In July I posted a blog discussing The Overuse of Cryotherapy. The controversy surrounding the topic made it one of the most popular blogs I’ve written. What is surprising to me is that a controversy exists at all. Why, where, and when did this notion of anti-inflammation start? Ice, compression, elevation and NSAIDs are so commonplace that suggesting otherwise is laughable to most. Enter an Athletic Training Room or Physical Therapy Clinic nearly all clients are receiving some type of anti-inflammatory treatment (ice, compression, massage, NSAIDs, biophysical modalities, etc). I evaluated a client the other day and asked what are you doing currently – “Well, I am taking anti-inflammatories and icing.” Why do you want to get rid of inflammation and swelling? I ask this question for both chronic and acute injury!
By now, some, if not most, have read the article of the 6-year-old girl who became the youngest ever to complete a half-marathon. Not only did she become the youngest ever, she finished 5th out of 10 in a group of competitors aged 14 and under – she was the only competitor under 12 years old. Race announcer said “she seemed to be barely even breathing hard at the finish line.” So the question being asked – is this safe and appropriate? The question I ask: is this a real concern or more of an excuse? Continue reading
Have you heard the old adage “if you don’t use it, you lose it”? Does this really happen? If so, to what degree does one “lose it”? I was riding dirt bikes since the age of three, began racing motocross at age six and ‘retired’ –moved from home and went to graduate school – around the age of 21. After 18 years of riding and racing, I know I can still swing my leg over a seat and take off and ride much better than most. But, I could not go as fast as I once could. I would not have the technique nor would I have the strength power or endurance to ride for long. What about my neural impulse and reaction – that would be nonexistent, wouldn’t it? Countless studies have demonstrated the positive correlation between practice and reaction. I haven’t practiced and with my luck, I’d hit a rock and run in to a tree. Continue reading
It has been far too long since my last blog post. It’s my own fault as I am my own worst enemy. I start writing and get carried away with science and ensuring quality research that a simple blog post becomes a painstaking 4 week mission. I constantly remind myself – “it’s a damn blog Josh, chill out!”. So, I did chill out and wrote a blog that does not require countless hours of mind-numbing literature review. Here are 50 exercises you can do anywhere. Continue reading
Vladamir Janda revolutionized human movement and rehabilitation when he described three compensatory movement patterns as a result of pattern overload and static posturing. Since Janda’s introduction we have continued to learn about hypertonic / hypotonic muscles and the delicate interplay they have on integrated functional movement. Static stretching helps correct dysfunctional movement by elongating shortened tissue. Unfortunately, the manner in which many stretches are performed does not target tissue appropriately. Continue reading
One of the most common inquires I get is from new moms looking to lose that postpartum belly. How is it possible that celebrities like Heidi Klum can drop 30-40 pounds in just 4 months? Anna Paquin goes from twins to 6-pack abs in 5 months. For new moms, that is frustrating, when you work so hard to lose stubborn body weight. What do they do that you don’t? Trust me, there is no super-secret information or magic formula that only they are privy to. You have the same physiology and weight loss capabilities as Hollywood superstars.
Normal weight gain during pregnancy is 30-35 pounds. Roughly 10 pounds is lost immediately after birth – seven pounds for the baby, plus two-three for blood, amniotic fluid and other. Through the first week your body will flush another 5 pounds of reserved water weight. Optimal weight loss should be 1-2 pounds per week. If you do the math, you will find that Anna Paquin and Heidi Klum lost about 2 pounds per week. Suddenly, Heidi and Anna’s weight loss isn’t so dramatic, does it? A loss of 1-2 pounds per week is easily attainable if you are diet compliant and dedicated to exercise. Continue reading
This blog post is long overdue. I have had countless people – friends, family members, athletes, clients – all ask me about shin splints. OK, before the Athletic Trainers, Physicians, PTs and other health care providers jump down my throat. Yes, shin splints is a junk term. I am talking about MTSS. I understand this, but the people you treat know them as MTSS, so relax. What are they? How can I get rid of them? Can they be prevented? Despite being one of the most common athletic injuries, recreational or competitive, shin splints are easily treatable and very preventable. Too often sufferer’s deal with the pain and never fix the problem. My goal with this blog is to provide tips to fix the problem and resolve shin splint pain.
Shin splints, or Medial Tibial Stress Syndrome (MTSS), is a chronic injury typically described as dull-ache on the medial, mid-to-lower-third portion of the lower leg. Pain is common during or after activity. In severe cases pain may last for several hours after activity and occasionally the individual will experience nighttime throbbing in the lower leg.
The pain from MTSS is attributed to irritation of the periosteum – a saran wrap like covering around bone – or a stress reaction to the underlying bone. Repetitive pounding or muscle pulling from these structures precipitates the injury. Popular belief is that shin splints are due to poor shoes, training intensity, and training surfaces. However, a critical review article written by Moen, Tol, et al., published in 2009 Sports Medicine found this was not the case. MTSS is often caused by poor joint movement and muscle imbalance. These movement patterns and muscle imbalances are easily identifiable. The best part is that you can fix these problems at home by following a simple flexibility and strengthening program.
