ACL Injuries No Longer a Career - Ender

This post originally appeared on the TD Athletes Edge blog on January 24, 2018 - my first guest post!  Special thanks to Tim DiFrancesco for the invitation and the learning opportunity.  

When it comes to scientific research, anecdotal evidence is lowest on the hierarchy of resources.  As a clinician, it is vital to review higher levels of evidence, but sometimes it’s impossible to ignore what you witness.  There are numerous publications reporting higher incidence of ACL injury in females compared to males, and there are also studies that outline the outcomes to these athletes.

When I was the manager for the Cheshire High School (Connecticut - GO RAMS!) Girls’ Basketball Team, my friend tore her ACL going for a breakaway layup and landing in a heap on the floor.  A few years later, as a team manager for UConn Women’s Basketball (Go Huskies!), I was standing three feet away from a player when she changed directions during a drill and dropped to the floor with a yelp…torn ACL. After an ankle sprain you're back to playing in a week or two… but with these injuries mean you're out for almost a year. 

Rosemary Ragle was the Athletic Trainer for UConn Women’s Basketball for 18 seasons.  She was kind enough to share with me that in her tenure, 6 athletes (average of 1 every 3 seasons) tore their ACL and she also treated several others, at least 6 more, who had the injury prior to arriving on campus needing rehab.  Of the six that were injured at UConn, all of them returned to the team roster and most moved on to play professionally. 

James Doran, the current Men’s Basketball Athletic Trainer at UConn has been there for 12 seasons.  He confirmed what I had read in this Hartford Courant Article that he had worked with two athletes (average of 1 every six seasons) who tore their ACL in a Husky jersey. AJ Price, later played eight years in the NBA and Terry Larrier is currently the team’s 2nd leading scorer.

After UConn, I spent four seasons with the Connecticut Sun WNBA team.  During that time, four Sun players (average 1 per season) tore their ACL either in a Sun jersey or while playing overseas.  All four recovered and played again at an elite level including one winning a 2016 Olympic Medal.  I asked Tim DiFrancesco how many Lakers guys had torn their ACL in his six seasons in the NBA: Zero! Basically – there’s a boatload of anecdotal evidence with a small sample size that demonstrates females are injured more often than males. At the end of the day, though, most of these injured athletes ultimately made it back to their previous level of competition.

My graduate research studied lower extremity injuries in the WNBA and (former) Big East Conference Women's Basketball Teams. Previous studies showed that ACL injury was uncommon: 3-5% of basketball players, but that was because it was looking at how many athletes were injured in a season.  From that perspective, sure, it's rare to tear an ACL. But my research looked at a large sample of women’s basketball players (246) over their whole career and showed that almost 25% of these athletes had experienced the injury, some of them multiple times.  25% doesn't sound so rare to me. These athletes were all currently playing in Division I College Basketball or in the WNBA at the time of their participation having overcome an ACL injury. 

To my knowledge, a study of this type has never been conducted in the NBA, but based on this 2006 article, the WNBA experiences more ACL tears than the NBA. A CBS Sports7 report from 2013 outlined that in each NBA season, up to 5 players (out of 491 roster spots) tear an ACL which is about 1% of all the players in the league. At that time, this was an increase to previous NBA seasons. If a set of teammates don't both experience the injury, 25 teams out of 30 will go through the season unharmed. I wish I had the access and approval to do my study in the NBA to see how many of these guys have ever torn their ACL in their whole career – and then made it back.  My suspicion is significantly less players have been injured in the NBA than in the 25% in the WNBA, and the majority have made it back to playing.

Twenty years ago, and sometimes still today, an ACL tear was considered a career-ending injury. It’s still devastating because of the time lost from sports and school for the injured athletes, lost work time for parents, costs, extensive rehabilitation, pain and potential long term physical and mental consequences.  Though it is easy to see the gender disparity, these injured athletes mostly return to basketball and are able to excel at a high level of competition.  Why these outcomes have improved is largely speculative, but since we started out anecdotally, why not suggest reasons for the improvement?

