injury Prevention – All Me Fitness

Perfecting Your Normal

Many anatomical differences mean each person will need to move in a customized way that suits their body, and unless you’re ambidextrous you shouldn’t expect to move the same way with each side of your body.

Pretty much everyone who has worked out at a gym has had the experience of getting advice (frequently unsolicited) about how to do an exercise properly. frequently, this advice comes with the intent of helping you avoid injury, maximize your efficiency, or to hit on you. However, I am about to blow your mind with a revelation. People come in all shapes and sizes. Brilliant as this view of human nature may be, it is something that is forgotten far too often in the gym. People are not machines. We are not all built the same way, move uniformly, or require the same fuel. Many anatomical differences mean each person will need to move in a customized way that suits their body, and unless you’re ambidextrous you shouldn’t expect to move the same way with each side of your body. So all that advice you’re getting on how to squat normally may be a load of crap, but I am here to explain how you can do the best with what you got to perfect your body’s normal.

Red Flags

Don’t go running off to the gym and start using the equipment all willy nilly thinking that there is no wrong way to move. Because there is. It’s a large part of my job to make sure you don’t jack yourself up by doing something you saw on Instagram. When it comes to movement, I worry about the red flags, not the minutia. A red flag that can be revealed by a squat test might include knee valgus, or knock knees. We know this can lead to knee pain and ACL tears in athletes (1). There you have it, folks! If you’re an athlete and you have knock knees then you should work on that. Do you have back pain? Well if you hurt you back by falling down, doing a dead lift, or in a car accident, then those are red flags. But there is no magic stretch, strengthening program, or posture that are red flags or fixes for that matter. I’ve written about it before, but I’ll say it again “Neck pain is not greatly associated with neck posture (2). Sagittal (front to back) spinal curve does not relate to spinal health or back pain (3). It is highly likely that we all have disc degeneration, a bulging disk, and/or protruding disk in our back right now, and that’s normal (4). It’s not an unequal leg length that’s causing your back pain (5). Even the best athletes in the world have asymmetrical muscle size and movement patterns, and they don’t have issues caused by them (6,7).“

Why We Must Move Differently

I’ll keep this brief. We must all move differently because of our bone structure, muscle/tendon location, and injury history requires us to. We are all so different that it’s impossible to define perfect posture let alone perfect movement. As our bones grow and change, they don’t do so uniformly. Most people know that women have wider hips than men because of the birthing process. Well, there are similar genetic differences amongst everyone that can lead to the bones of the hip to stop you from moving in an “optimal” way (8). It’s also why the phrase “squat like a baby” is total crap. The image bellow gives a good visual on how the hip can be different from person to person. This is why no amount of foam rolling, stretching, or muscle activation will help with “tight hips” in some individuals.

Making It Work For You

So here’s where we get down to business. If you, or someone you know, have specific questions about pain, performance, or application of any of the following suggestions, be sure to set up a one on one session with me by replying to this email so we can get into specifics for you.

It’s no secret that exercising can come with aches and pains. Commonly, the shoulder, back, and knee joints. What you need to know is that pain does not always mean there is tissue damage. It may simply mean you are overstressing a particular structure. Which is why switching from back squat to front squat can alleviate knee pain even though you are still putting pressure on the joint. If your knees move towards the outside of your feet too much try taking off your shoes (9). If squatting makes your back hurt, decrease the amount of weight that you use, squat deeper, and allow your knees to go in front of your toes as seen in the picture below (10). You can also adjust the depth of the squat, foot stance, and barbell location to target specific muscles which I wrote about extensively in this post.

If you want to build a bigger chest, use less weight on your bench press because of the heavier the weight the more you use your shoulders and triceps (11). In fact, getting more reps in is the name of the game. Stretching before you exercise will decrease the strength and muscle gain you can achieve, and may not even be achieving anything worthwhile, to begin with (hip flexors in particular) (12). A little cheating isn’t always a bad thing if a bit of a swinging/momentum gets you to squeeze out an extra few reps (13). At the end of the day, perfecting your normal means you are experimenting with technique so you don’t feel pain/do feel the targeted muscles work, you are getting as many weighted reps in a possible, and you gradually increase your body’s ability to do more work. This may require a trained eye, but it will never require a universally true way to do things.

Resources

1. Quatman, C. E., Kiapour, A. M., Demetropoulos, C. K., Kiapour, A., Wordeman, S. C., Levine, J. W., … & Hewett, T. E. (2014). Preferential loading of the ACL compared with the MCL during landing: a novel in sim approach yields the multiplanar mechanism of dynamic valgus during ACL injuries. The American journal of sports medicine, 42(1), 177-186.

2. Grob, D., Frauenfelder, H., & Mannion, A. F. (2007). The association between cervical spine curvature and neck pain. European Spine Journal, 16(5), 669-678. doi:10.1007/s00586-006-0254-1

3. Christensen, S. T., & Hartvigsen, J. (2008). Spinal curves and health: A systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. Journal of Manipulative and Physiological Therapeutics, 31(9), 690-714. doi:10.1016/j.jmpt.2008.10.004

4. Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., . . . Jarvik, J. G. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR. American Journal of Neuroradiology, 36(4), 811-816. doi:10.3174/ajnr.A4173

5. Grundy, P. F., & Roberts, C. J. (1984). Does unequal leg length cause back pain? A case-control study. Lancet (London, England), 2(8397), 256.

6. Hides, J., Fan, T., Stanton, W., Stanton, P., McMahon, K., & Wilson, S. (2010). Psoas and quadratus lumborum muscle asymmetry among elite australian football league players. British Journal of Sports Medicine, 44(8), 563-567. doi:10.1136/bjsm.2008.048751

7. Hespanhol Junior LC, De Carvalho AC, Costa LO, Lopes AD. Lower limb alignment characteristics are not associated with running injuries in runners: Prospective cohort study. Eur J Sport Sci. 2016 Jun:1–8. PubMed #27312709.