First, let’s see if you have these movement dysfunctions. Observe yourself (in a mirror) walking or doing repeated squats. Do you see one or more of these four things: hips in, knees in, feet flatten, or toes point out? You may have one or all of these patterns; some may be extremely pronounced or could be very subtle. The image here shows a moderate to severe movement. If you observe this, even to the slightest degree, you are at risk for developing shin splints. Overtime, these movement patterns create a muscle imbalance, where some muscles become overactive and some become underactive.
Using the above figure as an example, here are the typical overactive and underactive muscles we would see in a person with shin splints or with these movement patterns.
|Hip Flexors and Tensor Fascia Latae||Gluteal Group (Maximus, Medius)|
|Lateral calf (lateral gastrocnemius / soleus)||Medial Gastrocnemius|
|Groin muscles (anterior adductor complex)||Anterior and Posterior tibialis|
|Biceps Femoris||Medial Hamstrings|
Our goal is simple, turn-off the overactive and turn-on the underactive; simple as that. Below is a basic 3-step program that can help correct this issue, step 1 -Turn-off, step 2 – elongate, and step 3 – turn-on. This program can be done daily and would take no longer than 30 minutes from start to finish. Here is what a basic program would look like.
Step 1: Turn-off the overactive muscles using self-myofascial release
- Hip Flexors
Foam rolling is the best way to do this if you go at it alone. If you have a qualified therapist, manual release of these muscles will do the trick. When foam rolling, roll each muscle for 90 seconds and hold tender areas for 20-30 seconds. A YouTube playlist I created, provides good examples and tips on how to perform these techniques.
Step 2 – Elongate the overactive muscles with static stretching
- Gastrocnemius/Soleus Static Stretch
- TFL/IT Band Stretch
- Kneeling Hip Flexor Static Stretch
- Adductor Static Stretch
Perform 1-2 sets of the stretch per muscle group and hold the stretch for a maximum of 30 seconds. Brent Brookbush, has a good static stretching playlist that demonstrates these exercises.
Step 3 – Turn on the underactive with isolated strengthening
- Posterior Tibialis Strengthening
- Anterior Tibialis Strengthening
- Glute Medius Strengthening (Clams)
- Lateral tube walking
- Glute Maximus Strengthening (Ball Bridge)
The above exercises are just examples. There are many exercises to choose from. The important thing is to target the right muscles. Fix the core, attack the glute medius and glute maximus, and work the tibialis anterior and posterior.
In summary, too often I see individuals with shin pain ceasing activity, buying new shoes, investing hundreds of dollars in custom orthotics, or giving themselves an ice bath. Shin splints do not have to be the end of training. They are easily preventable and curable as long as you fix the problem. Following a simple and structured program to correct of common movement dysfunction patterns can eliminate shin splints and many other lower body injuries like Achilles pain, runner’s knee or hip pain.
A couple of weeks ago, I participated in a 5k and a 10k challenge that was scheduled 12 hours apart. Fitness enthusiasts would consider a back to back 5k / 10k as just another training session. I, on the other hand, am quite the opposite. I have developed a hate-hate relationship with aerobic exercise –specifically, running. I like speed, agility, quickness, strength, and power – arrg arrg arrg! I am five foot nothin’ and a hundred somethin’ (emphasis on the nothin’ and somethin’). I would rather pluck my eyelashes than run. But, I do love the exercise science.
You’d think I’d use my knowledge for exercise science as a useful tool. Unfortunately, my continued pursuit of knowledge does not translate to practical utility. What follows is what I should have done to enhance recovery and optimize performance during this short 12 hour recovery period between races. Since, I won’t listen to myself, maybe you will!
First, we must understand the physiology of producing energy, fatigue and recovery. I do not want to turn this in to an advanced exercise physiology session on metabolic pathways but this general background is helpful. When we exercise energy (ATP) is needed. This energy is created by our body using three systems: ATP-PCr system, the glycolytic system and the oxidative system. Each energy system has its own method of generating energy. Likewise, each energy system becomes fatigued after an imbalance occurs in its system.
In the ATP-PCr system our body uses stored Phosophocreatine and through a series of reactions quickly generates ATP. Unfortunately, this system gets depleted of stores rather quickly. This is why you can only perform and all out sprint for 10 – 20 seconds. After a 2 minute rest period the ATP resynthesizes giving you the ability to perform an all-out sprint again. If we going longer than 20 seconds our body must enter the glycolytic system. Here we begin to use glycogen to make energy. When glycogen is broken down without oxygen present, our cells becomes acidic (commonly known as lactic acid buildup or lactate threshold). This acidity inhibits enzyme activity. Since enzymes are the catalysts for almost all body functions, we fatigue when they stop working.
If intensity is low enough in the glycolytic system, our body has time to use oxygen to breakdown glycogen and prevent lactic acid build-up. This is the oxidative system. Using oxygen to breakdown glycogen is our long-term energy system, which we use to perform tasks like distance running. Carbohydrate is stored in our body as glycogen in muscle and liver. This is our preferred and primary energy source. However, when we exercise we deplete glycogen stores and sometimes have to call on fat to make energy. When we reach this phase our body will fatigue. So, in review, during high-intensity exercise we fatigue because we deplete ATP and Phosphocreatine stores. During moderate activity we fatigue due to lactate build-up. During long and steady state exercise we fatigue when glycogen stores become depleted.
To combat this fatigue we must train our body to adapt to these physiological changes, or provide opportunity for our body to recover through rest. You can also practice good post-exercise refueling habits. By eating and drinking macronutrients (carbohydrate, fat and protein) we replace what we just used. So, what do we eat and when do we eat to replenish?
A Study published by Howarth, et al., in 2009 found that ingesting a carbohydrate and protein mixture at a 4:1 ration provided the best benefits when compared to carbohydrates alone. Similarly, Koopman, et al., in 2005 found a 3:2 ration of carbohydrate to protein ingested post exercise was better than carbohydrate alone. The Koopman study also investigated the benefit of leucine – an essential amino acid found in soy, beef and salmon, known to facilitate muscle regeneration – and demonstrated an added benefit of this supplement. Even though some current data is contradictory most studies show that the amount of glycogen formed is significantly greater in athletes consuming the mixture of Carbohydrate and Protein.
Timing also plays an important role. You may have heard of nutrient timing – it’s getting a lot of attention lately. In order to compensate for protein loss during exercise, the timing of post-exercise protein supplementation is important. The efficiency of protein synthesis is improved by ingesting rapidly after exercise. Another challenge is the refueling with carbohydrates. Bottom line, the sooner carbohydrate is consumed post-exercise; the greater the amount of muscle glycogen is resynthesized. When time is short between fuel-demanding events, it makes sense to start refueling as soon as possible.
Keep it simple, post-exercise meals should be built on a foundation of carbohydrate-rich foods plus a smaller amount of protein. Greek yogurt or cottage cheese with fruit or bananas with peanut butter are both good options. If you are a stickler for protein powder, switch it up – make yourself a fruit smoothie and add a scoop of protein.
My times for the 5k and 10k were 29:37 and 63:26 respectively; certainly not awesome. Maybe if I’d apply what I know, I would have done better. Maybe if I replenished with a healthy carbohydrate protein drink instead of beer and pizza, I would have done better on day 2. If I’d just listen to my brain and not my fat cells I might have finished under 60 minutes. If I’d listen to my brain, not watch the ESPN, I could improve. If I chose to get up rather than drool on my pillow, I might approach 45 minutes. Someday I will get the hint and practice what I preach. Maybe I need the late Chris Farley’s famous character, Matt Foley, as my personal motivational speaker.
I have been looking for something to blog. No idea surfaced that said, “Yes, that is a great blog idea.” That was until yesterday’s tragic Boston Marathon bombing. Runners are a rare breed. You cannot keep them down. A runner’s passion for sport, resilience to challenge, and unique characteristic to rise above is unparalleled by any other athlete. I am not a runner. In fact I am the antithesis of a runner. I go in to anaphylactic shock just hearing the word aerobic exercise, but have many friends who are passionate runners. I dedicate this blog to my running friends, competitors of the Boston Marathon, the friends and family of those impacted by yesterday’s events, and runners everywhere from the competitive to non-competitive. I will keep it true to my blog site and remain sports medicine focused. I hope you find the information useful.
Running is one of the most popular recreational sports in the US. Race events can be found in almost every town. My town – Champaign, IL – has 2 events in the next 4 weeks. Some estimates say 20% of the population is runners and 10% of these people participate in race events. The benefits of exercise are well documented. Running has shown to build confidence and character, reduce stress and improve mood. However, the due to their very nature – the unwillingness stop – running does bring about an increased incidence of musculoskeletal injury.
You don’t need to be an astrophysicist to know running injury is secondary to cumulative overload. Running injuries are multifactorial; neuromuscular imbalance, poor arthrokinematics and other things such as age, nutritional status and environment are to blame. From a biomechanical point of view frontal plane knee adduction moments play a significant role in lower extremity injury. Q-angle – a measure of knee alignment – can indicate risk for running injury. An increased Q-angle can be a result of many neuromusculoskeletal inefficiencies from poor muscular hip control to limited ankle dorsiflexion and excessive forefoot pronation.
