The Benefits Of Exercise With Dr. Munoz

We discuss in this podcast:

  • The benefits of exercise for arthritis conditions
  • How to exercise properly and prevent injuries
  • A correct approach for exercise with inflammation
  • Passive and isometric exercises
  • Exercise as a lifestyle activity
  • Stretching and cooling down
  • Ice massage and cryotherapy
  • Biomechanical evaluation

Clint – Well, today, I’m super excited because we have rheumatologist, Dr. George Munoz, back on to the show. And today we’re going to talk about the benefits of sensible exercise. Now, we learned a lot from Dr. Munoz on his first appearance on this show. And today, I have invited him back because he has a tremendous amount of knowledge and experience in the area of exercise. And we’re going to learn about the benefits of exercise, how to do it properly, how to prevent injuries, and how to do it safely when we have inflammatory arthritis and health challenges. Now, Dr. Munoz continues to amaze me with his credentials. He studied martial arts for 10 years with a grandmaster specialist. And he is a well-rounded athlete and can bench press 300 pounds, deadlift 250 pounds at the youthful age of 66. He was a defensive back and running back at school, and he ran track and field. And he believes fully inactivity, exercise, fitness, and it’s a lifelong passion of his and a state of mind. And he also recommends it to not only his family but also to his patients. He takes care of elite athletes throughout their career as a physician. And he also helps them with their healing, their training, their injury prevention, and arthritis prevention. So what a treat to have you back, Dr. Munoz.

Dr. Munoz – Thank you so much, Clint and it’s always an honor. I always look forward to spending time talking with you and sharing hopefully something that helps water many of your listeners.

Clint – Thank you and I’m sure we will. My listeners know very well that I’m a huge proponent of exercise. And without moving my body in a quite ambitious way at all times since my diagnosis. Then, I would not be anywhere near the physical state that I am today. It’s been one of the backbones of maintaining a good quality of life when you have an inflammatory disease. I’m sure you’ve seen with so many of your patients.

Dr. Munoz – Absolutely, and there are not that many global truisms in medicine that, start to encompass and think about what you would ask, recommend or really tell people to go ahead and do as far as their personal health or health of others. But there is no pill and there is no medicine, I don’t know if that can reduce your mortality, which simultaneously reduces your chance of heart attack, stroke, and cancer. Reducing your mortality all simultaneously, there is no medicine or pill but there is only exercise. Therefore, I would say it’s the 1-A of the most important thing that we can do for ourselves and to help others do as far as health goes. No matter what the problem is, it doesn’t matter. While nutrition is highly important when people could say, nutrition is first or that’s one aim. For me, it’s exercise and one aim for me is exercise it’s based on, so many examples. And for our population of people, we’re talking about specifically with autoimmune and inflammatory conditions or even for people who don’t have specifically autoimmune conditions but have degenerative arthritis, which is really more than half of the people on the planet. Because lower back pain is the most common physical ailment globally and certainly in the US. It’s the one that causes the most problem as far as work absenteeism and the cost is mind-boggling. So, if there is anything that we can do to help our core, our balance, our strength, and our flexibility, it is a plus, plus.

Clint – Yeah, and we’ll go into each one of those in detail. Today, we will cover each one of those topics and I just want to make sure that there are no exclusions here. Do you think there’s anyone listening who thinks I’m excluded from that blanket statement?

Dr. Munoz – So, thinking hard and long, we’re going to say that there are caveats and situations where exercise is more of a situation. And where greater care and more supervision is required, such as in convalescence from a heart attack and scenarios like that. But even then exercise is going to be recommended, it’s just how early and how much. So it’s not that it’s excluded, it’s more on the when and how much under proper care. To be specific, it some certain neuromuscular conditions. One, in particular, is myasthenia gravis, which is an autoimmune neuromuscular junction disorder that results in fatigue with repetitive use. Since exercise is usually a repetitive action, one needs to be handled again under the supervision and the right amount of duration under the care usually of a neurologist, or a physical therapist, who is attuned to that scenario. And in joint reconstruction, we have Physical Therapy, and rehab and that becomes essential. So I’m going to say that exercise is critical, even before the surgery. In fact, exercise is very important before surgery. And that could be true, actually of any surgery that’s planned or elective surgery to make sure that we’re in optimal health. So there are very few permanent situations that we have to limit, watch, or supervise the exercise.