8. Pollard, T. C. B., Villar, R. N., Norton, M. R., Fern, E. D., Williams, M. R., Murray, D. W., & Carr, A. J. (2010). Genetic influences in the aetiology of femoroacetabular impingement. Bone & Joint Journal, 92(2), 209-216.

9. Southwell, D. J., Petersen, S. A., Beach, T. A., & Graham, R. B. (2016). The effects of squatting footwear on three-dimensional lower limb and spine kinetics. Journal of Electromyography and Kinesiology, 31, 111-118.

10. Hartmann, H., Wirth, K., Mickel, C., Keiner, M., Sander, A., & Yaghobi, D. (2016). Stress for Vertebral Bodies and Intervertebral Discs with Respect to Squatting Depth. Journal of Functional Morphology and Kinesiology, 1(2), 254-268.

11. Król, H., & Golas, A. (2017). Effect of Barbell Weight on the Structure of the Flat Bench Press. The Journal of Strength & Conditioning Research, 31(5), 1321-1337.

12. Junior, R. M., Berton, R., de Souza, T. M. F., Chacon-Mikahil, M. P. T., & Cavaglieri, C. R. (2017). Effect of the flexibility training performed immediately before resistance training on muscle hypertrophy, maximum strength and flexibility. European journal of applied physiology, 1-8.

13. Arandjelović, O. (2013). Does cheating pay: the role of externally supplied momentum on muscular force in resistance exercise. European journal of applied physiology, 113(1), 135-145.

Cramp Twitch Shake: What’s Making It Happen?!

Why can’t you control your own body while trying to work out?!?!

It’s a plague, a natural disaster, and a nightmare we have all experienced. Calf cramps that hurt so bad you don’t want to move, uncontrollable twitching in the thighs after a heavy squat or an embarrassing whole body tremble while trying to hold a plank. Muscle cramps, twitches, and shakes affect us all in one way or another. But what’s going on with the body when they happen? Why can’t you control your own body while trying to work out?!?! Well, the answer, as usual, is complicated yet very simple.

Exercise-Induced Muscle Cramps

Let’s start with a list of things that don’t help with cramping:

x Magnesium supplements

x Hydration status

x Sports drinks

x Electrolytes

x Shoe type

Muscle cramps happen for a wide variety of reasons, but for today we will focus in on the kind you get while exercising. It may surprise you to know that cramps do not happen because of dehydration or electrolyte loss/imbalance. Losses in fluids and electrolytes, plasma, blood volume, and body weight are similar in people who experience cramps and those who do not experience cramping (1). Ever get a cramp while doing calf raises? I certainly have, and I bet if you try to do calf raises until fatigue now, you will get a cramp regardless of your hydration status. The “until fatigue” part is important because that is why muscle cramps happen. The scientific way to put it is (2):

“The muscle spindle responds to length changes in the muscle. As length increases, the muscle spindle increases impulses to the agonist muscle to contract and decreases impulses to the antagonist muscle so it relaxes. The golgi tendon responds to length changes in the tendon and causes the agonist muscle to relax. Both work together to protect the muscle from over stretching. However, with fatigue, it has been noted that the muscle spindle activity increases while the golgi tendon activity decreases.“

In other words, your body thinks it’s going to injure itself through overtraining/overstimulation so it shuts down activity (3). The body does this by firing the nerves up to 150 electrical discharges every second (4). Aside from intensity of exercise, some causes of cramps include a family history of cramps, muscle damage, and heat illness (5).

The best treatments include (4,6,7)

– Static stretching of the muscle

– Acetic acid (found in pickle juice) to increase neurotransmitter inhibition to cramping muscles

– Maintaining safe body temperature via hydration and rest intervals

– Increasing total body strength to delay target muscle fatigue

– Avoiding stimulants

Shake Spasm and Twitch

Shakes, spasms, and twitching kind of come with the exercise territory. There are medical classifications for all of the following information; however, we will be talking about them from a benign exercise-induced standpoint. Shakes (tremors) are almost always harmless and will never be explained. They are a huge category of involuntary muscle activity, ranging from the trivial to the disastrous, from teeth chattering in the cold to the wobbles of Parkinson’s Disease. In healthy people, they are usually stress induced. So if your hands or legs are ever a bit shaky after a hard workout, it’s because our motor control systems are a bit delicate. This is why unwanted contractions are so common and yet usually meaningless. Muscle spasms are an informal, non-specific term often used to “explain” musculoskeletal pain. Back spasms specifically do not cause pain, but rather are caused by pain (8). Muscles are always turned on and active in healthy people, and there is no such thing as normal muscle tone which is why “feeling tight” really doesn’t mean too much. A “muscle spasm” is really just the body preparing for a task (9). Twitching/rippling (Myokymia) happens when your muscle gets fatigued, so the motor units of your muscle fibers, rather than firing all at once, alternate their contractions, like pistons. Essentially, there aren’t enough motor units available for smooth contraction, so muscles start to ripple and quiver with intense exertions.

A Riddle To Ponder

What’s caused by doing exercise, and what’s caused by not doing exercise? Cramps, shakes, spasms, and twitches! It all comes down to how you’re training. If you’re doing enough exercise, you will start to see these issue go away. If you increase your exercise intensity, you will see them return… temporarily. The body is a crazy mystical web of mysteries. We are still discovering a lot, but the more you learn, the more it seems like we only know the tip of the iceberg. So don’t be embarrassed if you shake like a leaf while holding a plank, it’s completely natural.

References

1. Schwellnus, M. P., Drew, N., & Collins, M. (2011). Increased running speed and previous cramps rather than dehydration or serum sodium changes predict exercise-associated muscle cramping: a prospective cohort study in 210 Ironman triathletes. British journal of sports medicine, 45(8), 650-656.

2. Miller, Kevin. The Neurological Evidence for Muscle Cramping. NATA Symposium, June 2011, New Orleans Convention Center, New Orleans, LA. Conference Presentation.