Perhaps surgical techniques such as physeal sparing in the youth population and the trend towards more bone-patellar tendon-bone grafts over hamstring grafts or allografts is a contributor to better outcomes.  When there is not additional internal derangement to the meniscus, it is likely that more accelerated protocols for early range of motion and weight bearing in rehabilitation are getting these athletes back into shape quicker.  There is research on return to sport protocols which have improved the process of assessing injured athletes to make sure they’re ready for return, hopefully preventing recurrence of injury.  There have been studies examining mechanical faults during ACL injuries as well as muscular imbalances that increase risk of injury which can be treated by physical therapy.  The development of more ACL Injury Prevention programs has been increasing and groups are working hard to get them disbursed that this may be improving outcomes.

Why does any of this matter?  It matters because even though these injured athletes make it back to their sports, there are a large percentage of them that could be preventable.  There is now ample research showing that ACL injury prevention programs reduce the risk of injury.  Newly released in January 2018 is the National Athletic Trainer’s Association Position Statement on ACL Injury Prevention which is the most up-to-date data on evaluating the levels of evidence that support the importance of participation in these programs.  It outlines that participation in an ACL injury prevention program can reduce the risk of ACL injury 52-61% but it can also reduce risk of other injuries, too. If your child, particularly middle-school or high-school aged is participating in a sport, ask their coaches if they’re doing a program with their team.  If they’re not, have your child independently examined by a physical therapist, a skilled strength and conditioning team such as at TD Athletes Edge, or consider some of the following resources which may be helpful:

1) Seattle Pediatric Sports Medicine ACL Injury Prevention Program: http://seattlepediatricsportsmedicine.com/injury-prevention/injury-prevention-warm-up-program/injury-prevention-routine/

2) FIFA 11 ACL Injury Prevention Program: https://www.kort.com/uploadedFiles/KORT/Content/Services/Sports_Medicine/Concussion_Management/FIFA-the-11-Booklet.pdf

3) Cincinnati’s Sportsmetrics ACL Injury Prevention Program: http://sportsmetrics.org/

4) As a parent or coach, watching an ACL Injury Prevention Program and trying to implement it with your child/team is not enough.  A skilled clinician should be implementing it or checking the movement patterns.  This is imperative.  Ask a local physical therapist or skilled strength coach to watch your child’s movement to assess their risk for injury and to develop a program tailored to their needs to decrease their risk.

References 

1)      Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: Summary and recommendations for injury prevention initiatives. J Athl Train. 2007;42(2):311–319. PubMed

2)      Deitch JR, Starkey C, Walters SL, Moseley JB. Injury risk in professional basketball players. A comparison of women’s national basketball association and national basketball association athletes. Am J Sports Med. 2006;34(7):1077–1083. PubMed doi:10.1177/0363546505285383 7. https://www.ncbi.nlm.nih.gov/pubmed/16493173

3)      Renstrom P, Ljungqvist A, Arendt E, Beynnon B, Fukubayashi T, Garrett W, et al. Non-contact ACL injuries in female athletes: An international Olympic Committee current concepts statement. Br J Sports Med. 2008;42:394–412. PubMed doi:10.1136/bjsm.2008.048934 http://bjsm.bmj.com/content/42/6/394

4)      Gordon AI, DiStefano LJ, Denegar CR, Ragle RB, Norman JR. College and Professional Women’s Basketball Players’ Lower Extremity Injuries: A Survey of Career Incidence. IJATT. 19:5 (22-35). September 2014.  http://journals.humankinetics.com/doi/pdf/10.1123/ijatt.2014-0020

5)      Padua DA, DiStefano LJ, Hewett TE, Garrett WE, Marshall SW, Golden GM, Shultz, SJ, Sigward SM, National Athletic Trainers’ Association Position Statement: Prevention of Anterior Cruciate Ligament Injury. Journal of Athletic Training. 2018; 53(1).

6)      Hartford Courant Article: Dom Amore. UConn Men’s Insider: Doran is a trainer with patience, but too many patients. January 31, 2017.  Accessed January 9, 2018. http://www.courant.com/sports/uconn-mens-basketball/hc-uconn-men-insider-james-doran-0201-20170130-story.html

7)      CBS Sports Article: Ken Berger. ACL Injuries Once Were Rare Occurrences in the NBA But No More: October 4, 2013. Accessed January 12, 2018. https://www.cbssports.com/nba/news/acl-injuries-once-were-rare-occurrences-in-nba-but-no-more/

"If it ain't broke - don't fix it" - Workout Programming Edition

They tell you in PT School that you need to be able to properly demonstrate any activity you're going to have a patient or client do. I'm 5'5" and I was working with someone over 6' tall for return to sport after an ankle sprain.  I set up a series of objects to jump over or onto in various directions including a 12" box.  I went to demonstrate the obstacle course, but when I reached the base of the 12" box, I completely chickened out.  I was glued to the floor.  I then spent my lunch working on box jumps. (And yes, I nailed that 12" box jump, and yes, I made all my coworkers watch repeats as witnesses, and no, I can't do it again unless I work my way up from a 6" box - but at the end of the day, I still can do it!)

