MENTAL REPS

the hell with body transformation

2012-02-03T21:03:00.000-08:00

Tomorrow, while some of the little ones are napping, I plan to journey to my basement for yet another adventure. On the agenda is a handful of big, basic weight training movements. But what I'm thinking about tonight is squats.

I'm going to squat a ridiculous amount of weight for an obscene number of reps. I'm not listing specifics because it will seem like bragging and that's really not my intent. I'm pretty sure that I can do it, but not certain. The total workload scares me. Which is how I like it.

Why? I don't know. Why do some people trick-out their cars or golf or play video games on a Saturday afternoon? The strength and conditioning aspects of heavy weight for high reps are mere side effects. It makes my body and mind resilient. I feel awesome with minimal repercussion, which is saying a lot for a middle aged father of five.

Don't get me wrong. I'll have to hold tight to the wall when I finish my sets, until the dizzy nausea passes. I'll have delayed onset muscle soreness for a couple of days. My knees will probably ache a bit. Which brings me back to the questions.

How do you age gracefully and yet still push the limits of what defines aging? Arthritis and dementia are not at all the same, and this is no crossword puzzle. I could care less about wrinkle lines that show I've spent some years under the sun, so why should a normal decline of speed and strength bother me so much?

I'm sure time will answer these questions, but I haven't figured them out yet.

What I do know is that I still get excited about this. I'll repeatedly tell my kids when their turn to "lift weights" is over and they have to get out of the way. A friend or two will be joining me again. We'll talk for a while before the music blasts and the suffering really begins.

And we'll walk up the basement steps as different people.

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Why Go Directly to a Physical Therapist?

2012-01-26T21:47:00.000-08:00

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Direct Access in physical therapy means that you can go directly to a PT for evaluation and treatment of pain and other movement related issues.

Yes, by law you may visit a licensed physical therapist without supervision, orders, or prescriptions from other health care providers.

[Mud bathing, bull riding, and bone setting are also things that the law permits you to do without approval of other health care providers, but we won't get into that.]

So what's in it for you? Why deviate from the traditional model where you are referred to physical therapy by a physician or other specialist?

1. Three certain things in this world are death, taxes, and rising (insurance) co-pays and deductibles. In most instances of musculoskeletal pain, you'll leave a physicians office with a prescription for pain relieving drugs and a script for physical therapy. Going through a trial of PT first saves you some time and co-pays. Which leads to point number two.

2. Physicians perform a systems review to identify "red flag" situations that warrant immediate attention. Physical therapists are trained and qualified to do this and specifically find root causes of movement related problems. Treating mechanical (movement related) problems requires mechanical solutions, and most physicians don't have the time, training, or desire to get into the nuts and bolts of movement.

3. Time is of the essence. Rest is good, up to a point. If medicine and a few days of rest are not helping your condition, the last thing you need is more medication with more rest. Rest does not identify and address the factors that cause pain or poor movement.

Seeing a PT sooner than later may substantially impact the extent to which you reach full recovery. For example, physical therapists attempt to address that painful plantar fasciitis or lateral shift of your spine before the mind and body begin to compensate and ingrain dysfunctional movement. Which leads to the final point.

4. Independence: A vast body of evidence from virtually every medical discipline shows that chronic pain is a major dilemma. The more someone adapts a fear avoidance mindset and depends on health care providers, the poorer the outcome. PT is a conservative, patient empowering, proactive means of addressing the root of movement related problems.

No, we don't fix every painful condition for every person. But doing all that we can to set you up for success, and building on that, a little at a time, often goes a long way.

What's the catch? After all, I'm a biased source for talking about the benefits of Direct Access to physical therapy.

The catch is that most physician groups have seen the validity of these claims. They seek to work cooperatively with therapists who they trust to communicate with them if the patient is not improving.

Insurance companies are absolutely on board with this. After all, they are the ones with the most incentive to scrutinize practice patterns and determine what's beneficial and cost effective. For many reasons, very rarely are surgeries, MRI's, and other diagnostic tests deemed medically necessary before you have had a trial of conservative care.

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News story on Direct Access in Pennsylvania: CLICK HERE.

top 8 exercises for physical therapy

2012-01-15T15:25:00.000-08:00

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And so it's on! I've officially opened the doors to my new physical therapy office in Mechanicsburg, working with Brian and Steve.

There have been a few new clients. A half dozen or so from my previous workplace have hunted me down. I'm doing a lot of set-up and administrative this-n-that, but it's a much slower pace than I'm used to.

So with that in mind, I present to you the top 6 exercises for your local physical therapy office.

1. The Flex and Twist: Bend with your back, not with your legs. That's right, disengage your leg and core muscles. Just go ahead and hang on your lumbar discs and ligaments. This technique works especially well when moving large awkward objects in confined spaces.

2. Down Hill Sprints: Who says you're not fast? No other exercise provides immediate improvements in peak running velocity like down hill sprints.

I'm sure the PTs in Gloucestershirestownvillesburg fully endorse down hill sprinting.

3. Sprint Through the Woods: If downhill sprinting seems a little extreme or just doesn't tickle your fancy, then you should try sprinting through the woods. When I was young my father told me that's always a great idea. And this is no trail run. You want a fast and direct route through the rocky outcrops, the cragier, the better.

4. Rekindle that drive in any once loved physical activity. Cold days in March are the perfect time to stretch that routine single into a triple.

Now is the time to relive your BMX and skateboarding hay day. Take up ice skating, test your ski jump proficiency, or strive for your fastest time in the 26.2 mile run.

The bottom line is to go for it. Or else you're just scared.

5. Stay Put: If you're not really the active type, into moving your body and all that, you still have plenty of terrific options. If you can muster the courage, try prolonged sitting marathons. Those who easily get bored with the same workout routine can mix it by sitting in the car, the chair, and the couch.

Don't check your posture. Heaven forbid get up. In fact, don't even think about thinking about movement.

6. P Insa90 X: For those of you serious about your local PT office, do a prolonged and repetitive DVD series. For PT extreme benefit, go from a relatively inactive lifestyle to exercising 60+ minutes 6 days per week. Really, who has time to read over the precautions and pre-test instructions?

7. Repeat It - Swing your hammer or golf club or tennis racket a few thousand times with one arm. Roll your head in large sweeping circles. Test the integrity of your achilles tendons and patellar ligaments with a few hundred jumps on concrete. Hold your arms up above shoulder level for as long as possible.

8. Impact - If you fail to get injured doing those things, then just go ahead and jump as high as you can and land on your knees or tailbone. Run into the wall. Repeat.

What are your favorite exercises for physical therapy?

Office is open at 8 a.m.

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Ben 3:15

2012-01-12T21:02:00.000-08:00

Okay here we go bragging on Ben again.

But there are lesson here that are not readily apparent to most people who want to get bigger-faster-stronger-awesomer and have it all in 6 weeks.

Last weekend Ben hit a pretty major goal, squatting 315 pounds...for twenty reps. TWENTY continuous reps! At a body weight of less than 170 lbs. You don't just roll out of bed one day and say, "I'm able to squat over 300 pounds twenty times, and I'm gunn do it."

Ben didn't start there. He started the journey about a year and a half ago with a stubbornly painful fractured spine with disc herniation, staring hard at a health care professional who instructed him to walk the dog but not run or do any type of strenuous activities.

Which I suspect meant no dead lifts. Or squats. Or flips of any variety.

Ben seeks and applies understanding. He regularly works brutally hard, suffers even, with his eye on the good that comes from it. He started with a little specific corrective exercise and low impact training. And then a little more.

There has been structured variation of training, but Ben has never complained about needing to "mix it up because I get bored." He's never worried about muscle confusion, or found excuses that raise barriers. He has focused his efforts instead of trying to achieve 3 or 4 incompatible fitness goals at the same time.

He's found a rhythm of hard work and recovery over a long term. And this is what you get.

Onward!

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Jump Training (Part 6): Two Warnings

2012-01-07T22:20:00.000-08:00

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So you're in! You decided to make a serious effort at a jumping focused, comprehensive training program. You're going to correct movement impairments, warm up appropriately and practice technique, and do plyos to amp the brain for explosive movements. In addition, you're going to hit the weights to gain strength and lean body mass or to maintain lean body mass while you lose body fat.

All this leads us to point 9 in our 10-point jump training series:

9. STOP with the overkill

My guess is that you are going to over do it. You won't over train because you're stupid, but because we all tend to fall into the "all or nothing" and "more is better" traps. We go all out gung-ho. We improve for a while and then hit a wall or get injured.

So this is a reminder that it's far easier to overdo it in the short term than it is to practice long term, disciplined moderation. There's magic in the rhythm of hard work, rest and recovery. Except for flexibility work and corrective exercise, everything you do should pass two tests:

Is this activity helping me to get stronger and bigger - or- maintain lean body mass?
Is this activity teaching my brain to utilize my body explosively?

Again, there are two typical patterns here:

A big guy or gal wants to lose ten or twenty pounds. So they start running three days per week along with higher rep weight training, you know, for toning. All the jogging teaches their brain to be efficient more than explosive and cuts into recovery from weight training. If you don't believe that too much cardio is counterproductive, go ahead and try to argue with these guys or those guys. Or try doing a lot of cardio and adding serious weight to the bar on squat and dead lift days.

Thin folks need to ask themselves or their coaches why they are supposed to be doing mile (and longer) runs in the off season. Is it so they can eat more? How are you supposed to add muscle with all the practice and other demands? Why are you always running bleachers? I'm not saying bleachers are easy, but they effectively conditioning the brain and muscles for small, high rep single leg leaps.

But instead, the big guys and gals would do well to remember that trying to train your way out of poor eating habits is always a bad idea. The thin athletes need to hit the iron brutally hard at regular intervals, do limited but intense sprints and plyos, and otherwise rest, rest, rest.

The bottom line is that you won't reach your ultimate potential for jumping if you're chronically overtrained, spinning your wheels instead of following a focused progression toward strength and power. You're not going to be able to fit in a lot of traditional cardio. You're going to have to get your calorie control and endorphin rush elsewhere, like plyo jump/sprint circuits!

If you think a runners high is nice, you've never tried heavy 20 reps squats
or nasty "core" finishers to your weight training sessions.

And lastly, lastly regarding improving your jump:

10. Genetics

Poor genetics for jumping.

No, this is not where I tell you some secret on how to improve your genetic potential, which was set long ago. Yes, genetics do dictate our ultimate potential. But I'm pretty sure that potential is overrated.

Everyone has potential. But how many people get even close to their genetic potential in any given area?

You're potential to be awesome is plenty good enough. So what's the use in worrying about genetics? Please don't read about all these modifiable factors and instead of going out and doing something, sit around complain about the one factor that's out of your control?

So there's your second warning: about how lame it is to pull the genetics card.

You know that 9th grader who can almost dunk? Sure, he has good genes. But he also has probably grown up in a supportive environment and jumped and reached and fell ten thousand times in his youth before finding a passion for basketball and training his ass off in the last few years. And with a little luck, no fitness folks have had the chance to make him work on his "cardio base" or some other fictitious load of crap.

So good for him.

Trust me, a 6'2" 35 year old guy doesn't suddenly force his will into basic gymnastics due to good genetics.

And a tuck jump over 5'. Yes, adding credentials for this series.

And you? Your video, next? You may not dunk. Or flip or clear 5 feet. But maybe you'll do far more. Who knows?

The only thing I can guarantee is the joy and satisfaction of the process. The goals and mini goals, the disciplined effort, the sweat, the risk, the victories and defeats, the planning for next time. That will keep you ticking, inspired, with a healthy mind and (usually) healthy body.

And that's meaningful.

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Jump to New Heights (part 5)

2011-12-15T21:25:00.000-08:00

6. Resistance exercise is necessary for anyone looking to realize their full potential in leg power. Yes, some serious time under the iron is in order for the 99% of you. But it's good to understand why big lifting is at least one step removed from big leaping.

The literature is mixed as to whether or not strength gains from resistance training carry over to improved jumping and sprinting. It only makes sense to think that if an athlete builds leg strength. i.e., the ability to generate great force, with resistance training, he or she may not optimally apply that strength without task specific power training.


You would totally kill these guys in any event that takes place on foot.

Simply put, resistance training should primarily be aimed at the following:

1. Ingraining proper movement patterns (see this detail on corrective exercise for the purpose of creating proper movement patterns).

2. Creating controlled mobility, the proper combination of strength, flexibility, and stability. This is, to a large extent, why yoga has its limits, and why free weights are far superior to resistance training machines.

3. Generating more force. The ability to generate more force doesn't only come by way of larger muscles. Resistance exercise causes numerous neurological changes. Nerdy professors talk about things like motor unit synchronization, rate coding, and disinhibition. But you can just call it your very own Bucket of Awesome.

At this point, some Physics101 is in order. Strength training is all about being able to generate more force, and for many of us, getting larger muscles.

Force = Mass X Acceleration.

On the other hands, the aim of power training is to help us quickly apply force toward the tasks we have in mind, where

Power = Force X Velocity.

This may seem like stating the obvious, but please understand that this is the core of a lot of misapplication of resistance exercise, where many confuse weight training with balance training (BOSU and fitness ball nonsense), general conditioning (cross fit type circuits), bodybuilding (tricep kickbacks to isolate the long head of the triceps), power training (Olympic lifts), or something else (Platform Jump Trainer Shoes, Pilates, Shake Weight, etc).

This is why I believe that Olympic lifts are highly effective yet inferior to plyos as a method to train athletes for power.

So in summary, we should weight train in a manner that stimulates the nervous system toward functional body control and tears those muscle fibers up, which gives the body reason to add muscle. Then, THEN, we need to get our plyos on, the sprints, hops, and jumps that enable us to apply what we've gained under the iron.

Resistance Training Template for Leaping:

A sound weight training program can look like a number of things, depending on the specific needs of the athlete. A weekly cycle should include some variation of the following, each performed for 3 to 5 sets of 4 to 10 reps:

1. Dead lifts or dead lift variation to functionally work the posterior chain muscles (the hamstring, gluteal, and lumbar erector groups). Exercise performance details are beyond the scope of this entry, but with so many options to choose, it should be no problem to find a variation that's right for you: dead lifts, sumo dead lifts, trap bar dead lifts, partials/rack pulls, or suitcase lifts.

2. Squat or squat variation to emphasize the quadriceps in "triple extension", which is a beautiful symphony of ankle, knee, and hip extension. Again, find a movement that's right for you and stick with it, upping the resistance into new realms of awesomeness: back (traditional) squats, front squats, goblet squats, belt squats.

3. Single leg work provides a little less emphasis on absolute force production as the resistance used will be somewhat lighter. Yet unilateral training demands extreme trunk and hip stability within fundamental movement patterns. Choose any one or two of the following: single leg squats, split squats, lunge variation, single leg dead lifts, or high step ups.

Just because it's a single leg exercise does not mean you can quit working brutally hard to progress the resistance while keeping good form.

For accessory work, feel free to add a few sets of glute-ham raises, hip thrusters, farmers walks, or calf raises. They're certainly not mandatory, especially if you're including any targeted corrective exercises that overlap these.

Other notes on resistance training.

Remember to respect recovery. Once your into it, barbells and dumbbells have the tendency to get kind of bossy. Don't fall for the thought that more work is better. Also, I generally don't advise heavy squatting and heavy dead lifting on the same day, or on the day after intense plyometric training or sports activity.

I have had good success training with a weekly routine where low rep dead lifts and moderate rep single leg squats are performed on one weight training day (say, Monday), and squats and accessory work on the other weight training day (say, Friday).

"But I have a bad..."

You can't squat because of your low back, hip, or knee? Fine, for right now. But I'm pretty sure that you can find some godawful hard work by focusing your efforts into a dead lift variation and a single leg variation. If your back absolutely won't tolerate any variety of dead lifts, even after 3 to 4 months of corrective exercise, then I would bet that you can pour yourself into single leg squats and goblet squats.

Have you had a thorough examination of your lifting form? A functional screen of your body? Who knows, your herniated disc may not even be at "fault" for your issues with squats and dead lifts. It may be that you cannot maintain a neutral back alignment during squatting because of a leg length discrepancy, a kyphotic thoracic spine, tight ankles, or deactivated glutes.

If worst comes to worst? [Deep breath.] Fine, go ahead and try to leg press and single leg press your head off. Just because the exercise is on a machine doesn't mean you shouldn't,

say it with me now,

"Work brutally hard to progress the resistance while keeping good form."

Nice!

The next factor for jumping that ties in heavily with resistance exercise is

7. Body Composition

Jumping ability has more to do with power to body weight ratio than absolute power. Neither plyos nor weight added to the bar are the absolute bottom line in jumping.

If you have a fairly muscular physique at around 20% body fat, dropping a few percentage points will do wonders for your leap. All the box jumps you can muster won't help your sloppy diet and the fact that you're carrying around a spare tire. The trick is to change that without losing precious muscles.

If a stiff wind would knock your jump off course, adding 10 or 30 pounds of powerhouse muscle will do wonders for your leap. The trick is to get big and strong without getting slow and dense.

Most of us, our bodies and our whole lives, defy neat categories. But let me tell you that wherever you stand between these two extremes, resistance training is essential for your own body recomposition.

If you want to get jacked with bigger, more powerful muscles, you obviously need to lift weights! Don't get me wrong, weight gain is good and necessary for many people in the pursuit of powerful legs. But adding 200 pounds to your squat strength may not be the best thing for jumping if you gained 70 pounds of body weight in the process.

If you want to get leaner, you need to lift weights in order to maintain muscle and strength. I cannot understate how important it is in both the long- and short-term to "signal" the body to retain muscle and strength while you're in a calorie deficit.

Losing muscle when you "diet" sets you up for a frail and hungry cycle that usually ends with you either giving up or feeling sorry about eating three bland salads per day and the condition of your white boy hops.

Diet is a huge piece of the body composition puzzle. I suspect that very few people will actually consider my unglamorous advice here, but a healthy diet for gaining weight should look remarkably similar to a healthy diet for losing weight.

Few fitness enthusiasts are content with small, gradual weight loss or gain that allows them to add muscle without adding much fat or to lose fat without losing much muscle. Few diet gurus are eager to admit that our physiology simply doesn't allow us to do it fast and right!

So if you need to gain muscle, pound the minimally processed foods and feel free to take in some junk right after intense physical activity. If you need to lose fat, focus on minimally processed vegetables, lean proteins, and fruits, in that order. Seek and destroy any refined, calorie dense foods that creep their way into your mouth. Allowing for one "cheat day" per week will help you mentally, to keep a pretty tight reign on things during the remainder of the week.

I realize that this sounds too simple. But to worry about all the nuances of dieting methods before giving an honest and sustained effort at the basics is a waste of your time and money, at best.

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Adding a little more of a conditioning focus to your training plan is fine if you're trying to lose body fat. But please be very careful with this, as over training and too much cardiovascular/endurance type exercise are two of the leading causes of gravitation decompensation syndrome.

[Final installment to come.]

Until then, NO EXCUSES!

&lt;p&gt;&amp;amp;amp;amp;lt;p&amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;br&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;br&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;br&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;br&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;br&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;br&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;br&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;br&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;nbsp;- - - -&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;br&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;amp;amp;amp;amp;gt;&amp;amp;amp;amp;lt;/p&amp;amp;amp;amp;gt;&lt;/p&gt;

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HOW TO not GAIN MUSCLE

2011-12-08T16:19:00.000-08:00

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If there's any subject matter where I can claim expertise, it's how to train hard and get nowhere. If you'd like to dedicate nearly a decade of your best years to resistance training and have little to show for it, you've come to the right place!

the mental repper ~1994

More recently, after about 10 years of training smarter, I've been occasionally accused of taking steroids. Those people tilt their head and stare as I fail to contain my laughter. Yeah, right, steroids - me and my hulking 6'2" 195 pounds.

If they only knew...the long, frustrating years of wheel spinning, learning the hard way.

I first hit the weights at about the age of 16, with the idea of getting bigger and stronger for sports. And, in theory, all ripped and awesome for the ladies. I don't recall the specifics, but by the age of 24 I had gained about 8 or 12 pounds. Now don't get me wrong, my cardiovascular profile was rockin' and I was in excellent condition to model J-Crew sport coats. But non coltish, functional muscle? I would have gained more by simply playing sports and resting.

I wanted to first take a moment to give credit for the many years of successfully not building muscle. Coaches, those of you who were just misinformed, and others who were plain negligent, thank you! Thanks also go out to Jim Weider, Bill Phillips, GNC girl, and that guy at the gym who was dishonest about his steroid use.