Running brings about many injuries, but the most common are Patellofemoral Syndrome, Iliotibial Band Syndrome, Medial Tibial Stress Syndrome / Tibial Stress Fracture, Achilles Tendinitis, Plantar Fasciitis, and Sacroiliac Joint Pain. What is interesting is that all of these injuries can be caused by biomechanical breakdown and neuromusculoskeletal inefficiency. The good is the dysfunctional patterns are identifiable, preventable and correctable. Below is a sample 15 minute injury prevention program from a blog I wrote in Sept 2012. Yes, 15 minutes is all you need to prevent many running injuries.
Step 1: Decrease neurological drive to hypertonic tissue – 3 minutes
- Self-Myofascial Release (foam roll) or Manual Trigger Point Therapy
- Gastrocnemius/Soleus – 60 seconds
- Adductors – 60 sec
- TFL/IT-band – 60 sec
Step 2: Lengthen hypertonic muscle or joint tissue – 3 minutes
- Static stretch or joint mobilization
- Gastrocnemius/Soleus Stretch – 1 set @ 30 sec
- Kneeling Hip Flexor Stretch – 1 set @ 30 sec
- Adductor stretch – 1 set @ 30 sec
- Posterior joint mobilizations at the ankle – 90 seconds
Step 3: Increase neurological drive to hypotonic tissue – ~ 6 minutes:
- Exercise: Isolated Strengthening or positional isometrics
- Resisted Ankle Dorsiflexion – 2 sets x 15 reps (slow) (2 minutes)
- Resisted Hip Abduction and External Rotation- 2 sets x 15 reps (slow) (2 minutes)
- Resisted Hip Extension – 2 sets x 15 reps (slow) (2 minutes)
Step 4: Integrated Dynamic Functional Movement – ~ 3 minutes
- Box step-up with overhead dumbbell press – 2 sets x 15 reps (slow)
Beyond the correction of movement dysfunction there are alternatives to treat running injuries which are effective and gaining popularity. This table highlights a few.
|Prolotherapy||This has been around since the late 1800’s, but has since become popular. The basis of prolotherapy is that it expedites healing by increasing fibroblastic activity and collagen repair.|
|Autologous Blood||Blood is the medium that carries tissue repairing materials to injury sites. However, sometimes, blood cannot deliver adequate amounts of material to the injured area. Thus, injections directed right at the injury site deliver tissue repairing material.|
|PRP||Like autologous blood, Platelet Rich Plasma (PRP) is injection of a concentrated mix of tissue repairing blood components, specifically platelets, which facilitate tissue repair healing.|
|Bone Marrow Aspirate Concentrate||Despite the negative press and belief that stem cells are only derived from an unborn fetus, stem cells do come from other sources – such as bone marrow. By taking stem cells from bone marrow and injecting in to damaged areas will facilitate tissue repair.|
|ESWT||Extracorporeal Shock Wave Therapy might best be known as lithotripsy. Lithotripsy is a procedure in which sound waves blast and destroy kidney stones. ESWT is the use of sound waves to destroy calcific tendons and ligaments.|
I prefer preventing and rehabilitating injury through correcting neuromuscular inefficiencies and dysfunctional movement. The problem with the above treatments is that they are treatments. If an injury is caused by dysfunctional movement patterns and those patterns are not corrected it is likely the above treatments will simply serve as a Band-Aid because the true problem was not fixed.
If the person(s) responsible for the Boston Marathon bombing were looking to put fear in people, they chose the wrong population to target. Runners are the most stubborn and prideful athletes. No means yes, and yes means do more. If you took a graphical representation of marathon registration numbers from last night through the end of this week I would bet you’d find a spike, rather than a decline. Social media is exploding with a rise of the runner. A quote from a friends Facebook page: “If you’re trying to defeat the human spirit, marathoners are the wrong group to target” –unknown. Other movements like, wear a race shirt tomorrow, donations, and wear yellow and blue (Boston Marathon colors) have already begun. So, thank you runners for inspiring this blog post!
Each day we are bombarded with new data. My goal is to share a breakdown of what I have discovered and read this past month. There is a little something for everyone here. How do I choose which articles to share? Is it clinically relevant? Does the story share something new or raise an interesting question? Most studies have some internal flaw that can be poked and while I try to only share those having high quality, my number one goals is to share something unique, progressive or surprising.
In the recent release of The American Journal of Clinical Nutrition there is a good article supporting the benefits of a high-protein breakfast. Data reveals that a high-protein diet alters ghrelin and peptide YY concentrations subsequently leading to decreased appetite and also curbed late night snacking. Is this study perfect – no. But it is pretty darn good – Yes. I have been blogging on this topic for sometime. Where, when and why did the public begin thinking high protein intake is unhealthy? Did you know quality of protein is measured by how it compares to egg protein? That is because the protein in egg, albumin, has near perfect amino acid distribution. Yet many consider eggs bad.
