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    Bone of contention: How to avert a late-life battle with osteoporosis 

    Nov 29, 2013

    (The article first appeared in the July 2013 issue of Men's Health Magazine)

    YOU don't expect to see an injury that's more likely to occur in a car crash happening in a basketball game. But in those rare instances when the unexpected becomes real, there are no words, only mental images that make you shiver, cringe, or vomit on the spot.

    The 40-year-olds among us can easily point to Terry Saldaña, then Ginebra’s star forward, who suffered a bad fall in one fateful PBA game back in 1987. Six years ago, almost the same thing happened in the NBA when Shaun Livingston’s left knee caved in prior to takeoff. The internet-savvy generation can also draw up links — ruining our appetites in the process — of the gruesome Kevin Ware incident last March in the US NCAA Elite Eight matchup between his Louisville Cardinals and the Duke University Blue Devils.

    Usually blamed for such freak incidents is improper training that results in fatigued muscles from years of demanding regular use, and eventually leads to strained — then torn — tendons and ligaments. But in Ware’s case, one reason stands out. In an interview with ABC News, Timothy Hewett, Ph.D., director of sports medicine at Ohio State University, stated that Ware has compromised his bone integrity due to vitamin D and calcium deficiency. In layman’s terms, Ware may have osteoporosis.

    Osteoporosis is a bone disease that doesn’t normally occur in men. “You often see osteoporosis in postmenopausal women, meaning women past 50 years old, dahil bumababa yung levels nila ng estrogen and nawawala na yung protective effect nito sa bones nila,” says Roberto Mirasol, M.D., an endocrinologist and head of the Diabetes, Thyroid and Endocrine Center of St. Luke’s Medical Center, Quezon City. Men can also suffer from this condition, but Dr. Mirasol explains it’s more common among us past the age of 70.

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    Now while it seems highly unlikely you’ll ever get osteoporosis, you have every reason to suspect that you are where Ware was before his bone-breaking misfortune. Studies carried out by the International Osteoporosis Foundation (IOF) in Switzerland showed that a significant number of countries in South and Southeast Asia — including the Philippines — are experiencing a “widespread prevalence of vitaminosis D (vitamin D insufficiency) in both sexes and all age groups of the population.” On top of that, the IOF says calcium intake is severely overlooked in these areas and it expects a major increase in bone-fracture incidents in our region, noting that “half of the world’s fractures will occur in Asia by 2050.”

    If you don’t take this as your cue to evaluate what you’re doing (or not doing) in terms of keeping your calcium and vitamin D levels in check, then it won’t be long before you feel something in your bones — and you won’t like it one bit.

    Bone of Contention

    Here’s a fact that couldn’t be stressed enough: Your lifestyle choices determine your health. Naturally, this truth applies to the state of your bones.

    Maintaining good bone health begins with the minerals you feed — or neglect to give — your body. “Vitamin D deficiency primarily affects the bonebuilding process, resulting in a poorly mineralized bone matrix,” says Sabrina Batac, R.N.D., a certified nutrition educator at the Center for Culinary Arts in Quezon City. When you’re low on vitamin D, your bones are unable to absorb calcium and naturally become vulnerable to fractures.

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    “Calcium deficiency, on the other hand, increases the risk of developing osteoporosis late in life,” continues Batac. This raises the likelihood of a decline in bone mass, which leads to deteriorating skeleton strength and upsets your overall structure. Your lifestyle therefore needs some bone-friendly tweaks, starting with your daily diet. Because fastfood chains are as ubiquitous as campaign banners during election season, it’s easy to fill up on junk and throw proper nutrition out the window.

    As irresistible as a burger-and-fries combo can be, however, the harsh reality is that your fastfood favorites are high in sodium, which your bones aren’t too excited about. “Sodium can cause calcium loss [through] urine,” Batac says. “It’s been found that for every 2,300 milligrams of sodium in the diet, 40 milligrams of calcium is lost. That’s like intentionally peeing out almost 1/8 of an 8-ounce glass of milk.”