Clint – Right. Yeah, I love it. Well, let me give you my summary in a short story and then you can comment on that towards whether or not you’ve seen this with other patients. When I was in my first few years after diagnosis, I was in a terrible state of inflammation and I am not suitably controlled from any angle, my diet was wrong and I wasn’t exercising. Well, why? I was not put on medications because I refused, not because of the recommendations but because my disease was uncontrolled. My left elbow and left knee were so severely affected that within three, maybe four years of diagnosis, I had to have a synovectomy on my left elbow because it completely locked up. Now, the point of this story is that throughout the pain period of the few years there with that left elbow being very sore. The medical guidance that I was given was, if it hurts, don’t move it. Because it sore and you better leave it alone. Well, that ended in surgery, and then later on, I developed some inflammation in the right elbow. Goodness, I got to tell you, I made that thing like crazy. And that right elbow never needed the surgery, even though it was afflicted by the inflammation at the time quite substantially. It benefited so much from the exercise that it almost became dependent on. I knew if I stopped moving it, that inflammation in that joint was going to continue and progress. So I have two examples, don’t move the left elbow just wait for the surgery and the right elbow, moved it like crazy and I got a pretty good outcome, so is this typical? Because I know people with inflammatory arthritis, they’re afraid to move the joint if it’s got some inflammation in it.

Dr. Munoz – And that’s such an instructive case and the personal history that you shared with us. Clint, that is a great starting point about when to exercise, and when not to exercise. So with inflammation, I think one of the key things that we need to do is to do the type of activity in motion and exercise that are not traumatic and that has, what we call a passive range of motion. And some limited isometric strengthening as opposed to pounding exercise like running, which is pound, pound, pound. So if you have a knee problem, or a hip problem, or an ankle problem, pounding is not a great thing to do. However, strengthening exercises of the hip flexor of the side of the hip, the abductors of the front of the thigh, quadriceps through the back of the top leg and the hamstring all supports the knee and doesn’t pound on the knee. It doesn’t cause damage to the knee as well as moving it, range of motion, and both passively meaning, somebody is moving it for us or we could move it passively. Like, with a rope or a band, because the ropes and bands are little tools that we can have with us. And now, we can travel with easy to use tools. It becomes one reason not to have an excuse that there’s no place to exercise. Always remember that we can exercise anywhere. So doing those passive ranges of motions or those passive exercises, allows us to really take advantage and prevent joints from fusing, and joints from freezing up. And that’s what you exhibited with the joint you didn’t lose, which then creates, in traditional Chinese medicine it causes, cheese stagnation. And cheese stagnation is one of the causes of pain, where energy flows through the meridian channels, which is not happening. So, whether we’re in a western paradigm or in an eastern paradigm, it doesn’t matter. We are energetic beings and the flow of energy is just one aspect of our health. And the balance of that energy of Yin and Yang is another measure of our health. If we get out of balance, then that’s when stagnation of energies occurs or when we begin to develop clinical symptoms. So passive range of motion and assisted active range of motion, someone else like a physical therapist helping us or a trainer using devices like ropes and bands or machines, all separate but we’re protecting the joint within the motion and we’re not pounding it. And that’s a part of the activity with joint protection in mind.

Clint – Yeah. I love it. You know, you mentioned my knees and one thing I found was very helpful for clearing inflammation in my knee was just sitting on a stationary bike with very low resistance. And so it’s not entirely passive like you said, but it’s close to it. You get momentum and the other leg is contributing and you start to build up quite a lot of momentum. And you can get to a point where it’s quite passive after a while. If you’re just sitting on the machine and allowing those the range of motions to occur without really putting a lot of force through the knee. And there’s no pounding and no impact, so I thought I’d keep that as an example of something that dovetails with what you’re saying.