3. Nelson, N. L., & Churilla, J. R. (2016). A narrative review of exercise‐associated muscle cramps: Factors that contribute to neuromuscular fatigue and management implications. Muscle & nerve, 54(2), 177-185.

4. Miller, T. M., & Layzer, R. B. (2005). Muscle cramps. Muscle & nerve, 32(4), 431-442.

5. Shang, G., Collins, M., & Schwellnus, M. P. (2011). Factors associated with a self-reported history of exercise-associated muscle cramps in Ironman triathletes: a case–control study. Clinical Journal of Sport Medicine, 21(3), 204-210.

6. Miller, K. C., Mack, G. W., Knight, K. L., Hopkins, J. T., Draper, D. O., Fields, P. J., & Hunter, I. (2010). Reflex inhibition of electrically induced muscle cramps in hypohydrated humans. Med Sci Sports Exerc, 42(5), 953-961.

7. Casa, D. J., Armstrong, L. E., Hillman, S. K., Montain, S. J., Reiff, R. V., Rich, B. S., … & Stone, J. A. (2000). National Athletic Trainers’ Association position statement: fluid replacement for athletes. Journal of athletic training, 35(2), 212.

8. Friedmann, L. W. (1989). The myth of skeletal muscle spasm. American journal of physical medicine & rehabilitation, 68(5), 257.

9. Szeto, G. P. Y., Straker, L. M., & O’Sullivan, P. B. (2009). Neck–shoulder muscle activity in general and task-specific resting postures of symptomatic computer users with chronic neck pain. Manual Therapy, 14(3), 338-345.

Get A Sexy Back & Healthy Shoulders By Doing This

For nearly all of us, there is one muscle group that’s often ignore which can keep our backs looking good and shoulders strong.

With pool, beach, and wedding season right around the corner, most of us are thinking about the implications of showing some skin. For others, our thoughts may rest completely on the thought of keeping our body healthy and pain-free. For nearly all of us, there is one muscle group that’s often ignore which can keep our backs looking good and shoulders strong. And that muscle is….

The Serratus Anterior

The serratus anterior (SA), AKA boxer’s muscle does a lot. When it’s strong, the SA holds scapula (shoulder blade) against the thoracic wall (the rib cage) and rotation of the scapula. But when the SA is weak, it can lead to a forward head posture, winging scapula, subacromial impingement, rotator cuff tears, glenohumeral inferior instability, sternoclavicular joint pain, acromioclavicular joint pain, glenohumeral osteoarthritis, frozen shoulder syndrome, scoliosis, lateral epicondylalgia, kyphosis, thoracic outlet syndrome, headaches, neck pain, and upper crossed syndrome (1,2). Aesthetically, scapular winging can lead some to avoid open back dresses or leaving the shirt on at the pool.

The Fix

For most people, I recommend some basic thoracic spine mobility drills. If you’re in a rush, some simple thoracic spine foam rolling for about 30 seconds will do in a pinch. As for exercises, the easiest thing you can do is incorporate pushups into your workout routine! Pushups are great for building SA strength when done correctly (3). And while I could write a book on the mistakes that can be made while doing pushups, let’s focus in on how to do them correctly. Keep your hands directly under your shoulders, brace the abdomen, keep your head and neck in neutral alignment with your spine (don’t look at your toes), and emphasize the last little bit of pushing at the end of each repetition. If you are already a proficient pushup pro, there are always fun ways to spice it up a bit like using a stability ball under your feet, BOSU ball under your hands, and performing pushups on an uneven surface.

Another great exercise is the dynamic hug. In this exercise, you use a resistance band wrapped around your back to increase the resistance of moving your arms forward for a hug. When done correctly, it should look the same as when my wife hugs me after I workout and stink like an old gym sock. Of course, there are dozens of exercises that work wonders for strengthening the SA, but these two exercises are safe, easily modified, and are very effective.

Bottom Line

At the end of the day, most of us exercise for our health and/or to look good in our birthday suits. Hitting the serratus anterior on a regular basis is a great way to accomplish both at the same time. So the next time you’re in the gym if you hear a trainer say “drop down and give me 20” you know it’s for a good reason.

Resources

1. 4Fayad, F., Roby-Brami, A., Yazbeck, C., Hanneton, S., Lefevre-Colau, M., Gautheron, V.. . Revel, M. (2008). Three-dimensional scapular kinematics and scapulohumeral rhythm in patients with glenohumeral osteoarthritis or frozen shoulder. Journal of Biomechanics, 41(2), 326-332. doi:10.1016/j.jbiomech.2007.09.004

2. Nagai, K., Tateuchi, H., Takashima, S., Miyasaka, J., Hasegawa, S., Arai, R.. . Ichihashi, N. (2013). Effects of trunk rotation on scapular kinematics and muscle activity during humeral elevation. Journal of Electromyography and Kinesiology : Official Journal of the International Society of Electrophysiological Kinesiology, 23(3), 679-687. doi:10.1016/j.jelekin.2013.01.012

3. Decker, M. J., Hintermeister, R. A., Faber, K. J., & Hawkins, R. J. (1999). Serratus anterior muscle activity during selected rehabilitation exercises. The American journal of sports medicine, 27(6), 784-791.

Everything In Moderation

Common causes, injuries, and solutions to the problem.

This week I wanted to talk about over-training and injury. This topic is particularly important to me because, well, it’s a big part of why I went to school to be an Athletic Trainer. In High School I played a lot of sports, and as a result, sustained a lot of injuries from over-training. So today I will share common causes, injuries, and solutions to the problem.