    You should also consider these nutritional numbers in your must-meet list: As a daily requirement, your body needs at least 1,000 milligrams of calcium (around 27 ounces of milk) and 600 IU of vitamin D (around 141 grams of cooked salmon). To help you hit those numbers, add these bone-building foods to your grocery list: spinach (it has bonemineral- density boosters), bananas (potassium prevents calcium loss), and prunes (high in copper and boron, and good against osteoporosis).

    Another important thing to note: While it helps you power through a stressful day, caffeine contributes to the deterioration of your bones, too. For every 100 milligrams of caffeine that you drink, 6 milligrams of calcium gets flushed out of your body. An 8-ounce cup of brewed coffee packs 104 to 192 milligrams of caffeine, while instant coffee has 100 milligrams of caffeine per 7-ounce cup. Multiply the calcium trade-off by the number of cups of coffee you drink in a day, then add in the fact that your body is already low in calcium. Your coffee-drinking habit doesn’t seem so harmless now, does it?

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    You should also keep tabs on the number of brewskies you down during your drinking sessions. We get you: The fire-breathing upper management is on your case every day, and capping each 9-to-5 grind with a couple of cold ones is the ultimate relief. Too bad your bones will pay for this habit. “Long-term alcohol consumption of about 2 to 3 ounces a day not only inhibits the function of bone-forming cells called osteoblasts, but also disrupts the balance of bone formation and remodeling,” reveals Batac.

    Moreover, skipping meals because of a hangover puts your bones at further risk. “Sometimes kasi when you regularly drink so much alcohol, hindi ka nakakakain nang mabuti [the day after] kaya kulang yung nutrition ng bones mo,” Dr. Mirasol adds. 

    Your lifestyle choices should also extend to how you maintain your training regimen. “Pag hindi ka nag-e-exercise, tataas yung risk mo for osteoporosis kasi there’s a decrease in bone-mineral density leading to a fracture,” warns Dr. Mirasol. “Weight-bearing exercises should be encouraged — around 30- to 40-minute sessions, 2 to 4 times a week.” Hitting the gym regularly or playing pickup hoops can do your bones a lot of good. Of course, that’s only if you’ve been taking the correct steps in the weight room or on the court.

    Be Unbreakable

    During your sweat sessions, you can’t underestimate what even a fraction of an error could mean for your bones. An incorrect landing, for example, shouldn’t be taken for granted. “Roughly 80 to 90 percent of sports injuries, like ACL tears and Kevin-Ware-type injuries, will happen on landing and not on takeoff,” says Julio Veloso, M.S, C.S.C.S., head performance coach of Focus Athletics. “Wala namang na-i-injure sa mataas na talon; madalas sila na-i-injure sa mataas o maling bagsak. Lack of muscle strength also contributes to this. Ang nangyayari, yung force applied to the ground napupunta sa ligaments and bones, rather than [to the] muscles absorbing them properly.”

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    Your trainer, coach, training buddy, and this magazine have long preached the value of proper form in doing your exercises — it protects not only your muscles but also your bones from debilitating damage. “Bad form, if done repeatedly, results in a fracture [wherein] your bones don’t really snap out of place,” Veloso explains. “It’s like they have a tiny break — smaller than a hairline.” And these multiple stress fractures can spell a Ware-like injury for you in the future.

    While stress fractures are difficult to detect, there’s one obvious sign you shouldn’t brush off. “If you’ve been experiencing lingering pain that doesn’t go away, then you might be developing a stress fracture,” says Veloso. “[Pain] is the body’s sign that there’s something wrong. And kahit ipinahinga mo at ayaw mawala, you’ll be better off having a professional look at [the problem].”

    Rest is likewise vital to building bone strength. A good trainer will tell you to push beyond your physical limits if you want to be unbreakable. A better trainer, however, will recommend proper recovery practices in between your training sessions to help you perform better and get results faster.

    “Training without rest leads to injury,” Veloso stresses. “You actually get stronger during recovery kasi doon nag-aadapt yung katawan after a hard workout. Coupled with good nutrition, doon lumalakas ang muscles, doon nagre-recover yung katawan. So if you continuously train for a week with no recovery, you’re actually making it worse for yourself.”