Here is another topic area I have been yapping about for some time – risk factors for hamstring strains. This systematic literature review was first published online and is now in print in the latest edition of the British Journal of Sports Medicine. This SLR included 34 articles for review, which is a pretty good number to include. Unfortunately, only 1 evaluated hip extension strength. Three found decreased hip extension ROM measures indicating shortened hip flexors. It baffles me as to why studies do not look at glute weakness and hip flexor tightness as a risk factor for hamstring strains. I’ve written about this and hope someday a good study will come out and study the correlation.
Mild Traumatic Brain Injury – MTBI is getting a lot of media attention lately and rightfully so. NFL labor union disputes and an enormous amount of published research has athletes and parents taking MTBI seriously. If that wasn’t enough, Junior Seau’s suicide was linked to depression secondary to chronic TBI. In the Archives of Physical Medicine and Rehabilitation, April 2013 issue, an article discusses depression after TBI. It’s a nice short quick-hitting synopsis, with full-text available.
I subscribe to daily email updates from ScienceDialy. Two or three times per week they share something good that I get caught reading. Two articles they shared link positive benefits of Vitamin D. One shows that Vitamin D replacement improves muscle efficiency and another found Vitamin D may lower diabetes risk in children. Now I am not advocating to go overboard on Vitamin D, but I am saying drink Vitamin D fortified milk and cereals and get outside in the sun to ensure you are getting adequate vitamin D.
ScienceDaily also had an write-up that I loved regarding foods to help fight inflammation. The article states citrus fruits, dark leafy green vegetables, tomatoes, and foods high in omega-3s, such as salmon are anti-inflammatory foods. Notice none of these foods are grains, breads and/or pasta. All are earth foods and not processed. This supports and is similar to blogs I wrote previously: how the US Food Guide Pyramid and MyPlate could be to blame for our chronic disease epidemic, another which is very similar linking arthritis and osteoarthritis to diet. Finally two of my most popular posts written Stop Destroying Your Body and Is Your Diet Making You Sick discuss the link between diet and disease.
Must Read Blogs:
There are so many smart people out there and I enjoy learning from them all. Here are some good blog posts from this month.
The first is from Sport Injury Matt (@SportInjuryMatt – twitter handle). He had two posts about foot mechanics and foot wear. Part I shares good crucial information on foot mechanics. Part II of this post talks about what one should run in and considerations when selecting certain shoes.
My good friend Jay Barss (@sportsrehabtalk – twitter handle) is new to the blog and twitter world. He is a smart dude and deserves some following. His most recent post talks about the a new perspective on management on patellofemoral pain management. As we all know, correction of faulty movement patterns is critical in management of the oft-diagnosed PFPS.
Last is a series posted by Allan Besselink (@abesselink – twitter handle). If you have not followed Allan’s blog I highly recommend it. In fact his blog was recently nominated as top choice for health and wellness. Everything he posts is high quality. I particularly liked his three-part series titled the Low Back Pain Paradox. Low back pain effects 80% of the adult population and Allan does a great job covering all the bases in Part I, Part II, and Part III.
Stay healthy and well!
For many, “cardio” sucks. Running – the boring monotonous “fat-burning” exercise that is nothing more than audbile thud, thud, thud of a foot slap whilst staring at mindlessly at CNN Breaking news on the overhead TV monitors. Some meathead gets on the machine next to you and insists on going 1% steeper grade and .1 MPH faster. You try the elliptical, which has absolutely zero relationship to how we move everyday, unless you have discovered an amazing pair of Back To the Future-esk sneakers that allow you to air pedal instead of walk. Then there are those who need upper body rest and choose to bike. Or better yet, if you are really tired you can choose the recumbent bike that is perfect for people who want to lie down while exercising.
For the “cardio” lovers out there; I get it, “cardio” can be awesome and burn calories. I get there are many training programs. So, before you get on your soapbox to scream “CARDIO ROCKS”; [relax, breath – this might sting] not everyone shares your opinion. For many “cardio” sucks.
By now you have likely noticed the quotes around “cardio”. People describe “cardio” as running, stairclimber, elliptical, biking or swimming. It’s not. Cardio – short for cardiovascular or cardiorespiratory and synonymous with aerobic exercise – is simply the act of raising your heart rate for an extended period of time (> 5 minutes) without allowing it to recover. That’s right, anything you do to increase heart rate for the duration of the workout is technically cardio. The best way to do this is by doing a circuit training program.
Circuit training is simply a series of exercises that are performed for a set of repetitions or time frame with minimal rest periods (<40 seconds) in between each exercise. The short rest period is the crucial component as it will not allow your heart rate to recover, which is why circuit training can be a cardio or aerobic exercise.
Designing a circuit program is easy. Pick a series of 5-10 exercises. Alternate the exercises between upper body, lower body and total body. Design your workout with 1 minute increments that have an “on” time (period of doing the exercise) and an “off “time (period of rest). For example, exercise for 30 seconds, rest for 30 seconds. Here is what a program might look like if doing a 30 on/30 off:
* Push-up (do for entire 30 seconds)
* Rest (30 seconds) During your rest get ready for the next exercise.