But it takes an amazing amount of stubborn knuckleheadedness and lack of focus to seize so little muscle out of so much time. So special thanks go out to me, as the majority of my failure was self-imposed.

And now, without further ado, here are the simple steps that I followed in order to spend lots of time and energy to not gain muscle.

[Excuse the snarky tone as I remind you that these are all personal mistakes, near and dear to my heart.]

1. Emphasize supplements.

To not gain muscle, what you do outside of the gym is just as important as your training. So I listened to the supplement companies. I went from eating crap to eating a super strict diet which included various essential supplements.

Every glossy magazine giving sports nutrition advice for mostly sedentary 35 year-olds was absolutely true and appropriate for me. Every pill and powder sold in big scientific looking jugs simply MUST be included in each of those six small, evenly spaced small meals per day. It was the mid 90's, and food was like, so 1985.

So you should worry about all the details regarding macronutrient ratios (carb, fats, protein) and organics. Don't bother with pounding boatloads of mostly natural, minimally processed foods, staying active, and letting the rest take care of itself.

2. Worry about getting fat.

Because when you're an active young man with a 6-foot frame and two-a-day sports practices and conditioning, putting on an ounce of fat is an emergency situation just waiting to strike. You're not in it to get all bulky and suddenly your nickname is Bubba and people start making you all-time offensive lineman during flag football.

It's all about calories in versus calories out, so toe that line between energy deficit and surplus. Eat just barely enough to get by during the day and then load up on protein recovery shakes and 5 bowls of cereal after practice and work outs. Be careful, because an ounce of fat is a terminal condition, and there's no way you can pull back and tighten up your diet if need be after you've gained 20 or 40 pounds of solid muscle.

If you slip up and eat like a human for a day or few, just train more. If you want to regularly eat junk food, simply add supplements and cardiovascular exercise, sets, and reps to make up for it. Yeah, that will work just swell.

3. Vary your workouts often.

You don't want to go stale, so switch it up to keep those muscles guessing. Why stick with the basics when there are so many ways to train? With just a little thought and even less effort, you'll never do the same workout twice.Who needs to bother with gaining proficiency and strength in the fundamental multi-joint movement patters?

Push horizontal (like, bench press variations)
Pull horizontal (rowing variations)
Push vertical (shoulder press variations)
Pull horizontal (chin-ups, lat pulldown)
Squat/Squat variations
Dead lift/Dead lift variations

Better yet, do numerous variations of each of the above and then add layers of accessory work. For example, you don't want to miss any of the three "heads" of the deltoid muscle, so include lots of shoulder raises to the front, side, and back, as well as upright rows. For the quads you should squat and leg press and hack squat and add in three variations of seated leg extensions.

4. Complexify it!

Ignore the thought that getting bigger muscles is simply a matter of time under tension.

[Struggling under a heavy load literally tears muscle fibers apart, which stimulates the entire body to repair and rebuild them bigger and stronger. Heavy one-rep max lifts provide high tension but for a less than optimal time. Low resistance for high reps allow for high total workload, but insufficient tension to tear the muscles down.

That's why 3 to 5 sets of between 3 and 8 reps is usually what provides the best stimulus - sufficient time under sufficiently heavy loading. Being strong enough in any exercise to handle a decent amount of weight is critical to getting the ball rolling, so work hard at learning some variation of the basic lifts.

Neuromuscular efficiency in the big movements begets strength which begets true muscle growth which begets more strength. Pretty soon you're deadlifting close to 500 pounds for reps.]

But you? Screw that. These two variables of time and tension are far too simple for your special neuromuscular physiology. Your muscles require drop sets, super sets, and super drop pick-up duper sets.

Before trying a sustained and solid effort at the basics, you should experiment with complex periodization schemes, bands, chains, and resistance training machines that have been precision engineered to match the length/tension curve of every deplorable movement imaginable. Mangled up in tangled up knots.

5. Do it all! At once!!

Set your sights on getting bigger AND more ripped AND increasing conditioning for your sport.

Believe everyone who promises the holy grail of fitness, claiming it's easy to lay down slabs of muscle and melt layers of fat at the same time, especially when you have very little of either to begin with. Also see point number two above.

Because if a little pummeling and tearing down your body is good, then a lot must be better. In fact, you can train every single day if you blast the hell out of just one muscle group each workout. Never mind that a "shoulders and calves" day does sound kind of ridiculous if you think about it.

Don't worry about how almost every chest exercise involves the shoulders and arms. And all that jogging to make up for your crappy diet - it won't cut in to your legs ability to recover and grow from the weights.

Lastly, don't worry about getting to bed on time. That whole sleeping this is over rated anyway, especially compared to 3 capsules of NO2 Glutamate Picolinate 3 times daily.

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But that's just me and my anecdotal evidence, the hard lessons I can share in the hopes of justifying all my wasted effort.

Please feel free to share your own insight on how to train hard and not gain muscle.

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dancing with the devil

2011-12-06T21:39:00.000-08:00

Last Saturdays workout was pretty ho-hum as Friday nights Bounce Plex binge left me hung over with a headache, sore neck, and sore knee.

Today was Tuesday, time for the other one of my two weekly weight work outs. It was close to 4:00 and I had to be finished by about 4:55. A 10-minute warm-up turned into a 25-minute back yard trampoline session with my 7-year old. Having fun left about 40-minutes to lift.

They say character is what you do when nobody is watching. K.C., Ben, Mike, Tim, Cort, Matt - none of the guys could make it today. Which made the resistance to begin even greater. Could have went light or skipped it all together. Yeah, I could use some rest.

But once you start me up...

I hammered out 4 pretty intense sets of overhead presses, finishing with 225 lbs. for 5. Then came single leg squats, which intensely suck, and today turned into a warm-up set plus 3 sets of 10 using 300 lbs. So this is why I regularly skimp on ab exercises or really any traditional core work. Who needs it when you chase twenty minutes of trampoline flips with 60 pretty heavy single leg squats?

Then came the loved, hated, anticipated, dreaded physical highlight of the week: dead lifts. After three warm-up sets I loaded the bar with 455 lbs and hammered out 4 sets of 5. That much weight for that many reps adds up for a guy of my stature.

That thing where you do one hard and heavy rep and then sit around drinking protein for 10-minutes? Not here, ever. But usually some of the guys have to get their sets in or we talk for a while.

So today I rushed without the guys, with little rest and compromised form on the last set to get those reps in. It was the type of form I would have ranted about on-line or lectured the guys.

"You're going to hurt your back when your hips extend too early like that."

Why couldn't I stop with three sets of dead lifts? Why did I have to push that last set to a 6th rep? Nobody was there to witness it. Nobody cares. It still would have been a fine work out.

I got it, that 21st rep. The plates rattled off the floor and climbed back so slowly. With crappy form. I could have easily, seriously strained my back. But I didn't.

And it was wonderful.

That challenge, that if, seems to be right where I thrive. But a 35 year-old pushing it like that with dead lifts, by himself?

What is wrong with me?

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Jump to New Heights (Part 4)

2011-12-04T19:24:00.000-08:00

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Corrective exercise is the responsible, bland, and yawn factor that may be holding you back from your launching potential. I mean, who wants to stretch and do foo-foo rehab type moves when they just want get right to being awesome?

Like this kid! Love the simplicity here:

Before you get to that, have you considered the details in how your body accomplishes movement? Is your body mechanically sound, segments moving when and where they should be moving and staying stable when and where they should be stable? It's not simply a matter of strength or flexibility. Controlled mobility requires strength, flexibility, and a brain that is tuned to proper movement patterns.

When it comes to jumping, your ability to squat 400 pounds is overrated if your hip flexors and hamstrings are tight. Being able to balance on one leg on a fitness ball while juggling dumbbells is overrated if your hip abductors are weak. Good reaction time, balance, and flexibility are overrated if you lack sufficient leg strength and core stability to squat at least 1.5 times your body weight with good form.

The point is to appreciate the fact that functional performance is limited by our weakest points, and yet most of us prefer to work at further improving our strengths.

Let's say that you have tight ankles which force you into a knee dominant pattern of squatting, jumping, and running. That's just you, and nothing you, your coach, or parents did right or wrong. Months and years of this fundamental movement dysfunction has caused your brain to partially lose touch with the gluteal muscles at the hip and stabilizing muscles of the lower trunk. Every time you go to jump, you're unknowingly missing out on the full use of the most powerful muscles in your body.

You can do squats or lunges or leg press or (try) dead lifts. You can faithfully carry out every detail of the plyometric training program listed in part three. You can try to tidy up your jumping form as recommended in part two. But so long as all these are carried out within that knee dominant pattern, you're doing nothing to address what holds you down the most.

Get that out of here, son.

Holding hundreds of appropriate ankle stretches (to loosen the ankle joints and lengthen lower leg muscles) is so unglamorous. Repping thousands of glute bridges and other corrective movements that wire the brain to recruit the glutes may bore you to death. If ankle mobility or hip strength and stability are not your weak points, then all of this is completely unnecessary. But if this is an issue, then do not pass go, and proceed directly to the corrective work before you risk injury.

No, seriouslyT there's research to prove it.

As far as dysfunctional movement and painful syndromes during jumping, the knee dominant pattern is a fairly common issue that occurs for a number of issues (not just because of tight ankles). Maybe you have a structural foot issue. Or a leg length discrepancy or a drastic side-to-side strength deficit. Maybe your back is tight or unstable. Are your hips externally rotated, walking around duck-footed all the time?

Again, you have to acknowledge that corrective exercise is unglamorous and requires some time and know-how. But there's no substitute for identifying specific deficits, isolating them, and then integrating them back into the functional movement.

Test yourself

Try a deep squat with nothing but your body weight. If your heels come up or your upper body leans forward or your knees migrate inward, you should raise your eyebrows.

Try the repeat tuck jump test. Jump straight up as high as you can, pulling your knees toward your chest at the peak of the jump, as if trying to clear a high fence. Hit the ground and quickly throw 9 more jumps.

Did you migrate left, right, or back? Were you able to do all ten without stuttering or regrouping, with control the 10th jump as well as the first? Were you starting to get out of sync and flail around? If you have an observer or a video, did your feet hit the ground evenly (contact equally and centered under you, not front or back)? Were your knees in alignment at the bottom of the launch and trunk upright with upper leg parallel to the floor at the peak of your tuck?

These two tests are easier said than done.

Hey, the good news is that corrective exercise exists on a continuum. Dead lifts, squatting variations, and other killer moves count, and that's a work out! Once you quit messing around with all the gimmicks and the weight machines at the gym, and instead focused your efforts at becoming mechanically sound, you can start loading up resistance without the injury potential. Ironing out any mechanical issues opens up new realms of progress in the weight room.

[To be continued...]

Jump to New Heights (Part 3)

2011-11-29T22:42:00.000-08:00

4. Plyometric training is the fouth of ten factors to your best jumping ability, leg power, and general awesomeness.

The word plyometric is a derivative of the greek words plyo, meaning "fun," and metric, meaning "wow that was cool." Not really, but when you think of plyometric training, you should think of movements that require quick acceleration like jumps, hops, bounds, and throws.

Distance jogging won't help you to break ankles like this:

The primary target of plyometric training is the brain. The art of loading the muscles and making a quick transition to explosive acceleration requires timing and coordination of multiple body segments.

The best thing about plyometric training is that it takes whatever strength and range of motion that you bring to the table and turns it into pure functional delight. The worst thing about plyometric training is that you will probably strain something.

You ~~can~~ will get hurt doing plyometric exercise. I'm not talking about season ending concussions or ACL tears, but the typical strains and sprains that come with pushing to new capacity.

If you're not in tune with your initial fitness level and general athletic ability...
If you're not mechanically sound (i.e. tight ankles, weak hips, etc., see corrective exercise detail to come)...
If you're strong and heavy (not necessarily fat)...
If you're careless about gradually increasing the "dosage" of impact to your joints...
If you're unaware of a few important tricks of the trade...

You can be smart about this. You do not simply have to accept misery. But pushing your limits is, well, pushing your limits. Greater risk and reward is not for everyone.

[***I've found that there truly is magic in acknowledging this at the outset. Injuries seem to be minor and few when the individual chooses his or her own risk/reward of any training activity.]

But let me tell you that nothing else will help you approach superhuman ability. If the idea of effortlessly leaping a full size picnic table doesn't excite you, then maybe the whole pushing thing is for someone else.

If you're still on board after that disclaimer, wondering what a solid plyometric jumping program looks like, you don't want to hear that the best program for you probably depends on a number factors such as the five "ifs" listed above. But you should be glad to hear that wherever you stand, you do not need a lot of equipment to get moving.

You do not need jump gizmos, parachutes and tubing, shutes and ladders, or special shoes. Even the use of simple weighted vests is questionable. Whenever you can honestly say that gravity isn't much of a factor for you is about the time you need to start using all the fancy jumping paraphernalia.

Here is a general template of exercises that will cover your basis.

Lateral jumping off two legs.
Vertical jumping off two legs.
Lateral jumping off one leg.
Forward jumping off one leg.

That's it.

Start easy. Pour yourself into becoming rock solid in these basic movements.

Specific progressions and the details of exercise technique are beyond the scope of this writing, but here are some examples.

Horizontal jumping off two legs:

Lateral hops over cones (or "cone" equivalent)
Consecutive lateral hops over a series of cones
Lateral box jump one side or alternate sides (progressively increase height)

Vertical jumping off two legs:

Jump and reach for max height (such as basketball backboard) with and without hop step into it.
Tuck jumps, clearing heights (personal favorite)
Depth jumps (hop down from between 1 and 3 feet and explode back up)

Lateral jumping off one leg:

"Ice skater" hops
lateral box jump (low box)
"Defensive slide" drill with false start
Single leg lateral hops uphill

Forward jumping off one leg:

Split jumps
Box jumps forward and back (low box)
Single leg forward hops uphill
Single leg leap for distance and height

Here's a nice/killer combo: a good example of lateral jump off two legs followed by some single leg forward leaping. Most individuals will have to build up to this. And the big finish is well, I'm not going to say I'm against it. Okay here you go.

A few other key points on plyometric training:

-Make sure to keep a general count of sets, reps, or total contacts between your feet and the ground. Your poor bones and joints will appreciate any effort to keep an objective tally of impact, distance, and height. Or they will rebel.

-Your sets should not be endurance cardio drudgery. Properly performed plyos are brutal even when the work interval is relatively short. Generally keep the reps under ten. Go hard, rest, and repeat.

-Some coaches and trainers will tell you, in a strictly confident coachy tone, that your primary objective in plyometric exercise is to be quick off the ground, to minimize the contact time between jumps. While there is a time for working on foot agility, jumping as high as possible and being quick off the ground are two different things. (Go ahead and try to beat your highest jump while also minimizing ground contact time).

In most cases, your focus should be on controlling your body segments to land and load your next leap in a biomechanically favorable position. Then focus on creating a strong forceful push through the ground, launching higher, higher, and higher still than before.

-Depth jumps are an effective and intense gravity overload. It is quite difficult to properly control such impact and transition to an explosive leap or bound. Doing depth jumps before you've mastered good form in other less intense activities is an invitation to injury.

v. grassy hill

-Repeated single leg hops are a super effective way to gain the core and leg strength pertinent to so many athletic activities. But they have been proven to be rough on knees. I've torn a major ligament in my foot while doing max effort single leg forward hops across a basketball court.

The trick is to do them on a graded surface. You could pay a couple thousand dollars for a cumbersome jumping device that allows you do to hard single leg work without the injury potential. Or you could find a grassy hill, which allows for all the benefits while drastically dampening the impact.

[Look for part 4 in the series, coming soon.]

Jump to New Heights (Vertical Jump Part 2)

2011-11-23T21:39:00.000-08:00

It sounds so simple. Jump as high as you can, and there you have it. But go ahead and try to turn your 21-inch vertical into 24 inches. Dare you shoot for the 30-inch mark?

There's no guarantee that you'll be throwing thunderous tomahawk dunks tomorrow or next week. But you can probably improve. A lot. And it's going to take more than those special training shoes or that key exercise.

You're going to need to approach your hops holistically. That's my intent with these ten components of your best vertical. They are listed from least- to most time commitment required for the payoff.

1. Form

If your form is less than perfect, you can expect to add an immediate inch or two by tidying up a few details.

-Stance Width: Don't take too wide of a stance. You're jumping, not power lifting, and the wide base of support effectively shortens the duration of time over which your legs can uncoil and apply force to the ground. Having the feet too narrow is far less common, but that error will make your launching muscles work just to balance you out. Placing the feet just barely inside shoulder width is usually about right.

-Arm Drive: Technically yes, you DO jump with your arms. They contribute roughly 20% of your height, so get use to throwing those babies down hard as you descend. Throwing them up hard usually comes naturally, but it will take just a bit of practice to get use to throwing them down hard and then timing the transition to accelerate up. Also, make sure you're reaching the hands up and slightly forward, as it's common to see people lose a bit from reaching back.

-If you're doing a vertical jump test where the feet must remain planted, take a mental "hop-step" as you initiate the descent before launching. It's not as good as a real hop step, but it places the achilles tendon and other leg muscles on a slight stretch, which gives you some free rebound elasticity.

2. Warm Up

Investing a few minutes in an appropriate warm-up will also add another inch or so to your vertical.

-Don't! If you want to introduce a lot of force-dampening slack into your muscle-tendon units, sit down and stretch your hips, hamstrings, and calves for nice long holds of at least a minute. On the other hand, if you want to go in to a max effort test with a cold body and sluggish brain, and possibly raise your injury potential, then don't warm up much at all.


Like this, but keep your chest up.

-You know what I just said about refraining from long static stretches?

Well, there's an exception. Almost everyone acquires some degree of tightness in the front of the upper legs - the hip joint capsule and the muscle group known as the hip flexors. The typical restriction here is an issue since those muscles work in direct opposition to the hip extensors, the primary drivers of jumping. Although the hip flexors have a role in running, they're not involved with generating jumping force. So stretch 'em long.

-The best way to warm up for a test of this nature is to simply raise your body temperature and amp your nervous system. Droning away for 5 minutes on a bike or stair climber is not the best way to prime the brain for a max effort test.

-It looks fairly ridiculous to put it into words, but an appropriate warm-up should look something like this:

Take a short jog around.

Then run in place for ten or twenty seconds before shifting gears to drive your knees up toward your chest for ten reps or so. Then proceed to kick your heels hard toward your butt for ten reps or so.

Then stand on one leg and give a little hop as you swing the other leg forward and backwards.

Then maintain a slight bend in your hips and knees as you perform some max effort hops by moving just your feet and ankles.

Do 5 or 10 reverse lunges on each leg, then 5 or 10 side lunges on each leg, exaggerating the reach out and then quickly pulling back to the standing position.

Then hit those hip flexor holds for about 30 to 60 seconds each side.

If you feel like it, do 5 or 10 split jumps and ice skater (side-to-side) hops, followed by a few quick-feet agility type drills.

What was that, about 4 minutes of activity? You're not at all fatigued, but breaking a slight sweat, with a nervous system that is primed to balance, control, and accelerate your body mass.

-Here's a cool experiment for those who are equipped, fairly experienced in the weight room, and interested in ultra potentiation of the nervous system. Try the following with either squats or deadlifts immediately before testing your vertical:

Do 6 or 8 reps with 135 lbs.

Then 3 or 4 more reps with about 60% of your "max" in these lifts.

After that, do two or three more sets of just 2 to 4 reps with about 75 to 85% of your max.

This shouldn't be tiring, given the low reps at less than max resistance. And it has been shown to add immediate inches to the vertical jump of highly trained athletes.

And now...you're ready for take-off!

3. Practice

Jumping for maximal height is a skill that improves with practice just like any other skill. Now, how often have you practiced max effort jumping? Jogging and running stairs and jumping rope and lifting weights and a million-and-one leg exercise variations are NOT practicing the skill of maximal effort jumping.

I'm not talking about 10,000 hours of practice here. Just know that if you want to teach your brain how to launch, make sure and practice that skill when you're not wiped out with fatigue from other exercise.

Tuck jumps over objects are one practice that I've found beneficial. I've recently come across some literature that also supports their effectiveness. Giving your brain a clear goal that requires a maximal effort commitment is the opposite of endurance training. It's both fun and brutally hard work.

A hurdle will do. So will a picnic table, a lawn chair placed on bricks, or some rubber tubing tied between trees.

If you start doing tuck jumps over things, expect to quickly post some huge gains. Most of the progress is from learning the skill, the timing of the jump and leg tuck. But the greatest benefit of tuck jumps is gaining the, uh, neurolgical aspects of ballsing into something awesome.

This video of Cort puts it perfectly!

