SMI Newsletter — June, 2013

Active Days Of Summer

Greetings from SMI,

Three things that we focus on here at SMI are performance enhancement, injury prevention and injury rehabilitation. In this issue of the SMI newsletter we tackle some performance based concepts and outline what the research has to say about how performance can be effected by stretching, acupuncture and nutrition. By performance we mean athletically, as well as in the office, around the house and in dealing with other challenges life throws your way each day. We don’t want you to just survive, we want you to thrive!

Hopefully you can use the information in this newsletter as a stepping stone to start the summer off right! Take care of yourself, and don’t forget to let us know if we can help!

~The SMI Team

SMI in San Francisco!

Just a reminder that SMI therapist, Eva Popper, is now working every other weekend in San Francisco! She is working in the Alamo Square district at 425 Divisadero St, Suite 209. You can schedule an appointment by calling the Palo Alto office at 650-322-2809.

Acupuncture for the Athlete

picture of acupunctureAll athletes from weekend warriors to world class Olympians are searching for ways to gain a step up on the competition. While there are a number of gimmicks readily available to anyone willing to shell out a few bucks, it is often times hard to find something that can actually provide real benefit. It turns out that acupuncture can!

Research on acupuncture in general is limited and its effect on sports performance is even more sparse, but the small amount of preliminary research has found beneficial effects. One study found that a single acupuncture treatment resulted in an increase in quad strength. (1) Another showed that after 5 weeks of acupuncture administered one time per week subjects had an increase in VO2 max and anaerobic threshold. (2)

Acupuncture has also been found to accelerate recovery from intense activity. One study demonstrated that receiving acupuncture after activity resulted in decreased post exercise muscle soreness. (3) A second found administering acupuncture prior to a treadmill run and then during periodic breaks from the run resulted in increased recovery after the run was over based on heart rate and lactic acid levels. (4)

Clearly more work has to be done to more thoroughly evaluate the impact of acupuncture on athletic performance. The research we do have combined with anecdotal evidence shows that acupuncture is a very promising approach for athletes looking to gain an edge. Let us know if you have any questions on how you can benefit.



Colleen Burke, MA, L.Ac.

SMI Staff Acupuncturist


read more about our acupuncturist Colleen Burke at

Nutrition: Water

picture of waterAny time you start to talk about getting your body to perform optimally you have to start with hydration. Without being properly hydrated your body is going to have a hard time performing. Period. As we make our way into the warmer summer months, it is important to think about how your hydration needs may start to increase.

So how much water do you need?

Your basic hydration needs are determined by your caloric intake. For every 1000 calories you consume you need 1 liter of water. So for a 2000 calorie per day diet you need 2 liters of water. That’s a lot of water! In addition, you also need to replace the fluid you sweat while exercising and engaging in other activities such as working in the yard or playing with your kids in the pool.

The amount you sweat varies from person to person but this can easily be around 1/2 to 1 liter when exercising at a moderate intensity for 1 hour. As it gets warmer outside it will be towards the upper end of this range. And working in the garden on a hot sunny day for a couple of hours can cause you to sweat 1/2 liter of fluid.

So remember, optimal body performance starts with hydration. Drink a cup of water when you first wake up in the morning and continue to drink throughout the day.

Most people don’t need to worry about replacing sodium that is lost by sweating unless you sweat A LOT or workout for longer than 1 hour a day. Both of these situations makes proper hydration a bit more complicated. For more information you can pick up the book “Endurance Nutrition: Trouble Shooting Guide” or “What, When, Water: Nutrition for Weight Loss Wellness.” Here is the link:

read more at :

Orthopedic Massage: Stretching – The Truth!

picture of streching

Over the past few years most of you have probably come across at least one article purporting how current research is finding that stretching is not beneficial and may even be bad for you. For example, Gretchen Reynolds recently wrote an article for the New York Times entitled “Reasons Not to Stretch.” (1) She points to a study published in the April 2013 issue of The Journal of Strength and Conditioning Research (2) and a meta-analytical review from The Scandinavian Journal of Medicine and Science in Sports (3). Both conclude static stretching prior to exercise results in decreased performance, but they do NOT conclude that we should stop stretching OR that we should even stop stretching before exercise.

