injury Prevention – Page 2

Hip Pain Part 1 – Your Hips Do Lie

Some basic anatomy of the hips and some common injuries that occur.

The hip is a fickle beast. When it works well and without pain, it can be used to control nearly the entire body. But, when there is discomfort within the hip, it can be caused by nearly anything in the entire body. With so much potential for disaster and success, today’s post is the first of a two-part series. In this, the first post of the series, we will be going over some basic anatomy of the hips and some common injuries that occur. Next week we will be going over how to avoid injuries and some exercises to help you recover from hip pain. So let’s get these hips shaking!

All Roads Lead To The Hips

The hips are difficult to describe. The hips control 6 motions of the legs, and there are at least 4 other motions that can be produced within the hip itself. There are at least 24 muscles and 4 ligaments that need to be considered when talking about hip motion. Not to mention the complex array of nerves, cartilage, and other tissues that need to be taken into account. Instead of boring you with the specifics, I’ll just say that there are no black and white answers when it comes to your hip pain. But we do have a lot of opportunities to find clues to the answer for your problems.

Endless Possibilities

Hip problems are so complex that they may not even have symptoms that appear anywhere close to the hip! So let’s dive head first into some of the most common issues.

Femoroacetabular impingement (FAI) – FAI is the new kid on the block because we have only recently recognized it as a true issue. FAI can cause symptoms such as pain that you feel deep in the groin which may be mistaken as a groin strain (1). Overgrowth of the bones of the ball and socket joint of the hip cause tearing of cartilage in the joint (2). This problem can lead to early arthritis and affects about 10-15% of young adults (3). There is not a deep understanding of how this occurs yet, but we are learning more about it every day.

Labral Tear – The labrum is a cartilage bumper within the socket of the hip. This problem can cause pain, catching, or clicking in the groin with activities. Labral tears can be caused by issues such as FAI, but they require an MRI to be diagnosed (4).

Athletic Pubalgia – AKA sports hernia. This issue can cause pain in the lower abdominal or groin area of athletes. The injury affects the lower abdominal wall, or adductor tendons, and is generally related to sport-specific movements (e.g. slap shot). This injury may require an MRI to diagnose (5).

Hip Flexor Strain – The hip flexors are the muscles along the anterior (front) aspect of the hip. Pain in the front of the hip when lifting the leg up will be experienced with this injury.

Adductor Strain – Also known as a groin strain, this issue is tough to differentiate from other injuries of the hip (2). Usually, an adductor strain involves a stretch or possibly a small partial tear of the muscle or tendon. These injuries can have a gradual onset with diminished performance, and warms up, or, an acute onset that worsens during exercise (5).

Osteitis Pubis – This is an overuse condition causing inflammation of the junction between the pubic bones.You might feel pain deep in the groin when playing sports involving a rapid change of direction or bringing the lower extremity across the body. You might also experience pain radiating to the thigh or bone tenderness (5).

Piriformis Syndrome – This issue is described as a neuromuscular disorder that is presumed to occur when the sciatic nerve is compressed or involved at the level of the piriformis muscle (6). You may experience sciatica-type symptoms, pain when sitting, and/or pain with hip flexion, adduction, and internal rotation.

Trochanteric Bursitis/Snapping Hip – Pain at the top of the hip is common especially among runners. Sometimes associated with IT band syndrome, these issues can often be caused by friction, overuse, trauma or too much pressure. You may experience symptoms such as pain getting up off your bed or pain while lying on the floor and sharp burning pain over the lateral thigh that worsens with exercise for bursitis and snapping hip respectively (7).

Sciatica – Sciatica is the result of a neurological problem in the back or an entrapped nerve in the pelvis or buttock. You might experience a pain in the butt (not spouse related), numbness, weakness, leg pain, or a host of other symptoms (8)

Summary

The problems listed above are just the tip of the iceberg. There are loads of other injuries that I would love to get into, but I will save my nerdiness for another day. What you need to know is that your groin pain may not be a simple groin strain. The sciatica you have been complaining about all these years may not actually be sciatica at all. And no matter what the issue is, there is going to be a solution to your problem. So be sure to read my next post to find out how to resolve your rear end issues!

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References

1. Sansone, M., Ahldén, M., Jonasson, P., Thomeé, R., Falk, A., Swärd, L., . . . Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation. (2014). Can hip impingement be mistaken for tendon pain in the groin? A long-term follow-up of tenotomy for groin pain in athletes. Knee Surgery, Sports Traumatology, Arthroscopy, 22(4), 786-792. doi:10.1007/s00167-013-2738-y

2. Chakraverty, J. K., Sullivan, C., Gan, C., Narayanaswamy, S., & Kamath, S. (2013). Cam and pincer femoroacetabular impingement: CT findings of features resembling femoroacetabular impingement in a young population without symptoms. AJR. American Journal of Roentgenology, 200(2), 389.

3. Leunig M, Ganz R. Femoroacetabular impingement: a common cause of hip complaints leading to arthrosis [in German]. Unfallchirurg 2005; 108:9–10, 12–17

4. Falvey, E. C., Franklyn-Miller, A., & McCrory, P. R. (2009). The greater trochanter triangle; a pathoanatomic approach to the diagnosis of chronic, proximal,lateral, lower limb [corrected] pain in athletes. British Journal of Sports Medicine, 43(2), 146.

5. Falvey, E. C., Franklyn-Miller, A., & McCrory, P. R. (2009). The groin triangle: A patho-anatomical approach to the diagnosis of chronic groin pain in athletes. British Journal of Sports Medicine, 43(3), 213-220. doi:10.1136/bjsm.2007.042259

6. Miller, T. A., White, K. P., & Ross, D. C. (2012). The diagnosis and management of piriformis syndrome: Myths and facts. The Canadian Journal of Neurological Sciences. Le Journal Canadien Des Sciences Neurologiques, 39(5), 577.

7. Franklyn-Miller, A., Falvey, E., & McCrory, P. (2009;2008;). The gluteal triangle: A clinical patho-anatomical approach to the diagnosis of gluteal pain in athletes. British Journal of Sports Medicine, 43(6), 460. doi:10.1136/bjsm.2007.042317

8. Koes, B. W., M. W. van Tulder, & Peul, W. C. (2007). Diagnosis and treatment of sciatica. BMJ: British Medical Journal, 334(7607), 1313-1317. doi:10.1136/bmj.39223.428495.BE

Common Exercise Injuries To Look Out For

One of my passions lies in sports medicine, specifically Athletic Training (hence the ATC/L credentials).

Today’s post features a topic that is near and dear to my heart. This is because one of my passions lies in sports medicine, specifically Athletic Training (hence the ATC/L credentials). With that being said I want to remind everyone that I am not writing the content of these email, but merely sharing tips and tricks of the gym. So I feel I must say that what you are about to read is not intended to diagnose or treat anyone’s specific problem, and if you have any specific questions please visit your doctor 🙂

Okay lets get to the heart of this weeks topic EXERCISE INJURIES!!! Growing up without an ATC at any of my sporting event I had to do a lot of self assessment and treatment which is why I got my undergrad in Athletic Training. This post was written by Linda Melone on theprevention.com website, and features one of my favorite people to follow Dr. David Geier. It is very well written and features 8 injuries that I have seen/treated/experienced many times with excellent suggestions on how to avoid them.

1. Patella femoral overuse syndrome

Also known as patellofemoral pain syndrome (PFPS) and Runner Knee, this common problem manifests as pain under the kneecap that worsens when running, going down stairs, or sitting for long periods of time with knees bent. Tips to avoid this issue include strengthening the quadriceps muscles, as well as hamstrings and calves..

2. Rotator cuff tear

This injury involves damage to one of the four rotator cuff muscles that keeps your shoulder socket in place. Avoid repetitive overhead motions, and consider seeing a doctor if you modify your workout to minimize pain without improvement for a few days.

3. Anterior cruciate ligament (ACL) tear

This issue is more often than not a non-contact injury. It tends to happen when you land awkwardly from a jump, stop suddenly, change directions rapidly, and slowing down while running. There are many prevention programs, and bio-mechanics experts (cough cough) that can aid in preventing these injuries. However, preventative steps include always trying to land softly on your toes with your knees bent.

4. Boxer’s fracture

“Even if you’re not a fighter, participating in boxing classes or other training programs where you punch pads held by a trainer or you pummel a heavy bag can result in a boxer’s fracture.” I see these injuries more often in novice “punchers” and frustrated teenagers who punch the ground. Easy preventative steps include proper protection on your hands and again proper bio-mechanics.

5. Hamstring strain

Also known as a pulled muscle, these injuries can take as little as a few days or a week or two to heal or as much as six to eight weeks or even more! Prevention includes warming up thoroughly and knowing how/when to stretch.

6. Ankle fracture

These nasty injuries, along with ankle sprains, happen when you land awkwardly and invert or “twist” your ankle. Having proper proprioception (hand eye coordination) and making every effort to avoid landing on uneven surfaces are good strategies to avoid these problems.

7. Labral tear (shoulder)

I have had the unique pleasure of suffering, and getting surgery for, this injury myself! Although my injury was from a stiff arm during rugby, the author sums the core issue well as “Falling on an outstretched hand during a cardio class, a sudden pull trying to lift a heavy weight in CrossFit, or trying to stop yourself from falling can all result in this injury, defined as a tear of the cartilage bumper within the socket of the shoulder.” To avoid this injury, use a proper weight and, notice the common theme, use proper bio-mechanics.

8. Stress fracture

These tricky injuries also known as hairline fractures, often happen due to repetitive stress and usually take time to develop. Stress fractures are largely preventable if you stick to a plan that never increases your exercise by more than 10% per week and has varying routines.

I hope this post was informative, and if you want some more detail please read the article by clicking here.

All About Shoulder Strength & Stability

How to maximize your shoulders’ ability to move in a safe and injury resistance manner.

You have a choice. You can either move around in almost any direction, but be at a high risk of injury, or you can be strong, stable, and at a low risk of injury, but you can only move around a little bit. Which choice sounds better to you? Well, if you’re the joints of the hands and feet you chose the latter. But if you’re the shoulder joint, you chose the former. Being such a dynamic joint with a very low level of stability, the shoulder is naturally very prone to injury. That’s why today’s post is all about how to maximize your shoulders’ ability to move in a safe and injury resistance manner.

How It Works

There’s a lot of moving parts when we talk about getting the arm overhead. There are 12 ribs and their spinal attachments, 10 of which have attachments at the chest. You also have scapular motion through 3 dimensions (to the side, to the front, and rotations), humeral rotation and alignment within the glenoid fossa, AC and SC joint motions or limitations, spinal motion of, at minimum, the 12 thoracic spine segments, and 24 muscles that attach through the thoracic spine, scapula and humerus. In total, there’s motion from 38 joints, making for a whole lot of potential for things to get wonky. By simply raising your arms overhead, a trained eye can tell a lot about what’s going on in the upper body. Take a look at the table below, or this video, to see how important it is for the muscles and the joints of the upper body to be in sync (1).

What’s The Worst That Could Happen?

One thing that drives the issues seen above is the ever-growing tendency for us to sit! Putting other health issues aside, sitting is bad for us because it drives poor posture. Sitting drives the head forward and bends the spine in a way that makes it difficult for the shoulders to allow the arm to get overhead. It also decreases the flexibility of the big Lats and reduces the strength of the lower traps, rotator cuff, and serratus anterior (2). You may not care about those muscles, but what you probably care about is the fact that these issues can cause problems that include 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 (3,4). YIKES!

What’s The Best Solution?

The best solution always depends on the problem. So what’s your problem? Well, if you have to ask, you may want to seek out a professional to help you find out. In general, most people should work on a few things in particular. If you are fit and looking to do overhead or military presses to get big strong shoulders, you need to work on technique and changing up your mode of training (i.e. using resistance bands with dumbbells, bottoms up training, or changing the plane of motion). If you’re not quite ready for that level of intensity, you should be working on some basics. Essentially, you need to get some scapular (shoulder blade) positional stability and glenohumeral stability. Try to resist rotating the torso, and use a little bit of abs to hold it all together. Here are some great exercises to work on basic shoulder stability (5,6):

Prone extension – Lie face down with the shoulders resting in 90° and raise the arms up off of the ground

Forward flexion in side lying – While lying on your side with your top arm straight, raise and lower your arm off of the ground

External rotation in side lying – While lying on your side elbow flexed 90°, rotate your arm upward with a towel between the elbow and trunk to avoid compensatory movements

Prone horizontal abduction with external rotation – While lying face down hands by your hips, raise your arms off of the ground and squeeze your shoulders together

Push up plus – While in a push up position against a wall or on the ground, perform a full push up and emphasis on an extra push once the arms are fully extended (bonus points for using an unstable surface)

Plank walking – Hold a push-up position with the feet together and walk the hands sideways while keeping the feet in place making an arch

Bottom Line

To have healthy shoulders, good posture, and lower chances of upper body pain and injury, you need to work on the basics. External rotation exercises are underappreciated by almost everyone. Whether you like to lift heavy weights, or if you simply want to place a can of beans on the top shelf without pain, you need to be working on shoulder health. And while there are many ways to achieve happy shoulders, simply working on the muscles of the back is a good place to start. So, sit up in your chair, roll your shoulders back a few times, and take a deep belly breath. See how easy it is to get started?!

References

1. Howe, L., & Blagrove, R. (2015). Shoulder function during overhead lifting tasks: implications for screening athletes. Strength and Conditioning Journal, 37(5).

2. Weon, J., Oh, J., Cynn, H., Kim, Y., Kwon, O., & Yi, C. (2010). Influence of forward head posture on scapular upward rotators during isometric shoulder flexion. Journal of Bodywork & Movement Therapies, 14(4), 367-374. doi:10.1016/j.jbmt.2009.06.006

3. 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

4. Fayad, 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

5. De Mey, K., Danneels, L., Cagnie, B., & Cools, A. M. (2012). Scapular muscle rehabilitation exercises in overhead athletes with impingement symptoms: Effect of a 6-week training program on muscle recruitment and functional outcome. The American Journal of Sports Medicine, 40(8), 1906-1915

6. de Araújo, R. C., de Andrade, R., Tucci, H. T., Martins, J., & de Oliveira, A. S. (2011). Shoulder muscular activity during isometric three-point kneeling exercise on stable and unstable surfaces. Journal of Applied Biomechanics, 27(3), 192.

About Cupping: Good For Your Health or Just a Hickey?

Let’s take a look at the history of poor decision making by Olympians, what cupping is and its supposed benefits, and what it actually does.

If you have been watching the Olympics at all, you probably have noticed the results of cupping. And by that I mean the ridiculous red circles that can be found on many of the athletes. But, I mean if they’re doing it, it must work, right?!?! Well after some digging, I have the answer to that question. So let’s take a look at the history of poor decision making by Olympians, what cupping is and its supposed benefits, and what it actually does.

Pursuit Of Excellence

Olympic athletes are not the same as you and I. They will do anything to get the gold. That’s why over the years they have been the test subjects for many ridiculous health practices. They are willing to try anything, even if it’s nonsense. Athletes can be very superstitious and often believe anything they hear. In the past, they have brought us money wasting scams like Energy Bracelets, negative ions or energy frequency therapies, and the every popular kinesio tape. None of these remedies have been shown to work, and they all have risen and abruptly fallen out of vogue as soon as the athletes get wise to it. But is cupping going to make a rapid disappearance, or is it here to stay?

What Is Cupping?

At its core, cupping is a form of bloodletting intended to remove stagnant blood, expel heat, and treat high fever, loss of consciousness, convulsions, and pain. The process of cupping involves taking cups, which are usually glass but can also be plastic, bamboo or anything, are placing them on the skin, and reducing the air pressure in them via pumps or by heating them and causing cooling contraction. The cups are placed according to traditional acupuncture points. After the cups are removed, bruises remain.

Today, cupping is used for different purposes and advertised in ways that don’t involve the words “blood letting” for obvious purposes. Modern day cupping works by helping to align and relax qi. Back here on earth where reality is, cupping has been thought to draw blood to the affected area and produce hyperemia or hemostasis, which result in a therapeutic effect (1). Cupping can be sold to us by saying that the suction will remove undescribed and nonspecific “toxins” from the body, even though we don’t have toxin glands. And like other nonsense therapies, it has been claimed to treat and cure loads of ailments such as herpes, muscle strain, “meridian” diagnosis, as well as to increase blood flow, activate the immune system, cure back pain, and 999 other diseases (2).

Does It Work? You Better Believe It!

There is a ton of research on cupping. And out of all the ailments that it is reported to help, pain management is the only one that has a shred of evidence. A very tiny shred at that. Of course there is no credible evidence that it helps athletic performance, be it in swimming or any other sport. This is, in part, due to the fact that research into cupping is mostly negative or of poor quality and with high bias (3). But that doesn’t mean you shouldn’t give it a try! Even though currently, there is a lack of dosage guidelines or known effect which means practitioners are pretty much making it up as they go along doesn’t mean it won’t work. I mean, if pro athletes think it’s doing something even though it has no positive effect on the human body in regards to recovery or pain, then it must be working some other way right? If you’re asking that question, you would be right. The best explanation of how cupping works is through a psychological mechanism. In other words, cupping works because people think it works. The word placebo comes to mind. So even though the data says that it won’t work for anyone, if you believe hard enough it will work, great for you!

Whats The Worst That Could Happen

Okay. You decided that I am full of crap and that the appeal to antiquity is too strong on this one not to give it a try. So what’s the worst that could happen, you get a few bruises? Well when it’s all said and done, you don’t want to be one of the unlucky ones. With any treatment, there are side effects. Cupping has some nasty ones. You could end up with large holes in your back, or a hemorrhaged artery (4) or maybe something less serious like a burn or infection. Wet cupping does draw blood after all, and our skin is never all that clean. Cupping is no different than acupuncture, bloodletting, phrenology, or any other medical pseudoscience. The treatment is based in pre-scientific superstitions, and has simply been re-branded in order to more effectively market the treatment to modern customers.

If you’re looking to recover quickly after exercise, or perhaps for some pain relief, I suggest you skip the cups and the bruises and just get a nice massage. A good massage is relaxing, which is something we all need at times. But on top of this, it can significantly improve the healing of muscle, reduce tissue inflammation, and promote cell regrowth (5). Now there’s something to get excited about!

References

Cao, H., Li, X., & Liu, J. (2012). An updated review of the efficacy of cupping therapy. PloS One, 7(2), e31793.
Bamfarahnak, H., Azizi, A., Noorafshan, A., & Mohagheghzadeh, A. (2014). A tale of persian cupping therapy: 1001 potential applications and avenues for research. Forschende Komplementärmedizin (2006), 21(1), 42.
Lee, M. S., Kim, J., & Ernst, E. (2011). Is cupping an effective treatment? an overview of systematic reviews. Journal of Acupuncture and Meridian Studies, 4(1), 1.
Interv Neuroradiol. 2016 Aug 1. pii: 1591019916659264. Extracranial vertebral artery rupture likely secondary to “cupping therapy” superimposed on spontaneous dissection.
Crane, J. D., Ogborn, D. I., Cupido, C., Melov, S., Hubbard, A., Bourgeois, J. M., & Tarnopolsky, M. A. (2012). Massage therapy attenuates inflammatory signaling after exercise-induced muscle damage. Science Translational Medicine, 4(119), 119ra13.

Water Water Everywhere!

Today’s post is another double whammy! I am talking about staying healthy in the pool, and for those non-swimmers, the delicious healthiness of watermelon.

Today’s post is another double whammy! I am talking about staying healthy in the pool, and for those non-swimmers, the delicious healthiness of watermelon. I figure that in this heat everyone should be looking to use one or both of these things to stay cool

Watermelon is one of my favorite foods because of how useful it is. Whether you slice it, cube it, freeze it, or make a drink from it, watermelon is endlessly delicious. Better yet, it is HEALTHY! Some of it’s good qualities include:

– Natural hydrator by containing 92% water

– Having heart healthy nutrients such as lycopene and citrulline

– An arginine precursor that can decrease body fat and enhance muscle

– Decrease post-exercise muscle soreness

Now that we know that watermelon helps out so much with exercise, lets take a look at swimming as a way to stay healthy. We all know that swimming is a great way to stay in shape. In fact swimming has been shown to reduce death rates in men, as well as decrease blood pressure. But it is not without its own set of risks for orthopedic injuries of the shoulders, knees, and lower back. So here are a few tips to keep those joints feeling good:

– Work on your stroke mechanics, and correct them before you develop pain

– Use traditional rehabilitation exercises as part of your injury prevention program. Target and strengthen the abdominal muscles, rotator cuff muscles, muscles around the shoulder blade, lower back muscles, and quadriceps and hip muscles (see me for details on how)

– When you are experiencing pain, tell some one and ADDRESS IT!!! Don’t fight through the pain. It drives me nuts when my athletes do this.

I hope everyone enjoyed this weeks post! Be sure to check out the NASM blog post about watermelon to get some great recipes, and check out Dr. Geier’s blog for more info about preventing injuries while swimming.

Serape Diem: Functional Core Exercise’s You Should Be Doing

How are you going to translate the force produced from those strong legs to the arms? By utilizing the Serape effect of course!!!!

Imagine your body is made up of two big blocks of meat. You have your upper body and you have your lower body. Now imagine you want to use both of those big blocks of meat simultaneously to do something like throw/hit a ball, dig a hole or golf , push a cart full of groceries, or punch a heavy bag. How are you going to translate the force produced from those strong legs to the arms? By utilizing the Serape effect of course!!!! The Serape effect is basically the use of the core to translate force from the lower body through the arms. There are a variety of “functional” exercises that you can, and should, be doing to make sure you’re not overusing joints which can lead to injury. So now that you have a little background knowledge, let’s dive into today’s post!

“Functional”

The term “functional training” is a bit of a buzzword garbage term. My favorite quote regarding this is from James Fell that says “It’s meaningless. Any time someone says an exercise is functional it means they don’t know what they’re talking about. All exercises are functional. Your mom is functional.” Funny and true. All exercise has function, and a variety of exercise is important to maintain function. For instance, if you exclusively use exercise machines, you may lose the ability to use those strong muscles in a rotational fashion. That’s where the functional aspect of training the Serape comes in. Broadly, the core can be described as being between the joints of the shoulders and hips.The muscles that attach the pelvis, spine, and rib cage perform many functions. Hip musculature generates the majority of power, then transfers it upward through the linkage to the arms through a “stiffened” core, which creates efficient transfer of forces, and is one of the keys to injury prevention. The Serape involves these features from both ends of the core in a spiral pattern (1). It actually wraps itself around the trunk of the body, perfectly designed for rotating the hips and shoulders in an opposite direction allowing the hips to lead and the shoulder to follow in many ground-based activities such as throwing, batting, golfing, or punching (2). Take a look at the pictures below and/or this video for a good visualization of how it works.

If you’re a nerd like me and want to know what exact muscles are involved, here are some pictures detailing the exact muscles used with the Serape.

Serape Training For Beginners

Training the Serape muscles is easier than it looks. Yes, there are a lot of muscles involved. But remember, we are not isolating any single muscle in particular, we are learning how to use them all in an efficient manner. If you’re not doing so already, you will want to start doing Olympic-style lifts and traditional strength lifts such as squats, bench press, and pull-ups. These are non Serape specific exercises, but if you don’t have strength in the upper and lower body then you won’t have strength to translate through the core to begin with! You will also want to start by training the four basic trunk movement patterns with dynamic and/or static exercises. Beginners should do exercises that train in what we call single-plane basic movement patterns. Single-plane exercises are usually easy to learn and include exercises such as the crunch (trunk flexion), back extension/hyper-extension (trunk extension), Russian twist (trunk rotation), and side bend (lateral flexion) (3).

For those more advanced, you may want to consider multi-plane exercises that target areas you’re not getting with your standard training. This is because there is huge inter-personal variety in terms of which ab-exercises work best for whom (4). By simply extending your arms over your head during a crunch, you can drastically increase abdominal muscle involvement. Take a look at the chart below to get an idea of what exercises work for different parts of the core (the lower the number the better). Before we move on to the last section of this post, I think it’s important to note that any exercise performed for abs will always use all the muscle groups that compose the abdominal wall when done correctly. Proper technique is paramount to all exercise, so make sure that you consult a professional if you are a novice, are unsure of what you’re doing, or experience pain during exercise.

Hard Work Pays Off

While it’s been long proven that abdominal exercises won’t turn a beer belly into a six pack, we do know that core exercises are paramount for a healthy body and for safety during exercises that will get you strong and help you lose weight (5). Core stiffness enhances athletic performance, and guess what your doing at the gym?… performing athletically (6)! So once you have set the foundation of a strong body, you can get into the fun exercises that greatly enhance your athletic performance on and off the playing field, (aka daily life activities). Here are some of the best ways to train the Serape movement pattern:

– Rotating exercises done from a standing position and alternating punching/pressing and pulling

– Utilize various stances, 2-arm and single-arm loading

– Alternating pressing/pulling patterns, as well as different stepping movements

I’ll finish up by reminding you of why we are working on the core and Serape. Muscles of the Serape form a spiraling system that enhances the efficiency of cyclic activity such as walking, together with power and speed activities such as throwing and golf. The stiffened core enables power produced in the lower limbs to transfer to the joints of the upper end of the core (or vice versa) forming a whip. So get of those machines and start whipping yourself into shape!

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References

Santana, JC., McGill, Stuart M., Brown, LE., (2015). Anterior and Posterior Serape: The Rotational Core. Journal of Strength and Conditioning Research, 37(5), 1519
Santana JC. The serape effect: A kinesiological model for core training. Strength Cond J 25: 73–74, 2003.
Willardson, Jeffrey M., editor of compilation, & ebrary, I. (2014). Developing the core. Leeds: Human Kinetics.
Boeckh-Behrens & Buskies, Fitness- Krafttraining. Die besten Übungen und Methoden für Sport und Gesundheit, 2000
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.
Lee, B. C. Y., & McGill, S. M. (2015). Effect of long-term isometric training on core/torso stiffness. Journal of Strength and Conditioning Research, 29(6), 1515.

All About The Heat, Hydration, & Sweat

Let’s take a look at what you should be doing to keep yourself healthy and cool while exercising and looking hot!

Today I wanted to stay on the theme of fluid consumption, so let’s take a look at how to have fun and stay safe during the summer heat. This topic is important to me for many reasons. I am an Athletic Trainer which means I am a health care professional who collaborates with physicians to provide preventive services, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions. So naturally, I want to keep everyone safe. In addition, I am a super heavy sweater, so I know firsthand the perils of not properly preparing. So let’s take a look at what you should be doing to keep yourself healthy and cool while exercising and looking hot!

Warm Up to The Heat

When it comes to exercising in the heat, you don’t want to go into it cold. And by that I mean, you need to get your body prepared for the extra stress that heat places upon it. Acclimation is the process by which the body adapts to heat stress, and it is a crucial element to heat safety. Because it can take a few weeks to get acclimated, you want to slowly increase the volume, duration, and intensity of your training. The complete process will vary depending on activity, but in general, during days 1-5 there should be light to moderate exercise lasting no more than 1 hour. During days 6-14, increase the exercise load up to 3 hours (1). This process is extremely important and should be taken seriously. It would also be wise to learn about the dangers of heat illness such as heat syncope, exercise (heat) exhaustion, and exertional heat stroke (2). Especially when you’re starting to get used to the heat, it is wise to prepare yourself by adjusting your training sessions, training with a partner, pre-cooling with ice towels before exercise. Try to and have ice vests/towels and even cold-water baths ready in case you need to rapidly cool down.

Sweet Scent of Sweat

Sweating is a normal, expected outcome of exercise. And before we talk about how much you should be drinking, it’s important to know how much you’re sweating. One way to figure this out is to use the simple test of weighing yourself before and after a run to get a sense of how much fluid you’re losing. This way you know how much water you need to be drinking during that time span.

But why do some people sweat more than others? Well, the answer might not be what you expect because it doesn’t have to do with how much body fat you have, or if you’re in great cardiovascular shape (3)! Sweating is a cooling mechanism that aims to dampen your skin. Then the sweat gets evaporated, and that process of evaporation cools you down. So essentially, those who produce more heat will be the ones who sweat more. Acclimation plays a role in this as well because as you exercise more in the heat, your body knows that you will be getting hot, so it starts producing a lot sweat quickly (4). There are other factors that play into how much you sweat. Factors you can’t change include how many sweat glands you’re born with (2 – 5 hundred thousand) and the fact that men sweat more than women (5). Modifiable factors that will make you sweat more include taking stimulants (e.g. caffeine), alcohol consumption, nicotine, and non-breathable clothing such as synthetic fabrics. There are also medical issues that will make you sweat more including hyperhidrosis and anxiety that require a doctor to diagnose.

Hydration, Electrolytes, Cramps, And Other Myths

When it comes to hydration during exercise, and life in general, there are a lot of myths, old wives’ tales, and misinformation thrown around on the internet. This is a bit off topic, but I would like to start by saying you don’t need to drink 8 glasses of water a day regardless of what marketing departments tell you (6). Even though dehydration will decrease your metal abilities, you would need to fight the urge to drink something for quite a while before that takes effect. Up next, coffee does not dehydrate you (7)!!!!!! Drinking coffee in isolation won’t cause dehydration because, guess what, it’s a liquid. The water that comes with the coffee far offsets the increase in sweating that comes with it. Here comes the big shock of the post… hydration and electrolytes have NOTHING to do with cramps during exercise (8)! This widespread misconception is again largely driven by marketing. Cramps are more likely caused by a high intensity of exercise, family history of cramps, and muscle damage (9). The latter point is the most important. Muscle damage caused by excessive heat can be a sign that your body is entering a danger zone. So when you’re exercising outdoors in hot and humid weather, take cramps seriously as a possible sign of heat illness (10).

Now that the myth busting is out of the way, let’s dive into what you should be doing to be safe in the heat. The first tip is to begin with the end in mind. And by that I mean you should come into an exercise session already hydrated. Euhydration is when you’re at an ideal, or slightly greater than ideal, level of hydration. This is important because many people can only drink about a liter of fluid an hour even though they sweat much more than that (11). So how can you tell if you’re at a euhydrated state? Well the answer is in your pee! Check out the chart below to see where your hydration level should be.

AM I HYDRATED? A URINE COLOR CHART

There are many hydration strategies out there, but your best bet is to just sip on water regularly throughout your exercise routine. If you don’t like the taste of water, then you can drink something with a little more flavor if you prefer. No matter what you drink, the end result will be about the same. But it’s important to remember that unless you are exercising for more than two hours, sports drinks aren’t going to be beneficial and will only add to your total amount of calories consumed for the day. The most important thing to do is weigh yourself before and after your exercise and drink back what you lost during that time.

Stretching The Truth

Today I wanted to talk about what stretching does. There are a lot of misconceptions about the actual effects of stretching are, and I am constantly asked about topic pertaining to stretching. Here are a few commonly asked questions; what should I stretch? how long/often should I stretch? what will stretching do for me? should I even stretch at all? Each one of these questions are important so I will address them one by one.

What should I stretch?

The answer to this is… it depends! There is no need to stretch a muscle that is at an already acceptable level of tonicity. Yes, a hamstring stretch feels nice but for most people the hamstring is not the problem. In many cases the hamstring feels tight because the hip flexors are putting them in a state of constant tension. This problem an even manifest as lower back pain! So, should you stretch the hamstring? No. You should stretch the hip flexors so that the hamstrings are able to get back to a normal resting length. This same situation, where one tight muscle causes another area of the body to have a problem, can happen throughout the entire body. In essence, if you want to know what you need to stretch you should probably take advantage of those free program design sessions to figure out what exactly is going on with your body.

How long/often should I stretch?

There is no definitive answer to these questions. However, a good rule of thumb to go by is stretch for around 30 seconds at least 5 days per week. The best time to stretch is after you’re done working out. “Not in the warm up?” you ask. The answer is no. Stretching the wrong area in the warm up can even be a bad thing in some cases. Like other forms of relaxation, stretching can also be the best thing for you when you feel stressed and anxious.

What will stretching do for me?

Let’s start with the things stretching DOESN’T help with. Stretching will not help with preventing delayed onset muscle soreness, injury prevention, enhancing performance, aligning muscle/tendon fibers, trigger points, or increasing muscle length. Wait… what? Stretching does’t increase muscle length? No, but I’ll explain that in a little bit. What you should know is that stretching is good for the heart, the mind, and,most importantly, it’s good for the nerves.

Should I even stretch at all?

The answer is absolutely YES. General whole body stretching is necessary to stay mobile. You need to be able to move, so stretching is a must. Moreover, a targeted stretching program can be used as a way to enhance a workout (think back to the hamstring and hip flexor story). This is why almost all of my clients receive stretching as a part of their corrective exercise strategy.

So at this point you might be asking your self “WTFruit happens when I stretch? I mean won’t it make me more flexible?!?!” Well here’s how it works. We all adapt to the stresses we put on our bodies. In turn, our bodies try to make our life more efficient to those stresses (i.e. our hip flexors become short if we sit for long periods of time every day). This action happens the nerves in the muscles sending signals to the brain on what is a “safe” length for the muscles to be at through the stretch reflex. What stretching does is increase the tolerance, or muscle length until you feel, the stretching sensation. Thus, becoming more flexible through stretching is a result of decreasing the sensation of stretching. It’s the same reason why you need two cups of coffee now even though you used to only need one. Our brain, and our nerves, just need a little more stimulus (whether its stretching or caffeine) to get the same effect as when we first started.

Bottom line. If you want to have the right range of motion, your brain, nerves, and their connection to your muscles, must be in tune. Stretching will help keep homeostasis, but other than that… well, not much else. For more info you can check out the first brief link and more extensive second link.

The Cause Of, And Solution To, Back Pain

There are too many myths about what causes back pain, and far too many treatments for back pain to ignore (most of which are a waste of time and money).

Today I wanted to give a more in-depth look at causes and solutions to lower back pain. I have previously written about this in a more general sense, but I really feel like this topic deserves more attention. There are too many myths about what causes back pain, and far too many treatments for back pain to ignore (most of which are a waste of time and money). So let’s dive into some surprising factors causing pain, and some practical tips on how to deal with it!

Why Do I Hurt?!?!

I’ll start by saying that 80% of people will experience an episode of back pain during their lifetime. So it’s good to know you’re not alone in wondering what’s going on with your back. But the reason behind your back pain is surprisingly complicated. Aside from acute sprains and strains, the exact diagnosis of the root cause of the problem is often never made, or made incorrectly.

Imaging

We know that using techniques such as X-ray and MRI are often ineffective at catching the true problem (1). This is because most people, HEALTHY pain free people, already have some form of disc or spine degeneration (2). This simple fact can be very misleading when doctors are trying to interpret radiographic findings. The only exception to this rule seems to be for SI joint dysfunction, but even that has some major issues (3). Ultimately, this means that there is no evidence that back pain is caused by a bone or joint in the back being out of place, some change in spinal alignment, or your pelvis being out of alignment. . But on the bright side, we know that more pain does not always mean more damage! Here are two great podcasts going over in detail what types of examinations are often used, and which ones actually workONE TWO.

Back Pain Exacerbates Itself

Often times pain can make someone afraid to move. This is called kinesiophobia and when it comes to back pain it can be terribly detrimental. This is because movement is key to preventing pain and getting your back better! We know that bending and lifting is not a problem, but rather that muscular fatigue during these tasks can be what causes back pain (4). And we know that stress and a lack of sleep can also cause low back pain (5,6). And if you read my previous post on back pain, you will know that sitting too long can cause back pain. So I hope by now you can see how back pain can make itself worse over time, and that it may not be caused by any physical issue that you may already have to begin with.

What To Do About That Back

DON’TS

Because there is generally no specific cause of back pain, there really is no specific way to treat it. However, we do have a good idea of what works and what doesn’t work. Let’s start with what’s on everyone’s minds… the core. Core training, is often the go to fix for back pain because one would think that a stable back/spine is what’s needed to fix a back problem. But as we know the spine is often not the problem so core training (e.g. targeted core training or Pilates) is not the solution (7). We also know that surgery, orthotics, or focusing on “perfect posture”are not helpful as well. Finally, alternative methods such as massage, trigger point therapy, glucosamine, and back crackin don’t work either (8)

DO’S

One great way to address the pain is by not freaking out and going to your doctor right away. The majority of people who experience back pain have their problems go away within 2-6 weeks of it’s onset. Even the dreaded disc herniation goes away on it’s own over time. Exercise your whole body to see the greatest benefits for both back pain and general health. Aside from making sure you have a strong tooshie (gluteus medius), there is no specific form of exercise that works the best but it seems that total body strength training does the trick (9). If you’re not up for that, then WALK!!! Walking has been shown to be just as effective, and walking backwards may even be a better way to go (10).

The key in all of this is to make sure you get a lot of exercise. Because when it comes down to it, it’s the quantity NOT the quality of exercise that you get that will solve your issues (10).

References

1. Chou, R., Qaseem, A., Snow, V., Casey, D., J. Thomas Cross, J., Shekelle, P.. . American Pain Society Low Back Pain Guidelines Panel. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the american college of physicians and the american pain society. Annals of Internal Medicine, 147(7), 478.

2. 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

3. Laslett, M. (2008). Evidence-based diagnosis and treatment of the painful sacroiliac joint. The Journal of Manual & Manipulative Therapy, 16(3), 142-152. doi:10.1179/jmt.2008.16.3.142

4. Seyed Hoseinpoor, T., Kahrizi, S., Mobini, B., & Naji, M. (2015). A comparison of abdominal muscle thickness changes after a lifting task in subjects with and without chronic low-back pain. Human Factors: The Journal of Human Factors and Ergonomics Society, 57(2), 208-217. doi:10.1177/0018720814544213

5. Truchon, M., Côté, D., Schmouth, M., Leblond, J., Fillion, L., & Dionne, C. (2010). Validation of an adaptation of the stress process model for predicting low back pain related long-term disability outcomes: A cohort study. Spine, 35(13), 1307. doi:10.1097/BRS.0b013e3181c03d06

6. Alsaadi, S. M., McAuley, J. H., Hush, J. M., Lo, S., Lin, C. C., Williams, C. M., & Maher, C. G. (2014). Poor sleep quality is strongly associated with subsequent pain intensity in patients with acute low back pain: Sleep quality and pain intensity. Arthritis & Rheumatology, 66(5), 1388-1394. doi:10.1002/art.38329

7. Wang, X., Zheng, J., Yu, Z., Bi, X., Lou, S., Liu, J.. . Chen, P. (2012). A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PloS One, 7(12), e52082.

8. Hegedus, E. J., Goode, A., Butler, R. J., & Slaven, E. (2011). The neurophysiological effects of a single session of spinal joint mobilization: Does the effect last? The Journal of Manual & Manipulative Therapy, 19(3), 143-151. doi:10.1179/2042618611Y.0000000003

9. Cooper, N. A., Scavo, K. M., Strickland, K. J., Tipayamongkol, N., Nicholson, J. D., Bewyer, D. C., & Sluka, K. A. (2016). Prevalence of gluteus medius weakness in people with chronic low back pain compared to healthy controls. European Spine Journal, 25(4), 1258-1265. doi:10.1007/s00586-015-4027-6

10. Ferreira, M. L., Smeets, R. J. E. M., Kamper, S. J., Ferreira, P. H., & Machado, L. A. C. (2010). Can we explain heterogeneity among randomized clinical trials of exercise for chronic back pain? A meta-regression analysis of randomized controlled trials. Physical Therapy, 90(10), 1383-1403. doi:10.2522/ptj.20090332

Foam Rollin Rollin Rollin

Foam rolling is a form of self myofascial release (SMR) used on tight muscles. But the question remains… what does foam rolling actually do?!?!

Foam rollers… you see them, you may even use them, but what are they good for? That is the question I am hoping to answer today! Foam rolling is a form of self myofascial release (SMR). I use this modality with many of my clients who have tight muscles and reduced flexibility at specific joints in an effort to get those tight areas to relax before an exercise session. I go through great efforts to identify muscle imbalances in my clients that need SMR, stretching, or conversely, strengthening. But the question remains… what does foam rolling actually do?!?! Well a fantastic review came out recently using 118 research papers. So here is a summary of what is going on with the body when we use SMR techniques, and what it is useful for.

What happens when we foam roll

I think it is prudent to first look at what fascia is, because that is the targeted tissue of SMR. Well fascia is complex, but it can be described as force transmission system made up of connective tissue that permeates the human body. Some times tender spots in discrete, taut bands of hardened muscle that produce local and referred pain develop. These are spots are called trigger points. Subsequently, these trigger points are targeted during SMR before or after exercise.

Although we (i.e. the scientific literature) are still not sure on exactly why SMR works, the best evidence points towards a neurophysiological mechanism (like stretch tolerance). This mechanism involves changes in muscle activity acutely, which differs from the way stretching is effective. Other ways SMR may work include lowering tissue pH, releasing inflammatory mediators (reduce inflammation), and re-hydrating the tissue.

What foam rolling is good for

ACUTE (IMMEDIATE) EFFECTS OF FOAM ROLLING ON FLEXIBILITY

SMR causes an increase in short-term flexibility that lasts for >10 minutes. However, it’s not exactly clear how much SMR is needed to achieve this outcome. Unlike stretching, SMR does not affect athletic performance in the short-term. Static stretching, on the other hand, often causes a temporary reduction in muscle performance. Additionally, SMR may decrease soreness and increase pressure pain threshold as a result of DOMS (delayed onset muscle soreness) during the 48 hours following exercise.

CHRONIC (LONG TERM) EFFECTS OF FOAM ROLLING ON FLEXIBILITY

SMR can increase flexibility in a long-term program of >2 weeks with effects similar to traditional stretching programs. Research has also found SMR to improve arterial stiffness, improve vascular endothelial function, reduce cortisol (stress hormone) levels post-exercise, increase parasympathetic activity(high frequency HRV), and reduce sympathetic activity (low frequency HRV). Interestingly, SMR might also improve balance in chronic stroke patients.

Key takeaways

There is a lot of information above but when it comes to YOUR exercise routine, here’s what you need to know. SMR can help with your flexibility immediately after foam rolling for a short time, and will have lasting results when done consistently. It will also help with DOMS so you don’t feel like crying the day after you do squats! Finally, it will tell your brain to release happy hormones so you leave the gym with a big ole smile 🙂

For more information, and to learn about the nerdy sciency stuff, you can access the article at the link here.