There are certainly other important strength and power-related exercises, but tuck jumping is one of the best ways to practice the skill of max effort jumping.

[More to come...]

Vertical Jump Power Mighty Awesomeness (Part 1 of 2)

2011-11-19T21:34:00.000-08:00

The brothers in Harrisburg always picked me up.

When the 6'1" white guy warmed up with a few dunks at Reservoir- or Cole- or Brightbill Park, the reality of his basketball skill didn't matter.

Because dude can dunk.

I wasn't showboating. I was trying to get some court time. Even the young bulls in Harrisburg know that size, skin color, shoes, and other attire are pretty horrible indicators of basketball proficiency. And dunkability is a pretty valid measure when you're trying to quickly pull together a 5-man squad and winners stay on.

Well that, and I was showboating.

Who doesn't want to increase their vert? Creating space between ground and feet is unquestionably the all-time greatest display of total body power, net worth as an athlete, and absolute value as a human being.

But seriously, vertical jump and jump variations have been shown to correlate with just about every facet of sports like football and baseball/softball and tennis and lacrosse and volleyball and on and on in sports that other people actually pay to watch. There's a reason for that, and it's because acceleration tasks are fun and powerful and poetic and freakin' awesome.

You want to know who can throw a baseball hard or has the potential to throw hard? To hell with the bench press and mile run and sit and reach and rotator cuff strength. You find out who has powerhouse lightening legs to generate enormous launchitudinal force from dead earth.

So if you or a loved one would like to overcome gravity for about .88 seconds rather than your typical .54, pay heed to the ten points to come.

These ten pointers are not listed in order of importance or effectiveness. But they ARE listed in time investment. For example, you can expect that attending to point number one will translate to an instantaneous inch or three on the vert whereas the payoff from later points will come with months of due diligence.

But they're all important if you want to get ups, white boy.

1. Form

2. Warm-up

3. Practice

4. Plyometric training

5. Corrective exercise

6. Strength training

7. Would you stop with the overkill already

8. Body composition

9. Something something (by law, no list has 9 points.)

10. Genetics

Barefoot Running is Unnecessary

2011-11-08T21:14:00.000-08:00

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Pure barefoot runners are like Big Foot. I've read a lot about them. I see pictures of them on the Internet. But I've never actually seen a barefoot runner, unless you count my four young children.

The most irritating thing about barefoot running is finding a single shoe under the ottoman.

I wish the barefoot running advocates would quit talking about how our ancestors use to run. Those of us with less than perfect foot structure and other physical attributes would like to fare better than our ancestors.

The fact that some of our ancestors 5- or 50-thousand years ago ran barefoot and survived doesn't say much about modern feet and footwear. While our ancestors who happened to be nearsighted were eaten, many modern folk greatly benefit from glasses and contact lenses.

We are taller and heavier than our ancestors. The feet of our ancestors did not get accustomed to working 40+ hours per week in shoes. They did not have to deal with cement and glass, and repetitive jumping and landing on basketball courts.

This is not to say that orthotics are the answer to every foot problem, or that minimalist shoes are a bad idea. I do believe that overblown, cushy shoes can encourage improper running mechanics and cause our feet to become fragile and imperceptive. The longer I've worked as a physical therapist, the more I've witnessed how interlinked and mold-able are our systems.

Without at doubt, every person presents a unique case that defies simple categories.

I've seen individuals experience immediate relief by wearing the right orthotics. Some of those require regular long-term use of orthotics. Some people can train their way out of flat footedness. This may sound like a huge oversell, but it is absolutely possible! Do not underestimate the way foot function is connected with neurological factors all the way up past the hip.

Whatever footwear you're in, you don't need to run barefoot to get all the benefits of running with better form:

-avoid a heel strike and large vaulting strides
-place your weight down softly on your mid-foot
-lean slightly forward, imagining a series of smooth controlled falls rather than pushes

The image at about 1:44 says it all!

Of course there's a catch. Abruptly changing to this form may cause your plantar fascia and achilles tendons to scream, especially if you're overweight. You can expect a variety of aches and pains if your core, hip, lower leg, and intrinsic foot muscle are weak, or if you have ankle or foot inflexibility or structural issues.

Whatever your form and function, being barefoot allows for less margin for error, at least initially. If you have issues while running, a few weeks off is not going to fix the problem. It is often worthwhile to have a qualified professional develop a plan of care that is specific circumstances.

In conclusion, many of you should probably keep wearing some type of footwear, unless your goal is to disappear or become a hide-and-seek champion, Big Foot style.

- - - - -

Should I try Glucosamine and Chondroitin Sulfate?

2011-11-03T21:26:00.000-07:00

This is a question I often receive from people suffering body aches and pains. The answer on this dietary supplement is that, as you probably guessed, it depends.

Although we do not know the exact mechanism of action, glucosamine and chondroitin (G/C) are thought to interact with cartilage in the weight bearing joints, namely the knees and low back. Unless you count the placebo effect, neither of these ingredients offer much for wrists, elbows, shoulders, muscle strains, ligament sprains, or tendinopathies (achilles tendonitis, plantar fasciitis, epicondylitis, etc.).

Low back pain is so broad and complex that any small benefit to the structure and function of the lumbar spine discs is trivial and difficult to measure. As for the knee joint, well controlled studies that are not funded by supplement manufacturers seem to give mixed results.

Overall, some results indicate that G/C helps people with mild to moderate knee arthritis experience less knee pain and increased functional performance. Although it had been thought that glucosamine and chondroitin work together for maximum benefit, evidence is mounting that leads some researchers to question the need for chondroitin.

It is important to point out the obvious fact that knees do not exist in isolation, and there are many factors relevant to cartilage wear and tear. From my physical therapist bias, I'm certain of what G/C does NOT accomplish for the knee.

G/C will not address deficits in hip strength or flexibility. It will not address impaired ankle mobility or problems in foot structure and function. G/C will not iron out the subtle nuances and asymmetries of your gait pattern. G/C will not confront your running, squatting, or sports habit layered over your specific biomechanical issues.

Yes, I'm aware that addressing these things take a little more time and effort than swallowing a few horse pills per day. If it were possible to design a G/C study that adequately controlled for these mechanical issues, I imagine that the effects of supplementation would be...well, mixed, with slight improvement at best (basically the data we have now).

It is thought that at least 3 to 6 months of supplementation (at a cost of at least $25 per month) are required to show any signs of effectiveness. Since the safety of G/C has been well established, there's at least no harm in considering a $75 to $150 experiment.

sellout

2011-10-21T09:49:00.000-07:00

Here's what I'm thinking about in the local PT industry. Asking about. Praying about.

A few of the 5 owners of First Choice Rehab, my bosses, apparently will retire sometime soon. They have decided to sell the company to a large health care provider rather than entertain my (and others?) less than generous offers of buying into the business.

Anyway, it's been fun, working for First Choice. They provided the structure and administrative support that I chose in order to save my nights and weekends. Otherwise I rarely heard from them, which was most of the time. They saw no need to micromanage, I'm sure because my clinic consistently delivered the numbers. My clinic performed within the top three of our 12 offices for almost the entire 6 years that I've been there.

And I didn't kill myself doing this. I got exactly what I wanted out of the deal, 40 or 45 hours of steady work per week, a fair salary, and plenty of time for my wife and kids and goofing off with friends.

Just f.y.i.: that free time was spent achieving feats of fun and awesomeness that I would never trade.

We had fun in the clinic - my small staff and hundreds of patients. We got to know each other. The magic to our physical therapy model was that when you don't have to report to investors and loads of middle management...when you DON'T have a huge facility filled with tons of fancy chrome equipment and rehab gadgets, you can make the financials work without cramming 50 patients in-and-out per day.

This minimalist approach allows a PT to give patients his time, care, and attention. You can listen to each other. You have time for a sore shoulder when the script is for knee pain. Excellent physical therapy does not require much more than a head and hands and some basic gear.

Marketing?

My clinic wasn't owned by any medical doctors or health care networks. It wasn't locked into questionable lease arrangements or other kickbacks that ultimately disservice the patient.

I came into this area with nothing, knowing nobody. I showed up at work and at parties and sporting events and fund raisers, usually dragging along 2 or 4 children, because I like these things. I welcomed local high school and college students who were looking for clinical experience. I made genuine friends, invited them to pick-up basketball and flag football and birthday parties and Bible studies and smashed some of them with brutal weight training in my basement.

I didn't do these things because I wanted to market my business, trying to get get more patients and hire more staff in order to open up new clinics and hire more staff. I wanted to be a solid person rooted in the community. THIS community where I live.

I wanted to do them well and do good business, the kind where I can look my past patients (and current neighbors) in the eye when I see them at the grocery store.

I never tried to fool anyone about my unwillingness to take on the task of running my own office. An additional PT office right around here would be overkill. The business side of health care drains me. Instead of going home to read up on Medicare regulations or getting credentialed with local panels, I prefer to spend plenty of time with family and friends. Instead of staying up late doing payroll and human resources, I gain passion and life from reading and trying to write about our bodies and our minds and the human condition.

And this is exactly what helps me to deliver unique perspective and quality care.

Moving on to exciting opportunities in other locations may mean losing the local connection that's so important to me. Staying put may mean less pay for more work within a healthcare philosophy that I'm not in tune with. Welcome to the real world, Bob.

Is there any room around here for a physical therapist who would like a little administrative support without the micromanagement and red tape?

Is it even okay to be content with making a living, helping a handful of neighbors without building an empire?

Will Select Medical approve our weekly Brusters Thursday treat for our staff and students?

Is this asking too much?

- - - - -

I pick things up & softly, nonthreateningly place them down

2011-10-13T13:41:00.000-07:00

I just had to.

So I Left Amy and the kids home on a beautiful Saturday morning to go train at Planet Fitness. I had to be there anyway to advise a past patient on some training matters. Paul the manager kindly grants me access in order to help clients transition to a long-term fitness routine.

I walked in and immediately...waited. I watched some guy use the only free weight rack to do about 19 sets of bicep curls.

When it was finally my turn I proceeded to do it all wrong. I completed only one exercise for "chest," hung from the smith machine to do chin-ups, and didn't have time to isolate anything.

The gym was mostly empty, which was nice. I tried to keep moving without making much noise or demanding attention. Things went well until it was time for dead lifts, the amazing epitome of lifting things up and putting them down.

Thump - thump - thump, is the low pitched sound of rubber plates bumping off rubber flooring. I've definitely heard people sneeze louder than my thump. After the third of my four work sets, a girl on staff came over from the the front desk. "Excuse me sir but you're not allowed to drop the weights. I'm sure it wasn't on purpose, but..." Then she turned and quickly walked away.

I could feel her discomfort in confronting me. So I grabbed the nearest dumbbell and tossed it in her direction, "You don't know what's dropping weights." Then I proceeded to quietly roll the loaded barbell back and forth across the open gym floor, asking the other patrons if this is too loud and intimidating.

No, that didn't happen. But I did say "oh I'm sorry" before completing my fourth set with a little extra impact control at the bottom of each rep, watching the Lunk Alarm out of the corner of my eye. It was a long, miserable set. The Lunk Alarm held its applause.

- - - - whew- - - -

I completed a couple finishing "core" moves and hogged the free weight rack with barbell bicep curls. I went over to peer at my nemesis, the hip abduction/adduction machine. Forty five minutes and my work was through.

Concluding remarks:

I caught a nice workout at Planet Fitness without having to put up with the typical gym culture tomfoolery.

Planet Fitness should decide if they want to be a gym or library.

I was definitely feeling a little judged. Make no mistake - Planet Fitness does (and should) judge in order to uphold a certain atmosphere. They should try to design a Lunk Alert that's less sensitive to dropped weights and more sensitive to a critical and hot-headed spirit.

- - - - -

I pick things up and put them down

2011-10-10T22:19:00.000-07:00

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I'm no marketing critic, but I think this Planet Fitness ad is hilarious, has retaining power, and gets their core message across. They got it right, the meat-head with an accent wearing ridiculous shorts and sleeve-cut flannel, swigging mystery fluid straight from the gallon jug.

I appreciate that Planet Fitness takes the promise of a nonthreatening exercise environment seriously. Although their "Judgment Free Zone" claim is a bit of a reach for a public gym, I know how often the typical fitness scene can become quirky and downright ugly.

Convenience is not the only reason why I've been training at home for the past decade or so. I've seen young and old men having staring contests with their biceps in practically every gym. I've noticed girls training in butt floss at the Paxton Community Friendship Center, draped over a hamstring curl machine situated in a high traffic area. I witnessed some cyborg inside the Slippery Rock Barbell Club intentionally bloody himself while doing dead lifts, rubbing the knurling of a barbell along his bare shins.

These are the type of things most of us just don't need for our health and wellness.

Planet Fitness caters to all the mostly sane, everyday people who simply want a gym without all the oddball duchebaggish behavior. But the irony in the commercial is that sane, everyday people would benefit most from nothing more than LIFTING THINGS UP AND PUTTING THEM DOWN.

Nothing else is as effective for increasing functional total body strength, balance, coordination, and muscle tone. Not the rows of elliptical machines, the tanning booths, the flat screen TVs, or the newest machines that isolate the triceps and obliques. None of those thing are as time efficient and effective as picking things up and putting them down.

Take lunges. The hip and quadricep (front thigh) muscles must generate force with most of the weight on one leg. Controlling momentum of the body (plus any additional loading like dumbbells) requires the abdominal and back muscles to stabilize the pelvis. The hip adductors (inner thigh muscles) and abductors (outer thigh/butt muscles) balance the leg so that you don’t tip over.

If you're not doing some variations of lunges, rows, dead lifts and chin-ups, pretty much anything that involves you picking things up and putting them down, you probably should be. I make this claim not as a gym-culture blind fitness fanatic, but as a doctor of rehabilitative medicine who has helped hundreds of people to decrease their pain and increase their physical performance.

Lifting things up and putting them down is what real life requires of us. Since we ALL pick things up and put them down, it's often helpful to identify dysfunctional movement patterns and use various modalities, hands-on mobilization, stretching, strengthening, and stabilization exercises to attempt to correct them to the greatest extent possible.

Some of this requires...you guessed it.

Up next is a report on what recently transpired when I tried picking things up and putting them down over at the local Purple.

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Olympic Lifts

2011-10-05T22:01:00.000-07:00

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Athletes and other serious fitness folks sometimes ask what I think of the Olympic Lifts. Of course the cost/benefit of doing these explosive movements depends on your training status and goals. But we'll move past all the hard evidence and wishy-washy canned answers in order to get down to some nice solid opinion.

In case you're wondering, here's a prime example of an amateur hitting a pretty impressive lift. It displays both the good and the bad of the clean, one of the simplest Olympic Lifts.

Olympic lifts are low-tech, brutally high on effort, effective movements. They are unmatched as total body lifts and will absolutely improve coordination and explosive power. The only problem is that, unless you're competing in the sport of Olympic weightlifting, the Olympic lifts are almost completely unnecessary.

Here are a few reasons why:

The Face Factor

I'm no stranger to missed lifts or strained muscles and joints. But just the thought of building up and pushing my capacities in the Olympic lifts scares me.

Mastering form on these technical lifts takes quite a while. Even then, you can fool around with submaximal resistance to learn technique all you like. That's fine and good for a time-efficient way to burn a lot of energy. But at some point most of us will want to push our limits into new territory, which mandates a lot of yanking and heaving in order to create the high velocity required to hoist heavier and heavier loads. That's when there's so little margin for error.

Contrast this with other big lifts like squats and dead lifts, which employ the use of huge loads and injury potential, but simply don't have the same face-driven-into-the-floor factor. The intention to create an explosive lift is there but because the load is so heavy, the movement is always controlled. You can tell when you're going to lose and/or miss a heavy squat. But Olympic lifts are sometimes...not the greatest for your health and fitness:

There are better ways to gain size.

Getting bigger is about ripping your existing muscle fibers apart and then allowing sufficient time for adequate recovery. The traditional lifts enable heavier loads and more total time under tension, both of which are primary factors in the big breakdown.

There are better ways to gain power.

If you want to get big, strong, and increase the depth of your personal awesomeness bucket, lift heavy things for a lot of reps. Gaining power is all about making your nervous system AMPED. If you want to be able to apply that strength to functional performance, do plyometric activities of maximal effort in various hops, jumps, and medicine ball throws. Plyometrics are a more fun, less risky way to fine-tune the nervous system for total body coordination and explosive power.

Training = Rehab, Rehab = Training

It's truly rare to find a person who does not have some kind of musculoskeletal issue. It may be a slumped thoracic posture, a leg length discrepancy, or poor lumbar stability. It may be inflexible hips, deactivated glutes, or tight ankles. Olympic lifts will absolutely exploit a weak area in a manner that allows little room to identify, much less correct faulty positions and movement patterns. Traditional lifts and their variations usually allow for some degree of focusing attention onto your weakest link.

Gear

The Olympic lifts require bumper plates, loads of space, and a favorable atmosphere. Not a huge deal, but go ahead and try throwing even the 3-pound purple dumbbells up overhead in your basement with light fixtures and 7 foot ceilings. Try dropping even your water bottle at Planet Fitness. I have yet to experimentally identify what sets off the lunk-alert, but I'm guessing that the threshold weight is somewhere right around pink.

And what say you? Have you found the Olympic lifts to be unnecessary and mostly pointless? Or are they an essential key to unlocking your greatest everything?

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pushing limits

2011-09-20T09:38:00.000-07:00

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There is a time for everything, and a season for every activity under the heavens.

Ecclesiastes 3:2

It happened when I gave up on playing collegiate baseball. I swore to avoid typical patterns that yield typical results.

I would not deny my age. I would not act my age. I'd resist the variety of college binges that create atrocious habits and leave you not forever ya, ya, ya, ya, ya-young [Kesha reference]. I wouldn't push through seven years of college so that I could carry a leather briefcase, fancy up the house, buy a luxury car, or invest in stocks for fun.

Tuck jump over 5' 3." is my thing.

I would always be an athlete, setting goals, thriving on the process of improving my game, strength, speed, or whatever. I would attempt to eat well while not overly burdening anyone, never have to worry about cholesterol or having to diet. I would playfully eye up walls and fences, imagining what strategy I would use to scale or jump that baby outright.

Later I would refuse to talk on the phone or read a book while the kids get to stampede around the yard or playground. I would invite a few like-minded young men, fit and nearly half my age, to train with me. I'd get a dose of youth, intentionally go under the influence of what repels the sneaky stale.

Making good on those promises has been wonderful. Challenges were confronted, risks taken, confidence gained, stories remembered, and friendships forged. We've pulled off feats we would have never imagined.

It would have been hard not to learn a few things along the way. Like how difficult it is to avoid typical patterns, why you don't see many 40 year-olds playing tag with their children much less launching quarter pipes or dead lifting 3 times their body weight.

How do we know when it's time to push limits or to respect them? There's no formula under the sun.

I caught a clue last week when I noticed Tim, Ryan and I leaning on our bikes during what we call Ridin' Time, talking about crab grass. I often perceive the slow closing of that window of time between feeling warmed up and feeling fatigued. I allow walls and fences to mock me. I've grimaced while getting dressed after a day of glorious impact.

And there is this knee pain turned chronic.

Nothing lasts, especially the "wow" feats of total body power and risk. Unfortunately, the awesome factor of an activity always seems to be inversely proportional to its longevity. All athletes retire, some more formally than others.

To age gracefully is to accept not so graceful movement. We grow wiser. And busy. Stiff, achy, and plain tired. We all slow down, eventually to a stop. Limits always win in the end.

And yet the theory that a spine or a pair of legs has only a certain number lifts and bends is rubbish. Would we do well do sit around saving our steps, jumps, and lifts? How can we afford to take it light when it is the loading that causes our mind and body to grow, when our entire being becomes more resilient through the magic rhythm of work, rest, and recovery?

And let us not forget the grace of movement, fluid art everywhere, immeasurable.

So I'm hopeful for another decade or so of pushing.

Will ten years make me content with a shift to maintaining health rather than pushing limits? Will I literally walk away after proving whatever I needed to prove, having had fun, made stories, and dragged a few good friends and family along for the ride? Would I retire before winding up like a some version of the Monty Python Black Night?

Probably not. No with mere time. Resiliency has its limits.

Ah, to be at peace with limits. To see golf and the elliptical machine and cooking on the grill and cruiser bikes and raking the yard as gifts. That simple and right gratitude pushes my limits.

Yes, I have some working out to do.  

  -----

Abgnostics: the secret secrets of ab secrets

2011-08-25T14:27:00.000-07:00

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This is for those in pursuit of a solid mid section, wondering what secret knowledge lies hidden behind the ab ads floating all over the place. Or maybe you've considered the numerous benefits of physical training and figure that while you're at it, you may as well do something for your core.

