H E A L T H L E T T E R No. 3
Fall Better: Skiers, My Dad & The Rest of Us
Last month my dad faceplanted in a parking lot.
After it happened I spent some time thinking about how much humans fall. You can fall running, skiing, even gardening. Anyone who moves with their feet can fall, not just people of "advanced age".
Falls can have consequences, from bruises to wrist sprains to torqued shoulders. The scariest ones are when the person goes down fast, whether it's because they've lost consciousness or don't have the strength to slow down their fall. Complications can include concussions, facial fractures, and even head bleeds.
My dad wasn't sure about the sequence of events. He was by himself; it happened fast. Figures he tripped on a parking bumper. Thankfully he got up with just a scrape under his eye, and we wondered if his tai chi practice and daily hikes "braked" him as he fell.
Turns out there's good scientific evidence that strength training can reduce your chances of sustaining a bad fall. The aha moment for me was learning that skiers whose quadriceps muscles are significantly stronger than their hamstrings are at higher risk for ACL tears, due to unbalanced forces at the knee joint.
Which means everyone from octogenarians to high-level skiers can benefit from developing their quadriceps (front of thigh), posterior chain (hamstring or back of thigh, glutes, low back), and core (mostly abdomen) muscles. Training these three domains in a balanced fashion will provide you with strength and stability.
Skiers who add in isometrics and lateral movement can further reduce their injury risk on the slopes. Ideally you're working these muscle groups year round, but starting right now is better than nothing if you'll be on the slopes come winter.
Next time you're in the office, check out Olympic champion skier Lindsey Vonn's book, Strong is the New Beautiful for an idea of how she trains. I also really like this preseason ski workout, which doubles as great stability training for non-skiers, both beginner and advanced. For those who like accountability, consider working with a trainer or check out Union PT's dry land ski conditioning program - sign up opens next week. Union, located in the Greenlake neighborhood, also offers a free online pre-season nordic ski prep.
Please talk to me if we can better address your risk of falling.
Healthy Routines
Fall brings crisp evenings and a chilly foreboding. It's a fast transition from Seattle's long summer days. Personally, I'm ready. After a season of driving kids around and standing on the sidelines, I'm behind on my own health. My one-leg stand time is lower than in May and my core feels wobbly. Which prompts three quick thoughts:
1) Routines and schedules enable fitness. Whether your routines hew to the school year or not, this is a good time to review your fitness plan, revamp if needed, and plug it into your fall schedule.
2) Simple metrics can reveal your personal trends succinctly. I like tests that show me how strong I am -- or am not. Please touch base if we haven't run you through the Sequoia Project fitness metrics yet.
3) Could I have been more adaptable when my schedule was in flux? For sure. It would have been easy to do the one-leg stand on the sidelines. You don't need to put on workout clothes or go to a gym. Even a 10-minute activity, especially one with some intensity, can provide benefits.
Diminishing Daylight & Vitamin D Stores
Sunlight not only feels good on the skin, it helps you synthesize vitamin D, which builds bones. Vitamin D is also the only supplement with decent scientific evidence showing it reduces overall cancer risk.
Here's the catch. In summer it takes just 10 minutes of intense sun to ensure adequate vitamin D levels but you'll need two hours of winter daylight at this northern latitude. Those with darker skin like me require even more outdoor light in winter.
So this is a good time for year-round Puget Sound residents to consider vitamin D supplementation. The body can store Vitamin D for months, and those with normal gut absorption should do just fine with a low daily dose. More is not better; high sustained doses can lead to vitamin D toxicity. But since vitamin D is classified as a nutritional supplement, there isn't good data about each of the different formulations. Reach out if I can help you decide what's best for your situation.
One more thing about daylight: As discussed more extensively in Health Letter No. 1, ten minutes of outdoor morning light and ten more minutes of late afternoon outdoor light helps to regulate your circadian rhythm, which affects sleep cycles and impacts mood. So prioritize getting daylight regardless.
No One Fought Harder for Patients
Dr. Michael Copass, who passed away in July, was best known for developing world-class emergency medical services in Seattle and the Northwest. I met Dr. C as a medical student. He was the probably most important mentor in my early years of medical training and practice, and I don't think there's a physician out there who impacted so many trainees. (Including Paul Farmer.)
In an era before smartphones, Dr. C stayed connected to the City of Seattle paramedics and the Harborview ER via a flip phone, a couple walkie-talkies and a string of pagers that he answered, seemingly 24/7. He personally taught advanced cardiac lifesaving protocols to thousands of health care workers. He insisted our most destitute patients be treated graciously, and if you slacked off in his ER, he was fierce.
Dr. C. taught me neurology and emergency medicine but more important, he taught me to fight for patients to get the best possible care. He was the only doctor I knew who gave his personal cell number freely to his clinic patients. He was all about getting better at the craft, saying, "How quickly can we work, how well can we do?"