Being a physical therapist is an active and physically challenging job.  When I worked with the geriatric population, there were numerous times when I found myself holding up 200+ pound adults who thought they could stand, but ultimately could not.  When I'm working with basketball players, if I go to stretch someone, I'm lifting a leg that is solid muscle.  When I work with really little kids, I have to make it fun which often means ball activities with balance on various apparatuses and obstacle courses.  Not only do I need to be able to demonstrate, I also like seeing what my body is capable of and I like that I get to stay moving for my job.  I also need to work hard to keep myself healthy so I don't hurt myself.

One of the changes I made in 2017 was to program my own workouts and schedule them on my calendar leading up to a stair climb event I have in March 2018. This was the first time I have ever programmed for myself in such a manner and I really enjoyed the experience.

Here's what I learned:
1) Planning made me more compliant with my workouts.  I planned 3x/week over 6 months and when I looked back, I only missed four.  Not too shabby for someone who has previously struggled - A LOT - with workout consistency and rolling out of bed to put the work in.  And, though I was frustrated each of those times, I felt that the sickness I was feeling on 2 of those days and the snow on the ground for one of them were legitimate excuses for three out of the four.  But having a plan meant I was able to get back on track, quickly, and get over regretting missed workouts.
2) Scheduling workouts into my weeks eliminated daily early alarm clocks to see if I would, in fact, drag myself out of bed - because when a workout was scheduled - it happened.  I planned them at the times that appeared to be best for the week, mostly on a regular basis, with enough flexibility should something pop up during my usual time.  I stopped making myself feel guilty, because I wasn't missing workouts unless it was truly what my body needed.  On the few occasions I did miss, I knew I had another workout scheduled in about 48 hours to get right back on track.  Let it go.  Move on.
3) I also learned that I grossly over-estimated my ability to progress my endurance training activities.  Because endurance training is not something I enjoy and I'm not entirely sure my body is built to be running long distances, my program had me increasing mileage every 2 weeks but I was only running once per week so it was too fast of a progression.  It didn't mean I stopped running... it just meant that I had to revise my program early on because my targets weren't appropriate.

Now I'm coming upon the end of my original six month program (5 weeks left) and have been doing some research on how to better write my program for the next period of time. I have a lot more learning to do in this area - definitely a weak spot of physical therapy education, but I consistently came across articles that outlined steps to writing a training program such as goal writing, determining your primary intent (increased muscle size/increased strength/increased endurance/weight loss), determining which exercises to include and at what volume (frequency/reps/sets). But this article on T Nation by Paul Carter had a sentence that really struck me: "You don't need to overhaul a program that's largely working... The worst thing you can do is overhaul an entire program that's producing results. Keep what's working and make minor adjustments to what's not."

I've been on the same program for six months: one day per week each of strength training, interval running, and stair training with the upcoming last four weeks a ramp up of the stair training leading to my event.  I like the variety, my body seems to be recovering from each workout pretty well, I can feel and see the changes, and I'm being consistent.  My primary goals for the last six months were to get into the habit of working out three days per week (not a focus on strength, weight loss, or any other physiological changes) and to be prepared for the stair climb in March.  Period. Since I'm still seeing progress in the physiological changes that weren't even my target - and I'm able to be consistent with the program - despite weeks of trying to more meticulously plan the next program - I'm sticking with it.  It ain't broke... so I'm not fixing it.