Maybe you could care less, and that's perfectly fine too, so long as you're active and healthy. But I still do receive a lot of questions and see much misinformation pertaining to ab secrets. I've had a fun time doing this before, trying to explain that Abs Are Not The Core, but here's the lean (not skinny) on what all the secrets are trying (or should be trying) to tell you.

Kung Fu Panda opens the secret scroll.
"It's you. The secret is you."

exercise

It's that simple. You can run, bike, swim, zoomba, scoot, crab walk, shuffleboard, rake, chase puppies, throw children, and so on. You can even do some crunches and leg raises if you like. Whatever you do to huff and puff and burn calories is fine as long as you also do some total body resistance exercise.

You could save a lot of time by simply challenging yourself with progressive resistance training. That would mean fairly high reps and fairly heavy resistance (relative for you) in variations of the big movements like squats and lunges, presses, push-ups and dips, pull-ups and rowing. A few sets of 10 on the seated leg extensions, bicep curls and the shake weight are not going to cut it - your abs. Neither will 1-rep max bench press or 1-rep power cleans.

It's muscle that sticks out - in a good way - in your midsection and other sections. It's the loaded resistance exercises that cause all your trunk muscles to work hard in a functional manner. You don't get that from just running, or swimming, or zoomba, or crab walk, or so on. Plus, muscle is functional, like totally good for doing things, athletics and otherwise; bigger and better, safer and more awesome. But oh, all those injury prevention and functional benefits are mere side effects of being ripped.

Please don't worry about 7 minute abs, 4 minute abs, or any other minute abs. Sure, you should try to include a few "core exercise" variations after or as part of your real training. And yes, Hershel Walker and so-and-so do 15,000 sit-ups each and every night. How dumb! Doing that much of anything does risk developing imbalance and later injury. Far more than that, it's a completely unnecessary waste of time.

On the other hand, gradually, systematically getting to the point where you can dead lift double your body weight for 6 reps and make it look easy...again, the resistance used is relative, but THAT'S what I'm talking about:

Ben C pulling 335 for 6 reps. No wraps or belts. Only
The Hawthorne Effect to prop him up.

eat

This side of the issue is complex because so many factors enter in to what and why we eat. The specifics probably vary and are highly dependent upon your starting point; whether you're already relatively thin or 15 or 100 pounds overweight. Here are a few things to consider no matter where you stand.

No amount of training will make up for a crappy diet. The perfect diet cannot do for your body and mind what intelligent training can.

If you feel like you don't have time to be at the gym 6 days per week and prepare and tolerate broccoli and chicken every day, good because you don't have to. You do not have to eat like a typical bodybuilder. On the other hand, you cannot eat like a "typical" American.

Start with this: give up fried foods, limit sweets to about once per week, and attempt to limit (but don't overly restrict) healthy carbs. Try to find a weekly cycle of a few meals/foods that work well for you and just stick to it, no questions. You WANT to be bored with your food most of the time, but NOT hungry. Nobody said it would always be fun.

These secrets are all general, but I'd be happy to try and address any specific questions or concerns. Just please don't ask about breakthrough supplements or ab machines unless you've tried at least 3 to 6 months of consistent total body resistance training along with boring, non extreme dieting with moderate amounts of mostly non-processed foods ; ) .

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perspective for pushing sports

2011-08-07T21:03:00.000-07:00

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The boy, twelve years old, appears about fourteen. Loves baseball. Pitched quite well for the team during the playoffs, which also earned him severe shoulder pain.

In the clinic, the boy rolls his head and drops his shoulders when I ask him to complete a second circuit of light scapula stabilization exercise. But he's willing. Dramatically drags himself back toward the weights. It's not that the exercises cause shoulder pain. He's already tired from ~~swimming~~ poolside horseplay in the heat all day. That, and he's twelve.

His dad, standing by, rolls his head and drops his shoulders.

"See? He has to understand that if he wants to stay healthy and improve, he's going to have to work at it. I just don't know how much to push a twelve year-old."

Dad is right to say that at some point, a young man absolutely must decide for himself if he wants to be the best player he can or just have fun. Either choice is definitely fine, but one requires enormous sacrifice and effort. For most children, 12 years of age is far too soon to face that decision.

How much should a parent push a twelve year old? In most sports like baseball, not much. People of all ages do benefit greatly from some structure and direction. But there's a fine line between inspiring our children to adapt an active lifestyle and dragging him or her half way across the state for their club team. So long that a boy is not sitting around all the time, there's very little room to push at all.

Dad, you have to make him want it.

Inspiring my daughter on the joys (and pains) of an active lifestyle

Which is impossible, of course. I don't think we can make a child passionately driven to high level athletic (or any type of) success any more than we can make him have a favorite food. On the other hand, the formula for burn-out is pretty simple. One great way to make a kid hate pizza is to start him early on pizza and push pizza every day and always talk about pizza.

How much should this father challenge this son to excel in athletics? Who am I to say? It probably depends on both the father and the son. It probably changes from month to month. To the fathers credit, he knows his son well. Clearly loves him. Shares loads of time with him.

Later, over some hands-on shoulder work, I told them that they both love baseball, and I think that's a great start. I reminded the boy that as he gets older and the competition improves, he will probably suffer a few more defeats than he's use to right now. That's when he'll learn some things about what he wants to do with his time.

Either choice really is okay. Lord willing, the boy will find passion for something. He'll need a father who challenges him and supports him. He'll need some time to horseplay in the pool. These are all good things.

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A Season for Disclosure

2011-07-19T22:36:00.000-07:00

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Patients often ask if my work varies during certain times of the year. The truth is that I've been unable to observe consistent seasonal patterns in the number or type of injuries treated in my office.

January rarely brings an immediate influx of people suffering strains from skiing and snow shoveling. Knee pains born of a New Year's fitness resolution may not reach maturity until July. The spring and fall are quite similar in terms of shoulder pain related to activities like pitching (baseball) and cleaning windows.

These issues are my typical labor and may be rooted in seasonal interests. But many factors obscure the effects of latitude on the yield of injuries, such as individual pain tolerance, patience (or stubbornness), job status, insurance deductibles, and backlogs in the schedules of orthopedic surgeons.

Whatever the season, people with various aches and issues continue to trickle into the office, and I'm thankful for that.

[Wait. Did he just compare pain to a crop and say he's grateful for injuries?]

What I mean is that gratitude through all seasons is critical to my work. This certainly applies to other professions and may seem obvious given a physical therapists calling and place in the entire realm of health care. But in my experience, some models of outpatient rehabilitation serve patients and therapists better than others.

Of course it's rewarding for a physical therapist to help clients regain a portion of their lives, their ability to work, play, or simply care for themselves. But quite honestly, those rewards do have their limits, especially during busy seasons. While all health care providers want to be busy, the art of providing excellent care during busy seasons is not for rookies.

If you or someone you know is in need of outpatient rehabilitation, there are a few things you should know.

It is good when a physical therapists livelihood depends primarily upon the quality of work that they do, and not upon affiliations with health care networks, contractual obligations, or creative lease arrangements.

It is good when the natural checks and balances of free enterprise can quickly dry up the trickle of patients where a therapist fails to deliver outstanding care.

It is good when important business concerns like medical necessity, proficiency, scheduling, and balancing efficiency with quality of care have the chance to take care of themselves instead of being mandated by out of touch administrators.

To list these strengths of small, independent physical therapy practice is not to say that other models cannot provide high quality care. But I've worked in settings where a constant swell of patients presses against you whether or not you take the time to pay attention to the details. I know what it is like to be busy on a beautiful Thursday afternoon when someone needs a lot of reassurance and a little specific guidance beyond the general exercise protocol for their diagnosis.

While there are no substitutes for clinical competency, I’m sure that both patients and providers could stand to benefit from an honest appraisal and disclosure of the season they are in.

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training the "core" - an example

2011-07-18T20:22:00.000-07:00

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Check the vid of Kyle. We did three rounds of this circuit after some traditional heavy lifts. Done.

"oohhhhh"

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20 Rep Squats (are not for everyone)

2011-07-12T21:50:00.000-07:00

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If your employment required you to load far more than your body weight onto your shoulders and repeatedly lift it, you would be moaning and griping, soliciting the services of Metzger Wickersham.

There would be a TV news hard-luck segment about what a person will go through to provide for their family. Those watching would feel both pity and admiration for your miserable lot in life. Some might even ask how they can help you evade all that weight in favor of something more sensible.

But once every week or so in my basement, a few lunatics line up to willingly experience a misery that defies sensibility. We don't get paid a cent, though the payoff per unit of time is enormous.

I can’t wait to dread it. Under the bar is a deep place of meditation, with "twenty” my mantra.

-------- -------- --------
Is everybody in?
The ceremony is about to begin.
WAKE UP.

-The Doors

Wake up. Your head must be ready for this.

Stand with your arms draped across the barbell set to chest level, loaded with a weight that's a struggle to handle for one good squat. You're going for twenty. Doing twenty. Just go.

[Disclaimer - barbell squats are an awesome exercise that make you awesome. Yet most individuals could use a few days, weeks, or even months of corrective exercise and work on precise form before challenging themselves. Squats don't hurt people. People hurt people.]

Injured? Heck no. You may fail, but you probably won't get injured. It's only 1 or 2 percent more resistance than what you attempted just 6 or 7 days ago.

So get in there. Step under the bar and lock it into the groove across your scapula. Breath deeply and brace your entire upper body for one punishing isometric. In the last moment before the first and possibly worst descent, you must see yourself hitting that first rep, feel the joints loaded, digging out of the bottom position.

It’s time.

Descend smoothly, see white as you brake and accelerating the weight upward.

1

Damn, that’s heavy. You’re crazy for lifting it once, much less twenty times.

2

The sooner you move on, the sooner you’re finished. This will end.

3

A little winded, hearts racing. Nothing exists except the task at hand. Nice.

4

Somewhere in here, a rep or two actually feels pleasant. You’ve found the groove, firing on all cylinders.

5

6

You're in plenty deep enough to experience the misery. This is not joint pain, but the ache of every muscle ablaze from the mental effort required to maintain form.

7

8

Few hard-core gym-rats squat, and most that do have racked the weight by now. They're sitting on the leg extension machine drinking bottled water.

9

The whole idea of 20 reps squats is pointless stupidity made up by some idiot.

10

Yes, half way! Ugh, half way.

11

You embrace the sting and throbbing as evidence of pushing your limits. Yeah, you went there.

12

When everything tells you to quit, you decide not to.

13

You’re an unfeeling machine executing pre-programmed instruction. There's no choice in the matter.

14

You will never look at a barbell again, much less lift one.

15

It’s down to five. Right about now is why you don’t train on a full stomach.

16

The bar heaves, climbs upward so slowly. You thought you saw a splinter of light. Is that the end of the tunnel?

17

No. That thought helped you for one rep, but you’re heading into the valley now. The dark pit of hell, the physical and mental test that's the point of all this. [Whether you're fighting against 40 or 400 pounds is not the least bit important, as long as it drags you through the valley.]

18

19

Each and every time you make it through the valley, you really do come out as a different person.

No. Nobody. No one fails at 19.

You explode, throwing the weight through the roof. Did gravity lessen? No, the bar still sank and then barely ascended at all.

20

You stagger and lean forward to rack the beast. Unload. Unwind. Finally. Careful now. You should sit down or hold onto something for at least a minute or so. The world will return in a moment.

You did something…strange and extraordinary. Your potential is not unplumbed. You didn't need 26 miles to find a test. You didn't need a surfboard and a tsunami to get you adrenaline pumping. You didn't need to have your face turned inside out to get something you can feel.

Squats are easier on your face than Fight Club

Cholesterol, blood pressure, hormone regulation, blah blah blah. Yeah, I'm sure you can - next week, move the resistance up just 1 or 2 percent. That's not very much more. That's not for everyone.

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fitness guys have issues

2011-06-27T22:51:00.000-07:00

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Adult fitness dude, trying to buck the trend of sick, soft, and slow:

You probably grew up in a good home, playing the days away. There were no hardships or rash demands. You had it a lot better than you could know. You were an active little guy. Probably excelled in sports at that level. Rocketed a hand overhead to lead gym class. Cared who banged out the fastest 10 push-ups in the whole entire classroom.

You probably ran, "worked," biked, and played into the night. Baths and restaurants were a chore. Until about the age of 12, when you slowed down from hummingbird to sparrow pace. You were expected to sit and not fidget once in a while. Sports practices left you slightly tired and sore, in the mood for a nice video game "sesh."

Google search: ~1992 stacked athlete. Yep.

Then one day you heard you are what you eat. A realization hit you, about the gallons of Hi-C and tubs of Planter's cheese balls, dinners of entirely chicken nugget, and post-game feasts of pudding and ham cubes at the Rax buffet.

By 15 or so you managed to get slightly soft. Or if that wasn't reality, you started noticing that your coltish body didn't exactly look like a pro athlete or the guys on TV and magazines. It was still mostly all fun and games and sprinkles maxed out on ice cream cones.

At school you were repeatedly barraged with the idea of discipline and dedication, strive, effort, and work ethic. So. Much. Work ethic. You needed to hear those things, yes. But with little counter perspective, it's no wonder that during the most arduous period of gaining independence and finding identity, the accelerator started to stick.

I’m guessing that you suddenly started keeping an orderly (or more orderly) bedroom and your grade point average jumped. You decided that the National Honor Society and being huge and ripped for sports and for the ladies was...well there just wasn't anything else. And all that wasn't going to happen from living like any sort of a human being. Certainly not from eating grandmas stew and those damned pumpkin cookies.

The discipline schtick worked pretty well in some ways, for 6 months or so. You saw progress in the classroom and gym. You enjoyed the consistency, the illusion of control, the clear results of living out your philosophical modernism. There were good points, for sure. There were certainly worse ways for knucklehead teenagers to error.

But error you did. Your imbalanced, self-absorbed life caught up with you. Knotted you like the hair of a mopey Seattle grunge band. You had almost no fun and were less fun company. Ladies learned not to care about your cut bi's because you were a 160-pound zero.

Clever marketing misinformation.
I mean, he's lifting supplements out of
the ocean with a fish net??

Nine months of nearly perfect discipline started to show. Your family knew nothing about anything, and you taught them lessons about control. People worried, seeing what happens when a young man makes good on two workouts/practices every day coupled with the dietary advice good for mostly sedentary, middle-aged bodybuilders.

All this, of course, meant that you weren't training enough or eating right, according to the gospels of Joe (Weider) and Bill (Phillips). Is it any wonder that you now have a chip on your shoulder about stupid supplements and worse than useless over-training practices?

Dialing UP the discipline and grit pretty much ruined your chances of being a friend, much less a collegiate athlete. You wanted to blame it on illness, honestly not knowing how being frankly messed up in the head creates dysfunction somewhere in the body.

You didn't learn fast, but you did learn. At the bottom you said "This isn’t working very well, and it sucks.” Even more determined, you devoured books and journals, learned plenty, transformed your love of knowledge. But of course knowledge alone didn't immediately advance you toward a strong mind and body, much less joy.

A tight grip through college had its benefits. Like no "Bs" in class or STDs or trouble with the law. Somewhere you heard that over 2 BILLION people have no toilets much less one pound of protein per pound of bodyweight. Put old Joe and Bill right in their place.

The grip gradually loosened as you became stronger, with graduate school, a marriage, a regular job, and children. You had way...more fun...with all that responsibility pressing on you.

Weird.

One day you woke up to see that you were actually getting somewhere. Training was important and the results were kind of a side effect. Not that you were the epitome of awesomeness and wisdom. But you realized the ebb and flow of a balanced life, of work and recovery. You knew the MIRACLE of flexibility within a framework of disciplined consistency.

first tree flip

Now you notice when other young men seem to be spinning their wheels. You try not to project your issues onto them, but you see it a mile away. You want them to learn from your mistakes. You pull your net of training and living wisdom from the ocean of possibilities, display it lightly. You hope some aren't so knuckleheaded, having humility to forge ahead of you instead of digging a rut of their own.

Were you lucky to have found your way? I don’t believe in luck, not at all. And who has arrived? I certainly haven’t. But I believe in a God of freedom who seems to help at least two at a time, who weaves paths together through seasons and situations.

- - - -

don't train like it's 1985 [please]

2011-06-22T22:41:00.000-07:00

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a question

Since ranting against long drawn out cardiovascular exercise (L-doc) may not be the best way to inspire change, my serious question is this: can you afford to spend that much of your valuable time and energy doing L-doc?

The repetitive, mind-numbing exercises like jogging or that elliptical thing at 60 to 80% of your maximal heart rate for at least 40 minutes costs you something. There are many factors, but you must consider the possibility that random cardio is easily and often over done.

But first the disclaimer.

Who am I to tell someone not to engage in physical activity that they enjoy? When well below 40% of adults exercise at all? Whatever the age, if you're up and moving away from the work desk, TV, and computer, great for you. I'll admit that L-doc does have some value as a component of many athletic and fitness goals, though less than you would think. If cardio workouts are compatible toward your sport- or activity-specific training goals, then certainly, have at it.

split squats - always worthwhile

But with your hectic work week, your limited days of summer break, your finite physiological ability to adapt, can you afford to devote the majority of your training time to random cardio? Are you stuck in the 1980s cardio overkill mindset where if a little is good, then a whole lot must me better for all things?

what say you?

You, 160-pound forward who wants dunk by next basketball season? You, middle aged mom, hoping to avoid achilles tears and rotator cuff impingement while playing softball, tennis, or freeze tag with the kids? You, old timer, wielding exercise in the fight against the many tired heads of frailty?

And you...YOU coach or parent of a female athlete? My next exhibit in the case for less L-doc is a lunge for the jugular. I must drag out the dreaded anterior cruciate ligament because women suffer about 8 times more ACL tears than men, and about 1 in 100 high school and 1 in 10 collegiate female athletes tear an ACL.

that moment

Imagine that it's the fourth quarter of an intense soccer match-up. Every player on the field is suffering some degree of neuromuscular fatigue (certainly not for lack of cardiovascular conditioning). Our female athlete lunges off her left leg to avoid a defender, recovers with the right leg, redirects her body, accelerating to the ball.

What happens internally at the knee in that moment ? Do the quadriceps have enough power to decelerate the forward glide of the femur on the tibia? Do the hip and trunk muscles sufficiently hold the femur from buckling and twisting into the knock-kneed position? Has the athlete ingrained correct movement patterns beyond consciousness; summer time training memories of how the hips, knees, and feet should feel and react during leaps and cuts?

An off season 7-mile jog does virtually nothing to address the neuromuscular and biomechanical patterns of an at-risk female athlete caught in that moment. (I also suspect that various balance exercises on unstable surfaces do little to prevent ACL tears, though the literature is mixed, and that can of worms is hereby reserved for another writing.)

how now shall we train?

ACL and weekend warrior sprain/strain prevention is simply just plain smart training.

The details depend upon the individual, but the weekly routine should include a day or two of plyos and/or form sprints. A day or two of full body resistance training with emphasis on the legs and "core." Maybe a day or two of L-doc for some, but certainly not all athletes.

And of course, intervals for a relatively healthy grandma look a lot different than our teenage soccer player.

Intelligent training is structured with a few individualized goals in mind; goals beyond "stay toned" or "maintain an 8-minute pace over 5 miles." Even if distance running is your main end, rather than thousands upon thousands of linear, mid-range ploddings, why not mix it up with just a little whole body, multidirectional movements that address aspects of both strength and coordination?

Swap a day or two of the same old thing for something different now and again. Emphasize power over efficiency as the brain is tuned into a progression of pre-stretch/counter-movements. Do it now, before I'm tempted to bust out some Jane Fonda lyrics.

sprinters aren't happy about all that L-doc

Evidence that a little less L-doc does help endurance athletes, especially from an injury-prevention perspective:

Improvement in Running Economy After 6 Weeks of Plyometric Training

TURNER, AMANDA M.; OWINGS, MATT; SCHWANE, JAMES A.

Journal of Strength & Conditioning Research. 17(1):60-67, February 2003.

Maximal Strength Training Improves Cycling Economy in Competitive Cyclists

Just a few of many other sources that support my ~~rant~~ question.

Sunde, Arnstein; Støren, Øyvind; Bjerkaas, Marius; Larsen, Morten H; Hoff, Jan; Helgerud, Jan

Journal of Strength & Conditioning Research. 24(8):2157-2165, August 2010.

Hewett GD, Myer TD, Ford KR, et al. Biomechanical measures of neuromuscular control predict anterior cruciate injury risk in female athletes: a prospective study. Am J Sports Med. 2005;33:492-501.

Meeuwisse WH, Tyreman H, Hagel BD, Emery C. A dynamic model of etiology in sports injury: the recursive nature of risk and causation. Clin J Sport Med. 2007;17:215-219.

Ekegran CL, Miller CM, Celebrini RG, Eng JJ. Reliability and validity of observational risk screening in evaluating dynamic knee valgus. J Ortho Sports Phys Ther. 2009;39:665-674.

Myer GD, Brent JL, Ford KR, Real-time assessment and neuromuscular training feedback techniques to prevent anterior cruciate ligament injury in female athletes. J Strength Cond Res 2011;33:21-35.

- - - - -

toss this around

2011-05-24T21:43:00.000-07:00

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There's been some debate regarding whether or not a pitcher should be doing long toss. Each side has both sports medicine and traditional baseball "experts" claiming how wonderful or terrible it is to throw on a high arc for maximal distance versus direct line throws of shorter distances.

If this seem like a silly debate of minutia, it is. There are a lot of "big picture" issues that simply cannot be skipped. As I wrote about here, the data indicates that there are more important considerations, like the number of months of rest from throwing per year, total throws per game, innings pitched per year, and about 20 other factors that pitchers should be considering. Intelligent training of the entire body is the best way to spare the throwing arm.

That being said, with 6 out of 10 pitchers sustaining a significant shoulder or elbow injury, athletes, parents, and coaches need to give some attention to the minutia.

Well, authors of a recent study advised against long toss for maximal distance based on their observation that the mechanics of long tossing are different than throwing for shorter distances, and that long toss throws cause greater torque at the shoulder and elbow.

From this I conclude, "Oh really?"

Long tossing, like, where the athlete takes a few skips and a crow hop and reaches way back, orients his chest to the heavens, grits his teeth, and launches the ball out and up... The "kinematic and kinetic" values of THAT are different than throwing from a mound? THAT move, which creates higher arm speed, causes more torque on the elbow and shoulder?

For reals?

Well, if we're talking about returning to rehab after an injury, it's pretty clear that you need to be careful. This study did affirm that long toss is probably not a very good idea for rehab. But lets talk about someone with a relatively healthy arm who wants to gain velocity and total body rhythm that actually helps decrease strain on the arm.

The measured differences listed by the authors, like higher arm speed and the mechanical variation from pitching off the mound, these are exactly why long toss is a valuable component of training. Pitching with high velocity and good control is total body effort. Throwing should occur in three planes of motion {rotation, front to back, and side to side), not just linearly (front to back).

I think long toss is one of the best ways to "fix" pitchers who are all constipated in their delivery, "arming" the ball with a robotic linear pattern or without transfer of energy from their legs. It's a great way to create some sport specific strain that's a slight variation from the forces and trauma of pitching in games.

With pitching, even in the best case scenario, micro-trauma occurs throughout the entire upper extremity. The risk of injury certainly goes up if pitchers simply add any type of maximal effort throws to an already over stressed arm.

Like just about everything, long toss can be overdone and used inappropriately. But lets at least allow for long toss until we get more evidence that all pitchers should never long toss.

- - - - -

Training for Power (II)

2011-05-19T12:19:00.000-07:00

Power to the people

For athletic speed and power, should you lift weights or do plyometrics? The answer, without a doubt, is BOTH.

The specifics depend on you; your strengths and weaknesses, your current abilities and goals, and the demands of your sport or other activity. Of all those "depends," I think the best place to start is with your weaknesses. Identify your weaknesses so that you can set specific goals and start the journey, building off your strengths (for almost everyone already knows their strengths).

Many people fail, er, "workout routines" fail because they don't put much thought into that process. Or they try to accomplish two or more incompatible goals at once. Or they try to accomplish too much too quickly.

Typical situations

An 18-year old soccer player who would like to gain some strength and power over the summer should be doing strength training and plyometric training. Apparently, some coaches imagine that it's possible for active young men to gain 10 pounds of lean muscle, increase their peak speed and power, while also simultaneously achieving peak conditioning for distance/endurance type running. All this in 80 days of summer heat.

Regular intense 50-minute jogging gives the body numerous signals that are in direct contradiction toward the goals of increased strength and power. For soccer players, there is (questionably) a time for long distance running and grueling repeated 800 meter sprints; it's called the pre-season. Trying to achieve and maintain that type of peak "conditioning" year 'round is insanity.

Muscles with more cross sectional area (thickness) can produce more force, which can then (via plyometric and skill specific training) be applied to bigger and better skills that impress. It's the power that awes crowds. Endurance in team sports is important for sure, but nobody ever became elite because of their endurance. If you're carrying around an extra 10 pounds of powerful, opponent smashing muscle and get a little tired at times when there's no natural break in the action, well, that's why they have subs and time-outs!

Likewise, a person who's trying to drop a few pounds the right way, feeling a little too solid and slow, also needs to be doing BOTH strength training and plyos, with a bit more conditioning focus. Whether you'd like to do long drawn out cardio is up to you. You certainly don't have to, especially if you're able to eat non horse-sized amounts of mostly unprocessed foods.

Training program ideas

Whatever your goals and weakest link, be you male or female, footballer (US) or footballer (UK), the overall pool of strengthening and plyometric exercises that you really need are not all that different.

Just about everyone should include a variation of the deadlift and/or squats and a variation of loaded unilateral (single leg) work like lunges or single leg squats. For the upper body, there should be one horizontal and one vertical "pulling" exercise as well as one good horizontal and one vertical "pushing" exercise.Throw in some specific corrective/mobility exercises and core work and you have a nice program on your hands.

Yeah, that just about covers it.

Simple. Effective. I like it.

Template for strength/power focus:

Day 1: Bench press, deadlifts (or deadlift variation), and single leg squats, each performed for a few warm-up sets and then 3 to 4 sets of 4 to 6 reps.

This workout is very simple and miserable when you work hard on each and every work set, and see to it that, little by little, you are adding resistance to the movements. Finish with two or three circuits of an ab exercises (leg raises, ball tosses, or planks) coupled with an "arm" exercise like narrow grip bench or dips.

one or two days off

Day 2: Conditioning/plyo day includes 8 to 12 short (~40 to 60 yard) sprints followed by a series of double leg vertical jumps (Chairs!!), single leg side and forward hops up an incline.

one or two days off

Day 3: Incline dumbbell press, weighted pull-ups (or lat pulldown), seated overhead barbell press, and dumbbell rows, each for 3 or 4 sets of 6 to 10 reps, followed with a "finisher" of 20 reps squats. One miserable, I-hate-lifting-and-don't-even-want-to-look-at-a-weight-for-a-few-days, set of squats.

That's about it for the week. Bilateral and unilateral leg work, horizontal push and pull, vertical push and pull, a little arms and abs, all in less than 4 hours of training per week. It would take more like three if you would quit your yackin' between sets and if you don't have to get your kids a snack and a catfish bucket and off the swing and so on.

Template for power/conditioning focus:

Here we may do something similar but pick up the pace and add one day of conditioning for a total of 4 rather than three workouts for the week. That may look something like this.

Day 1: Deadlifts (variation) coupled with bodyweight dips, bench press coupled with single leg squats holding dumbbells (4 sets of 4 to 12 reps each). Finish with 3 one minute bike intervals coupled with a core exercise like medicine ball tosses or prone roll outs (praying mantis).

day off

Day 2: 6 to 8 80 to 100 yard hill sprints. Finish with corrective/mobility exercise and maybe some upper body plyometrics like medicine ball tosses, clap push ups, etc.

The perfect fitness equipment.

day off

Day 3: Chin-ups (or lat pulldowns) coupled with incline dumbbell presses, overhead barbell presses coupled with dumbbell rows, bicep curls coupled with a core exercise, and either Farmers Walks (carrying heavy dumbbells for distance) OR 20-rep squat finisher.

Day 4: Short sprints, plyometric hops and jumps (see day 2 of the other template), and possibly finish with some jump rope intervals or "X-drill" multidirectional short sprints.

So you're talking about 4 to 5 hours of exercise that counts. The weights involved in the conditioning focus template will obviously have to be less than those used when really pushing to increase resistances in the strength/power template. But please, don't ever go in wtih the mindset of "light weights and high reps for toning." You are still working hard and relatively heavy.

The rap

That's really it. There's no magic beyond semi-intelligent planning, consistency, progressing slowly with the long-term in mind, and a little attention to detail regarding exercise selection and execution. Remember that this is a template, and most everyone will need some variation to suit their specefic limitations and goals. Most people are suited for some movements better than others. Many people who say "I can't squat, press, deadlift, etc...) simply need a few weeks or months of corrective work. A trained professional may help with some of the details, and most people do fine with just a little guidance.

Yes, that's my own secret workout formula for athleticism and general neatness. You got it for the cost of some time. How neat is that?

The ab loung is a great piece of equipment.
If you pick it up and do lunges or farmers walks or press it overhead.

- - - - -

power for living

2011-05-14T22:06:00.000-07:00

- - - - -

Life demands power, the kind that doesn't necessarily corrupt.

Being strong (able to produce a lot of force) is good and all, but most physical activities both on and off an athletic field require the ability to generate a high amount of force quickly. When it comes to everything from dunking a basketball to dancing the night away, carrying groceries up stairs to shoveling tanbark to catching yourself from a stumble, the name of the game is power.

Power is the rate of doing work, or [Force X Velocity]. As you can see, being able to generate more force and being able to move faster both factor in to generating more power.

Plyos: a nervous system tune-up

Plyometric training is the best way to "teach" the brain how to coordinate the body and body segments to rapidly generate high forces.

What's considered "plyometric" is definitely relative to the individual, but movements like various sprints, step-ups, jumps, medicine ball tosses, and lunges are typical. In the back yard we push the limits of our horizontal and vertical leaping abilities with single- and two-leg exercises. In the clinic I spot older folks as they attempt to rapidly lunge and reach various directions, then recover to their starting position.

You really don't need much space or equipment for plyometrics. At home I have some gravity, ledges and graded surfaces for lower body training. And CHAIRS (see video)! We sporadically attempt higher level upper body plyometrics (which includes abs!). This usually involves "clap" push-ups, a medicine ball for various tosses, and a sledge hammer for hitting the big tire over at the neighbors.

If you're older and haven't trained in this manner, go ahead and test your body control with a simple set of lunges. If you're generally young and fit go ahead a try a few circuits of, say, 10 split jumps coupled with 5 to 10 clap push-ups*.

Briefly on resistance training

Resistance training is still essential for pretty much every training goal that you can think of. The right weight training (i.e. not isolation exercises seated on fancy chrome machines) also fine-tunes the nervous system, primarily for body control and stability. And of course, weight training is by far the only thing for body re-composition.

Getting jacked with bigger muscles is one thing, but resistance training is also critical for conditioning/weight loss purposes. I cannot understate how important it is in both the long- and short-term to "signal" the body to retain muscle and strength while you're in a calorie deficit. Lose the body fat and retain the magic-magic-magic.

I've said it before, but losing muscle when you "diet" sets you up for a frail and hungry cycle that usually ends with you either giving up or eating bland salads three meals per day and still not feeling very happy about the condition of those pesky "problem areas."

All we have is time

Not knowing the outcome. Pushing it. THAT's the moment.

The best part is that all of this really doesn't take much time. Cut the fluff, pin down a few goals, and get moving toward a fit, functional body. I train less than four hours per week and play hoops for about an hour once per week.

It's a matter of choices. This stuff is sort of a hobby that happens to be compatible with my profession. I live in a pretty modest home, drive a 98' Subaru to work, and have a pretty crappy tool collection. But I could care less. Today I wasn't worried about being in debt or hyper cleaning the house and I enjoyed plenty of time with my family and friends and I jumped over a freakin' 57-inch chair.

Do you know how far along those things will carry you into a productive, truly generous work week?

Training Plan

You do need to start slowly and give consistent effort and discipline over a long period of time. Training the entire body with "big" beneficial movements requires patience and some attention to detail. If you get bored or injured or stop prioritizing time for your physical well being after 6 weeks, well, now there's really no excuse.

You would have plenty of time and energy to do both strength training and plyos if you would step away from the seated leg extension/curl/abduction/adduction machines and cut back on all the random cardio and "split" body part routines.

Your shoulders are involved with almost all back, chest, tricep, and bicep exercises, as well as most squat and deadlift variations. So please don't tell me that you packed work clothes and toiletries and woke up at 5 a.m. and drove through traffic to do a "shoulders and biceps" workout. While this does qualify as disciplined effort, it's not exactly practical or effective.

Part two of this will include some specifics geared more toward athletes, including a sound training template.

- - - - - -

Split jumps - Begin with one foot out in front of you and one behind you. Jump high and land with the opposite foot in front/back. Upon landing, jump again, alternating which foot is in front/back. Start slow and pay attention to knee alignment.

Clapping push-ups - Like a push up, but do a quick turn around at the bottom and throw your upper body off the ground so you can clap your hands, land and begin the next push-up.

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chairs !!!

2011-04-25T08:27:00.000-07:00

Researchers are beginning to hypothesize that there's a link between "forward head posture" and sitting around most of the day with your head slumped forward.

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So You Wrenched Your Ankle (part II)

2011-04-17T14:15:00.000-07:00

Part 1 - what to look for right away.
- - - - -

You have rested, iced, and elevated your bum ankle for a few days or weeks, depending on the situation. It's likely still swollen, but you're at the point where you can bear weight on it. You need to get moving again. The first thing is to try some light stretching of the ankle to recover dorsiflexion.

Place a belt or towel under the ball of the foot and pull back to apply more stretch.

Make sure the feet are "aiming" STRAIGHT toward the wall, not flared out.

You MAY need a little help

As mentioned in part one, look for pinching when the ankle is stretched in this manner, or with real life movements like squatting or walking down steps. If the motion feels blocked and there's pinching toward the front of the ankle rather than a pulling/stretching feeling in the back of the calf and ankle, you probably should be evaluated by professional. This is a very common, stubborn problem after an ankle sprain that won't show up on an X-ray.

A skilled doc, trainer, or (yes) PT should be able to determine if there's excessive laxity (the ankle ligaments have been overstretched or torn) that would warrant further imaging or a period of immobilization. They can also perform a trial of manipulations aimed at restoring normal spacing between the top foot bone (the talus) and the lower leg bones (the tibia and fibula).

Take dorsiflexion seriously. Lacking this movement causes you to unconsciously shift strain to other areas on the same leg or to the other leg. Chronic ankle dysfunction can be particularly hard on the knee and low back, and researchers have measure differences in joint movements and muscle activation all the way up into the trunk.

The reccurance rate for ankle sprains is somewhere between 50 to 70%; pretty horrible numbers. My friends and I have definitely ~~walked~~ hobbled down this road. Exercises and braces are your first steps toward better...steps.

A word on exercise

This is one time when exercises I like to make fun of are actually called for. In the weeks to months after ankle (or knee) sprain, you should be working on balance and controlled movement on both stable and unstable surfaces. We won't get into the specifics of exercise progression right now, but here's a quick screen for sprained ankles:

The intermediate phase of ankle (and knee) rehab is one time when goofy squats and reaches on unstable surfaces are actually beneficial and I shouldn't make fun of you for doing it. Unless, well, yeah, this guy.

-Try to balance on one leg with your eyes closed - no wrapping the "up" leg behind the balancing leg.
-Try to do a full toe raise on one foot - no holding onto anything with your hands.
-Try to stand on an 8 to 10-inch step and lightly tap the "good" heel forward on the floor - don't transfer your weight, just lightly touch the floor.
-Do a deep squat with your feet straight ahead and heels staying glued to the floor and your knees staying over your toes and your chest staying up without a forward trunk lean.

Compare your injured side to the "good" side. People often feel wobbly on their injured side, or have to use different movement strategies due to weakness and inflexibility.

A word on bracing and shoes

The absolute BEST device for stability when you need stability, and explosive movement when you need explosive movement, is a primed and efficient nervous system! The best way to shut down all your lower leg muscles and hinder the ability of the brain to fine tune movement is to lock the foot in a concrete block of a shoe and brace/tape your ankles.

Many studies have examined the performance effects of wearing ankle braces. Although there's some conflicting findings in this area, recent work from the Division of Orthopedic Surgery at the University of Utah (and a few others) showed that ankle braces do decrease vertical jump height, broad jump distance, and maximum sprint velocity.

Other studies specifically address the price your body pays for increased ankle stability. Braces and tape at the ankle allow for less movement and sensory feedback from that joint, removing a large part of the shock absorption system of the leg. This leads to measurable increases in shear strain and torque (twisting strain) at the knee. Protection of the ankle may cost you at the knee, over time.

We do need to reach a balanced perspective, however. Sometimes athletes need to get back to the game sooner than later; before their ankle is completely recovered. Many sports involve hard cuts on uneven terrain and/or lanky athletes jumping and landing all over each other. In that instance, braces and tape just plain make sense. They may be the lesser of two evils.

The athlete that makes a living out-running, out-jumping, and "out-cutting" people should consider taping or bracing WITH an end-point in mind - maybe three to six months as they rehab in controlled environments. If taking a few percent from sprinting or jumping performance really doesn't mean that much, brace or tape for nine months to a year. But there should be an end in mind, for the sake of your knees, hips, and back.

Surgery is sometimes needed. Rarely. I have a few specific stories on this for anybody who wants to hear, but this is already too long. Maybe a part 3 or maybe not.

- - - - -

"Ron"

2011-04-09T13:46:00.000-07:00

- - - - -

He appears headless from behind. Literally. Ankles plantar flexed. Knees flexed. Hips flexed. Kyphotic thoracic spine, flexed. The whole thing, orthopedic nightmare, culminates in a neck and head stuck forward like a weepy Dr. Seuss tree.

We've been working with Ron (fake name) for months. He wasn't always like this, not before weeks of bed rest for a pulmonary complication left every joint fragile and locked tight, perfectly fit for a soft couch.

Lay him down on a treatment table. Massage the neck muscles. Apply traction, and pull that baby back. Pressure under his jaw and pull back. Out and back, out and back, out and back. Crank on the ankle and lower leg while pushing down just below the knee. Throw a whole leg over the therapists shoulder and lean in, again bringing force to straighten the knee. Drop the leg over tables edge to open a hip. Extend and rotate the spine.

Each position is held twelve or twenty times. Every single repetition feels like stretching a piece of wood. Who knew these Dr. Seuss trees were oak?

The entire sequence is repeated on the other side.

More than half an hour later, Ron has gained some mobility. Maybe five or fifteen degrees, depending on the joint. It all adds up to a slightly looser, longer Ron. It's time to rise. In less than a minute, about one fourth of the time it takes him to gain his feet, it all falls apart. Ron strains hard to look you in the eye, standing right in front of him.

The therapist strains hard to look Ron in the eye. It hurts.

Ron needs to gain strength and postural stabilization to maintain the effects of all the discomfort that he (and the therapist) just endured. It is easier to climb Everest. His posture has annihilated various braces and corsets that we have tried.

Kim, my sweet assistant, treats Ron like a king. Jokes with him. Patiently waits fifteen minutes for him to walk from the rest room to the pulley system he tugs on. Purchases Easter eggs from Ron's steadfast, beautiful wife.

I think Kim prays for Ron more than I have.

Ron takes it in stride. Slow, short stride. He's awfully kind and gentle for someone that spends so much time looking at the floor. Ron's posture isn't the only thing that other patients notice. He's joyful, even.Yes, king Ron.

Ron chooses to keep pushing. Rehab gives him hope, if nothing else. I don't think that qualifies as skilled, medically necessary health care. Surely we are part of the reason why Ron can live independently at home without other medical issues. I don't feel too bad about those Medicare dollars.

We push with him, fighting gravity with his frail body, fighting despair with his strong mind. He'll eagerly show up for the fight and enjoy the therapists efforts and company, for as many days that God and Medicare "authorize."

I tend to think that number may be one and the same.

- - - - - -

So You Wrenched Your Ankle...

2011-04-06T22:08:00.000-07:00

- - - - -

You probably slipped, got hit, or came down on something uneven. Your ankle twisted, things popped, bones and gristle jammed and disengaged. You rolled around a little on your back, gritting your teeth.

Someone assisted you back to your feet, telling you to apply ice and compression and it will be fine in a few days. You stood there, mostly on one leg, wondering how that first step on your blue balloon is going to be. Someone else advised you to get an X-ray, and once you sprain your ankle it's really never the same.

You hardly heared either of them because you were just hoping for someone with Advil.

You, my friend, have wrenched your ankle. Don't feel too bad - it is estimated that about 22,999 other people in the United States have wrenched an ankle on the same day.

