Photo credit: Ester Max
Stuart is a successful lawyer who came to me with knee pain. There was a level of frustration in voice when talking about the knee pain he had;
“I don’t understand it, I’ve played Rugby all my life and I’ve been doing bootcamps for the last 6 months. Suddenly my knee is giving way”
As with all new clients I do a movement assessment to see what the body is up to. It give me a chance to see if there is anything glaringly obvious to work on.
With this client, he was frustrated that he “suddenly” started getting knee pain. The assessment showed it was almost inevitable;
- My clients hip mobility wasn’t going to light up Strictly come dancing anytime soon.
- The rugby experience had made him have very strong quads but weak, tight hamstrings & hardly any glute (backside) activation.
- His knees moved inwards every time he walked & ran
- He was stressed up to the eyeballs.
Dodging the bullet
Now, you could get 50 people all with these same symptoms and 10 of them may be symptom free. They would say they’ve had no pain and move pretty freely. However, unless you’ve experienced direct trauma, it is rarely JUST one thing that influences your health.
Health leaves clues
A group of scientists travelled around the world to explore pockets of the globe that had an unusually high number of centenarian (people living over 100 years old). They labelled these areas ‘Blue Zones’ and wanted to find associations that could provide a clue for these people living as long as they have. Whilst there were differences among the groups, the scientists did find similarities including:
- A purpose in life
- Regular exercise
- Calorie controlled intake
- Plant based diet
- Engagement in spiritual, family & social life
Just as good health leaves clues, poor health does as well. A heart attack doesn’t come out of nowhere and (unless direct trauma) neither joint pain, neither does realising you are out of breath at the top of stairs and neither does your clothes getting tighter.
Luckily there are many tests you can do to give you an idea of where you are at. You don’t have to wait in a GP surgery to get 10 minutes of a GP’s time to carry out these tests.
Done Within 30 Minutes
All of the tests I am about to show can be performed in the comfort of your own home and within 30 minutes.
This doesn’t take away the value of these tests. Each one provides an indication of the level of health you are experiencing at this moment in time.
From this you can then surmise whether you are more or less at risk of a particular condition should the results carry on the way they are.
The following test are as follow:
- BMI/hip to waist ratio
- Blood Pressure
- Get up and down from the floor
Test 1 – BMI & Hip to Waist Ratio
Body mass index (BMI) has got a bad rap over the years. The common argument is you can have 2 individuals, both 35 years old, 5ft11in height and weighing 18 stone. Both would get the same BMI score but one could look visibly overweight while the other is a bodybuilder.
This is true and it is rare the BMI score would be used in isolation. The formula to work out your BMI is:
(Weight in kg / Height in m) / Height (m)
For example, if you weighed 70kg and you were 1.75m tall it would be:
70 / 1.75 = 40
40 / 1.75 = 22.9 BMI Score
You can see what your score corresponds to in the following chart:
|20 - 24.9
|25 - 29.9
|Overweight (Level 1 Obesity)
|30 - 40
|Moderately Obese (Level 2 Obesity
|Severely Obese (Level 3 Obesity)
I have said before, the BMI score can come into a lot of flak due to an overweight individual can get the same score as another individual with a lot of muscle mass. Which is why I like to compliment the BMI score with another simple formula called the hip to waist ratio.
Hip To Waist Ratio
To calculate the hip to waist ratio you have to do as follows:
- Measure the circumference of your waist around your belly button in cm.
- Measure the circumference of the widest area of your hips in cm.
- Divide your Waist score by your hip score.
Your Score will be interpreted as follows:
|0.8 or lower
|0.95 or lower
|0.86 or higher
|1 or higher
What do your results mean?
As with all the tests I present today they are about associations, what could be true if you continue with your current health habits knowing these results. With BMI & Hip to Waist ratio there are a number of associations you should be aware of:
- In a meta analysis of studies involving over 30 million participants, a strong association was found between high BMI and premature death. This was amplified further in the smoking group.
- In a study looking at over 7000 men that spanned 30 years from ages 20’s to 60’s it found a strong association with a high BMI in your 20’s and Type 2 diabetes later in life. A high BMI in middle age was associated with type 2 diabetes and cardiovascular disease.
- In a review of the literature relating ‘abdominal obesity’ (a large waistline) and type 2 diabetes it found that waist circumference was a very good predictor of the likelihood of getting diabetes.
- In a study of 15,000 adults looking at the effects of body size on mortality, they found you are at an increased risk of dying prematurely if you have a high waist to hip ratio EVEN if your BMI is normal. This individual can sometimes be labelled ‘skinny fat’ as they have a large belly even when the rest of them looks relatively lean.
