boundary ambiguity can affect military families in two ways: ambiguous absence (during deployment) and ambiguous presence (post-deployment).
When one member of the family is deployed, the rest of the family knows that their service member is absent physically but senses psychologically that he or she is present. The family continues to focus on its service member by seeking information about his or her location and well-being. When deployment information turns out to be uncertain, feelings of hopelessness, confusion, and at times resentment may increase among family members.
As with most families, flexibility is important for military family success and happiness. When the service member leaves for deployment, the usual roles and responsibilities he or she once filled now have to be filled by the other family members. This can cause additional uncertainty because, although they still consider their loved one is a viable family member, the other spouse must take over decision-making responsibilities that affect the family unit. The spouse at home can also feel a loss of emotional support, which heightens the stress load he or she is carrying.
Additionally, once the service member has returned from deployment, the rest of the family knows that he or she is physically present yet still perceives psychologically that he or she is absent.
The reunion, although joyful, may bring about the added and unanticipated stresses of trying to get back to the family’s pre-deployment lives or adjust to new roles. Role confusion may increase if the family is not comfortable communicating with each other regarding each person's roles, responsibilities, and needs. And at the same time, the returned service member may feel disconnected and may not know how to re-engage without interfering with the family’s new roles.
Researchers of military reserve families in wartime interviewed 16 reservists and 18 family members (spouse, significant other, or parent) upon the reservists’ return from deployment, and they found that all family members experienced boundary ambiguity. Family members sought to cope with these feelings during deployment by:
- Continuing to seek additional information from the media, even though too much information sometimes caused additional stress; and
- Attending a military-sponsored Family Support Group (FSG) for family members of reservists, which provided emotional support.
When reunited after deployment, family members and reservists adjusted over time. Once the reservist went back to civilian employment, the family’s routines became “normalized” and roles were established. In addition, open communication about issues such as reestablishing previous tasks or assigning new ones helped to stabilize the family unit.
Once home, my husband wanted to resume certain family roles immediately, while I was hesitant to give up my new capabilities so quickly. Fortunately, after reestablishing open discussions over the next several weeks, we began to speak honestly about our preferences. Once we opened up clear lines of communication and listened to each other, our stress levels diminished. We made some compromises and were able to establish an even better household environment than we had pre-deployment.
So be flexible, take advantage of available counseling and support resources, and be patient with your spouse when reestablishing your family roles. After all, there aren’t many things more important than the happiness of your family.
Most people understand what it means to have high blood pressure, excess fat around the middle, a high cholesterol level, and the importance of addressing these health problems. What some may not realize is how serious the situation becomes when a person has been diagnosed with three or more such conditions in conjunction with other health issues.
This occurrence is called metabolic syndrome.
People who suffer from this combination of conditions (a reported one in four—50 million in the United States alone) have a dramatically increased risk for developing heart disease, type-2 diabetes, or a stroke. Individually, these symptoms pose a health risk, but identified together they raise the risk for cardiovascular disease.
Metabolic syndrome is characterized by a cluster of symptoms that include excess fat in the abdominal area (as measured by waist circumference), borderline or high blood pressure, high cholesterol that fosters plaque buildup in arteries, insulin resistance or glucose intolerance indicating the body can’t properly use insulin, raising blood sugar levels, and the presence of a protein in the blood, which can cause inflammation.
People with metabolic syndrome have at least three of the following risk factors:
- Excessive body fat around the waist
- Low levels of HDL ("good") cholesterol
- High levels of triglycerides (a type of blood fat)
- Elevated blood pressure
- Elevated glucose (blood sugar) levels after fasting
The complications of metabolic syndrome are serious and, if not addressed, can cause major health problems. If you are overweight and don't yet have these problems, keep in mind that the older you get, the more likely you are to develop them. Older adults can develop metabolic syndrome without being overweight, so it is important to get annual physical exams.
What can be done to prevent metabolic syndrome? If you are fall into the categories above or are overweight, one way to reduce your risk of metabolic syndrome is to incorporate healthy habits such as starting an exercise regimen. (But be sure to consult your doctor before starting a new exercise program, especially if you have not been active for a while.)
Diet is also key to reducing the risk of metabolic syndrome. By making small changes in your diet—such as decreasing the number of calories you take in per day; eating more fruits, vegetables, whole grain products, and low-fat meals, and avoiding fast/fried/fatty/oily foods—you can reduce your chances of developing metabolic syndrome.
If you would like to know more about metabolic syndrome, we recommend the following resources: