Strength – All Me Fitness

25% Of Us Have Knee Pain Due To…

Just because it’s common doesn’t mean you have to develop it or that it will last forever. So don’t stop moving!

Our knees hate us. Or at least it can seem that way when they aren’t doing what we want them to do. Creaky, achy, and wonky knees are all too common among my friends when I ask them to help me move. And while those may be excuses for them, I bet it’s a reality for most of you. The sad part is that because the knee is so complex, it is often misunderstood. When you have a bum knee, rest is almost never the answer. This is particularly true for the 25% of us who will end up having knee pain due to patellofemoral pain syndrome (PFPS) (1). Also known sometimes as runner’s knee, PFPS is a complex issue without one true solution. Let’s take a look at why the knee cap can make us feel like knee crap!

So What’s The Problem Again?

As the name implies, PFPS is not a single problem but a group of signs and symptoms. Generally, the epicenter of the pain is somewhere under or around the kneecap, and will usually be mainly on the front of the knee. It can be caused by variations in strength, flexibility, patellar tracking, quadriceps angle, and patellofemoral joint (PFJ) morphology and even psychological issues such as depression, fear-avoidance, and anxiety (2). However, I like to think of PFPS as the knee leaving homeostasis. Homeostasis can be described as a zone, or “envelope of function”, where the tissue is capable of tolerating loads (3). So as you get stronger, you increase your envelope of function. And when you over-do it with your training, your knee may no longer tolerate levels of loading even during routine activities, such as descending stairs or previously well-tolerated running distances (4). In other words, when you over-do-it with your training or exercise, you may not be able to do half as much as you used to without pain.

How Do I Avoid/Fix The Problem?

While I would love to tell you how to screen yourself for potential red flags, there really aren’t any good predictors of injury (5). What will help you out is strengthening the quadriceps (6). By using a progressive overload scheme (aka gradually doing more over time), you can make those quads stronger and avoid pain and/or injury! Here are some exercises to try out for good quad activation and strengthening (4):

– Knee extension with a weight attached to the ankle

– A knee extension machine

– Single leg squat to at least 65 degrees of knee flexion

– Squatting between 0 and 45 degrees of knee flexion

– Leg presses between 0 and 45 degrees of knee flexion

You can also try taping (anywhere on the front of the knee) or bracing the knee to alleviate the pain. You can pretty much tape your knee however you want because it doesn’t change the biomechanics of the knee (7). Strengthening the hip muscles will be helpful for more than just bikini season because strengthening those glutes (and other muscles of the hip) can help reduce pain and improve function (8). Similar to taping and bracing, strengthening the hips won’t improve biomechanics. Hip strengthening will, however, increase the load tolerance of the knee and supportive structures (9).

For Runners

This segment is for runners, so feel free to skip it if you don’t anticipate doing a 5k anytime soon. Runners, in particular, are susceptible to having issues with their movement patterns that can lead to knee issues. Movement re-education through simple techniques can be extremely helpful for reducing knee pain. Reducing hip drop while running is a great way to help reduce knee pain. In addition to using glute strengthening techniques, mirror and verbal feedback can reduce hip drop and hip adduction (knee movement inwards) while running (10). A general increase in step rate by 5-10% can also be very beneficial for reducing knee load and pain (11). A metronome works great for achieving a faster gait pattern.

Summary

While knee pain may never be completely eliminated, there are some steps that can be taken to decrease pain and the likelihood of developing pain. Work toward having strong quadriceps, move with good technique and don’t advance your exercise routine too quickly. And while shock absorbing insoles and arch supports may be useless, throwing on a little tape or knee support may give you enough pain relief to build up your leg strength (12). For runners, watch yourself in the mirror and make sure you don’t have hip-drop and increase your running cadence. Just because PFPS is common doesn’t mean you have to develop it or that it will last forever. So don’t stop moving!