So - Step 1: Write Goals for 2018
1) Continue training three times per week.  Get the schedule onto my calendar.  We're forming a habit here. This is my top priority.  The other goals are either ways to try to spend my time to achieve this goal or hopeful side-effects of achieving this goal.
2) Cover 1000 miles for the year (tracker located on the right of this page - tracked by FitBit, updated when blogs are posted.)
3) Climb 75,000 stairs for the year (tracker located on the right of this page)
4) 60 second plank.  Because #core and #strengthgains
5) Of course I have a weight loss goal, as well - but this requires my training program combined with an eating plan which is an entirely different blog post.
Step 2: Volume: Continued plan of 3x/week.  Reps and sets to be planned ahead of time because this is what training looks like.  It's not an arbitrary workout where I get to the gym and think "what am I doing today?"  There's no guessing.
Step 3: Exercise components: The next six month cycle has been broken down into smaller pieces, unlike the last six months. Seattle summer is gorgeous and once the sun comes out, we only get about 90 days to enjoy it for the whole year so you won't likely find me lifting or on a treadmill once that happens.  Summer is for kayaking and hiking with my favorite hiking pal.  And my stairs are outside - so they get to stay in the program.  As long as there's an active activity 3x/week for more than 30 minutes - it'll be ok to skip the weight room if I'm kayaking.  Flexibility is permitted in the workout content as long as there is consistency.

The plan:
January through March 5th - completion of the previously planned cycle.  Includes ramping up stair training and endurance training for my annual Climb to the Top of Rockefeller Center fundraiser for Multiple Sclerosis.  Can't wait to see how this year's training pans out in comparison to previous years which weren't planned.  Goal time for completion is 25 mins.  If you want to donate to that cause, click here.

March:  Recovery from stair climb with more soft tissue work, lower volume of stairs, and lots of core/planking.

April through May: Ramp up strengthening days using this program from Bret Contreras, "The Glute Guy" that has consistently been kicking my butt (pun intended) along with cardio days of  running and stairs as I ramp back up for:

June: June is the Shoreline Stair Climb Challenge and I'll be aiming to climb 15,000 stairs during the month of June.  Last year I made it just past 10,000. Stairs will be supplemented by hiking and kayaking and sunshine.

July: Recovery again with increased soft tissue work and decreased volume with core and planking.

August through September: back to the progressed cycle.

That will bring me back to the time when I will determine if I'll be Stair Climbing again in 2019 and when I would start my training program/what it would look like as we enter the gray days of Seattle for winter.

Why would I share this?  First off - accountability.  Second - sometimes it helps others to plan their training program by seeing how someone else has structured it.  If you're hoping to increase your glute size or strength, you could review Bret's program that I've included. If you want to start a workout program for the first time in a long time - or ever, the ideas I've used to get into a routine may help you.  Or you can come join me on the stairs.  They never seem to get any easier but the view from the top is gorgeous.

Book Alert: The TB12 Method by Tom Brady

Another Book Review - this one by the New England Patriots quarterback, Tom Brady.

photo: Amazon.com

I just finished reading Tom's new book, The TB12 Method: How to Achieve a Lifetime of Sustained Peak Performance.  Published in 2017, Tom is on the verge of breaking into the fitness industry with his facility, his methods, and his plan for the future. Sounds like his retirement plans are in order - but he keeps saying he wants to play into his mid-40's so he has a few seasons left in him.

He starts off with “Ability allows athletes to achieve. Durability allows them to continue achieving. Pliability makes both possible.” Pliability is “targeted, deep force muscle work that lengthens and softens muscles at the same time those muscles are rhythmically contracted and relaxed.”  This is the premise of Tom's training program but thankfully, he integrates nutrition and recovery and has a more holistic approach than just deep manual therapy. 

Basic book outline:

Tom used to believe that he needed to improve physically being only the 199th pick in the NFL Draft in 2000 and never being the biggest, strongest, or fastest but always with a strong work ethic.   He initially thought that the means to make these physical improvements was through strength and conditioning.  Now, though, he believes the typical strength and conditioning cycle that most athletes participate in includes injury and extended periods of rehab ultimately limiting career duration in all major sports. The usual strength and conditioning approach is missing pliability training.

Looking more at pliability, Tom advocates for deep muscle work while he is contracting and relaxing his muscles. It’s a little like a deep tissue massage combined with an active pin-and-stretch technique or active release technique with the focus that it is not a passive treatment and has neurological benefits as well as the ability to facilitate blood flow.  He also notes that these treatments can mostly be done using vibrating foam rollers or spheres which he has for sale- but you can't use a regular foam roller because the vibration stimulates the nervous system and this is important.  He refers to this pliability training as “positive, intentional trauma that causes new learned behaviors.”