It's probably going to be fine. But maybe not. Really.


PTs get to deal with this.

If you can bear some weight through the injured foot and it's not highly sensitive to moderate pressure to the inside or outside of the lower leg, you don't need an immediate X-ray. I've seen ridiculously huge ankles displaying all colors of the rainbow recover fairly well in a week or two. Had a few of those myself.

I've also seen simple ankle sprains go from acute pain to chronic nag in no time. Had of few of those myself - one on each leg. It's April and I'm just now getting over an ankle sprain in October. The truth is that until you have the pain just a bit under control and some of the swelling down, it's very hard to tell if an ankle sprain is going to cost you days or months.

Evidence of two mistakes:
Falling off my mountain bike and getting a Soundgarden tatoo.

Since about 15% of ankle injuries involve fractures, if you can't bare much weight on it two or three days later, you should probably get an X-ray. Fractures require (at least) a period of immobilization before moving on to much of what's described below. Otherwise, in the absence of fractures, getting to work on some of the details helps ensure that "never the same" doesn't come to fruition.

The typical ankle wrenching causes persistent swelling. Supporting muscles and ligaments loosen. The result is vastly decreased proprioceptive (positional sense) feedback to your brain, which further weakens muscle drive as you unconsciously unload that leg. Researchers have measured altered movement patterns all the way up through the hip and trunk in people with a history of chronic ankle instability.

The "high" ankle sprain involves separation of the lower leg bones as the talus (the top foot bone) is essentially driven up between them like a (wood) splitting iron. This injury usually has a longer recovery period and different course of treatment than the typical inversion sprain pictured below.

Early movement has been demonstrated to be helpful in many ways. Use common sense, of course. Don't go jumping and running around on a recently wrenched ankle. But that same ankle probably can and should be doing non weight bearing stretches and active movements that help restore mobility, decrease swelling, and add enough strain (but not too much) to stimulate a strong repair of collagen and other connective tissue.


The typical inversion sprain.

Diagnostic imaging has shown that with even modest inversion sprains, the talus and outer ankle bone may slip forward, causing some motions to increase and others to decrease. You're left with a predisposition to more ankle sprains and a mechanical blocking of movements needed for everyday life.

One of the best indications of "displaced" ankle bones and loose ligaments is a pinching feeling in the front of the ankle when flexing the knee out over the foot (ankle dorsiflexion). If you get this anterior pinching after some of the swelling subsides, you really should check in with someone who knows what "posterior mobilization of the fibula and talus" looks like.

As far as how soon to start pushing the envelope with higher level weighbearing exercise, I often go by how much pain and laxity is present with ligament stress tests. If anterior drawer and talar tilt tests are not too painful and reveal minimally increased laxity compared to the other ankle, then an advanced track of rehab and return to sports (or whatever) is usually appropriate. If those tests cause a lot of clunking around and pain, then a more conservative pace really is needed.

If that's the case, but you're a tough guy and too good for a time out, you could try playing basketball and flag football before it's adequately healed and stable. That will leave you (and your friends) suffering six or eight months of you playing hard and whining around because it hurts or playing easy and whining about not being at full speed.

The only option that doesn't involve a lot of whining is to just take a break, do some corrective exercise, and follow a gradual progression of impact activities.

The recurrence rate for ankle sprains is anywhere from 50 to 70%. What do helpful "higher level" exercises look like? Do you need to tape, brace, or buy different shoes? Will there be more pictures of nasty, probably stinky, swollen feet?

Part two is coming.
- - - - -

Dad, Ted Czekaj, and Deadlifts

2011-03-24T21:43:00.000-07:00

- - - - -

Some can't understand why a grown man, or anyone for that matter, would voluntarily do something like dead lifts. Most people have never considered pulling dead weight from the ground as a way to test and strengthen their being.

With anxiety high, spine ratcheted oak stiff, hand calluses ripping, and the tune of multiple weight plates clanging off the floor, dead lifts are more than a total body exercise. They literally raise the body from walking dead; ascending from the can'ts and use'tas and leaky toilets and work schedule and Roth IRA and six varieties of cream cheese and a zillion other things that may be important but mean little in the moment.

As if you don't have time. As if jogging miles on end is somehow so much better for you. I know many legitimate "as ifs." This is for anyone interested in how I came to the truth about dead lifts.

- - - - -

It's in my blood.

My father was a beast. Lightening fast 220 pounders were exceptionally rare among high school athletes in the late 60's. He passed up offers from DI college football programs (most notably PSU) in order to sign as the 1970 first round draft pick of the Minnesota Twins.

Numerous times, men in dad's age bracket would come up to me as an adolescent telling tales of glory days. The exchange typically went something like this:

"Hey, you're Bobby Gorinski's boy," sizing me up, clearly unimpressed with my 6'1", 160 lb frame.

Small head nod, "uh, yeah."

After the awkward pause often came a personal testimony about the one that dad hit off the scoreboard at Forbes or over the trees behind left field at Shaft. Middle aged men have actually stiff-armed me in the chest as they recounted being pancaked while trying to make an open field tackle on Oldbobbygorinski.

I gave more head nods and smiles. How else do you respond? "Yep, you really got flattened" never seemed appropriate.

I bit on sports before I could talk, and have been involved with athletics for all of my life. I've always done fine, but nothing near the level of dad. Nobody posted a wikipedia entry about my athletic career.

Despite all the stories I've heard and what I've read on-line and in old newspaper clippings, I've never actually seen dad in action. I've been inspired by him, for sure, but not in the way of modeling.

- - - - -

Enter Ted Czekaj (pronounced check-eye). He was a different kind of stand-out. When I was an impressionable freshman hooper, he was a cool senior and starting point guard. Ted was somewhere around 5' 10" with a very average build. He could handle the ball and shoot pretty well. But let me tell you that

Ted
played
like
an
animal.

Ted was intensity.

You could tell that the world disappeared when he stepped on the court. He outplayed guys with twice his strength or "natural" talent because he reserved nothing. That scene also stands out in my mind; Ted gasping for air, eyes bulging, face like a mercury thermometer about to explode, making a steal here, diving after the ball there, fighting through screens, and setting up a teammates all over the court.

Here's an important thing: Ted didn't scurry out of control like a drama king for personal attention. He always operated with a cool head. On and off the court he was disciplined, respectful, and kind, even to freshman nerds. While underachieving peers mocked Ted, I watched him, identified with him.

Ted taught my first lessons in doing something wholeheartedly. Doesn't every success comes attached to a long line of "begets?"

That feeling of all-out commitment and Terminator-like oblivion to care and pain - I saw that it was good. I did carry the ethic and attitude of Ted through high school hoops, to the tune of about 900 career points. From there I took it to the classroom, finishing first in the Slippery Rock classes of 1998 (undergraduate) and 2001 (PT school).

Dad was proud of me.

- - - - -

But there's something about the sweat. Anything wholehearted without sweat is at least a step removed from intensity. You simply don't sweat the same in classrooms and PT clinics. Well, not usually. That's why a day or two per week this middle aged man needs to go Czekaj mad on the basketball court. Or preferably, when recovery allows, I work things out with the iron in my basement.

I have no idea who this is, but she's awesome.

I need to strain against something.

Life is still a mystery far beyond my control. And sports have far too many variables to recon with. But I'm given a say in resistance, sets, reps, and resolve. For a little while, anyway. I swear that if I couldn't strain against weights I would carry buckets of water or lift growing farm animals or work the earth by foot. Which is basically what dad does for his physical and mental health.

Ted? I haven't seen him for almost 20 years. I have no idea where he is or what he's done with his life. But I'm sure, certain even, that if he's still around, he's doing quite well.

And here I sit, forever inspired by Ted and others who remind me of him; here still with dad's blood but not his size or talent, obsessed with physical performance, quite possibly because I never achieved what he did. This is the path that's led me to the sweet spot between plates of heavy iron, to a rite and ritual that has also shaped me in ways that matter.

Wide(ish) shoulders, functional strength, and favorable blood counts are but side effects. How many days will I be given to do dead lifts? I often can't understand how anyone lives without them.

- - - - -

A Spin on Vertigo

2011-03-09T21:16:00.000-08:00

- - - - -
Breathe deeply and brace hard. The chance of sudden heaving, volatile twisting, and terror is 100 percent. Hersheypark and its employees are not responsible for lost or stolen items, including items that fall out of pockets.

People drive great distances, stand on pavement for hours under the blistering sun, and pay large sums for this.

But the experience is not so great while rolling over in bed or putting on shoes. Positional Vertigo (PV) is all the terror of Hershey Park's best (or worst) brought to the comfort of your own home. It's a specific type of spinning, nauseous misery. The symptoms usually worsen with movement of the head but in severe cases may also occur while at rest.

Since treatment for feeling horribly sick and dizzy often involves specific methods that make you horribly sick and dizzy, it helps to have some understanding of what's going on.

Inside the temporal bones just behind each ear is a small organ called the vestibular labyrinth. This includes three fluid filled canals that are lined with very fine hair cells. Head rotation causes the fluid to create a waving motion of the hair cells, which in turn send signals to the brain. Specialized portions of the labyrinth contain small crystals that are sensitive to horizontal and vertical movement.

Yes, you do have rocks in your head.

To appreciate the almost unbelievable design of the vestibular system, simply roll your head in a moderate size arc of movement while reading this. For every degree of head movement, the eye muscles reflexively create a precise, equal and opposite amount of eye movement. Don't take it for granted that the letters remain in focus and your lunch in your stomach.

For a variety of reasons, the crystals can become dislodged and make the hair cells in the canals hyper sensitive. You and the house are not really moving, of course. The vestibular system sends signals to the brain that are in conflict with what the eyes are seeing. Suddenly the couch is a thrill ride, far worse than any amusement engineer could imagine.

It's difficult to say exactly why this happens. Problems often begin after a severe cold or prolonged period of bed rest. Other times the vertigo occurs with Meniere's disease, following trauma to the head, or as a general deterioration of the vestibular system in older populations.

While positional vertigo literally stops people in their tracks, it's rarely serious except for increasing the chance of falls. The condition tends to disappear within six to twelve months, but the chance of reoccurrence is 30 percent. Medications that lessen nausea help buy some time but do not directly target dysfunction of the vestibular system.

Of course there is a "spin" to this! There's no need to grin and bear the debilitating discomfort for six or more months, hoping for the best. Trained physical therapists are able to help confirm whether or not the problem is truly a vestibular dysfunction as opposed to a wide range of other issues that cause people to "feel dizzy."

Interventions broadly fall into two categories. Moving the head through a specific sequence is thought to cause repositioning of the crystals in the vestibular canals. Side effects of this treatment for dizziness include dizziness. But only for a minute, or more precisely, 5 to 30 seconds. Accommodation exercises are thought to recalibrate the vestibular system and strengthen the mind's sense of equilibrium.

Treatments are often successful within two days to two weeks. Really - this is the closest thing to a quick fix that physical therapists offer. We may test your balance, your ability to turn quickly, look high and low, and send you back to normal life. Whether or not that includes bearing The Claw with a grin is up to you.

----

aches and prayers

2011-03-04T12:10:00.000-08:00

"Do you hear it?"

Ryan's stands teetering on his left leg as I lower an ear toward his right knee. A group of children slow their way through the church lobby, watching me listen to Ryan bend and straighten, bend and straighten, bend and straighten his knee.

"Seems like your kneecap is slipping over the edge of the femur."

I don't have ears to diagnose a creek from a pop. But I do know what problems are typically exposed when the knee is locked straight with the foot off the ground.

"So what should I do?"

I pause, thinking hard, not about functional anatomy. I'm usually glad, even honored to try and help. But in the past I've assumed too much, ready to talk biomechanics when friends and family are just looking for low pitched "hmmms" and common sense advice.

I'm not sure what's behind the noisy knee. Kneecaps grind unevenly on femurs all the time for various reasons. If I had knowledge of a fool proof technique or set of instruction that would immediately relieve the misery of a dear friend, by all means, I'd eagerly share that.

But getting to the root of any matter takes time. We must prod, strain, and explore what precipitates the problem. We have to check strength and mobility at the foot, ankle, and hip. Then we scrutinize the details of basic activities like walking and squatting. And that's just the evaluation. Correcting the issue usually takes time. It's an investment, never without effort, rarely a simple matter of "in" versus "out," crack, clunk, and you're all fixed.

Oh, right. Ryan is still in front of me, waiting out my though pause with a look of expectation.

"Do you want to take a few minutes to look at the details?"

"Or maybe, hmmm, you should rest and take it easy for a few days."

- - - - -

I don't blame anyone for not wanting to go there - with all the detailed investigation. I'm pretty sure that I've done this in my prayer life. I'd like simple clarity on an issue. Some specific instructions or divine intervention would be nice.

Or would it? It just seems so...improbable...that the full complexity of any life issue can be holistically addressed by a simple, pain free granting. How are we to be reformed by quick answers and miraculous fixes? I'm not saying God can't, or that we shouldn't bring our concerns before him. Who am I to tell anyone how to pray? But it does seem that a shift in emphasis is in order.

Ugh. Who has time for all the self examination, the seeking, the deliberate waiting and watching as things unfold? Who wants all the prodding of sensitive areas when a knee brace and some ibuprofin may do the trick?

Who brings themselves still and quiet before the Lord with no agenda? Who humbly listens and prays for patience and the ability to be at peace while actually engaging the uncertainties, challenges, and pains of real living?

Anyone who can do this - they might move mountains.
- - - - - -

Top 5 Training Mistakes

2011-02-22T05:57:00.000-08:00

JMC and Jason Reed recently gave me an opportunity to speak on their radio program called Fresh Set. One of the topics we hit on was common training mistakes. Let's just say that my speaking skillz could use some work.

Truly legitimate disclaimer: No matter how many mistakes this training snob wants to write about, the biggest mistake is not training at all, sitting around complaining about how you look and feel and "use-ta" be way awesome.

Nonetheless, if you're awesome enough to undertake the discipline of regular exercise, get the full pay off. Try to avoid these mistakes.

1. Failing to set specific goals.

You should be specific about a few goals, both long- and short-term. Goals like "gain muscle" and "lean out" are not going to cut it. Identify and write down realistic yet challenging goals, so you see it concrete. Make sure there's a time frame. Don't try to accomplish anything too fast or set too many goals at once.

There's nothing wrong with setting a goal to complete a 5K race or half marathon if you enjoy that sort of thing. But distance running is not the measure of all things fitness. Neither is bench press THE measure of the man.

Writing out specific goals helps you choose your training wisely. For example, no reasonably fit person is going to max out their fat loss and muscle gain at the same time. If you're fairly sturdy and strong and would like to focus on your conditioning, don't also expect to put on 10 pounds of muscle.
Goals for a wiry 20 year-old may be to attain 18 body weight chin-ups and a 28" vertical jump. If those are the goals, then don't train with a body part split routine that's tailored for a 35 year-old bodybuilder who's mostly sedentary outside of the gym.

If your goal is to lose 4 pounds per month over six months and maintain that weight at 12 months, then don't train like a marathoner. I've seen people get trapped in the cycle that you simply can't win: eating less and less and jogging longer and longer distances to sustain weight loss. There are better ways to go about this.

2. Poor exercise selection.

First off, you can and should do more than just run (or walk). In this writing I proclaimed the good news that you don't have to jog!

I'm no fan of machines for strength training. Leg press and lat pull-down machines are okay at times. Chest press when you're in a hurry. But that seated torso twists machine? I've written about the ridiculous leg outtie-inny machines here.

Free weights are best; just you and some iron and gravity. Understand that a very large portion of functional strength has to do with building a strong and efficient nervous system. That simply doesn't happen when doing hard core Nautilus seated shoulder raises or Hammer Strength leg extensions.

Skipping the three sets of 8 to 12 on 10 different strength training machines should leave you plenty of time to get well acquainted with the big lifts. Squats, dead lifts, overhead presses, horizontal presses (bench, dumbbell presses, etc.), weighted dips, rowing, and weighted chin-ups. Depending on your baseline strength, stability, and mobility, it may take you 3 or 4 months to identify what variation of these lifts are best for you, and another month or two to find your groove of good form in those lifts.

ACTUAL RESULTS from doing one dead lift!

And yes, people get hurt jumping into the best exercises like squats, dead lifts, and heavy presses when they haven't given adequate time and careful attention to the details. Be patient and move along slowly. No, really be patient.

Some of the most unglamorous advice you will read: put the time into identifying what exercise variations are best for you and perfecting form. Maybe you simply can't squat safely, but I'm pretty sure that your knees and low back will tolerate heavy single leg squats and backward lunges off a step.

Also, a lot of isolation exercises, free weights or otherwise, are rarely a good idea. This includes ab crunches. And that thing where you do a massive drop set of bicep curls, going down the rack from heavier to lighter dumbbells? You will never see a fit and strong guy doing that.

If I could pick just one exercise that's most worthy of heckling, it's tricep kickbacks. Don't let me catch you doing them unless you can press at least 193.67 pounds overhead or do eleventeen handstand push-ups.

3. Poor frequency.

What I'm referring to here is over-doing it or under-doing it on a regular basis. People seem to be gung-ho all-out or nothing. Both work against you.

Athletes push themselves hard under the weights 2 or 3 times per week, then condition for their sport twice per week on top of games and practice. That's a lot of time and painful effort for little to no benefit. Is it any wonder that performance goes down when coaches and athletes pay no respect to recovery?

On the other hand, some folks never get around to consistent exercise because they just don't have the time. If working out means packing a bag and driving to the gym and shooting the breeze and training 3 sets of 10 on 15 different resistance training machines then doing some abs and cardio then driving home; well yeah, who has time for that?

Just about anyone can warm up and then go run (or speed walk) some intervals on a hill. It takes very little time and equipment to perform variations of squats and/or deadlifts, an upper body horizontal push and pull, and an upper body vertical push and pull.

4. Too much variation.

This refers to changing things up and beginning a new training scheme every other week. While getting stale and stuck in a training rut can also be a problem, rarely do people work too hard at a good training cycle for too long. Structured variation is absolutely called for. But please understand that "never doing the same thing twice" isn't necessarily a good thing, especially for athletes.

The term muscle confusion has been used to describe variety. Varying reps, exercises, and other training variables so that you never adapt to one thing. The bad news is that you never adapt to one thing. Muscle confusion is great if you want to be perpetually sore and never find your true limits in any performance measure. I call that chasing fatigue. Why are you getting tired and (later) sore? "Confusing" your muscles is a lot easier than challenging them head on to do 2% more/faster/higher than they did 2 weeks ago.

Again, be patient. Beginning slow and easy seems to build a "training momentum" that helps you continue to roll when things really get challenging. Schedule your routine and set your goals over months and years, not days and weeks.

5. Incompatible nutrition

I'm no nutritionist, but running two miles 3 or 4 times per week is not a license to eat like a stray animal. I've wondered how adult men can play some pretty intense basketball 2 or 3 days per week and look exactly the same year to year. I'm really not one to judge others, but they are often the ones complaining about getting heavier. On the other hand, super strict dieting and other fast weight loss tricks will come back to get you one way or another.

If you're training like a bear to gain size or strength in the middle of practices and an active life style, for heaven's sake, eat. A lot. It's much harder to put on lean (muscle) weight than it is to lose (fat) weight. If you're training hard and eating boatloads of mostly healthy food and somehow getting a big beer belly, deal with that later. Until then you need to eat to support muscle growth and not worry about getting simultaneously more ripped. Putting on some muscle always causes the body to appear more "ripped," even if you have not actually lost any (fat) weight.

6. Oh, and here's a bonus training mistake that I don't see often, but a big one nonetheless.

For heaven's sake, WHY?

Seriously get off the unstable surfaces unless you're rehabbing a significant ankle or knee injury/surgery.

High Performance Minutia

2011-02-15T22:00:00.000-08:00

- - - - -

I don't think you're nervous enough
It happened to show its own face
Search for the soulless ends
Now point him towards rest.

-Chevelle/Highland's Apparition

Power = Force X Velocity

There are many methods (exercises, program design, equipment, supplements, etc.) of developing a powerful body. Some of them are nearly worthless. Quite a few provide an ounce of benefit in exchange for a boatload of effort and expense. The few that deliver that tiny edge with little expense? Those are the details you want to give some attention.

A recent edition of the Strength and Conditioning Journal contained three studies on the type of strength and conditioning minutia that I can stand behind. If you want to develop more power in training and achieve new heights in competition, get scared and have some caffeine.

Researchers noted wins and losses of high level power lifters, collecting data on various hormone levels before, during, and after competition (1). Although all competitors experienced a surge in testosterone after their events, the winners hit a higher level than the losers. It feels great to compete and to be finished, and victory is sweet.