Dr. Munoz – Yes, and so for home exercise and if you’re thinking of getting any equipment or if you belong to a gym, although right now, it’s been a little challenging getting to the gym and gyms are opening up, the stationary bicycle, recumbent stationary bicycle, and even a pellet (Inaudible). I don’t endorse any specific equipment, but there are many types of stationary bicycles where the ergonomics and the setup are quite beneficial. And yes, we don’t have to use a lot of tension. Just the range of motion helps get the joint lubricated, for lack of a better term, and the autoregulation, the body’s ability to heal itself is still there. And the motion is allowing the energy to flow, like how a cheetah flows. And we have a tendency to self-right, it’s only when we can’t (Inaudible) outside interventions are needed. And sometimes if we’re doing these things, less of the outside intervention is needed and if we weren’t.

Clint – Yes, so let’s say that I’m a rheumatologist or a general practitioner, that has the same degree of 360-degree awareness of how a patient can benefit or improve their situation and do recommend exercise. I know that you do obviously in your clinic, given it’s one of the aim that you think is beneficial. So let’s say a doctor has said you need to exercise, you’ve covered some excellent ways already if you have inflammation in the joints, is there some more to it?

Dr. Munoz – Great question and the answer is, yes and it was never taught in medical school. I wasn’t taught a thing about exercise like, how much, when, and how and these are the three concepts of any prescription of a doctor. The frequency, the strength, or the intensity of the exercise, and for how long should I take this medicine, doctor? One week, three days a month, or refill twelve months till I tell you otherwise. So depending on our health status, our age, whether we have exercised our whole lives or not, whether we’re newcomers, or whether we’re convalescing from psychologic reasons, depression, anxiety or physical reason, a surgery or an injury or an illness or an accident or not convalescing but have never exercised. There is a tempo and a prescription for you. In general, we’re going to use common sense. But I asked my colleague physicians to look at their patients in front of them, who they’re going to write a prescription for. And also for the individual person to clue in their physician as to their mindset of what they think they’re capable of to start and to minus it maybe by 20 percent. Until it goes slower because it’s not a race rather, this is a marathon because the concept is lifestyle. This is a lifestyle activity along with healthy eating patterns. We’re not going to do diets rather, we’re going to do healthy lifestyle interventions of which, proper and healthy nutrition is one that fits the exercise capability and the intensity of the individual. So I like to recommend that people exercise three to four days a week and a goal to strive for. According to the American Heart Cardiology, American Cancer Society & Osteoporosis Foundation, I look at those recommendations as well as for individuals with potential for heart disease prevention. And so the recommendations are when you look at them globally, it looks like people are recommending for about 45 to 60 minutes, minimally three times a week, and to build up to that. But if you’re able to go for an hour for about four to five days a week, it doesn’t mean you have to go intensely. But everything counts and as of now, we don’t even have to do it continuously that is to say, that if we are limited by time for whatever reason. And you can only have ten or fifteen minutes in the morning. But after the day you have another half hour and that’s forty five minutes, and that counts. And we should not ignore the opportunity to exercise for five, ten, or fifteen minutes because it counts and it’s all a part of it. So the right time for exercise is thirty to sixty minutes, but I like forty-five minutes of exercise. The number three is the minimum and the recommendations are based on, how much per month based on those time limits. So if we can do more or less close to one hundred eighty minutes per week, that’s going to come out for about twelve hours a month. So ten to twelve hours, how intense? Well, if you’re just starting it has to be mild. We don’t want you to be injured. Soreness is not an injury rather, it is when there’s a biomechanical problem that could include tendinitis, a bursitis, a strain, a tear, or partial tear and a stress fracture. So we want to avoid all those things, but with more intensity, the risk of developing bursitis or tendinitis can occur. But we don’t want to get into a joint tear, stress fractures or compression fractures. We want to void that and there’s no reason to have that. And that is how when we start getting careless and overdoing things without proper technique or perhaps without proper guidance or supervision. So the intensity should start mild and if you’re someone who exercises regularly, you should warm-up. You already know this and you are beginning to understand that your body needs proper warm-up.