The book includes a fair amount of negative perspective towards weight training with more support for the use of resistance bands.  The analogy he used is: “imagine your body is a pickup truck. It’s weighted down with 1000 pounds of bricks in the cargo bed. This is what weight lifting does to your muscles, ligaments, and joints.  Now imagine your body is a pick up truck towing 1000 pounds of bricks behind it. There’s minimal weight on your structure. This the difference between load and resistance.”  He thinks the use of bands can be structured more to mimic sport-specific actions and has several exercise photos in the book that you can use to get a workout program going.  This summarizes Tom's workout routine and soft tissue work.  Then he proceeds to discuss the other components he finds essential: hydration, supplementation primarily with electrolytes, nutrition - mostly a plant-based diet with occasional meats, positive mental attitude with brain training and rest/recovery components.  

What I liked:

I’m a supporter of the use of manual therapy and generally I apply more deep tissue work than superficial. I also think this is frequently neglected by athletes- primarily because when reviewing my own current program I have minimal soft tissue work programmed in or even sufficient recovery time and self mobility work. If I’m likely to skip it myself, wouldn't professional athletes who may not buy into it even more likely to skip out?

Train your muscles for the activities you want them to do.  A quarterback doesn’t need to be able to run a marathon.  He does need to be able to quickly move and change directions and throw a football.   There are some good exercises included that will help me grow as a physical therapist. I already love to use a pallof press in various positions but have never used a pallof squat before and know I will now. 

He breaks down the different sources of water: tap, distilled/filtered, spring, mineral, carbonated, and purified and describes how they differ.  ’ve been thinking that seltzer was making me dehydrated having considered the biochemistry of carbonation and the function of bicarbonate/carbonic acid in the cloud stream so it was nice to see that he agrees that it can be a dehydrating option since I haven’t done any research in that topic yet. 

From a nutritional standpoint, the suggested diet somewhat overlaps with Deep Nutrition and Whole 30 principles which I already subscribe to.  Interestingly the book suggests that you should avoid meals which combine protein (needs acidic digestion) and carbohydrate (needs alkaline digestion) which I have not seen before.  

What I didn’t like:

N=1: Tom Brady. You say you have a training center focused on your principles. Bring on the data. From the perspective of evidence-based practice - there are no cited sources in this book and while I have learned and studied some of these ideas, there are numerous statements included that I would need references to review in order to buy in entirely.  So far this is all anecdotal- of course you’re having better physical outcomes in football by taking better care of your body. People differ, though. The back of the book has a few pages of anonymous testimonials but that's not sufficient from an evidence- based perspective.  

I have concerns over the risk of deep tissue work by untrained people  with no discussion of the risk for blood clots or other potential complications such as issues with skin integrity or while already injured or who are diabetic.  The book shows you the principles enough that I could actually complete a full pliability session and workout, but there are definitely going to be non-clinicians reading the book and I don't think there is adequate precaution or concern for potential reasons you would not use these methods. 

The diet/nutrition could be considered pretty rigid. To be fair- so is the Whole 30.  If he's targeting the general population, it will be interesting to see how many people get on board with it or just take small bits and pieces to make small improvements in health.  For example, Tom goes as far as saying he eliminates night shades because despite the antioxidants, they can slightly increase his inflammation. He has every right to exclude so many foods- but he also has the funds and access to a food service that prepares meals for him which so many of us do not have available. He’s working on optimizing his body to be the all time greatest quarter back in the NFL- major difference in his physical demands compared to my own. If he thinks he gets a competitive edge from this program, I’m impressed he has sustained this lifestyle for so long.  I don't know that I would need to be quite this extreme. 

Ultimately- would I consider taking one of his courses to certify as a TB12 body coach to learn more and (hopefully) get some of the research that is essential to back the program?  Sure I would. I like to learn. And I like manual therapy.  And I think there are some great points to the program.  I definitely don't hydrate sufficiently and I know my body feels best when it follows a somewhat similar nutrition plan.  I disagree with the negative impact of weight lifting - but also think this varies between people and it makes me wonder if he could have had similar benefit with the addition of pliability along with typical strength and conditioning rather than the use of his resistance bands.  Will I incorporate the techniques in my own programs? I absolutely think I might add more soft tissue work and self myofascial release or foam rolling with pin and stretch into my next training cycle to see how I respond and I added some of it to my workout the past few days and know that my soreness improved.  