More importantly, those with the highest cortisol levels before battling the weights demonstrated superior lifts. The ones who lifted the most were nervous, excited, on edge. There are a number of ways that elevated cortisol is thought to improve athletic performance. "Fight or flight" helps the brain, nervous system, and muscles to lift things, apparently about 2 to 3% heavier than those with less cortisol.

The second study examined the effect of caffeine on bench press performance. All subjects performed a bench press test after having either caffeine or no caffeine (on two different days). After a moderate does of caffeine, subjects completed (on average) two more repetitions in a bench press test and reported lower levels of perceived exertion.

This study adds to a long line of evidence (some of which I talked about HERE) that caffeine helps your body to move better and your mind to feel like pushing it. But don't overdo it, rock star.

The final study measured each participants vertical jump under three slightly different conditions. The conditions were 1) jump as high as you can, just jump, 2) jump for maximal height, reaching toward a target, and 3) jump as high as you can over a hurdle set near the subjects estimated peak jump height.

Subjects jumped highest when a challenging hurdle was placed in front of them. I've had suspicions on this for quite a while. In the back yard, I've made friends jump onto and over picnic tables and lawn chairs stacked on boogie boards.

Jumping into naked air is kind of lame. Jumping toward a target is good for some motivation and feedback, but it's not the same as jumping OVER a challenging obstacle that scares and mocks you. You have to ignore any hint of fatigue and make every jump count, or else you pay a little. The result is a lot of repeated, extra high maximal effort jumps, which adds up to a killer vert.

O's ottoman jump

Forget the supplement stack, the fancy chrome exercise machinery, and the reverse undulated periodization lifting schedules. Cortisol, caffeine, and lawn chairs are your ticket to Awesometown. And rest, we all need rest.

Maybe it should have been Awesomeville. I don't know, I haven't been there myself. I was just excited to see some verification of the back yard and basement observations.

- - - - - - - - - -

1. The effects of training volume and competition on the salivary cortisol concentrations of olympic weightlifers. BT Crether et. al, J Strength and Conditioning Research 25(1) 10-15, 2011.

2. The effects of caffeine ingestion on mood state and bench press performance. MJ Duncan et. al. J Strength and Conditioning Research 25(1) 178-185, 2011.

3. Kinematic and kinetic variation among three depth jump conditions in male NCAA DIII Athletes. JP Smith et. al, J Strength and Conditioning Research 25(1) 94-102. 2011.

Donkey Shoulders

2011-02-08T12:24:00.000-08:00

= = = = = =

Friend: Why do you think my shoulder is still like that?
The Doctor of PT: I'm not sure. Who's to say?

= = = = = =

Research says that eight in eleven people currently have shoulder pain. No, I just made that up. But there does seem to be a lot of shoulder issues going around. Right now I have four friends dealing with it for various reasons. They're wondering why rest and pain medications have not been very helpful. Well, except for Ryan, whose treatment includes over shooting ski jumps. He's not wondering why it hurts.

Shoulders can be a bit tricky, to say the least. They're like donkeys, responding better to a smart coaxing than a kick in the ribs. The more you try to force them, the more they inflame and stubbornly resist. And don't try to sleep on one - a sore shoulder or a donkey.

I've learned to be pretty conservative with exercise and hands-on mobilization directed at the shoulder, at least for the initial visit or two. Shoulders will refuse to do their part very well until you've addressed the lay of the land around them, namely the scapula, thoracic spine, and soft tissue restrictions of nearby muscles and fascia.

Understanding finnicky donkey shoulders (as well as many other orthopedic problems) requires a good grasp on the concept of a symptom threshold. Symptom threshold is why it's challenging (or dishonest) to say precisely why any one body part is not happy.

Many people have tears in the cartilage ring that deepens the shoulder socket (the labrum), rotator cuff tears, or other structural defects of the scapula. Many times tendinopathy of the involved tissue is visible when viewed under a microscope. But not all of those people have problems. Many of them function fairly well because they haven't reached the threshold of pain...

YET.

There's usually a number of factors that contribute to crossing that threshold. I've read and learned through experience that while most people manage to get by, their body is just a step or two removed from threshold.

A fall, a heavy strain, or last weekends painting project may have seriously stirred up a batch of shoulder pain, but there are often factors that have been years in the making. Those "years in the making" issues are often a factor in the shoulder (or other body part) having a chance to heal correctly after trauma.

Shoulder... mistakes.

A typical example of the symptomatic threshold might look something like this:

-Most people sit for a significant amount of time with their thoracic spine stuck all slumpy, their shoulder blades protracted and arms rolled in front of them (poor static posture - factor 1).

This exercise is good for physical therapists.
Do it if you want to go to rehab.

-Then don't exercise much, or they go and exercise, to stay healthy and buff, and perform far too many pressing movements (poor exercise program selection - factor 2).

-The exercise and other movements takes place in that same kyphotic, protracted position (improper movement patterns layered on poor posture - factor 3).

-They have weak rotator cuff and upper back muscles (factor 4).

-Maybe they have a type 3 Acromion. This is a slight structural issue of the shoulder blade that allows less space for the upper arm bone and shoulder tendons (factor 5).

-On top of those issues that were present all along, the person suddenly gets a "factor 6." Maybe that's a weekend golf tournament or tree pruning competition. Or maybe there's trauma, like a fall from a horse or bike. After not throwing for years, the shoulder is called upon to furiously fire a water bottle at an annoying seagull that just crapped on your spouse and stole popcorn right from your children's little hands.

Okay never mind. But the point is that there's some kind of heavy strain, trauma, or repetitive overuse that's simply the straw that broke the camel's back. The shoulder that had been sitting on the brink of a problem crosses the threshold and ouch.

When it's been a few weeks and the shoulder has not recovered from factor six, you really do need to address the other factors.

Simply resting and taking some medicine will often get the shoulder back below threshold. Physical therapy and other rehabilitation that identifies and addresses a few factors may get your dishes back to the top kitchen cabinet. But then you reach up to buckle your seat belt, throw a lawn jart, lift your grandchild, or make an early morning stab at your alarm clock.

Back to square one.

I'll save you the bobgpt testimonial and just say this:

Please don't imagine that bobgpt has had a 100% success rate of fixing every stubborn donkey shoulder. But he does try to take the time to identify and address as many modifiable factors as possible.

That's about the best we can do.
- - - - -

weather the weather

2011-02-02T21:30:00.000-08:00

- - - - -

Lately the weather
has been so much better
and consequently so have I .

-Reliant K

Many of my patients claim they can tell when bad weather is coming. They feel it in their joints, and I believe them. Why does bad weather seem to cause people to turn into meteorologists?

After reading some reviews like this semi-scientific look into meteorology, I imagine that grandmas knee couldn't do much worse than the local accuweather team, especially if grandma reported the forecast with charm and charisma.

"Yeah, it's going to rain tomorrow. Or maybe snow. About zero to ten inches."

Wintery mix? Is "wintery" a word? Spell check says no.

Anyway, one reasonable explanation for the achy and stiff joints has to do with barometric pressure.
Every moving joint in the body is encapsulated by a tough connective tissue called the...joint capsule (imagine that). Joint capsules add a little stability and secrete synovial fluid. Synovial fluid delivers nutrients to joint structures and helps to lubricate the spin, glide, and roll that takes place between cartilage and bone.

There's good evidence that synovial fluid responds to changes in barometric pressure, just like any other type of fluid. When the barometric pressure drops, the pressure of the synovial fluid also drops, which may cause fluid retention within and around the joint capsule.

Under normal circumstances, a little change in the pressure and fluid content of the joints is no big deal. You don't hear many teenagers going around forecasting rainfall based on how high they can elevate their shoulders. But degenerative and inflamed joints are highly sensitive to such changes in pressure.

Change is the key word here. There has been no clear scientific connection between specific joint symptoms and barometric pressure. If anything, it's simply the change in barometric pressure, altitude, humidity, and other conditions that are thought to lead to symptoms.

In other words, moving to Florida is not going to fix arthritis, and a bad back should be able to tell when good as well as bad weather is coming. Everyone hurts more on a gray February day in the mid-Atlantic. A week in Aruba may be "medically necessary," indeed, but your synovial fluid won't be thanking you for all the change.

And if your physical therapist asks if his plan of care has left you moving better, worse, or no different, whatever you do, don't put the blame on you. Blame it on the rain. Yeah, yeah.

- - - - -

no brain - no gain (III)

2011-01-18T09:20:00.000-08:00

Part one introduced this series and the limited value of complete rest for "treating" pain. Part two focused on some specifics of back and neck pain. This final entry offers a few thoughts on pain as related to high level sports performance.

One of the things that separates good from the great athletes is the ability to endure both "good" pains and "bad" pains. Pain? Yes, please. It hurts to be awesome, and we should make no apologies there.

I don't care what sport you're talking about, from cheer leading to golf (okay, maybe not golf)...to mountain climbing, neither of which I know much about. In just about everything that a 67 year old man can't easily destroy you (like golf), there comes a point where you have to decide if you want to have fun or work to get better. Even snowboarding becomes tedious, I'm sure.

The best athletes are driven. They enjoy the sport/activity so much that it's worth it for them to sacrifice a significant portion of their lives in order to be the best they possibly can be. They have consistently delivered the goods for a decade or more, and nobody was calling them "lucky" or commenting on their "freak genetics" when they were stuck at practices for three hours a day and up early for individual conditioning and skill work.

While I don't have "beef" with the pain and suffering required to achieve new heights of performance, I do have a problem with the typical training methods. If you're going to dive in and suffer in order to build a better machine, so be it. But oh, what a shame, to sacrifice and be miserable in order to stay the same or go backwards?

A recent issue of the official publication of the National Strength and Conditioning Association is a perfect illustration of the typical overkill. One article details an off-season training program for football players. The speed conditioning workout includes 4 80-yard sprints, 6 60-yard sprints, 8 40's, and 10 20's, all separated by twenty seconds of rest. And this was after 20 to 30 minutes of dynamic warm-ups and form running drills. Oh, and the training week is to include another conditioning day similiar to this as well as two to three days of heavy lower body weight training.

Are you kidding me? Are they training some kind of half human machines? This speed program definitely sounds like the work of a coach or trainer who hasn't actually done a hard sprint in a very long while.

I'm sure your typical 340-pound lineman can do 28 sprints of any distance and set new personal records in squats and power cleans the next day. I question if it's possible for even the leanest, meanest defensive backs to make it through this workout going full bore, without pacing the "sprints." Athletes who are deconditioned and in need of some leaning out may become faster. But the far majority of football players are going to be run into the ground, made literally slower and less powerful in no time flat.

As mentioned in this piece about over training, the body responds not by how much training an athlete performs, but by how much training an athlete can recover from. Every athlete is different. You don't need a PhD in kinesiology to know that these two athletes couldn't possibly both benefit from the same training program.

Probably could use some speed/conditioning focus for the demands of basketball.

Could use strength/power focus for the demands of baseball.

I believe you can and should focus on strength/power while maintaining "conditioning" or focus on "conditioning" while maintaining strength and power. But you simply cannot make optimal improvement in both. Yet is seems that we try to accomplish both, year round, training young athletes as if they're otherwise sedentary middle aged men who need to lose 30 pounds in order to compete as middle distance runners.

Pain and gain, yes, but what kind?

The typical wiry 15 or 22 year-old will never gain much size or explosive strength on an off season running protocol like the one above. They should sprint, for sure. They should train brutally hard in the weight room, and rest and recover. It's the off season, for crying out loud. Pick a goal and stick with it.

Running bleachers three days per week and being timed in the mile can be painful. Quite painful indeed. But that's far from the best way to increase vertical jump and sprint speed. There's little reason why higher level athletes should have to bench press or perform any other pressing type movement more than twice per week.

What do I know - I'm not a coach at the high school or collegiate level. But I've been run into the ground by a few. I regularly see the consequences of the "more is better" mentality all the time. Why do young athletes and their parents jump through all these hoops with unproven overkill training methods? Am I missing something?

- - - - -

no brain - no gain (II)

2011-01-13T13:28:00.000-08:00

The previous entry made the claim that "no pain - no gain" is a half-truth. Yes, it's cool that the words pain and gain rhyme, but there's a lot of other words that end in -ain that maybe we should give more attention. Besides, you don't see wheat farmers walking around in T-shirts that proclaim in bold script "no rain - no grain!!!"

It's easy, you see?

"Well, no pain - no gain" is never an acceptable answer or motivational statement. Pain informs! Knowing a few details is tremendously beneficial to the pursuit of health and fitness.

Of course there are gainful pains associated with discomfort as well as bad pains associated with injury and regression. While the "just work it out" philosophy is rarely beneficial, it also holds potential for damage. On the other hand, more than a few days of rest is a less-than-proactive way of dealing with pain. Two weeks of rest does little to get a person moving toward their goals.

Since about 9 out of 10 people will experience varying degrees of spine pain at some point in their life, it may be good to know:

Case in point 2 - Centralization is less pain here, more pain there

While pain in and immediately around the spine can certainly be miserable, the prognosis for short-term recovery is usually quite good. On the other hand, pain that starts to migrate away from the neck and back is bad news. Call it sciatica or radiculopathy or radiating; the tingly and numb feeling down an arm or leg, the stabbing shoulder blade or buttock pain, and a rapid onset of weakness are all symptoms of nerve root compression associated with significant spine issues. That ain't no muscle spasm.

When it comes to activities and movement that increase symptoms peripherally, no pain - no gain is just about the last philosophy you want to live by. On the other hand, positions and movements that decrease peripheral symptoms should be encouraged, even though that often comes with an increase in pain near the spine.

Lets say you do one of the simplest tests for the lumbar spine, standing and bending forward toward your toes. If ten or twenty movements in that direction cause an increase in peripheral pain or makes the back or buttock pain feel like it's migrating down to the knee or foot, avoid that direction of movement, at least for now. But if repeated bending forward or backward happens to cause centralization of symptoms (a reduction in peripheral pain or numbness), we explore that direction of movement further even if it causes an increase in central back pain.

Generally speaking, anything that causes peripheral pain gets a red light. Activities that cause peripheral pain to "move" to a more central region get a yellow light (proceed with caution). Systematically applying basic, gentle movements allows you to gradually hone in on appropriate loading strategies.

There's an art to "tweaking" the basic movements, and that's where qualified orthopedic care -ahem- comes in. The process allows us rehab people to perform manipulations and other hands-on procedures without fear of making the problem worse, as random cranking often does.

Systematic force progression sounds a lot less impressive than dramatic cracks and pops and requires quite a bit more time, but there's much less risk of harm than trying to jam that baby "back in." An added benefit is that many times patients suffering back pain can learn how to treat themselves, independently, without needing to be "adjusted" 3 times per week for 3 or 30 weeks. In the very least, clients learn how to reinforce the hands-on work of their rehab provider, which often goes a long way toward that independence.

The ability or inability to get peripheral pain to centralize is important. Researchers examine a wide range of factors involved with back and neck pain, from the patients flexibility and strength to their body weight to their work environment to their tendencies toward depression, and it turns out that centralization is one of the only things that is predictive of good long-term recovery. That's why I sometimes tell clients that I'd be happy to give them MORE back pain, especially when that goes along with less peripheral pain.

A specific type of pain = a specific type of gain. This is not cheesy 80's sentiment or the opinion of one wack-o PT. It's evidence-based medicine that actually helps someone beyond the rehab provider trying to justify endless "adjustments".

[The final installment of this series will talk about pain and sports performance.]

no brain no gain

2011-01-06T21:35:00.000-08:00

- - - - -

I hear “no pain, no gain” almost daily. The mantra comes from the lips of the frail elderly and hulking construction workers, scholars and adolescents. I nod my head with mild approval to show that I appreciate the willing spirit.

But of course there are different types of pain. I stubbed my toe yesterday and gain eluded me, other than remembering not to try walking through my garage in the dark. At least it wasn't this painful:

Beyond accidental bumps and painful mistakes, sometimes the best intention and discipline of the will may actually work against the "gain" wanted in the first place. Pain is an extremely intricate, life-saving message. No pain, no gain - insane.

Beginning an exercise regimen when you’ve neglected your body for a while is a painful decision. Then comes sweat and breathlessness, not to mention the pain of walking away from the second doughnut and taking time to plan and prepare balanced meals. But "no pain, no gain" should be put on the shelf beside "listen to your heart" and other half-truths of the 1980's.

Case in point 1 - Just need to work it out

People say this as they place one hand on the painful area while rolling the involved joint in some kind of circular motion. Has that ever worked? For very long? When is it okay to take a few Advil and just get moving? Is a few weeks off all you need?

Advil and a few weeks off will get you better until you try doing some physical activity again, which usually translates into doing a lot of nothing. It's true that a few weeks off may do the trick when an injury or issue was caused by accidental trauma. But a few weeks off does nothing to address the biomechanical issues and other factors that cause most instances of tissue overload and injury.

If running has been hurting your knees, the best treatment may be a few weeks off and then some. That allows time to strengthen the core and hips and improve mobility of the ankles, hips, and spine. It's often necessary to address soft tissue restrictions and the subtleties of running mechanics. Finally, don't go back at it without a structured plan of resuming the desired distance and frequency of running.

And then see what happens! Just stay away from the bulls, won't ya?

The next installment will provide two more illustration of dealing with pain mindfully, through common occurrences in the areas of back pain and sports performance.

The Work of a Physical Therapist

2010-12-27T14:23:00.000-08:00

- - - - -

For all the talk about health care ethics and codes of conduct in physical therapy school, nobody ever taught me to care.

The tag line of the American Physical Therapy Association is "The science of healing, the art of caring." But how do you care for a relative stranger suddenly placed before you? No health science professor directly addressed where that comes from.

[Read more here at The High Calling.]

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technically inferior

2010-11-30T12:10:00.000-08:00

Less is more when it comes to technology for exercise. Gadgets may help you be informed and design programs and track progress. But for the part where you have to physically do something, there's no app for that.

Take strength training. Most major gyms offer a line-up of resistance machines. Train your low back with torso rotation and extension machines. Choose one of many crunch machines for the abs. Use leg extension machines for the front thigh muscles and leg curl machines for the hamstrings. Hit the hip adductors and abductors with those inner and outer thigh machines that should be reserved for the obstetrician.

No wonder people are bored and don't have time for strength training.

And then there are lunges. The hip and quadricep (front thigh) muscles must generate force with most of the weight on one leg. Controlling momentum of the body (plus any additional loading like dumbbells) requires the abdominal and back muscles to stabilize the pelvis. The hip adductors (inner thigh muscles) and abductors (outer thigh/butt muscles) balance the leg so that you don’t tip over.

Lunges require no equipment and work all of these muscles functionally, rather than isolated along fixed lines of motion. Proper lunges help prevent problems and improve balance, walking, and running efficiency.

Why use five machines to train in a less efficient, less functional manner when better results can be had with just one exercise? Do you really think that a giant "seated bicep curl" machine that's been specifically engineered to match the leverage of the elbow offers your tiny biceps something that some heavy iron can't?

Lunges and rows and chin-ups and pretty much anything that involves simple you and gravity and a maybe a little iron are uncomfortable. And plain better.

- - - - -

pain and your three knees

2010-11-21T19:21:00.000-08:00

One of my first anatomy lessons came from a rodeo clown yelling to an announcer.

Aaaauuuugghhh! He got my knee. That bull got me in the knee.

He what?

My knee!

Oh. You're walking kind of funny. Did he hit your left knee?

Nope.

Your right knee?

Uh-uhhh.

What? Well then which knee did he get ya?

It was my HIGH knee.

- - - - -

That heiney bit was hilarious when I was a kid. A recent experiment here at home has confirmed its continued effectiveness in young populations. But it's no wonder that many older folks groan and roll their eyes. The twenty seven million Americans suffering knee osteoarthritis (OA) are in no mood for dumb knee jokes. It has been estimated that of all joints, the knee is most frequently affected by OA and leads to the greatest loss in function.

The role of physical activity in causing and treating osteoarthritis has been studied and reviewed. What we know is what you could have guessed.

-High impact activities and traumatic injuries to the knee are bad.

-There's a downward spiral of pain, decreased activity, and generally poor health.

-Low impact exercise and not being overweight are helpful, so those with knee pain should walk and stretch and quit doing anything fun like tennis and skiing and mountain biking.

King hippo probably had bad knees.

-If you still have debilitating pain after you've quit doing anything fun and tried conservative treatments like anti-inflammatory medications and injections of corticosteroids and lubrication, then you're a good candidate for knee replacement.