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Dr. Munoz – So what about stretching? Stretching is an interesting topic because it has changed. When I started as an athlete, we were stretching with static. And now we do dynamic stretching, what does that mean? It means we move as we stretch and we don’t just stretch cold. And so, there are certain movements that you need to do. You can see this on YouTube like the proper way to stretch the Achilles tendon, it is the back of the calf, while you’re walking and moving, as opposed to going up to the side of a tree, or putting your foot up and leaning forward when you’re cold. No, don’t do that, that’s how we create micro-tears and pull muscles when we’re not warm. So the right way is walking, or having a light jog, or doing some dynamic stretching while we’re moving and then the exercise begins. It is applicable to any sports or exercise like weights, swimming, biking, walking, jogging or doing some type of strength training, whether it’s machines, bodyweights or bands.

Dr. Munoz – And then the cool down period comes after we finish. We should always cool down at least five minutes and then, we can do the classic stretches to re-allow or rebalance the muscles that we just used. So that we’re walking it in a balanced way because we do get out of balance and that a part of what causes lower back pain and hamstring gluteal pain. And periodically you should get a massage, it is a part of our injury prevention, good for mind, body, spirit, and it keeps the ability to exercise ongoingly. You can also use ice for any area after we exercise if that’s a little sore. And also things like arnica gel, over the counter tiger balm. You can stretch it and apply some pressure or acupressure of an area that sore. In summary, just find the sore, massage it and you won’t break. You should just apply some pressure and you can use ice then, massage it like just with a little cup of water. For example, these little Dixie cups that your little one would like. Just take one out, peel off the paper, and then everybody can just massage the area that hurts, you can massage it fairly and firmly. And that’s the biggest healer to any soreness and to preventing injuries. So cryotherapy or ice massage and then for your more elite athletes or active athletes, your listeners that are there are athletes or people that are very active population. They’re working out three to five days a week, moderately to significantly strenuous. They may compete or not or they’re running anywhere from three to fifteen miles a week or biking anywhere from one to three hours on certain amounts of time or they’re doing cross-training there. And they’re a different group, those people need to get into an ice cryo bath at least once a week after an intense workout to prevent injuries. And to induce healing and decrease cytokines, aisle six, and TMF that are released during normal strenuous exercise. I’m going to stop there because I gave a lot. But I gave you a big overview and now you pick the (Inaudible)

Clint – What caught my greatest interest was the use of rubbing ice against muscle pain. And when you said that is the greatest healer or the greatest relief of pain, now I want to talk about that a bit more, if you don’t mind. There was a book that I read many years ago, and I can’t remember the author’s last name, but the name of the book was called Pain Erasure or Erazor and it was Bonnie something. And the whole book was pretty much about, find a spot in the body that hurts and put pressure against it with the thumb for seven seconds and then release and then do it again. And the whole concept was push against things that hurt, right? Now, I’m all on board with that and I’ve been doing that for a long time. I’ve always had this perhaps limiting belief around cold therapy. And if you don’t mind, my limiting belief is that I have this concept of healing through blood flow. And if we’re putting ice either sitting in an ice bath, which I’ve never done, or applying ice to something directly, we are cutting off or we reducing the blood flow. So where have I got my wires crossed here as to how that heals?