References

Nunes, G. S., Stapait, E. L., Kirsten, M. H., de Noronha, M., & Santos, G. M. (2013). Clinical test for diagnosis of patellofemoral pain syndrome: Systematic review with meta-analysis. Physical Therapy in Sport : Official Journal of the Association of Chartered Physiotherapists in Sports Medicine, 14(1), 54-59. doi:10.1016/j.ptsp.2012.11.003
Meira, E. P., & Brumitt, J. (2011). Influence of the hip on patients with patellofemoral pain syndrome: A systematic review. Sports Health: A Multidisciplinary Approach, 3(5), 455-465. doi:10.1177/1941738111415006
Gabbett, T. J. (2016). The training-injury prevention paradox: Should athletes be training smarter and harder? British Journal of Sports Medicine, 50(5), 273. doi:10.1136/bjsports-2015-095788
Willy, R. W., & Meira, E. P. (2016). CURRENT CONCEPTS IN BIOMECHANICAL INTERVENTIONS FOR PATELLOFEMORAL PAIN. International Journal of Sports Physical Therapy, 11(6), 877.
Whittaker, J. L., Booysen, N., de la Motte, S., Dennett, L., Lewis, C. L., Wilson, D., . . . Stokes, M. (2016). Predicting sport and occupational lower extremity injury risk through movement quality screening: A systematic review. British Journal of Sports Medicine, , bjsports-2016-096760. doi:10.1136/bjsports-2016-096760
Kooiker L Van De Port IG Weir A Moen MH. Effects of physical therapist-guided quadriceps-strengthening exercises for the treatment of patellofemoral pain syndrome: A systematic review. J Orthop Sports Phys Ther. 2014;44(6):391-B391.
Whittingham M Palmer S Macmillan F. Effects of taping on pain and function in patellofemoral pain syndrome: A randomized controlled trial. J Orthop Sports Phys Ther. 2004;34(9):504-510.
Lack, S., Barton, C., Sohan, O., Crossley, K., & Morrissey, D. (2015). Proximal muscle rehabilitation is effective for patellofemoral pain: A systematic review with meta-analysis. British Journal of Sports Medicine, 49(21), 1365-1376. doi:10.1136/bjsports-2015-094723
Willy RW Davis IS. The effect of a hip-strengthening program on mechanics during running and during a single-leg squat. J Orthop Sports Phys Ther. 2011;41(9):625-632.
Willy, R. W., Scholz, J. P., & Davis, I. S. (2012). Mirror gait retraining for the treatment of patellofemoral pain in female runners. Clinical Biomechanics (Bristol, Avon), 27(10), 1045-1051. doi:10.1016/j.clinbiomech.2012.07.011
LENHART, R. L., THELEN, D. G., WILLE, C. M., CHUMANOV, E. S., & HEIDERSCHEIT, B. C. (2014;2013;). Increasing running step rate reduces patellofemoral joint forces. Medicine & Science in Sports & Exercise, 46(3), 557-564. doi:10.1249/MSS.0b013e3182a78c3a
Bonanno, D. R., Landorf, K. B., Munteanu, S. E., Murley, G. S., & Menz, H. B. (2016). Effectiveness of foot orthoses and shock-absorbing insoles for the prevention of injury: A systematic review and meta-analysis. British Journal of Sports Medicine, , bjsports-2016-096671. doi:10.1136/bjsports-2016-096671

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

What’s In Your Protein Shake?

it’s not the when, but the what and how much that truly matters.

Lifting weights and drinking protein shakes go hand in hand. Because getting that protein flowing through your veins immediately after a workout is the essential,right? Well, not really. Because it’s not the when, but the what and how much that truly matters. So whether you’re a vegetarian, meat eater, or milk drinker, I have the shake answers for you!

Why Not When?

The old way of thinking that you must get protein within your “anabolic window” after you workout is nothing more than a meathead myth. There have been loads of studies on the matter, and we know with a pretty high level of confidence that having protein immediately after your workout will have the same result as having protein 6 hours after your workout (1). Unless you’re Wolverine and have super fast healing powers, your muscles take a long time to repair and regenerate after getting broken down during your workouts. In fact, muscles can be highly sensitive to the anabolic influence of protein up to 2 days after a workout (2)! Now, I will say that there is one caveat to protein timing. It is most beneficial to consume protein every 3 hours. However, that point is moot if you’re not getting enough total protein.

What Totally Matters?

