San Antonio Express-News (Sunday)
Accept the pushup challenge, but listen to your body
Q: I am a 69-year-old man in pretty good health. I have some normal age-related arthritis in my hand. I am an active walker and hiker; all in all, I have no major issues. I do pushups and have done so for many years as a way to keep my upper body and core strong — usually four sets of 12, with about five minutes of rest in between. I have been mostly doing this every other day, or three times per week.
I have read about the “pushup challenge,” where you do them every day, trying to get to 2,000 in a month, or about 75 every day. At my age, is it advised to have a day of rest for muscles to “rebuild,” or is an everyday routine safe? Wouldn’t doing pushups every day wear down muscles?
A: Most serious athletes who weight train do have a day off for specific muscle groups to allow the muscle to recover. Particularly for adults in their 60s or those who are older, building stamina slowly is recommended to reduce the likelihood of injury. However, the body is resilient, and most people will adapt to higher levels of exercise.
If your muscles are not sore on the days you don’t normally do your pushups, it is fine to do more that day. You will likely be able to get to 75 per day. However, I still recommend you listen to your body. It is far more important for you to do the right exercise for you than to achieve an arbitrary goal that might not be appropriate for you. If you are getting really sore, are unable to finish the goals you set for yourself or simply aren’t enjoying it, back off and put your rest days back in.
Q: Over the past couple of months, I wake up each
morning with my left arm tingling and feeling numb. I am not sleeping on it, nor is it being pressed on in any way as I wake up. It tingles and feels numb between my elbow and my fingers. It sometimes then continues to tingle and stays numb when I start to exercise, right after I get out of bed. Can you tell what is happening at night to cause this?
A: This sounds like it is a nerve compression, which is often worse when people wake up. Several nerves may be affected, but the two most common are carpal tunnel syndrome and cubital tunnel syndrome.
In carpal tunnel syndrome, the median nerve in the wrist is compressed, and most people note numbness and tingling in the thumb, index, middle and sometimes ring fingers. In cubital tunnel syndrome, the ulnar nerve is compressed in the elbow, and most people notice the pinky finger and sometimes the ring finger affected.
You may not think you are sleeping on it, but while you sleep, the arm
can get into certain positions that pull and irritate the nerve. Sometimes a splint to keep the wrist or elbow in a neutral position is all that’s necessary. A careful exam is needed to determine the particular cause. Occasionally more sophisticated nerve tests (such as an EMG) must be done to be sure.
Q: If a person has a titanium hip as a result of
hip replacement surgery and that person later falls, is it possible the hip would break?
A: A hip replacement, or total hip arthroplasty, replaces the head and neck of the femur with a prosthesis, which will go into a cup in the hip. Modern materials, such as titanium, are exceptionally light and strong, and it would be extremely unusual to break the prosthesis.
However, a fall can still do damage to the hip, such as dislocating the hip or loosening the prosthesis in the person’s femur. Falls can also certainly damage or even break the other side, or even the same side in the shaft of the femur.
Consequently, it is critically important after a total hip surgery to strengthen the muscles to reduce the likelihood of a fall. Balance exercises provide additional benefit in reducing the chance of a fall. My experience, after decades of taking care of patients before and after hip surgery, is that those patients who put in the extra effort after surgery with physical therapy are those who do the best long term.
Q: I really appreciated your recent explanation of how vaccinations work. However, if the mRNA “tells” the body to start the process that protects against the virus, why don’t they know if people can still get the virus but not get sick and then carry it?
A: As of the time of this writing, there is much stronger evidence that the mRNA vaccines do prevent people from having an asymptomatic case of COVID-19, which is potentially transmissible. While the data is not conclusive, several lines of study suggest a 90 percent reduction in asymptomatic COVID infections among vaccinated individuals. This is very good news, and with enough people vaccinated, the ongoing community transmission of the virus could stop entirely.
Many people written me about whether to get the vaccine after having a case of COVID. One person was so angry, they vowed to destroy my reputation!
There is certainly conflicting evidence, with a new study showing high levels of antibodies in (most) people after infection with COVID-19, even after eight months. However, real-world evidence did show that those with a history of COVID-19 and who had positive antibodies became reinfected with COVID-19 at about the same rate as those who never had the disease. This suggests even survivors of the infection would benefit from getting the vaccine.
Further, public health officials continue to worry about new variants. Epidemiological evidence from Brazil showed far higher levels of reinfection than was thought to be possible after introduction of a new variant into the city of Menaus.
Until the transmission rate for COVID-19 is much lower across North America and the rest of the world than it as I write this, we still need to continue wearing masks and social distancing in high-risk situations as vaccinations continue to be given to the population.