Dr. Munoz – No, you don’t have your wires crossed at all because it is counterintuitive. So it’s not that your wires are crossed. I’ll give you my simple-minded thinking about it but it’s panned out in my 50 years of activity in sports and that is a truism of ice and of its redemptive qualities. So the simple-minded concept that I have, is that there’s local inflammation and it’s hot, even if it doesn’t look hot. But sometimes it does look hot, sometimes it does look swollen, and sometimes it does get red. And basically, we’re applying the yang as we are balancing and it takes cold to overcome the heat. It’s like the kids with their little game. It’s like rock, scissors, paper, and shoot. It’s like I can’t get the hierarchy of who’s winning. But when energy is blocked and there is heat, then it is cold that pressure wins. So, we don’t have to do rock, paper, scissors, and shoot on that one. So it has to do more with that and then the ultimate thing is it works. And if I couldn’t come up with an explanation, I would just say, Clint, I don’t know but it just seems to work. And it worked in so many instances of minor injuries or fairly major injuries and it works quickly. And if we have a new injury, that’s when it works the best. And we do a particular exercise and then, everything’s good. But there was one movement where we felt the tweak. And then after we finished the exercise, wherever that tweak was, and now I have a problem, ice is to the rescue. Many times it’s a tendon micro tear that gets inflamed and that has a poor blood supply to heal. Yet, it is injured, and being able to put pressure, stretch it, and make it cold seems to have a rehabilitative healing effect. I don’t know that we can fully explain it yet, but it is clearly a truism. Whenever we have repetitive injuries like pounding injuries, it’s very, very good. If we have a brand new injury with warmth and swelling, it’s a very, very good if we’re preventing injury from overuse of a shoulder. Let’s say a rotator cuff, elbow tendinitis, hip bursitis, knee meniscal irritation or ligament injury, Achilles tendinitis, and acute muscle spasm. It’s going to require a combination of physical myofascial release, massage, stretching and cryotherapy. So when do we use heat? It might be what people are saying. Now he’s talking about ice, I thought heat is better?. So, heat, in general, is better with chronic things and ice, in general, is better with something new and acute, and here’s a truism.

Clint – Great. I love it. Thank you. You mentioned about preventing injuries earlier on. Is there a way that we can do some kind of evaluation, where we can know whether or not we’re likely to be susceptible to injury?

Dr. Munoz – So, there is and I have a dear friend, he’s a physical therapist, Frank maybe one of these days we’ll get him on one of our podcasts. He’s a great person and he quite enjoys speaking on this topic. And you would think as a rheumatologist, having studied in some of the most elite programs in the country, that biomechanical evaluation would have been one of the things that was covered. I never heard the term previously until I heard it uttered in that way from Frank (inaudible) mouth years ago. And it was quite an awakening and a dawning like why weren’t we taught this? Yet I found myself understanding that I had been doing a biomechanical evaluation on my patients, on my own, in my own way, getting better at it over time, but never really taught a simple structured method to do it. And basically, what a physician or practitioner, skeletal physician or skeletal practitioner like physical therapist, chiropractor, orthopaedic surgeon, physiatrist, neurologist, rheumatologist, anybody who touches the individual from a skeletal perspective needs to have this assessment tool in their mind and in their little bag of goodies of how to evaluate someone. How are they moving? How do they sit? How do they stand? What is their static posture like? And what is their dynamic movement like? Is it free flowing or is it out of balance? Do they have an (inaudible) gait, meaning the way they move and walk is not free flowing? Yes, there is an (inaudible) gait, where is it originating from? And this is brings up a concept of chain of injury. Chain of injury, so a toe could cause neck pain or a headache if the foot doesn’t move properly. The gait, heel to toe stride isn’t normal and isn’t on the outside of the foot, that can put stress on one side of the knee, the inside. Which puts pressure on the outside of the hip, which puts pressure on the other side of the low back the right side, and sacrum which travels up the spine. Now the spine is trying to get rebalanced, so there’s some spasm all the way up, all the way up to the neck. Once you get the neck involved, though, tension and pain takes over. And then you can get headaches, visual complaints, jaw pain. So a toe, can cause problems all the way up away from where the person is exhibiting. So that’s what we call the chain of injury and deconstructing where does the pain originate from? Actually, from the dynamic mechanical perspective. So I just gave you an example.

Clint – And that’s fantastic. And I’m sure everyone listening is doing what I’m doing and thinking about our own bodies. And if we walk on the front of our foot or outside the foot, and I know that I, I have a reduced arch on my left foot and that my ankle rolls in a little on the. And that exactly as you said, it causes a little pain on the inside of the knee.