What matters more than the type of protein and the timing of protein is the total protein you get in a day. Like sleep, if you’re not getting enough, it doesn’t matter when you get it. Just get more! There really is no limit to how much protein you can have in a day. We know that very high protein diets don’t result in harmful effects on blood lipids (cholesterol) or liver and kidney function (3). We also know that not getting enough can result in sub-optimal recovery from exercise, and poor health outcomes especially for an older population (4). While the general recommendation is 1.2 to 2.2 g/ kg of body weight (1g/lbs) of protein per day, I personally recommend shooting for 100g of protein a day as a starting point. That means getting 20g of protein every 3 hours. This isn’t a strict recommendation. Your body can process a lot of protein at one time, especially when the protein eaten. Even if you drink your protein, the old myth of your body only being able to process 20g of protein at a time has been busted. Especially after a full body workout, you will utilize every bit of a 40g protein drink without wasting anything (5).

Yo Soy Whey Cool

So what does all the previous information have to do with protein shakes? Well, for most people, trying to get 20g of protein every 3 hours means drinking a shake every now and then. It may also mean that when your choice of protein sources is limited (vegan/vegetarian), that you will need to find a way to get a few key protein components into your routine. This is due to the fact that plant protein sources, such as soy and peas, are often low in key amino acids such as methionine, tryptophan, lysine, and leucine. This means you will need to plan ahead to make sure that you get all of these essential amino acids, leucine being of the greatest importance, especially after a workout. Regardless of the source, you will want to look for proteins high in leucine because that’s the component that will help your muscles repair and develop the best (6). Instead of blabbering on, I’ll finish with a list of fun facts and pertinent tips:

Best protein sources for weight loss – casein and soy. These protein sources will fill you up the best, which means you need to eat less, which means you lose more weight (7).

BCAA’s are worthless – Drinking protein during your workout won’t really do anything at all to help you gain more muscles. BCAA drinks won’t make you feel full or burn more calories than eating your protein or drinking a shake either. Unless you’re in the middle of a marathon, skip the BCAA’s.

Confused? Here’s what to do – Focus on getting more protein in general. Don’t worry about the minutia until you nail down the basics. When it comes to protein, the more the better!

References

1. Schoenfeld, B. J., Aragon, A. A., & Krieger, J. W. (2013). The effect of protein timing on muscle strength and hypertrophy: A meta-analysis. Journal of the International Society of Sports Nutrition, 10(1), 53-53. doi:10.1186/1550-2783-10-53

2. McGlory, C., Devries, M. C., & Phillips, S. M. (2016). Skeletal muscle and resistance exercise training; the role of protein synthesis in recovery and remodelling. Journal of Applied Physiology, , jap.00613.2016. doi:10.1152/japplphysiol.00613.2016

3. Antonio, J., Ellerbroek, A., Silver, T., Vargas, L., Tamayo, A., Buehn, R., & Peacock, C. A. (2016). A high protein diet has no harmful effects: A one-year crossover study in resistance-trained males. Journal of Nutrition and Metabolism, 2016, 1-5. doi:10.1155/2016/9104792

4. Deutz, N. E. P., Bauer, J. M., Barazzoni, R., Biolo, G., Boirie, Y., Bosy-Westphal, A., . . . Institutionen för folkhälso- och vårdvetenskap. (2014). Protein intake and exercise for optimal muscle function with aging: Recommendations from the ESPEN expert group. Clinical Nutrition (Edinburgh, Scotland), 33(6), 929-936. doi:10.1016/j.clnu.2014.04.007

5. Macnaughton, L. S., Wardle, S. L., Witard, O. C., McGlory, C., Hamilton, D. L., Jeromson, S., . . . Tipton, K. D. (2016). The response of muscle protein synthesis following whole‐body resistance exercise is greater following 40 g than 20 g of ingested whey protein. Physiological Reports, 4(15), np-n/a. doi:10.14814/phy2.12893

6. Phillips, S. M. (2016). The impact of protein quality on the promotion of resistance exercise-induced changes in muscle mass. Nutrition & Metabolism, 13(1) doi:10.1186/s12986-016-0124-8

7. Acheson, K. J., Blondel-Lubrano, A., Oguey-Araymon, S., Beaumont, M., Emady-Azar, S., Ammon-Zufferey, C., . . . Bovetto, L. (2011). Protein choices targeting thermogenesis and metabolism. The American Journal of Clinical Nutrition, 93(3), 525-534. doi:10.3945/ajcn.110.005850

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 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

The 4 Pillars of Fitness

The 4 pillars of fitness that truly cover the basics of the gym.