The Problem

Over-training is a complex beast. It’s determined by an imbalance of pro- and anti-inflammatory factors, and can rear its ugly head at the worst of times. When it comes down to it, over-training occurs when the body doesn’t have enough time to recover, and can manifest in the following ways:

elevated resting heart rate and blood pressure

loss of appetite and weight loss

chronic fatigue, workouts described as draining

chronic soreness/slow recovery rates

an increase in colds or infections

a decrease in performance, or an inability to reach training goals

lack of enthusiasm, psychological staleness

Injuries

It’s important to note that while experiencing muscle pain is normal, not all pain is good pain. Make sure you know the difference before you run to the doctor with every little nagging problem, or conversely, avoid the doc when you do have an issue.

As a result, injuries can also pile up. I commonly see injuries of the shoulder, lower back pain, and even shin splints due to over-training just to name a few. In particular, the shoulder can be fickle. From weight lifting, to swimming, or even throwing a ball around, the shoulder is the poor joint we love to overuse. Some symptoms to look out for include an obvious deformity, it gets popped out of place, difficulty lifting the arm, clicking or popping sensation deep in the shoulder, and/or pain reaching across your body. These symptoms warrant a trip to your favorite doctor, but the good news is that many shoulder injuries DON’T require being sliced and diced to fix them.

Solution

To avoid missing long stints of exercise, you will want to treat over-training by doing… well… nothing! One of my favorite sayings is “you don’t build muscles in the gym. You build them in bed.” The key here is to make sure that you are getting enough rest and proper food to support your physical activity. You should also make sure you shake things up here and there. Doing the same thing over and over again can be stressful on the body and mind, so moderation is crucial. In fact, doing a mix of cardio, weight lifting, and HIIT (join me Monday nights at 6:15 for our HIIT Grit team training) is optimal for reaching almost any goal. On that note, it’s important to remember that you will want to increase intensity carefully. You should make small steps every day toward those goals, one pound or mile at a time. Finally, you will want to take a chill pill. Everyday stress can affect our performance in the gym, so grab a stress ball (or a beer), take deep breaths, and smile more often to feel more refreshed.

Big Belly, Big Biceps, Big Training Mistakes

We make efforts to get to where we want to be, but often times we do the minimum to get there and never really breach our comfort zone.

Why do you exercise? Are you trying slim down that big belly? Looking to have shirt-busting biceps? Or perhaps just trying not to become a three-toed sloth (even though they are cute)? Well, I can tell you that we all make mistakes in our never-ending quest to be fit as a fiddle. It’s in our nature to be comfortable. We make efforts to get to where we want to be, but often times we do the minimum to get there and never really breach our comfort zone. So if you have ever asked yourself, “Why isn’t this working?”, read on to see some classic mistakes you’re probably still making.

Tummy Training Troubles

At some point in our lives, we have all wanted our midsection to look at least a little bit different. Whether you’ve wanted to have washboard abs, a flat stomach, smaller pant/dress size, or even to see your toes again, we have all had goals. Training to see these goals come to fruition, however, can often feel like an uphill battle on a treadmill covered with petroleum jelly. No matter how hard or fast you move your feet, you just seem to see no progress. When it comes to seeing progress around your midsection, the difference is truly made in the kitchen and not the gym. This is because no matter how many crunches you do (or adductor machine squeezes you do for legs), you won’t see a bit of difference in fatty tissue laying over those areas (1). In reality, trying to zap away your problem areas is literally an exercise in futility, because spot reduction DOES NOT WORK (2)!!!! Furthermore, burning fat does not mean you’re losing fat (3). If you want to lose the muffin top, you should weight train (no not cardio), eat at least 500 fewer calories than you burn in a day, and face some of these hard truths:

1 – You will fail. Not everything you’re going to try will work. Keep trying new ways of losing weight and stick with what’s working for you. Whether it’s more exercise, eating less, or cutting out booze, find your weight-loss sweet spot to see that belly boil down to nothing.

2 – Your body is your fault. You’ve spent your entire life getting into the habits that have turned you into the person you are. Whether you’re happy with the way you look and feel, or get upset every time you look in the mirror, the sooner you start to take responsibility for your health and body, the sooner you’re going to make a change.

3 – Fat loss sucks. It’s damn hard and there is absolutely nothing “effortless” about it. You WILL have to get out of your comfort zone.

4 – You will never look the way you want. Our imaginations get the better of us by blowing things way out of proportion which results in some hybrid, demi-god version of ourselves. If you have ever thought to yourself, “I just want to look like I did when I was in high school/college”, then I’m sorry to burst your bubble Uncle Riko, you probably didn’t look that good in the first place. Our memories stink, we all think we are above average/better than we really are, and we are all getting older. Which leads me to my last point.

5 – Men and women lose fat differently, and our bodies don’t work the same as we age. This is especially true for postmenopausal women who have a harder time losing weight due to drastic hormone changes (4).

Programming Your Exercise For Getting Big

Getting bigger muscles is not easy. It takes dedication, lots of effort, and most importantly, consistency. Spending a few weeks lifting weights in the gym is not how you get bigger or stronger. You need to spend months, and even years, of heavy lifting to look like a muscle-bound gym rat. And even then, you will need to be doing a few key things to see success. To be clear, if you’re a high-level athlete there are a few very specific things that you need to consider, but we are not going to get into those topics here. If you are trying to get into a generally better body, then take a gander at what you need to be doing.

* Ignore the overrated minutia of training that just about everyone online is talking about. Even smart people and trainers get bogged down in the never-ending pile of garbage that’s out there these days.

* Progressive overload is the name of the game. More weight, more reps, more volume, more frequency, more quality, more efficiency or more intensity (of effort). These are all different forms of overload and this increased workload from one workout to the next is fundamentally what triggers muscle growth.

* Beginners can add weight to the bar at almost every workout, and enjoy rapid muscle gains with about 5 sets of exercise a week per muscle group. Experienced lifters will see gains come slower and need about 10 sets of exercise a week per muscle group (5). So don’t get frustrated; keep at it.

* Think long term. Not only does muscle growth happen slowly, your progress rarely occurs in a continuous, straight upward line.