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Dr. Munoz – Which then causes an imbalance in the stride which causes the contralateral hip to work harder. Which then you’re right side is trying to rebalance. And then the chain of potential biomechanical imbalance can become either corrected with an orthotic or proper rebalancing or becomes the source of a chronic problem, chronic low back pain, mid-back, neck, and I described the rest. So this is true for everybody. OK. So part of the biomechanical evaluation since you brought it up is to look at the foot and to see does the person have an adequate arch? If not, they’re going to need orthotics. OK. These can be customised. Luckily, now they’re much more affordable than years ago. They can be scanned and by 3D technology. You know, have a very good orthotic that can be used for daily use as well as for athletic use and exercise, depending on the type of athletic activity. You know, it becomes more and more important. So for track, it’s very important for jumping. It’s important for, you know, stop and go exercises, tennis. You know, any padel exercise is very important for your skiers in the boot. It becomes important because every pressure, a double black by diamond skier by the way. The boot sensitivity and the amount of pressure that is transmitted simply by pronation, supination is affected by whether the orthotic is allowing direct contact to the edges of the boot, which translates to the edge of the ski. So just giving you some ideas that the concept, the biomechanical balance is important for really any sport. We probably underestimated and underappreciated and really from my youth sports track and field soccer, American football, rugby, basketball, the basketball player in general. OK, tall, thin. Many of them with a lot of big foot. Many of them with pest planis, meaning flat arches. Same with my American football lineman, my linemen, big three hundred pound, 250 pound guys with pronated knees coming together and the arch collapse. So we orthotics for them to prevent injuring arthritis in their knees and hips as they get older within their sport. So this is also important for arthritis prevention in the foot and ankle, in the knee and in the hip.

Clint – Let me ask you this. Obviously, you’ve mentioned the orthotics a lot, and I know that that’s something that you’ve seen work a lot or you wouldn’t recommend it. However, you know always wanted to seek as something a natural solution as much as possible. My physical therapist has suggested that if I were to use one of these loop elastics and sit on the edge of a chair, and then develop a lot of tension between the two ankles and then to move the arch away. So it’s not rolling in where it tends to go with the ankle but move it away from the body, say, building strength in the outer part of the foot and trying to raise the arch with each motion. Long term, do you see that that may have some benefits in reversing some of the situation?

Dr. Munoz – Yes, I do. And so I’m going to say that we as Western civilised people have brought this on ourselves by wearing shoes because we did not wear shoes. So the people I met in the Amazon, they didn’t have shoes. I tried to walk barefoot like they did. And I didn’t last two steps by westernise, hypersensitive soft skin, felt a little pebble as though it were a razor blade. And yet they’ve walking through everything and anything, and there’s no problem. Their strength of their feet, it was equally amazing. And this is who they are. And it affects their biomechanics all the way up. So the short answer to what you asked is, yes, any and we should not wear Flip flops. Beach flip flops as an ongoing all day habitual footwear because all it does is weaken the midfoot to the opposite of what you asked me, whether the exercise would strengthen it does the opposite. Though it messes up the foot, it weakens the arch and weakens the muscle. And it’s causing a pandemic of this problem, further increasing the incidence of low back pain that was already at a sky high rate, this is just aggravating it. Now in younger people, because I notice that my athletes of all ages, youth, high school, collegiate and the pros are in flip flops. So I’ve taken it upon myself through education, cajoling and prodding to suggest to them that what they’re doing is going to affect them adversely and that if they’re going to do it to do it in limited amounts of time, beachwear, pool wear, don’t be in it all day long because it’s just adversely affecting the biomechanics of the foot, which begins the chain of injury that we’ve already discussed.