This week I decided to go back to the basics. So often I find myself nerding out on scientific articles and the latest trends that I forget what fitness is all about. So this week I am talking about the 4 pillars of fitness that truly cover the basics of the gym. The blog post referenced today was sent to me by a friend, and was originally written by The Fitnessista.

So as you can guess the information shared today is not all inclusive by any means, but when done regularly these guidelines will put you far ahead of the curb. So lets get down to it:

1. Strength – Strength training is a must for all populations. Far too often I have women tell me “but I don’t want to get too bulky.” Well here’s the thing… The people you see who look “too bulky” work very VERY hard to get to that point. It takes a tremendous amount of effort to look like a body builder, so pick up some heavy weights. Why? Well there are many reasons. Aside for getting that toned look, and glamour muscles for the guys out there, lifting weights does a lot more. For instance it is imperative for bone health and maintaining bone density as we age. This means less chance to break bones and maintain independence. Read the blog post to learn more about keeping your weight lifting routine fresh!

2. Cardio – We all know what cardio is, and I’m sure we have all been bored to death while doing it at some point. But this component is extremely important for things like heart health, releasing those feel-good endorphins, and like NEAT it’s a great way to burn extra calories. To decrease your time on the treadmill, you can add in some intervals (like our wonderful new Les Mills Grit series Wednesdays at noon) to boost EPOC (our oxygen consumption post-exercise).

3. Flexibility – This component is ignored too often. The goal of flexibility is to maintain full range of motion in your joints, prevent movement compensations and injury, and to have healthy posture and blood circulation. The key is to find a modality that you love and stick with it. Read the blog post for some fantastic ideas.

4. Rest – By far the most underrated aspect of exercise is rest. My favorite saying is that muscles aren’t built in the gym, they are built in bed (or the kitchen). The reason is that during exercise we are actually stressing and damaging our body so muscles aren’t able to adequately rebuild and repair themselves without proper down time. Not mentioned in the blog is the nutrition side of things, so I will add in that when we exercise we use nutrients. If they are not replaced then most people end up feeling more tired than they need to. Adequate protein and micro nutrients (vitamins and minerals) can be obtained through your diet, or via supplements. Not only do I take supplements my self, but I have spent a great deal of time studying the field so please don’t hesitate to ask me any questions.

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.

Stopping DOMS

Today’s post is all about mitigating Delayed Onset Muscle Soreness (DOMS).

Today’s post is all about mitigating Delayed Onset Muscle Soreness (DOMS). Now I want to be clear that DOMS is neither a good or a bad thing. It is just a part of the exercise experience for all of us. However, no one wants to be disabled the day after a heavy exercise session. So in an attempt to help us all walk normally after leg day, I will do my best to explain what causes DOMS, and how to dampen it.

Speaking of leg day, I think we have all been there. Day 1 you squat. Day 2 you feel tight. Days 2.5-4 you feel like every step, stair, and leg movement will make you cry. Days 6-7 you start to feel better and you do leg day again. This problem is experienced frequently and more severely with the initiation of an exercise program in a previously untrained person or muscle group. There is debate as to the exact cause of DOMS, however it is safe to say that muscle damage plays a large roll in its causation.

Here are a few ways to prevent DOMS when starting a new program, brought to you by the NSCA.

1. Caffeine! That’s right, a cup of Joe can help relieve some of that muscle pain. But the dose and timing make this intervention difficult to nail down. Around 5 mg/kg before a workout is recommended, but that equation isn’t always right for everyone.

2. Cryotherapy – This fancy term for ice bath, is an intervention that has been used for years. But realistically it’s just not practical. No one likes to be dunked in cold water, and especially not for the 10 minutes suggested. But hey, I won’t stop you if you want to turn your self into a Popsicle to avoid a little pain the day after a heavy lift.

3. Branched-chain amino acids (BCAA) – I am personally not a big fan of this intervention. Research shows that it has modest effects, and there’s no consensus on how much to take or when. For me, the best option is to take a high quality protein before and after exercise. It’s cheaper, tastier, and has a multitude of additional benefits.

4. Aerobic exercise – This should already be a part of your exercise routine, so it should be easy to implement. Doing 10-20 minutes worth of cardio before resistance exercise, or using active rest between sets, can be a great way to off set some DOMS.

I hope you all learned about some new ways to decrease your DOMS. Be sure to check out the full article for more information about each intervention, and to check out some of the science behind it all.

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.