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    The odds of having osteoporosis are a lot less for men—young men, especially—compared to the ladies. But even if you’re a betting man, you don’t want to gamble with such a limb-threatening risk at stake. Being wary about the possibility of fractures is the way to go. “[Whether] you’ve developed any stress fractures or not, [it’s best] to still have yourself checked,” Dr. Mirasol advises. “Baka kasi secondary na pala siya sa osteoporosis.”

    CRACK THE CASE

    Know the difference between an injury you can remedy right away and a life-threatening situation you should rush to your doctor

    SPRAIN

    According the American Academy of Orthopedic Surgeons, a sprain occurs when one of your ligaments (connectives tissues which stabilize your joints) is stretched. It happens when a certain incorrect movement displaces your joint from its original position. For ankle sprains, the usual culprits are running on an uneven surface or landing on the side of your foot. Finger sprains are also common in ball sports.

    Do this now: Apply P.R.I.C.E.—P stands for protecting the injured area, R for resting the injury and allowing it to heal, I for ice you should be applying to your sprain, C for compression, and E for elevating the sprained area to bring down the swelling.

    STRAIN

    An injury to a tendon (cords of tissue that attach muscle to bone) or a muscle is called a strain, says the American Academy of Orthopedic Surgeons. Strain incidents can be due to repetitive movements that lead to overuse of the muscles and tendons. For example, a back strain is an injury mostly seen in volleyball and basketball players who’ve been jumping for years. As a result, their back muscles are pulled, twisted, or even torn.

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    Do this now: While it may be bearable, a muscle strain should be examined by a doctor so proper therapy can be recommended.

    DISLOCATION

    When there’s a separation between your joints, it’s called a dislocation. These are often acute injuries that happen on the spot and can compromise the bond of your nerves, tendons, ligaments, and even muscles around the injured area. Shoulder dislocations often happen in contact sports.

    Do this now: Sure, one of your buddies can pop your shoulder back into its socket, but it would be downright irresponsible to not have it checked by a physician.

    STRESS FRACTURE

    “It’s easy to mistake one injury for another. Like for example, if you had an ankle sprain and you think it’s healing but the swelling hasn’t subsided for months, you might want to have it checked because it could also be a stress fracture,” says Geoff Quevedo. A physiotherapist at Focus Athletics. Though cases are varied, a stress fracture is an injury which happens to the bones over time. Think small cracks that, if left unchecked in time, will cause any structure to break. Lingering pain is a common symptom of a stress fracture and it commonly occurs in the heel and ankle.

    Do this now: Where there’s pain, there’s a problem. So when you feel something’s amiss, head to a doctor for a proper diagnosis.

    FRACTURE

    Your bone snapping into two or more sections which results in misalignment is called a displaced fracture. You also have non-displaced fractures where bones are broken yet remain in place. If your bones are broken into many pieces, it’s classified as a comminuted fracture. These all fall under the umbrella of closed fractures. What happened to Kevin Ware is called a compound injury where the broken bone punctures the skin after it has snapped. Open fractures present high risk in deep bone infection.

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    Do this now: Walking it off is unwise. Call an ambulance (if you can) or have a buddy do it for you.

    SAFETY FIRST

    No benefit can be gained from subjecting your bones to undue stress, asserts Julio Veloso, M.S., C.S.C.S. Apply these hassle-free measures to your workout habits and expect better results

    BEGIN WITH THE BASICS

    Know which exercises truly matter. “Master the basic human body movements—squatting, lunging, pulling, pushing and pressing,” recommends Veloso. Focusing first on body-weight movements allows you to train functionally and efficiently.

    DON’T HURRY

    Pace yourself and stick to your workout’s proper progression. “You can’t begin with the hardest exercise kaagad,” Veloso points out. “Even the pros [always] progress from easy to hard. Hindi pwedeng biglaan na you align yourself to pro level just because you think kaya mo na.”