* Sacrificing form for weight is unacceptable. I know you want to see more weight on the bar, but if your form goes to crap, then what’s the point? Strict form is always important for results and safety, but a standardized form is also a must when it comes to quantifying your progression from one workout to the next.

* Keep a training journal. Your memory isn’t so hot either, so write it down. How can you possibly get better if you don’t remember the sets, reps, and weights you did last time?

Bottom Line

When it’s all said and done, you need to take care of you. Everyone experiences weight loss and muscle gain differently. What works for me probably won’t work for you. But if you’re not making an effort to get out of your comfort zone, then nothing will work. If you’re not tracking your process, successes, and pitfalls, then you won’t know which direction to go next. Work hard consistently to get to your destination.

References

1. Vispute, S. S., Smith, J. D., LeCheminant, J. D., & Hurley, K. S. (2011). The effect of abdominal exercise on abdominal fat. Journal of Strength and Conditioning Research, 25(9), 2559.

2. Idoate, F., Ibanez, J., Gorostiaga, E. M., Garcia-Unciti, M., Martinez-Labari, C., & Izquierdo, M. (2011). Weight-loss diet alone or combined with resistance training induces different regional visceral fat changes in obese women. International Journal of Obesity, 35(5), 700-713. doi:10.1038/ijo.2010.190

3. Stallknecht, B., Dela, F., & Helge, J. W. (2007;2006;). Are blood flow and lipolysis in subcutaneous adipose tissue influenced by contractions in adjacent muscles in humans? American Journal of Physiology – Endocrinology and Metabolism, 292(2), 394-399. doi:10.1152/ajpendo.00215.2006

4. Green, J. S., Stanforth, P. R., Rankinen, T., Leon, A. S., Rao, D. C., Skinner, J. S., . . . Wilmore, J. H. (2004). The effects of exercise training on abdominal visceral fat, body composition, and indicators of the metabolic syndrome in postmenopausal women with and without estrogen replacement therapy: The HERITAGE family study. Metabolism, 53(9), 1192-1196. doi:10.1016/j.metabol.2004.04.008

5. Schoenfeld, B. J., Ogborn, D., & Krieger, J. W. (2016). Effects of resistance training frequency on measures of muscle hypertrophy: A systematic review and meta-analysis. Sports Medicine, 46(11), 1689-1697. doi:10.1007/s40279-016-0543-8

Biomechanics Aren’t As Important As You Think

With so many variables to consider, how can anyone claim to really know what’s supposed to happen when any given individual moves?

These days it seems like everyone’s a biomechanics expert. From gym teachers to physical therapists, to personal trainers, and even fringe clinicians like chiropractors and massage therapists think they have the end all be all answer to the way we should move. With so many experts around, I had to ask myself “is anyone right?” Don’t get me wrong, I’ve spent years studying movement, so I am in no way saying there isn’t something to proper movement. But, with so many variables to consider, how can anyone claim to really know what’s supposed to happen when any given individual moves? A quick breakdown of variables to consider would include 3 independent planes of motion (never used in isolation), 46 miles of nerves, 206 bones, 100-300 major muscles (out of 700), 360 joints, and seeming endless ways of combining them to move. I would need help from a statistician just to figure out how many ways there are to move, so how can anyone really know how to move perfectly?!?! Well, one thing is for sure, we can only guess and learn from the best.

Biomechanical Boogymen

All too often I have people tell me that they can’t do things because their chiropractor found something on their X-ray, their trainer said it was bad for their joints, or their massage therapist said it was giving them trigger points. When I dig a little deeper, I general find that there is nothing to substantiate the claims. Why? Because I know that some practitioners use fancy terminology to sell their services knowing that less educated folks are somewhat more likely to swallow fancy-sounding bull**** (1). And because being asymmetrical and/or abnormal is normal! Neck pain is not greatly associated with neck posture (2). Sagittal (front to back) spinal curve does not relate to spinal health or back pain (3). It is highly likely that we all have disc degeneration, a bulging disk, and/or protruding disk in our back right now, and that’s normal (4). It’s not an unequal leg length that’s causing your back pain (5). Even the best athletes in the world have asymmetrical muscle size and movement patterns, and they don’t have issues caused by them (6,7). To sum it all up, movement systems seem to have reserve capacity to allow for asymmetry and imperfections to exist without failure or symptoms (8). You’re not made out of glass and tissue paper, and pain is complicated!

The Catch

No, you do not have free reign to ignore your exercise technique and/or posture. This is because we know there are ways to avoid hurting yourself! For instance, we know that runners with weak hamstrings are more likely to be injured (9). We know that rounding your back during a deadlift is bad. But, a lot of other technique coaching tips are sort of just semantics for the deadlift. My point is, there are things that we can do to control the likelihood of injury, but seeking perfection is fruitless because it doesn’t exist. Personally, I believe that being in tune with your body is one of the best things you can to do know what’s causing you pain or discomfort. By this, I mean you should have a general sense of what your body is doing. Have proper motor planning by figuring out the actual steps involved in a movement (i.e. map out all the steps from point A to point B). Learn to have motor control by practicing perfect technique in a mirror. Gain proprioception by having a sense of knowing where your body is in space. Enhance this skill by selectively contracting individual muscles, and balancing on one leg with your eyes closed. If you don’t know whether you’re moving well, how can you tell when you’re not? Was it really that deadlift that bothered your back, or was it from sitting in hunched-over position?

What’s most important when considering all of this, is getting strong. You can’t alter biomechanics without getting strong. It takes over 1,000 lbs. of force to deform fascia by even 1% (10). So foam rolling and massage won’t change your biomechanics. Having your back cracked or hips adjusted back into place may feel good, but it’s temporary and normal for things to go back to the way they were. That is unless you get stronger overall. It’s funny how things work out when you keep the body moving. Even if you don’t have textbook technique.