* Ball squat
* Bent over row
* Step-up with over head press
* Ab crunches
Repeat that cycle 5 times. Your total workout time would be 25 minutes.
You can make the circuit harder or easier by manipulating the rest time or changing the intensity of the exercise. Here is a harder circuit program using the same 30 on/30 off time, but with more intense exercises:
* Plyometric Push-up
* Squat Jump
* Medicine ball slams
* Speed ladder
Repeat that cycle 5 times. Your total workout time would be 25 minutes.
Need it more intense? Repeat the cycle 7 times. Still not enough – decrease your rest time so “on” time is 40 or 45 seconds and the rest period is 15-20 seconds. Trust me, if you can do the above workout with a 45/15 on/off time for 7 cycles, you don’t need to read this. You should be competing at the next Ironman.
The beauty of circuit training is that it defeats monotony. You can plug any exercise in to the circuit routine. You can do this program 5 days per week and never do the same exercise twice. Use your imagination.
“But will I get the same calorie burn as I would with running?” No, you will have more!! Exercises in a circuit program are more intense than a steady state cardio. Your heart rate will shoot up during the “on” time creating a higher peak heart rate. Since the rest period is short, you will also have a higher average heart rate. Higher heart rate = higher caloric burn.
More positives; because the intensity is higher you can achieve the same caloric burn in less time. Which would you rather do: spend 60 minutes to burn 400 calories on an elliptical or 25 minutes doing a variety of things? Want more – your circuit program has weight training in it. Not only are you getting cardio, you are lifting – two birds, one stone.
Finally, no blog of mine could be mine without a little bit of geeky-ness. The concept of EPOC or excess post-exercise oxygen consumption. We need oxygen to feed our cells and produce energy. When you perform high-intesity exercise – like that in a circuit program – you create an oxygen debt. In a sense your body is starving for oxygen. After exercise your body must continually consume oxygen to make up for the debt. This is metabolism and extended caloric burn. With a circuit program the oxygen debt is greater than that of traditional “cardio”. Thus, you continue to have increased metabolism for 12-24 hours after the exercise. With a slow steady state “cardio” exercise, your metabolism is done after 2-4 hours.
See, cardio doesn’t have to suck. However, if you are hell-bent on strolling along on that elliptical while reading 10 chapters of the latest John Sanford novel – have fun.
Selkowitz, DM, Beneck, GJ, and Powers CM. Which Exercises Target the Gluteal Muscles While Minimizing Activation of the Tensor Fascia Lata? Electromyographic Assessment Using Fine-Wire Electrodes. J Orthop Sports Phys Ther. 2013; 43(2):54-64.
Overview and Introduction:
Vladamir Janda revolutionized human movement dysfunction and rehabilitation when he described three compensatory movement patterns as a result of pattern overload and static posturing. Most musculoskeletal injuries are multifactorial, but more often than Janda’s described three compensation patterns – upper crossed syndrome, lower crossed syndrome and pronation distortion syndrome – are the key contributor to our pain complaints.
Since Janda introduced this topic research has continued to answer what and why questions surrounding these compensatory patterns. We have learned hypertonic / hypotonic muscles and the delicate interplay they have on integrated functional movement. Studies continue to show how these dysfunctional patterns lead to our most common injuries – PFPS, ITBS, Achilles tendinopathy, plantar fasciitis, epicondylopathy, biceps tendinosis, impingement syndromes, MTSS, etc.
As research evolves we continue to fine-tune our clinical decision making. For several years now rehabilitation journals have published articles linking a myriad of injuries to lower-crossed syndrome, gluteal inhibition, and over-activation of the tensor fasciae latae (TFL). We have learned that these should be a focal point in our rehabilitation techniques to resolve lower extremity overuse injuries. The article by Selkowitz, et al., in the Feb 2103 edition of JOSPT is unique and what I believe to be one of the most clinically relevant studies to be published in the last few months. I liked it so much I had to blog it.
Statement of the Problem:
A common descriptor associated with lower-crossed syndrome is femoral internal rotation and hip adduction. From a rehabilitation perspective we must enhance neuromuscular firing of hip abduction and external rotation. In addition we must inhibit over activity of hip adductors and hip internal rotators.
As a health care practitioner we understand the delicate interplay of functional anatomy. The problem is how do we inhibit a chronically hypertonic TFL while activating the hypotonic gluteal group if they both produce similar movements? It is a fine balance we must be cognizant of when designing rehabilitation programs.
This study examined which exercises elicit the greatest gluteal (medius / maximus) activation while minimizing activation of the TFL. This is exactly what we need to know when designing a rehabilitation program to target lower crossed compensatory patterns.
Electromyographic data of the gluteus medius and superior gluteus maximus was collected utilizing fine-wire electrodes on 20 healthy participants during the execution of 11 exercises.