If you have a high waist to hip ratio you are at an increased risk of cardiovascular disease & type 2 diabetes, even if you have a normal BMI. If you have a high BMI (25 & over) as well as a high waist to hip ratio it is time to take action on making changes to reduce them immediately.
Test 2 – Blood Pressure
In an episode of ‘Mad men’ the hard drinking, non stop smoking Donald Draper was having a health check and told he had high blood pressure. He took it in the same way you’d take finding out the supermarket has sold out of your Saturday newspaper; mild annoyance.
High blood pressure, or hypertension is simply the pressure at which blood is pumping through your arteries. As the blood pumps through it places a certain amount of pressure against the walls of the arteries, the strength of which is called Blood pressure.
When you have a test, you get two numbers; Systolic, which is highest level of blood pressure in each heart beat and diastolic which is the lowest level of pressure.
You can get a blood pressure monitor from most supermarkets for as little as £10. This might be advisable compared to waiting to go to the doctors due to ‘white coat syndrome’, which is the increase in blood pressure due to being in a doctors surgery!
You can get your score from the following chart:
What do your results mean?
The problem that can occur with high blood pressure is, whereas you can physically see an expanded waistline, a high blood pressure can be happening outside of your awareness. This makes it easier to put to one side and get on with your busy life….until you’re clutching your chest in the freezer aisle in Asda Walmart.
So, what does a high blood pressure potentially mean?
- A study of over 77,000 adults over 65 found a blood pressure higher than 160/90 significantly increased the chances of cardiovascular related mortality.
- In a study spanning 25 years, those with a high blood pressure in early life (early 20’s) had a greater chance of cardiovascular & heart disease in later life.
- In a review of the association between high blood pressure and dementia, it was concluded there was a significant risk factor between hypertension & the development of dementia.
It is clear, high blood pressure can be associated with heart and cardiovascular conditions. Ensure you have a number of readings before you determine if you have high blood pressure as the results can vary within certain contexts (like at the doctors!).
Test 3 – Getting up & down from the floor
One of my big bugbears is a heavy emphasis on cardio exercise for over 40’s. Sure, it is important for cardiovascular health and better than not doing anything. However, when you consider one of the top causes of workplace sickness is musculoskeletal problems (back, neck & shoulder pain usually), running isn’t going to help you so much with this.
Missing Link: Strength, Stability & Mobility
Strength, stability and mobility are vital components in having your body do what you want it to do without creating problems.
Strength is the force you can apply against a load, whether that be your own bodyweight, a barbell or lifting the Christmas shop from the car.
Stability is about protecting your spine while your extremities (arms & legs) move.
Mobility is about having full range of motion in your joints that allow for full range (ankle, hips, wrist, shoulders).
Problems can arise when the ability of these 3 factors diminish. For example, a common occurrence of sitting down for long periods over time your hip joint gets tight.
When hips fail to have the range of motion they are supposed to have, other areas of your body have to compensate.
A common example is hunching over when you sit down. Over time this can contribute heavily to experiencing pain in your joints.
The test is to sit down on the floor without using your hands known as the ‘sit to rise test’.
Photo credit: Roen Kelly/Discovery
- In comfortable clothing and in an open space lower yourself down to the floor aiming to be in control at all times (i.e not suddenly drop half way down!)
- Once sitting aim to come up exactly the same way you went down, again feeling in full control.
- You begin with 10 points. In both going down and up points are deducted for use of hand, knee, forearm, one hand on knee or side of leg.
Photo credit: Roen Kelly/Discovery
This test utilises strength, stability and mobility in order to perform the move. However, why would these be important for everyday life. Here are some common factors:
- In a review of various studies relating to hip impairment & low back pain, it was found there was a common correlation between impaired hip internal rotation & back pain.
- In a study looking at male & female athletes it was found those with stronger hip abduction (moving leg away from centre line) & external rotation were the ones who weren’t reporting injuries.
- In a study looking at the strength, balance & gait between a group of 60+ year old with a history of falling & those with not, researchers found those with a history of falling scored significantly lower scores in lower limb strength, dynamic balance & gait alteration.
Maintaining a level of strength, stability and mobility is vastly important at every age. It is worth pointing out something important. An individual who has poor hip mobility and little evidence of core stability may not experience any pain. Yet, this is like saying someone could have no saving and yet never experience money problems. It is better to condition your body than to leave it to chance.
I have provided 3 simple tests you can do to get a snapshot of what your body is up to. In my personal training I provide a more assessments at the beginning of training a new client.
The advice is clear, your body is very adaptable. However, this doesn’t mean it is not continually moving over a continuum of health month by month, year by year. Pain, injury and more dramatic health events rarely come out of nowhere…the clues are usually there!