References

1. Weisberg, D. S., Keil, F. C., Goodstein, J., Rawson, E., & Gray, J. R. (2008). The seductive allure of neuroscience explanations. Journal of Cognitive Neuroscience, 20(3), 470-477. doi:10.1162/jocn.2008.20040

2. Grob, D., Frauenfelder, H., & Mannion, A. F. (2007). The association between cervical spine curvature and neck pain. European Spine Journal, 16(5), 669-678. doi:10.1007/s00586-006-0254-1

5. Grundy, P. F., & Roberts, C. J. (1984). Does unequal leg length cause back pain? A case-control study. Lancet (London, England), 2(8397), 256.

8. Lederman, E. (2011). The fall of the postural-structural-biomechanical model in manual and physical therapies: Exemplified by lower back pain. Journal of Bodywork & Movement Therapies, 15(2), 131-138. doi:10.1016/j.jbmt.2011.01.011

9. Devan, M. R., Pescatello, L. S., Faghri, P., & Anderson, J. (2004). A prospective study of overuse knee injuries among female athletes with muscle imbalances and structural abnormalities. Journal of Athletic Training, 39(3), 263-267.

10. Chaudhry, H., Schleip, R., Ji, Z., Bukiet, B., Maney, M., & Findley, T. (2008). Three-dimensional mathematical model for deformation of human fasciae in manual therapy. The Journal of the American Osteopathic Association, 108(8), 379.

Do This Super Super Set!!!!

The dynamic duo of fitness dominance, the walking lunge and renegade row!

Today’s topic is exercise! For those of you who don’t know what a super set is, I recommend you read my prior post discussing them in detail, as well as this blog post on the basics of training for beginners. The TL;DR version can be described as exercises targeting unrelated muscles done back to back. And today’s super set is one of my favorites… The walking lunge and renegade row! So let’s dive into the details of this dynamic duo of fitness dominance!

Deconstructing The Walking Lunge

If you have ever seen me at the gym shuffling around and looking like I’m straight out of an episode of The Walking Dead, it’s probably because I just finished doing some walking lunges. That’s because the walking lunge uses loads of muscles including the gluteus maximus, iliopsoas, quadriceps (vastus lateralis, vastus intermedius, vastus medialis, rectus femoris), hamstrings (semimembranosus, semitendinosus, biceps femoris), calf (soleus and gastrocnemius), and all the muscles of the trunk (1).

When done properly, the lunge is an excellent exercise to increase the strength of the leg and reduce the likelihood of injury for runners, field sports athletes, and those who actually do “leg day” from time to time (1,2). But, it needs to be done properly. So let’s go over how to do it right. Then, let’s go over how most people lunge.

The Correct Form

Begin By – Feet are between hip- and shoulder-width apart and pointing forward. Torso should remain erect. Keep chest out and up. Shoulders are back. Keep head and neck straight with eyes looking straight ahead. Before stepping forward, breathe in and hold it.

The Descent – Take an elongated step straight forward with one leg (lead leg). Keep your arms straight, with the dumbbells held firmly at your side and your torso in an erect position, as the lead foot goes forward and comes in contact with the floor. The rear leg (trail leg) remains constant in the starting position, but as the lead leg moves forward, balance should shift to the ball of the foot of the trail leg as the trail leg begins to flex. Place the lead foot flat on the floor with the foot pointing straight forward. Once balance is established on both feet, flex the lead knee to enable the trail leg to bend towards the floor. The trail leg should flex to a degree slightly less than the lead leg. The lowest finish position of the descent should occur when the knee of the trail leg is 1–2 in. from the floor, the lead leg is flexed to 90°, and the knee is directly above or slightly in front of the ankle. Continue to hold your breath throughout the descent.

Rise Up – While maintaining an erect torso, shift the balance forward to the lead foot and forcefully push off the floor with the lead foot. As the lead foot returns to the starting position, balance should shift to the trail foot, resulting in the trail foot regaining full contact with the floor. The lead foot should be lifted back to its original starting position, with

feet between hip- and shoulder-width apart and pointing forward. Avoid touching the lead foot to the floor until it is returned to the finish position (unless balance is lost).

LD;DR video

While these instructions are very specific and technical, they are important and correct (3). Of course, lunges won’t work for everyone. But, under proper supervision, you can modify the lunge to work for you even if you have pain in your knees or hips. Now let’s take a look at what most of us struggle with!

Common Mistakes

Leaning Back – When you lean back too far, your rib cage flares and your spine hyper-extends. This is so bad for your back that it hurts the guy watching you from across the gym! Work on that core control ASAP!

Side To Side Knee Movement – When your knee caves in or flops out, it is often the telltale sign of weak glutes. And there are lots of fun ways to fix that!

Poor Balance – This ties in with the knee movement because they both can be caused by weak feet. Weak and unstable feet will cause a chain reaction of instability and dysfunction throughout your entire body. Just another reason to have strong feet!

The Renegade Row

The jig is up. The news is out. They finally found me… on the floor doing renegade rows! If you don’t know what song I’m referencing then shame on you! Okay moving on. The Renegade Row is a tremendously effective exercise that develops upper body pulling strength (back and biceps), lumbo-pelvic (abs and hip) strength and control, as well as shoulder stability, a quality that is lacking in most people. In fact, it is one of the best exercises to do for the prevention of shoulder pathologies such as impingement and rotator cuff tears (4). This is because the renegade row has all the benefits of a plank while making you feel like a beast from lifting weights. But once again, if you’re not doing it right, you will pay the price!

Technique

Start – Get into a plank position with feet shoulder-width apart, maintain neutral spinal alignment for the duration of the exercise. Each of your hands should be gripping a dumbbell directly under your shoulders.

The Up – Keeping your hips and body completely neutral by actively tucking your rib cage towards your hips, row one dumbbell up to your ribs by initiating the pull with the muscles in your mid-back, not your arms. Be sure to end your rowing motion when your elbows are around the height of your ribs.

The Get Down – Bring the dumbell back to the start and repeat with the opposite hand without rocking from side to side.

TL;DR Video

Like the lunge, this technique should be simple but is often completely butchered. Here’s what’s going wrong, and how to fix it.