Disclaimer: I am not a New England Patriots Fan... but I am from New England and I certainly respect any professional athlete who can remain at their post for nearly 20 years.  And I like to learn - so Tom Brady's book declaring new and innovative ways to improve longevity in sport - of course I'll check it out.   Tom is a public figure - if his methods can help someone prevent or recover from injury, I'm a supporter, and I want to know how he does it..

Cyclops Lesion

Photo: http://www.kneeguru.co.uk/KNEEnotes/articles/general-articles/2016/cyclops-lesion-after-acl-reconstruction

I learned something new this week!  I was listening to an older episode of Mike Reinold's Podcast, "The Ask Mike Reinold Show," when Lenny Macrina mentioned a Cyclops Lesion, something I had never heard of before.

Of course I immediately googled to get a definition and then hit PubMed for a few articles.  A Cyclops Lesion, also discribed here, nicknamed the Cyclops Lesion for its appearance on imaging is also known as Localized Anterior Arthrofibrosis.  It is basically a build up of scar tissue in the intracondylar region of the femur.  It is a limiting factor in terminal knee extension (TKE) following ACL repair which is important because if TKE is not fully restored, future comorbidities are more likely later down the road.  According to this case study by Dhanda et al, 1-9.8% of patients who have had an ACL reconstruction may experience a cyclops lesion.  Most importantly from this article, "aggressive physical therapy does not improve extension loss associated with cyclops lesion."

I looked into this a little bit further and came across this study from Shelbourne which describes the importance of the relationship between surgeons and physical therapists as well as the key role in ROM symmetry in the knee.  They note that the surgical knee should be within 2* of hyperextension to the non surgical side and within 5* of flexion.  This is a case when symmetry matters, where so often in rehabilitation we allow for asymmetry because this is more natural.

After learning about the Cyclops Lesion, I went to PT Pub Night Seattle and met up with some fellow PTs and surveyed the crew... several had either not heard of or seen this in their practice despite mostly being in orthopedic practice.  I hope the new learning will benefit as much as I anticipate it will help me.  How could this affect my practice?

I definitely have a greater appreciation of the need for symmetry for post op ACL patients and I now know that this exists so that if I encounter issues with ROM, particularly achieving and sustaining terminal knee extension beyond around 8 weeks post op, I need to refer back to the surgeon with concerns.  Hopefully this will help others who may be unfamiliar with this condition.

The Whole 30

Update April 2021 - This blog post expresses an opinion and lifestyle that I previously supported.  But after years of learning about diet culture and the negative outcomes associated with dieting, I no longer subscribe to these beliefs.  I've kept the post because of growth over time, but no longer support restriction of food because of the negative impact it had on my life.  

Shrimp Tacos on Jicama Slices - made by me!

January 2018 is here and with its arrival come the annual resolutions to commit to a healthier lifestyle. New year, new you, right?

his January I’ll be completing my 6th round of the Whole 30. For those of you who haven’t yet heard about Melissa Hartwig and her Whole 30 Empire- here are the cliffs notes. 

The Whole 30 is a month of eating certain foods while eliminating other foods so that you have the opportunity to see how your body responds when you add the eliminated foods back in. There are rules and they must be strictly adhered to for the whole 30 days or you have to start over. The key rules (as I prioritize them) are:

1) No sugar... see ya later chocolate!

2) No dairy products... I’ll miss you, cheese!

3) No grains- gluten or otherwise.  This includes wheat, rice, corn, quinoa, granola, oatmeal... Basically a lot of the carbs are out- but not all of them.  Potatoes are my friend. 

4) No legumes or peanuts... I look forward to the return of my chunky peanut butter when I reintroduce legumes Every. Single. Time. 

5) No alcohol... hence the rise to power of La Croix/Seltzer and Kombucha.

6) No fake stuff... like additives to foods, colorings, fake sugars... who misses these anyways?  We’re literally eating chemicals in tons of our foods. 