Clint – I love it. Everything you say is so fascinating. I could listen to you all day, but we’ve got to respect your time. So I’m only going to ask you two more things and I’m going to ask them together and you can answer them in the order you wish. Really important little strategies that we can do here. One, work on our core, I’ve been told by a personal trainer that every client that he has throughout his whole life, he always in every session gets people to work on the core and work on their glutes. You’ve talked earlier about, you know, building strength and you mentioned the glutes and some hamstrings and quads and stuff. So I want to hear your thoughts on the importance of core work and then grip strength. It’s something that I have been fascinated by recently. I’ve just been really getting back into, you know, using a grip strengthener. Trying to hang from bars and things, even though it’s, you know, the gym shot just to try to maintain my grip strength because of the importance around that. So can you speak about core work and grip strength? And then I’ll let you go.

Dr. Munoz – OK. So core work and grip strength. Two excellent topics, and there’s so many an exercise. I’m so happy to be going through some of these highlights of the repertoire.

Dr. Munoz – So core strength is important. First of all, what is the core? The core is the group of muscles that are both visible and invisible, are palpable and not palpable, meaning we can touch them and then also that we can’t touch them normally that are in front and in back of the spine on either side, and to the right and left of the spine as well. So in front and back and to the right and left surrounding the spine, that gives stability to the spine. And remember, the spine is not perfectly straight there is some curves to it. So homosapiens were actually not meant to walk upright because our spine is not straight because of these curves, and I can’t mimic it all with my hand. But there’s a curve appear in the neck curve back here in the lower back. And the whole point is that the balance point of force of balance should come straight down even though there’s a curve.

Dr. Munoz – So core strengthening requires two things. One, flexibility. And two, isolating those muscles that we talked about so that they’re stimulated and not weakened. Activities that weaken the core are being on our glutes all day long, which is the number one health nemesis of Western civilisation, sitting. Number one, health risk now. Number one, surpassing smoking. All right, so in this age of technology, in this age of office work, although now we’ve been moved out of the office, perhaps to our homes. But let’s not be sitting at home the whole time. Take breaks, movements stretch. But for the core and for any exercise, you can do static meaning you can strengthen it without moving or you can do dynamic strengthening. So there’s static core work and then there’s dynamic core. Let’s talk about static for real quick. If I have an injury and I cannot move my spine, I’m talking about if I have pain. If I have a tendinitis, if I have a disc problem, if I have sciatica, which is a pinched nerve, usually in the low back at one of the lumbar levels, if I have those kind of situations and they’re telling me my core is weak, I have to strengthen my core. Well, what kind of exercise can I do that won’t aggravate the injury or the pain or the pinched nerve? We can do static core, which would be things like laying down prone on a mat or on the floor and doing a plank type of exercise, and you can Google what kind of planks, you can put your arms like in a V, you put your hands straighter like this. And the whole point there is don’t jam up your shoulders or your elbows, but whether you’re in a V or like this, you’re going to keep your back straight and off the floor on the backs of your feet, and you’re going to do you’re not going to move and you’re going to do this timed. And you’re going to do plank core, if you can only do five seconds, you do five seconds. If you can do 10 seconds, you do 10 seconds, and we build it up. So and we build it up in intervals like any other exercise. We do intervals, we do the exercise and we rest for a period of time. So if you did have 10 seconds, maybe rest 20 and you do eight to 10. And that’s one cycle. OK. And then we do it again. And over time, we want to be able to do this so that. You’re between 30 and 60 seconds per time of core and you will sweat. You’re doing isometric core strengthening, meaning your body is not sitting up doing a situp, you’re hurting your low back. You’re straight, but yet we’re using the core. So once we have that down, then you can do isometric core exercises face up where we exhale through our mouth, take a nice deep breath and blow it out through our mouth, and simultaneously the belly button is sucked in, we’re laying up. And now, without releasing the belly button, we lift one leg a few inches straight and back down, and up and back down, and up and back down.