The study and the review that Reynolds cites as well as numerous other studies have clearly changed the way we need to approach stretching. Static stretching prior to activity negatively impacts performance, BUT static stretching is not the only way to stretch and before activity is not the only time to stretch. Reynolds and others are misleading readers into thinking that stretching is bad. This is simply not true! Stretching the wrong way is bad. Stretching correctly is beneficial.

Over the next few newsletters I will try to shed some light on how, when and why to stretch. In this piece I will focus on pre-exercise stretching.

So exactly what should you do prior to activity?

The answer is a dynamic warm-up routine. A number of studies have found that a dynamic warm-up before working out has a beneficial impact on performance. There are a number of ways to perform a dynamic warm-up including dynamic stretching. A 2005 study published in the Journal of Strength and Conditioning Research (4) found that dynamic stretching of the lower body resulted in increased leg strength compared to static stretching and no stretching at all. A 2011 study (5) found that jump height was significantly better after performing a dynamic stretching routine versus static stretching or no stretching at all.

What is Dynamic Stretching?

Dynamic stretching is movement based stretching. There are variations in how one can stretch dynamically, but in general you actively move in a controlled manner through a normal range of motion. You move into a stretch position but do not hold the stretch for more than a second or two. The movements should be similar to how you will be using your body during your workout. One of the best ways to stretch dynamically is a type of stretching known as Active Isolated Stretching (AIS).

To perform an Active Isolated Stretch, contract the antagonist (opposite) muscle group of the muscle you are trying to stretch and move into a stretched position. Hold the stretch for no more than 2 seconds and return all the way back to the starting position. Repeat 6-10 times. With each repetition go deeper into the stretch until you feel the area is warmed up and ready for more intense activity. For example, to stretch the hamstrings (back of the thigh) lie on your back and engage the quad (front of the thigh) to lift your leg off the ground as far as you can comfortably go. Hold at the end range for 1-2 seconds before returning the leg all the way back to the ground. Repeat 6-10 times. This can be accompanied by some light jogging or other form of light aerobic exercise such as jumping jacks or stationary bike. The amount of warm-up will vary depending on the intensity of the activity you are about to perform and how tight or loose you are to begin with.

What about injury prevention?

Research on the effect of pre-exercise static stretching and injuries has not been very extensive, but the existing literature is finding that the effect is neither positive nor negative. (6) (7) And unfortunately there simply has not been enough credible research on pre-exercise dynamic stretching and injury prevention. Hopefully this is an area that will be explored more thoroughly in the near future.

So the bottom line is that everyone should be engaging in an activity appropriate dynamic stretching routine before working out. It helps prepare your body for activity and helps you perform more effectively. And the next time you run across an article that says stretching is bad for you make sure to dig a little deeper and find out more details about exactly what the research has to say!

Don’t stop stretching, just make sure you stretch appropriately!


Mark Fadil
Sports Medicine Institute

1. Reynolds, Gretchen, “Reasons not to Stretch.”
New York Times, April 3, 2013.

2. Gergley, JC, J Strength Cond Res. 2013 Apr;27(4):973-7. doi: 10.1519/JSC.0b013e318260b7ce.

3. Simic L, Sarabon N, Markovic G, Scand J Med Sci Sports. 2013 Mar;23(2):131-48. doi: 10.1111/j.1600-0838.2012.01444.x. Epub 2012 Feb 8.

4. Yamaguchi, Taichi; Ishii, Kojiro, Journal of Strength & Conditioning Research. 19(3):677-683, August 2005.

5. Perrier ET, Pavol MJ, Hoffman MA. J Strength Cond Res. 2011 Jul;25(7):1925-31.

6. POPE, R. P., R. D. HERBERT, J. D. KIRWAN, and B. J. GRAHAM. A randomized trial of preexercise stretching for prevention of lower-limb injury. Med. Sci. Sports Exerc., Vol. 32, No. 2, pp. 271-277, 2000.

7. Thacker S, Gilchrist J Stroup D, and Kimsey C. The Impact of Stretching on Sports Injury Risk: A Systematic Review of the Literature. Medicine & Science in Sports & Exercise, Vol. 36, No. 3, pp. 371-378, 2004.

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