7) No baked goods or treats that resemble them but are made out of approved ingredients. Don’t try to make pancakes out of almond flour and mashed bananas. It’s just 30 days.  You'll survive.
(For more details on the rules, you should read Melissa Hartwig's Books or just start at the website which has lots of helpful tools including the rules, food additives that are allowed (like citric acid which can be manufactured but occurs naturally in citrus fruits - and several others), a list of all the different names for types of sugars - none of which are permitted, and several suggestions for meal preparations, grocery shopping, etc.  I will say that I did my first whole 30 program based on the website and have since read several of the books which have made the process easier in subsequent rounds.

What you can, and should eat:

1) Vegetables. Cooked or raw. 

2) Animals that lived happy lives or as close to organic as you can afford and acquire. For me, as a non red-meat eater- this means a lot of chicken, turkey, and fish and eggs. 

3) coconut, olive, or avocado oils or ghee/refined butter for cooking. 

4) so many seasonings like herbs and spices as long as they don’t include any of the not allowed items. I personally live on cumin for tacos/fajitas and Franks Red Hot (original flavor) made into buffalo sauce during my whole 30’s. 

5) Nuts and seeds including nut butters that aren’t peanuts

6) Fruit

Basically- eat healthy for 30 days. Read your labels and see what kinds of things are added to our food to make you more aware.  Cleanse yourself. 

After the 30 days is up- you can either follow the guide in the Whole 30 book to introduce the eliminated components one by one or you can choose which one to add first. For example, I was really sure before doing this that dairy products bother me—- but after reintroducing them first on several rounds, I’ve determined that it either isn’t dairy products or that it is a certain dairy product that I have not yet isolated. In comparison- chick peas/garbanzo beans definitely make me feel miserable so I now avoid eating hummus and adding chick peas to my salads and only eat them if they’re in a felafel sandwich that looks and tastes amazing when I’m not in whole 30 mode.  Interestingly, I don’t seem to have the same reaction to quinoa or peanuts and haven’t tested black beans or pinto beans enough to be sure.  

So- why would anyone do this? I can tell you that I lose weight every time I do a whole 30, but that I have gained it back every time I reintroduce sugar.  Since I've been calorie tracking for about 4 months continously while not on the Whole 30, and now am 4 days into this round - it's easy to see why.  A single piece of cheese and two pieces of bread which I may have had with my turkey sandwich while not on the plan were 300 more calories - and that's just in a lunch sandwich.  It's unfortunate I haven't been able to sustain the loss - but maybe that will be different if I keep tracking moving forward.

Regardless, I’ve learned valuable things about what I eat and how my body responds to those foods. In particular, I feel a whole lot better when I eat this way, so it’s a nice way to start the year off with clean eating, trying to get on track, and test out what foods seem to bother your gut or your skin or your body in various ways. When I do a whole 30, I have more energy after the initial few days, I feel less bloated, my skin, hair, and fingernails are much nicer, and I don’t have ANY of the binge eating issues that plague me when I’m allowing myself to eat whatever I want. The program is not intended to be for weight loss- it’s intended for improved self awareness and personal growth so you can achieve Food Freedom.  This is the idea that you control what you consume and that your food does not control you.  I have, on too many occasions, known that food was in control. For the next 30 days- and typically longer when I’m reintroducing things - I feel very much in control.  

I personally have not reached my place of Food Freedom, yet, but with my new nutritional knowledge after reading “Deep Nutrition” and overlapping some of the consistent ideas, I’m looking forward to combining these ideas moving through 2018 to see if I get closer to 2018. Deep Nutrition advocates for some dairy and ohhhh man do I love cheese- so that’s a key difference. It also recommends fermented foods, meat on the bone and bone broth as well as organ meats, and raw vegetables while eliminating sugar and poor oil sources. In combination, I think there might be a happy medium for me and look forward to sharing my journey.

Disclaimer: as a physical therapist - I don't just go around advising people to participate in this program because that's not within my scope of practice.  But as a human being, this is what I'm doing for myself and lots of patients have heard about it and often ask.  This is to better educate you about the plan - since it's been around for years and is increasingly more common.

Anybody else doing a whole 30?  How’s it going? Any fun recipes you want to share?  I'm happy to share my favorites if you're in need!

Happy New Year.  Here's to a healthy 2018.