Dr. Munoz – And we do that eight to 10 times, and then you want to breathe. So, yes, you’re going to breathe, and you do the opposite side. So that kind of core strengthening is been our dynamic., but you’re not moving the spine up and back and forth. Those two things you can do with a back injury with sciatica. You can also sit on the ball and balance. And now you’re engaging the core and you can do light exercises of the arms, either with barbells or with bands and do bicep curls or overhead. And at the same time, you’re engaging the core. So that’s a static core, but it’s a complex exercise on a ball. But not doesn’t take a lot of equipment, a ball in some lightweights or a ball in bands. Remember, I said we should invest in bands and a little light set of weights for home exercise. OK. So those are static core strengthening, you know, doing crunches, doing abs. Yes, you can do that, but it’s important to do it properly, to breathe, to suck in the belly button, and to do it with a good biomechanical fashion, which means that when you’re doing it, you’re not creating pain in the low back. If you’re getting pain in the low back, you’re doing something wrong. Get a trainer and stop and don’t injure yourself.

Clint – Yeah, love it. I just. Is it satisfactory if you would just do the planks? I mean, if you got really good at planks, you probably going to have a pretty good core. Right? Just by doing that?

Dr. Munoz – Correct. You’ll have a phenomenal core, phenomenal course. And you know the thing with grip strength. So as a rheumatologist, we were taught to cheque grip strength mostly, but not for the reason we’re speaking about some. That was to assess rheumatoid arthritis Inflammation effect, chronic Synovate effect in the wrist and the tendons and musculature of the hand. What we’re talking about, grip strength assessment is as a health assessment. What is it about grip strength that intrigues us? Why we’ve been talking about it? And again, this is not commonly known by physicians, it’s mind-boggling to me. It’s as important as a blood pressure. Again, maybe more important. And since it’s exercise, it’s 1-A in importance, grip strength has been likened to a easy, cheap version of assessment of lifespan. Lifespan, it has been likened to the ability to recover from serious illness or, you know, trauma or certain serious surgery. That’s how important grip strength is. You know, we strengthen our grip through normal exercises that involve the upper body. But you can also do specific grip, specific exercises that will strengthen the forearm. As well as the (inaudible) muscles of the hand, so bands to separate. And in martial arts, there’s a lot of that, you know, for power in the distal and the tips of the digits and claw strikes, in palm-heel strikes, which is mostly, you know, the area which you don’t want to hit with the carpal tunnel. But I’m going to say that one of the key things of strength in the hand is to make sure we don’t lose flexibility and mobility.

Dr. Munoz – So besides strengthening doing, for example, grip grippers and besides bands, besides those things, that flexibility and being able to bend the hand back and the fingers back and hold it without injury is important for strength. So flexibility is important for strength any place in the body and it holds true in the hand. So keep your hands in digits flexible, and that improves strength as well as when doing exercises for isometric strength in grip.

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Clint – Mm hmm. Fascinating. Thank you. I hope everyone goes out there and works on those aspects of their physical body the way that you’ve described, as you said, everyone’s a different set of circumstances and may need to speak to someone who can give them some advice. But you know, what we’ve learnt from you today is that we all should be moving our body as the A-1 priority in our life for longevity, for reduction of all these other potential conditions, and that there’s so much that we can do and get a lot of enjoyment about and the way we move our body. You’ve been doing it all your life. You obviously love it. You’re passionate about and it comes across. And therefore, you’re such a great teacher on this topic. And we could go further. I had some more questions, but I want to respect your time. We’ve had you here a little over an hour or so. I just want to say thank you. And can you remind us again, if someone wants to reach out to you and get some consultation from you, how to contact you?

Dr. Munoz – Sure Clint, thank you for that.

Dr. Munoz – So you’re in Miami, the or 305 682 8471 is the direct number that we can go ahead and the staff will be happy to assist you in making a consultation.

Clint – Awesome. Thank you so much. And members of rheumatoid support and rheumatoid solutions. You’ll have the pleasure of being else able to ask Dr. Muni’s your personal questions in the chat bar. He’s joining us on a webinar shortly, so make sure you join us on that if you’re part of one of those groups. Thanks again, Dr. Munoz. It’s been an absolute pleasure.

Dr. Munoz – Thank you so much. Always a privilege and lots of fun conversing with you. And it seems like time just flies every time we do this.


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