Seven of the 11 exercises -bilateral bridge, unilateral bridge, side step, clam, squat and two quadruped variations – demonstrated statistically significant greater muscle activation in the gluteus medius and gluteus maximus when compared to the TFL. Side-lying hip abduction, hip hike, the lunge, and the step-up were either not significant or demonstrated higher TFL values compared to the gluteal group.
The authors ranked the exercises in order of highest gluteal to TFL ratios. Clam, side step, and unilateral bridge had the highest ratios, while lunge, hip hike, and squat had the lowest ratios.
Clinical Application of Data:
Altered arthrokinematics and muscle imbalances are a common cause of overuse injuries. Lower-crossed syndrome is a common compensatory pattern that is associated with hypertonicity of the hip flexors complex, which elicits altered reciprocal inhibition of the gluteal group. Targeting this dysfunctional pattern using proper exercise selection indicated here can prevent injuries, improve patient outcomes, and restore optimal function. When designing your program be sure to reference the material here to determine a proper rehabilitation program.
Studies are equivocal on reliability of surface EMG vs intramuscular. However, the authors cite using the method by Delagi and Perotto, which appears reliable. Still one has to question specificity and sensitivity to a minimal degree.
The participants were instructed on proper exercise technique. However, substitutions patterns are common in patients exhibiting muscle imbalance. Any slight deviation from proper technique can skew the data. I am curious how closely exercise technique was monitored and what occurred when deviation did occur.
Like I said from the top, rarely do we have a published data with such clinical relevance. Studies that show how deep ultrasound penetrates a rats muscle are great, but clinically have little clinical utility. Data revealed here will guide decision making on proper exercise selection and ensure they are applying the proper strengthening exercise to specifically target the underactive glutes while avoiding the over active TFL. Kudos to the authors.
I was recently asked by a colleague: Why does NASM recommend performing core exercises prior to SAQ and resistance exercises when most other organizations state to perform core at the end? It is a long-winded, highly-debatable question, so I decided to write a short blog on the topic providing my thoughts.
The theory of performing core exercise at the end of training is very valid and certainly has utility.The primary theory to performing core exercise after resistance training is fatigue. Resistance, reactive and SAQ training targets our prime movers which are predominately made of Fast Gylcolytic (FG) and Fast Oxidative Glycolytic (FOG) muscle fibers. These fibers are easily fatigued due to their avascular properties. Core musculature is rich in Slow Oxidative (SO) muscle fibers. High vascularity makes SO fibers resistant to fatigue secondary to the accessibility to oxygen.
A common fault with core training technique is allowing the prime movers – saturated with FG / FOG fibers – to dominate the SO dominant muscle fibers of the core. Subsequently, we are not properly working the core muscles, we are just training our prime movers to act as core stabilizers. During higher intensity exercise like SAQ, reactive, and resistance training the FG and FOG muscle fibers become fatigued. Thus, when we transition to core exercises, the fatigued prime movers are less likely to become dominant and will allow for the core musculature and SO dominant muscles to do there job. So the organizations that support this method are certainly not wrong.
Conversely, NASM has a completely different outlook on when to perform core exercises. By performing core exercise after flexibility and prior to SAQ, plyometric, or resistance exercise serves as a functional warm-up to stimulate the neuromuscular system and enhance neuromuscular efficiency during more intense exercise. By doing so, our neuromuscular system is prepared and ready for higher intensity exercise and can prevent unwanted motion of joints and prevent injury.
The thought process behind this is the increased neurological stimulation that occurs when performing core exercise. This increased neural stimulation is much like the neural response that occurs with post-activation potentiation (PAP). PAP operates on the principle that heavy muscle loading creates increased stimulation of the central nervous system, resulting in greater motor unit recruitment and subsequently force production (1, 2).
There are two theories behind PAP. The first states that maximal muscle contraction yields an increased phosphorylation of myosin. The increased phosphorylation causes actin and myosin binding to be more responsive to calcium ions released from the sarcoplasmic reticulum (3). This enhances force muscle production at the structural level of muscle (4). As a result, faster contraction rates develop (1).
The second theory behind PAP involves the Hoffmann Reflex (4). The Hoffman reflex is excitation of muscle spindle nerve fibers. Physiologically, PAP increases speed of H-reflex, thus increasing the firing rate to muscle (5). It is this rate coding, and the aforementioned phosphorylation of myosin that the NASM model suggests occurs during and following core exercise.
By stimulating the core musculature, the core will be active during the core exercise and also be activated during higher intensity exercise. Subsequently, the core is working longer and it is helping prevent injury by enhancing neuromuscular efficiency during higher intensity exercise.
What do you think? Which method do you prefer? Personally, through research and exercise experience, I favor the NASM version, but that could easily be attributed to my work experience at NASM. Nonetheless, the question remains and I think it would be a great research study comparing the two variables. Any doctoral students looking for a project?