    TRAIN YOUR BODY TO MOVE

    “Try not to work your body just in isolation,” says Veloso. Instead, opt for a squat or a lunge and don’t rely on machines to do the move for you. “Rather than working your quadriceps in a leg extension, performing a lunge allows you to work your quadriceps, glutes, hamstrings, calves, and even your core muscles,” Veloso adds.

    KEEP YOUR BODY GUESSING

    “Make your workout as diverse as possible,” says Veloso. Fine-tuning the different aspects of your fitness not only makes you a more complete athlete, but also improves your overall bone structure. “Mataas ka nga tumalon, mahina naman core mo. Hindi naman din pwede na puro power ka lang, wala kang endurance

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    PLATE THIS!

    According to the Nutritionist-Dietitians’ Association of the Philippines, these foods boost your levels of bone-strengthening essentials

    FOR YOUR CALCIUM NEEDS

    FISH

    LIVER

    FRESH FISH (LIKE SILINYASI AND TUNSOY)

    OYSTERS

    SOYBEANS

    DRIED AND FRESH DILLS

    BUTTER

    EGGS

    MONGGO

    DRIED AND FRESH ALAMANG

    CREAM

    SALMON

    DRIED BEANS

    DRIED FISH

    CLAMS

    SARDINES

    LEAFY VEGETABLES

    FOR VITAMIN D

    MILK

    MARGARINE

    STURDIER THAN STEEL

    Develop your bones’ strength and density with this 15-minute training plan from Veloso, who also trains the National University basketball team. Remember to follow the form and order of the exercises. Feel free to substitute dumbbells for kettlebells depending on equipment availability.

    1A Kettlebell swing (3 sets, 15 reps, no rest)

    Stand with your feet wider than shoulder-width apart, with each foot pointed outward by about 30 degrees. Keep your shoulders pulled back and down to avoid rounding your back. Swing the kettlebell forward while squeezing your glutes and thrusting your hips forward. Don’t squat on the backswing and don’t let your shoulders go in front of your knees at any point.

    1B Sumo squat to hamstring stretch (3 sets, 5 reps, 1 minute rest)

    Stand with your feet shoulder width apart. Bend at the waist and grab your toes. Drop your hips to the ground and lift your chest up. Push your hips up and back until you feel your hamstrings are stretched. Keep your back straight. Then, drop your hips back to the ground and repeat.

    2A Kettlebell front squat (2 sets, 8-10 reps, 30 seconds rest)

    Stand holding 2 kettlebells in front of your shoulders with your elbows up. Squat until your thighs are parallel to the floor, initiating the movement with the hips. Return to the starting position by pushing through with your hips.

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    2B Feet-elevated push-ups (2 sets, 6-8 reps, 30 seconds rest)

    Assume a pushup position with your hands on the floor and your feet on a bench or a box. Contract your core and keep your torso engaged and straight while bending your arms to lower yourself toward the floor. Push back up as far away from the floor as possible.

    3A Dumbbell half-kneel curl to press (2 sets, 10-12 reps, 30 seconds rest)

    With your knee on a soft pad or mat and the opposite foot flat on the ground in front of you, hold a pair of dumbbells at your sides. Curl the dumbbells to your shoulders, then press the weights overhead while keeping your legs and torso stable. Lower the weights back to the starting position. Finish the set and switch leg positions for the second set.

    3B TRX inverted row (2 sets, 10-12 reps, 30 seconds rest)

    Adjust the handles of a suspension trainer (such as the TRX or the Jungle Gym XT) to around hip height. Grab the handles and hang at arm’s length from the trainer with your legs straight in front of you. Pull your chest towards the handles while keeping your torso straight and your glutes contracted. Pause, then lower yourself down to the starting position.

    3C Kettlebell one arm/one leg Romanian deadlift (2 sets, 8-10 per  side, 1 minutes rest)

    Stand on your right foot while holding a kettlebell with an overhand grip in your right hand. Lower the kettlebell as you raise the non-support (left) leg behind you. Return to standing position by contracting your hamstrings and glutes. Finish the set and switch sides. Don’t round your back or allow your hips to open up during the entire movement.

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