Poor Hip Control – If your butt is way up in the air, down near the ground, or twisting all over the place, you’re doing it wrong. The arms are the only part of the body where the movement should be occurring. Practice being a plank for a while and consider using less weight if you struggle with these issues.

Using Momentum – If your elbow travels well past the ribs during the rowing movement, body twists, or hips collapse and/or pike, you’re swinging for the fences too much. Use less weight, so you can control your body. That’s the name of the game, control.

Poor Shoulder Stability – Shoulder instability might be due to a past injury, an unbalanced training program, or weakness in general. Get your shoulders checked out by an exercise pro if they are causing you problems.

Super Set Super Ending

So, back to my original point. These exercises make for a great freaking super set. When done correctly, they both promote dynamic control of the hips, prevent future injury of almost the entire body, and burn some major calories. They are also fantastic for posture and getting out of the bad movement habits that sitting at a computer all day long creates.

If you want strong and sculpted legs, glutes, abs, arms, and back muscles, be sure to super set walking lunges and renegade rows. Four sets of 10 reps with a low weight for each should do it at first. So get moving!

References

1. Kritz, M., Cronin, J., & Hume, P. (2009). Using the body weight forward lunge to screen an athlete’s lunge pattern. Strength and Conditioning Journal, 31(6), 15.

2. Whatman, C., Hing, W., & Hume, P. (2011). Kinematics during lower extremity functional screening tests–Are they reliable and related to jogging? Physical Therapy in Sport, 12(1), 22-29. doi:10.1016/j.ptsp.2010.10.006

3. Graham, J. F. (2007). Dumbbell forward lunge. Strength and Conditioning Journal, 29(5), 36-37. doi:10.1519/00126548-200710000-00005

4. Arlotta, M., LoVasco, G., & McLean, L. (2011). Selective recruitment of the lower fibers of the trapezius muscle. Journal of Electromyography and Kinesiology, 21(3), 403-410. doi:10.1016/j.jelekin.2010.11.006

Core Concepts

The core is the keystone to a strong body, but there is so much more to it than that.

Today we are talking the importance of the core!!! I get a lot of questions about the core and why it’s important. In general I say that it is the keystone to a strong body, but there is so much more to it than that. Today’s article was published by the prestigious National Strength and Conditioning Association and does an excellent job in describing what the core is, why it’s important, and what we can do to make it stronger.

Here are a few highlights:

1.Core stiffness is essential for injury prevention and performance enhancement.

2. Stiffening the core between the hip and shoulder joints, produces higher limb speed and force.

3.Core training to enhance stiffness is the foundation and underpinning of one of the most fundamental laws of human motion.

A great quote from the paper describes what the core actually does “proximal stiffness enhances distal mobility and athleticism.” An example of this importance involves the pelvis when walking. If you can’t sufficiently stiffen the lumbar spine with quadratus lumborum (QL), your whole body will simply bend to the side the stance phase (foot on the ground part) of the walking cycle. This is because the QL is an essential core muscle forming the outside core. “What else can core training do” you ask? Well not much I guess. Except reduce the risk of back injury, enhance performance, reduce the risk of groin injury, sportsman’s hernia, and knee injury, particularly to the anterior cruciate ligament (ACL). Essentially, noone can afford to neglect this building block of function. So work on your core to enhance stiffness by doing things like suitcase carries, farmers walks, and planks.

Feet On The Ground – Balance Training

Staying on your feet and keeping balance is crucial for staying healthy throughout your life.

Do you know what the leading cause of death is for those over 55? It’s not heart disease, cancer, or spouses. It’s actually complications due to falls! Staying on your feet and keeping balance is crucial for staying healthy throughout your life, even more so as you age. That’s why today I am going to go over some strategies to keep your feet on the ground and your butt out of the hospital!

The Major Issues

There are several key factors to think about when considering a balance and stability training program. Muscle weakness, especially in the lower body, and problems in the feet such as foot pain, loss of sensation, or even improper footwear (slippers without traction, high heeled shoes, etc.) are at the top of the list (1). Additionally, medications and their side affects, declines in vision, and environmental factors like clutter or unsecured throw rugs can play a roll in falls. Today, we are going to focus on the former topics. Of primary interest, the strength of the lower body is paramount. Focusing on strengthening the lower body not only builds up the ability to resist gravity, but it also enhances our ability to know where our body’s at in space (proprioception).

The Exercises

No matter what your age or skill level is, there are exercises you should be doing to enhance your natural abilities. Today, I will be breaking things down into a beginner and advanced category.

Beginner

These exercise can be done by just about anyone. You can choose to do them standing, with assistance, or even seated if needed.

Hip extensions (back leg raise) – This exercise builds strength in the hamstring and hip. Perform this by slowly lifting one leg straight back without bending your knee or pointing your toes. Try not to lean forward. The leg you are standing on should be slightly bent.

Side Leg Raise – This glute exercise is a standby for seniors and professional athletes alike. Perform by slowly lifting one leg out to the side. Keep your back straight and your toes facing forward. The leg you are standing on should be slightly bent.

Knee Curl – This hamstring exercise is a classic. Perform by slowly bringing your heel up toward your buttocks as far as possible. Bend only from your knee, and keep your hips still. The leg you are standing on should be slightly bent.

Calf Raise – This calf exercise can be done just about anywhere and any time. Perform by slowly standing on tiptoes, as high as possible.

Advanced

Plank for core stabilization

Bird dog (Quadruped arm raise) for core, hip, and rotator cuff strength

Floor bridges for glute strength

Floor bridges with march for hip strength and balance

Medicine ball slams for hamstring and abdominal strength

Finally, working on activities that include some form of agility should be done. Dancing, playing with pets, or even simply doing yard work are great ways to build strength.