- Chiu, L.Z., Fry, A.C., Weiss, L.W., Schilling, B.K., Brown, L.E., & Smith, S.L. (2003). Postactivation potentiation response in athletic and recreationally trained individuals. Journal of Strength and Conditioning Research. 17(4), 671-677.
- Rixon, K.P., Lamont, H.S., & Bemden, M.G. (2007). Influence of type of muscle contraction, gender, and lifting experience on postactivation potentiation performance. Journal of Strength and Conditioning Research, 21(2), 500-505.
- Hamada, T., Sale, D.G., MacDougall, J.D., & Tarnopolsky, M.A. (2000a). Postactivation potentiation, muscle fiber type, and twitch contraction time in human knee extensor muscles. Journal of Applied Physiology, 88, 2131-2137.
- Hodgson, M., Docherty, D., & Robbins, D. (2005). Post-activation potentiation underlying physiology and implications for motor performance. Sports Medicine, 25 (7), 385-395.
If you read my blog before you are well aware that I am a big proponent of identifying human movement dysfunction and correcting functional imbalances to reduce chronic pain, such as knee osteoarthritis (OA), patellofemoral pain syndrome (PFPS), and low back disorders such as sacroiliac dysfunction, facet arthropathy, or generalized lumbago.
A few years ago I read about a new neuromuscular technique called AposTherapy. For those unfamiliar, AposTherapy corrects gait abnormalities by retraining muscles to adopt an optimal gait mechanics. The primary goal of AposTherapy is to correct the foot center of pressure (COP) during gait. This is done by wearing a unique, foot-worn biomechanical device. At the time, I heard good results about the use of AposTherapy, but data was too young to consider valid just yet or share-able, just yet.
Recently, when looking at functional rehabilitation techniques for chronic knee pain I came across an interesting study in the Journal of Biomechanics the evaluates the benefits of AposTherapy, to correct kinetic chain dysfunction responsible for the development of knee OA (1). The results of the study were significant. Following the intervention patients demonstrated significant reduction in knee adduction (valgus) moment (KAM). Several authors have demonstrated KAM to be a primary cause of knee OA, including Miyazaki, who noted KAM correlates with the progression of knee OA (2). In addition, patients who participated in AposTherapy demonstrated increased walking velocity, reduced pain, and improvement of functional living (1).
The foot-worn biomechanical device alters foot COP, allowing for proper kinetic chain alignment neuromuscular efficiency. Clark and Lucett, noted that dysfunction at one joint precipitates altered movement patterns, at adjacent joints, both proximally and distally (3). This is the foundation of AposTherapy. By correcting foot COP during gait, altered joint mechanics up the kinetic chain are nullified and neuromuscular efficiency is enhanced. Overtime, strength gains occur allowing for optimal gait patterns. Sharma, stressed the role of neuromuscular ineffciency, suggesting that secondary to elevated joint stress with higher impact loads and altered joint mechanics facilitate the pathogenesis of the chronic joint disease (4).
Biomechanical interventions focusing on foot COP, neuromuscular development and agility, enhance functional ability, reduce pain and increase spatiotemporal patterns of gait (1). Working knowledge of human movement dysfunction and human movement compensation patterns are prudent to health practitioners. Health practitioners should emphasize and correct human movement dysfunction when treating clients with chronic joint pain such as and certainly not limited to knee OA, PFPS, SI pain, and other low back disorders like facet arthropathy. Training to enhance neuromuscular recruitment, force-coupling, as well as the correction of altered length-tension relationships and poor joint arthrokinematics will go far in reduction of pain, prevention of chronic pain, and improved functional outcomes.
What techniques do you implement to train for optimal neuromuscular efficiency?
1. Haim, A, et al. Reduction in knee adduction moment via non-invasive biomechanical training: A longitudinal gait analysis study. J of Biomechanics. 45 (2012) 41–45.
2. Miyazaki, T., Wada, M., Kawahara, H., et al. Dynamic load at baseline can predict radiographic disease progression in medial compartment knee osteoarthritis. Annals of the Rheumatic Diseases. 2002. 61, 617–622.
3. Clark, MA, and Lucett, SC. NASM Essentrials of Corrective Exercise Training. Lippincott, WIlliams and Wilkins. 2010.
4. Sharma, L., Dunlop, D.D., Cahue, S., et al. Quadriceps strength and osteoarthritis progression in malaligned and lax knees. Annals of Internal Medicine. 2003. 138, 613–619.
For years there has been a gap between performance enhancement and injury management. Strength coaches fail to address rehabilitation and injury prevention during performance training whereas health care practitioners (ATs, PTs, OTs) fail to address performance training during injury management. There are some who continually seek to merge the two disciplines, by utilizing the unique training principles from each side. I am not saying ALL fail to bridge the gap, but it certainly is the majority. Health care practitioners could be a bit more boundaryless and integrate performance enhancement concepts and protocols into injury management programming. One method we can use is Postactivation Potentiation or (PAP). Continue reading