Balance Training

Balance specific training is different from exercising to build strength. Like any other skill acquisition, it takes patience. However, we know that the best outcomes are when balance training is used in combination with strengthening exercises (2). You can enhance your balance by using a progression of challenges to enhance the difficulty of your exercises. Try the following progression of challenges:

Start by holding on to a sturdy chair with both hands for support.

When you are able, try holding on to the chair with only one hand.

With time, hold on with only one finger, then with no hands at all.

If you are really steady on your feet, try doing the balance exercises with your eyes closed.

Finally, when you have mastered all the previous steps, you can try standing on unstable surfaces like foam pads, BOSU ball, or even pillows

You can also work on other exercises specifically for balance. For instance, you can try simply standing on one foot, walking heel to toe, and walking in a straight line. In other words, perform a sobriety test. In the end, anything you can do to challenge yourself while on your feet will help (3). The moral of the story is if you never stop moving, you won’t end up on the ground.

References

1. Centers for Disease Control and Prevention. Important facts about falls. Accessed online September 20, 2016. http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html

2. Penzer, F., Duchateau, J., & Baudry, S. (2015). Effects of short-term training combining strength and balance exercises on maximal strength and upright standing steadiness in elderly adults. Experimental Gerontology, 61, 38-46. doi:10.1016/j.exger.2014.11.013

3. Baudry, S., (2016). Aging Changes the Contribution of Spinal and Corticospinal Pathways to Control Balance. Exercise and Sport Sciences Reviews, Vol. 44 – Issue 3: p 104–109

Hip Pain Part 2 – Fixing The Problem

Hip new ideas on dealing with that pain in the butt.

As we found out last week, lots can go wrong within the hips. And while figuring out the problem can be difficult, finding the right solution may be a little bit more simple. For many of the issues that we have discussed the solution may ultimately be a surgical or pharmacological intervention. However, today I wanted to go over some exercise interventions that may be worth a try. So let’s dive into some hip new ideas on dealing with that pain in the butt.

The Big Three

There are three main domains that are thought to lead to hip pain including sitting, muscular imbalances, and skeletal imbalances. Sitting for long periods of time can lead to the latter two issues, but in a more direct sense, it can cause problems all on its own. Primarily, sitting causes compression within the hip joint itself and can, in a sense, squish the muscles, nerves, and blood flow. If you have ever had a “dead leg” from sitting on your wallet too long or one leg crossed over the other then you will know how troublesome sitting can be. Muscular imbalances can be described as building strength in some muscles while neglecting others resulting in an unnatural amount of strain on particular muscles. Runners, for example, often ignore the muscles used to move the body from side to side. Finally, skeletal imbalances are the uneven stature or movement patterns that many individuals have due to things like genetic bone differences, old injuries, and leg-length discrepancies.

What Should You Do?

Every person and every issue is unique and deserves a unique solution. This is due to the fact that pain is complicated. Pain can be caused by the various tissues (sprains and strains), by the nerves (sciatica), and other issues that aren’t understood yet (fibromyalgia, chronic low back pain). More often than not, however, movement is paramount to success. So let’s take a look at what you need to do for the specific issues discussed in last week’s post!

Femoroacetabular impingement (FAI) – FAI is unique because it is a combination of bone structure problems and hip tissue problems (1). These issues are far from uniform so the specifics of what needs to be done to fix the problem will change from person to person. However, some keys to success include hip-specific function and lower limb strengthening, core stability and postural balance exercises (2).

Piriformis Syndrome, Trochanteric Bursitis/Snapping Hip – These issues are common among runner, and as you can guess, are generally thought to be caused by muscular imbalances. You can try to alleviate these problems by foam rolling the piriformis, quadriceps and IT-Band, statically stretching the piriformis, biceps femoris and hip flexors, and performing exercises such as leg slides, floor bridge, lateral tube walking and ball squats.

Sciatica – Because sciatica can be caused by at least 6 underlying issues, there really is no one true way to best treat it (3). For best results, skip the exercise and talk to your doctor about medication options (4).

Strains – When it comes to strains of the groin and/or hip flexor, the general recommendation is to regain full range of motion, and restore full muscle strength, endurance, and coordination. You can prevent these injuries by doing programs similar to the one seen bellow (5).

Summary

One of the best ways to avoid injuries of the hips is to strengthen the hips. Because we sit on our butts all day long, we tend to lose the ability to use our glutes. This can lead to all sorts of problems in the long run. This is why I recommend you start by strengthening the glute muscles. Here is a great resource for learning how to strengthen the glutes. If you’re looking for pain relief, your best chance of seeing results quickly is to consult your doctor.

References

1. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement

Br. J. Sports. Med. 2016;50:19 1169-1176

2. Wall, P., Dickenson, E., Robinson, D., Hughes, I., Realpe, A., Hobson, R., Griffen, D., Foster, N. (2016). Personalised Hip Therapy: development of a non-operative protocol to treat femoroacetabular impingement syndrome in the FASHIoN randomised controlled trial. Br J Sports Med, 50:1217-1223 doi:10.1136/bjsports-2016-096368

3. Verwoerd, A. J. H., Luijsterburg, P. A. J., Lin, C. W. C., Jacobs, W. C. H., Koes, B. W., & Verhagen, A. P. (2013). Systematic review of prognostic factors predicting outcome in non-surgically treated patients with sciatica. European Journal of Pain (London, England), 17(8), 1126.

4. Lewis, R. A., Williams, N. H., Sutton, A. J., Burton, K., Din, N. U., Matar, H. E., . . . Wilkinson, C. (2015). Comparative clinical effectiveness of management strategies for sciatica: Systematic review and network meta-analyses. The Spine Journal : Official Journal of the North American Spine Society, 15(6), 1461-1477. doi:10.1016/j.spinee.2013.08.049

5. Tyler, T. F., Silvers, H. J., Gerhardt, M. B., & Nicholas, S. J. (2010). Groin injuries in sports medicine. Sports Health: A Multidisciplinary Approach, 2(3), 231-236. doi:10.1177/1941738110366820