-Knee replacements do reliably reduce pain and improve self-reported quality of life in 90% of patients. Yay.

-Knee replacement is a major ordeal. D'oh. You can expect about three days in the hospital, unless the new joint gets infected. Then you go home and have at least a month of increased crabbing around and depression due to pain, constipation, restless nights, and thrice-weekly trips to your choice of rehabilitation specialist.

And here are a few bits of evidence that we probably wouldn't have guessed:

-Patients generally plateau in their recovery by about six months after surgery, and function begins to decline at about two years after surgery. A new knee won't keep you from getting older. Sorry.

-Although most patients have much less pain and recover to preoperative levels of strength and range of motion by about six months after surgery, they still exhibit the EXACT same level of functional limitations.

-"Preoperative level" does not imply good strength. People are painful and weak in the legs going into surgery, and pain free and STILL VERY WEAK well after surgery. It is thought that this strength deficit holds the key to the unfortunate stats below.

-Compared to adults without significant knee pain, those who have had knee replacement surgery exhibit 18% slower walking speed, 51% slower stair-climbing speed, and a 40% leg strength deficit. They report having greater difficulty kneeling, squatting, moving laterally, carrying loads like groceries, exercising and playing light sports, dancing, gardening, and participating in sexual activity.

Don't ask me, that's just what the literature says.

I'm unsure what else we can gather from all this. Knee replacement surgery helps with pain but not with function. Some people are content with that. But I can add just a few points of personal observation for those of you kneeling on the brink of a trip to the orthopedic doc.

-Despite your neighbors friends uncle who experienced Job level devastation after having his knee replaced, the orthopedic docs are great at selecting appropriate candidates for surgery. In the clinic at three weeks after surgery, almost everyone regrets having gone through with it. On a scale of zero to ten, their pain is rated right around "you-know-where-you-can-shove-your-scale." And by about two or three months, those same folks very rarely regret having surgery.

-There's definitely an x factor here, an unknown. The x may have to do with expectations and other deep psychology that's hard to quantify. It may have to do with other unmeasurables involving blood chemistry and inflammatory response.

You may be a fit, active, and otherwise healthy adult. But that won't make an ounce of difference in how your body handles the pain, swelling, and other miseries due to the controlled trauma of orthopedic surgery. Some knowledgeable dude just subluxed your kneecap, hacked off the ends of your femur and tibia with a fancy saw, jammed a peg into the marrow, added some glue to hold everything together, and stitched it back up. Your morning green tea and years on the elliptical probably has little to do with all that (though your omega-3 fatty acids might).

Take ginseng in order to...do more pirouettes on the beach?

-Why is it that with or without surgery, those with knee OA function about half as well as people without significant knee pain? Is it ginseng? I truly don't know, but the literature indicates that it's NOT just the pain.

There are other, mechanical factors that do exist and can help, though they're extremely difficult to quantify. Are there nuances to your habits and how your body moves? What chewed up your knees to begin with? I bet there are imbalances in strength or flexibility or motor control of your ankles and hips and core. I bet you walk with increased transverse plane (torquing) motion at the knee and/or move with a knee dominant pattern that doesn't allow the strong hip and pelvic muscles to perform their stabilizing roles. It may not be the case. But if I were a bettin' man...

-Pretty much everyone with knee pain has to sit on the sidelines far more than they would like, and this sitting has propitiated poor balance and an "I can't" mentality. That's one of many reasons it's probably not a great idea to give grandma a new knee and then send her back home without a lot of ongoing work.

-Surgery or no surgery, it's worthwhile to explore these things. It's important not to expect a pain free existence. I've seen some people who have worked on their functional strength and balance and movement patterns, and despite a pretty bad x-ray, were able to manage quite well without knee surgery. And I would certainly think that even if the effort doesn't save you from surgery, it holds value for gaining peak recovery, so you're not functioning at half capacity like the literature reports.

-On a final note, us rehab folks focus a lot on getting that knee flexibility back. You need to get the knee straight to allow a grossly symmetrical gait pattern. You need at least 110 degrees of bending to allow stairs, stooping and such. But the literature suggests that the most important factor for improved function is not flexibility, but strength.

Get up and working on your feet, a.s.a.p.

"Successful" knee replacements with little pain and adequate flexibility still show limited strength, and strength dictates function more than anything else. So the latest thought is that really pushing the strength training is critical, especially in that first month after surgery when strength plummets the most. That means pushing 20 pounds instead of 2 pounds on that exercise where you sit and kick the leg out. It means challenging your limits in balance and doing lunge variations and steps-ups if you can, rather than 3 sets of 100 leg raises and heiney squeezes.

So there you have it. Osteoarthritis is a pain in the knees. I got lazy bones typing here at the end, but references are available upon request. Except for the heiney part. I refer you to the expert testimony of rodeo clowns.

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Z-Rx

2010-11-03T20:46:00.000-07:00

Coming this weekend, for a limited time only, while supplies last.

Increase growth hormone, blast fat, rev the immune system, extinguish inflammation, focus-in mental acuity, stave off emotional collapse, and increase your day by 4.1%!

No side effects!
Any one product or service that promises everything-and-the-kitchen-sink is probably pretty worthless. That's usually a good rule of thumb.

But not Z-Rx. Z-Rx is not a sleep aid, but sleep, clinically tested and proven in the kitchen sink, and more. And for a limited time this weekend, it's FREE.

Behold DAYLIGHT SAVINGS DAY, where 60 minutes magically appear from thin air. It's the one day of the year when nobody can throw up their hands saying, "if only there were more than 24 hours in a day." It's the one gift you will receive while unconscious at 2:00 a.m.

You will be sleeping, right? You can't afford to administer this gift any other way.

Seriously. Just go to bed.

When it comes to improving health and fitness, people spend hours planning and implementing exercise routines, nit-picking their diet, and searching (and shelling out for) the next big performance-boosting supplement. This can paradoxically serve to take them further from what's needed most: time to chill.

Do you imagine it's healthier to discipline yourself to chill or to wash down your gingko and vitamin B pills with another shot of 5-Hour Energy?

If what the National Sleep Foundation has to say is even the least bit accurate, most of us could use nothing more than some restful quiet. I would like to think we should pay more respect to sleep.

Before we diet hard.
Before we consider pretty much any supplement.
Before we start getting up at 4:30 a.m. in order to fit in a morning workout.
Before we start making major overhauls aimed at increasing creativity and productivity at work.
Before we stay up reading blogs of questionable content and quality.

It would take many moons to sight reference upon reference dealing with the ill effects of sleep deprivation. Sleep deprived athletes show decreased measures of mental and physical performance. High cortisol interferes with optimal repair, recovery, and growth from a number of angles. Even a single night of deprived sleep has people feeling hungrier and actually eating significantly more than those coming off eight good hours of rest.

Researchers suggest that changes in insulin resistance, as well as the hormones ghrelin and leptin, explain why higher rates of obesity, heart disease, diabetes, and high blood pressure occur in chronically sleepy folks.

You don't exactly feel up to the task of working hard when you're mentally exhausted. And it's difficult to be like Jesus when you're staggering around like a tired and irritable zombie bundle of hell because you were up all night goofing off on your bike.

What?

Clinical sleep disorders are complex and really do have a wide grip on our health. But there are many who need to JUST GO TO BED. For those of us who stay up too late reading and typing and watching re-runs of House, fine, we've made our decision. But there's no room for complaining and puzzled looks when we're sick and crabby and making little progress toward our fitness goals.

This weekend really is the most wonderful time of the year, especially for parents with pre-school aged kids who love a good 6 a.m. cry fest right in their siblings ear.

Merry Day Light Savings Day to all, and to all a good, 60-minute longer night.

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bike

2010-10-24T12:13:00.000-07:00

My six year old recently requested that his nickname be changed from Trout to Bike.

"Just Bike."

While he still enjoys fishing and playing ball and all that, Bike has found his first love. And I'm good with it. More than good. Bike is gaining some initial confidence. He's motivated to get after his book-learnin' so he can go ride. He's building body awareness and multi-joint coordination that surely transfers to other playlists.

He's learning his limits too. Bike has a pretty good handle on what he should try and what he'll leave for the Youtube "fail" videos. This isn't due to some kind of stellar genius. I think it comes from the process of risk analysis that forms naturally when little ones know that they are allowed to try things without constantly being hovered over.

The concept of relative risk deserves a revisit. Sure, I worry about Bike getting wrapped up and breaking an elbow or ankle. I understand the tears and misery and other costs of the ER. But what of the risk of him living in fear or rebelling because we failed to let him try, and learn his own lessons? What about the fact that we drive our children everywhere? Like, at great speeds in giant metal(ish) machines? We stare down a far bigger, uglier risk on a daily basis, and say "bring it."

Somehow driving is acceptable, while allowing our kids to bike and play football and lift weights is questioned.

I still think that the biggest risk is couch-TV syndrome. And putting our sons and daughters into a batters box for a showdown with a flighty, uncoordinated, but strong for his age 12-year old on the mound.

Development. Confidence. Performance. Lessons in baseball. Injury rehab.

This whole entry is kind of how I make a living.

- - - - -

Confident Does Not Equal Competent

2010-10-22T06:48:00.000-07:00

[A guest post from Kyle Wagner.]

When you're involved with baseball you invariably run across all types of coaches. Some you seem to like right away and others you'd just rather not have dinner with.

I'm always skeptical of the coach that seems to have ALL the answers- especially those involving the hitters. The one that doesn't hesitate to offer any little bit of advice that he feels is necessary at that moment. At times like that I always remember the old adage by Abraham Lincoln, "better to stay quiet and let people think you're a fool, then open your mouth and remove all doubt."

It isn't that they don't have good intentions - they do. It's that they believe, at least that's what I can only assume, that by being loud and quite confident in their opinion they are a vastly superior coach.

Let me explain why I believe this coach is victim to the "confidence" illusion.

Hitting a baseball requires many skills for sure. But, gameday is not the time for major wholesale swing changes. Gameday is the time to make sure the player is ready to compete against the pitcher. It's not about the stride or the hands too high or the head pulling off the ball. It's about competing in the batters box. Yet, coach after coach seems to offer technical advice to these young kids and if it wasn't so darn devastating it would be comical. Paralysis by Analysis.

Hitting a baseball is a timed event. You need to apply your skill in a given amount of time. It is not golf where you can swing on your own terms. You have a ball moving at you in unpredictable locations. If you want to help your player in the moment you must give him something that will help his quickness to the ball. For the most part, on gameday, these pieces of advice sound like this...

"Turn it loose"

"Free and easy"

"Get a good pitch to hit and hit it hard"

"Don't give up your strength" (In other words - "look fastball!")

These pieces of coaching advice are vague by nature. They are supportive, subtle suggestions to make a hitter more focused and less pre-occupied with unnecessary swing thoughts.

When the ball comes out of the pitcher's hand a hitter needs to react to what he sees. It's this reaction time that separates the great hitters from the good hitters, the good hitters from the average hitters.

The easiest thing a coach can do to improve a players reaction time is to improve a players anticipation strategies. In other words, give him better things to think about if you want to make his swing faster and quicker to the ball. As the ball moves towards home plate the three primary elements that effect how quickly your barrel moves in the direction of the ball are 1) anticipation (Green Light Hitting strategies) 2) swing quickness (mechanical efficiencies) and 3) bat speed. Are you really going to change variables 2 and 3 in 10 minutes? Very, very doubtful. It takes time. A lot of time.

So, the only thing left to impact as a coach is a players anticipation strategies. Give your player's a thought process that makes them quicker to the ball- not cues of doubt that WILL absolutely slow them down. Here are some doubt producing cues for sure.

"Make it be there"

"It's gotta be perfect."

"Don't swing at the high pitch"

"Don't chase 'em out of the zone"

"Watch out for the curveball."

The "competent" coach knows not only what to say but when to say it. And, when to roll their eyes at the "confident" coach.

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Cinnamon Toast Crunch

2010-10-12T19:38:00.000-07:00

Is there anything better to "consume" after a workout that Cinnamon Toast Crunch?

[Or insert your favorite sugary/junk cereal.]

I really don't think there is. After years of trying out and studying up on expensive recovery supplements and fooling around with blenders and what not, I can tell you that none of those are any more (or less) effective than Cinnamon Toast Crunch.

I'm resisting the urge to write a parody, like I did here in an attempt to get across the proven effectiveness of chocolate milk.

Some may read this and judge me a dimwit. What about high fructose corn syrup? What about the ratio of protein to carbs and the milk, with it's supposed suboptimal amino acid profile?

What about the fact that after intense exercise, your body benefits greatly from a surge of insulin with some easily digested carbs and protein in store. How about worrying a little more about getting the rest of the week right, eating and drinking mostly non horse-sized portions of unprocessed foods, before ruminating the minutia of post workout recovery formulas.

Others may read this and go around telling people that Cinnamon Toast Crunch is the "secret" to fat loss, muscle gain, and many other great mysteries of the universe. But make no mistake, Cinnamon Toast crunch is primarily good for, above all else, cinnamon sugary goodness. And it happens to fit the bill for a moderate amount of high glycemic carbs and protein.

If you're regularly training hard for the purpose of weight loss, have a bowl of cinnamon toast crunch. Go ahead after a workout, because that's the time when eating a moderate amount of pretty much whatever you want will actually work for you.

If you're training hard for the purpose of gaining size and strength, have two bowls of cinnamon toast crunch and a normal dinner an hour or so later. The common themes here include regular, hard work and Cinnamon Toast Crunch. Hard work, not like the recumbent bike or a stroll through the mall. Hard work, like, there were at least a few points where you felt pretty miserable and would have loved to lay down and create a pool of sweat on the floor.

The timing is important. Total calories count, and you don't want to eat like that all the time, whatever your goals. But it can totally work for you. And since the window of optimal recovery is open for about 30 minutes immediately after exercise, better go get you some

cinnamon and sugar
we're baking up a bunch
baking homemade taste
in the Cinnamon Toast Crunch.

Testimonials. Do you really need to see a series of exaggerated and completely fictitious testimonials?

- - - -

Logo

2010-10-03T21:30:00.000-07:00

This week I'll be speaking to pre-physical therapy students at Messiah College about interpersonal skills in the clinic. I'm certainly not the expert on this, but chose this topic because:

1) It's relevant for all health care providers and especially so for this profession. It applies on a daily basis whether you're a PT or intern or volunteer. I succeed and fail with this stuff every day.

2) It's not another academic fact binge. They're probably getting their fill during all the rest of the time they have to sit and listen to middle aged people talk.

3) Although things may have changed since I was in school, interpersonal skills don't get much coverage, at least not practical, realistic, honest attention.

So for 30 or so hopefully not too boring minutes, it's gonna go a little something like this...

- - - - -

The American Physical Therapy Association attempts to summarize the essence of physical therapy with a little blurb under the APTA logo. Has anyone seen it?

"The science of healing. The art of caring."

I think it's great. I REALLY like that motto. What therapist (or any health care provider) wouldn’t do well to take it seriously and examine themselves by it?

How do you feel about "art" and "caring" being put up there with equal status of "science" and "healing?"

Things may have changed a lot since I was in school almost 10 years ago, but I would bet my gluteals that all of you can guess if it was "caring" or "science" that occupied 99 percent of training. We heard a lot about ethics and codes of conduct, but nobody even tried to teach us how to care. I can understand why it's that way, and I'm not so sure it could be any other way (especially at a state school).

The assumption, I guess, is that you do care. You want to help people, right? But I can tell you that when you're put in any kind of competitive environment; when you're asked to walk the line between efficiency and quality of care; when you're up against a schedule full of folks with arthritis on a rainy day and everyone is achy, the caring isn't always foremost on your mind.

Art, really? What professor or clinical expert confesses to art? Are you going to mention your artistic ability during entrance interviews? Maybe you should.

In defense of science

There's no substitute for clinical competence. All else being equal, what person with a miserably sore knee would pass on a top clinician with poor bedside manner in favor of a kind chap who uses the Magic 8 Ball in his clinical decision making?

There’s a reason why much of our weight is planted on science while art barely gets a toe touch. We believe that PT can help many people function and that it makes sense economically. We believe that our methods are reliable and valid. But believing does not make these things true. After all, therapists have a vested interest in doing a good job, even if their “caring” only concerns themselves.

Art and caring are soft and non empirical. Neuroscientists may track electrical activity in the brain that are vague evidence of some thoughts, but who can calculate caring? You can quantify caring no more than you can see a ground reaction force. Employers and insurance companies don't reimburse you for caring.

The caring of science

Or do they?

The problem with the above scenario is that all else is not equal. The bridge between science and caring is the reality of two whole people. Go ahead over to Medline and search "bedside manner." Notice the number of studies that pop up, and the trouble they have with even defining, much less studying bedside manner in purely humanistic terms.

Caring isn’t just the spoonful of sugar that makes the medicine go down. It's a vital ingredient in the medicine itself. It’s science that now confirms and helps us understand the complex interaction between the body and mind. Among many mysteries, we now have an inkling to how experience, expectation, stress, and other purely mental “events” have an effect on pain perception and other facets of healing.

So we're learning and practicing in terms of clinical pathways, prediction rules, and confidence intervals. And the patients...nobody cares. Really, nobody cares about how much you know until they know how much you care. In a decade of treating patients, I can tell you that people, whether they want to admit it or not, care far more about how you make them feel as a person and how you satisfy their personal needs than they do about how well written and effective your treatments are. Just watch. You don't need an MRI to see that.

So care, damn it

If healing and caring are a package deal that were never meant to be sold separately, what are some practical suggestions for caring?

1) Stand on evidence, yes. You have to. But stand at the edge, where you can still reach over and wrap both arms around a whole person in need of some caring (the hug may be metaphorical at times).

2) Our caring should have feet. External validity, if you will. Does your life generally validate your work? Do you highlight research journals on weekends and catch yourself analyzing the gait of strangers? Does your physical appearance affirm that you know something about body maintenance and repair? Do you offer your services to your closest friends and your own mom for no other reason than because you think you can help?

3) Maybe you need to seek or create an environment that leaves a little room for art. This may be difficult to do as a student, but again, watch and learn. I'm certainly aware of clinical models that have PTs "treating" four patients every hour, many of those patients going out and telling their friends that rehab doesn't work.

4) Do you care enough to look them in the eye and listen? Part of INTERACTING "in a confident yet respectful manner" entails your mouth being shut. Wisdom knows how to pull off engaged listening without getting caught up hearing about a sisters sons cat for the third time. I could certainly use some help here. But I can say that if your caring is mostly just about your competitive drive and need to defend your chosen profession and pay the bills, the clients can tell. And sooner or later, so will your "outcomes."

5) It all counts-the type of person you are developing into along the way toward your PT license. Credentialing exams don't test you for caring, by the way. I think that seeing PT as a calling is the only route to this caring. Otherwise, it’s just a bunch of knees and backs and shoulders. I suppose it's possible to get by that way, but it can't be very easy and rewarding. Or fun.

The logo captures far more than the academics of PT. I’m humbled and challenged.

- - - - -

Respect Recovery

2010-09-28T21:19:00.000-07:00

Most serious athletes and fitness fanatics are either training too much or not enough. I'm pretty sure it's one of those. "Optimal" improvement lies on a razor thin line somewhere between training and rest. Athletes can't know for sure if they are walking that line, but it's easy to tell if they stray far in either direction.

While it will always be easy to make excuses that result in laying around with a bag of chips and unreality TV, there are growing numbers of driven and devoted athletes who would benefit from nothing more than a day or three of rest.

On one hand, a certain amount of consistent training is needed to stimulate the body to adapt and reach new heights of performance. On the other hand, too much training and competition tears the body down before it has had time to recover, much less improve. Outside of technique, nobody gains or improves during training. The magic happens in all the other hours of the day; when the athlete is sitting in class, playing video games at home, and especially while sleeping.

Athletes, parents, trainers, and coaches would do well to remember that actual results are determined not simply by how much training is performed, but by how much training an athlete can recover from. Sorry coach, but an athletes recovery ability is determined by far more than what you can program. Age, gender, genetics, diet, stress, and the amount of sleep all play a large role.

So before you schedule those 5 a.m. workouts before class, please consider the 6 to 8 hours of classwork, hour of social time, minutes of family time, and hours of homework that will be wearing on the athlete until well past 11 p.m. If you want a thin 18-year old to gain 15 lbs of muscle before the spring season, don't have him or her running bleachers for 40 minutes 3 days per week on top of practice and weight training. Athletes who can tolerate, much less improve from, such a schedule are truly outliers.

I understand the value of extreme pre-season conditioning practices that build character and team unity and act as a self selection process for the final roster. There are certainly times for those lessons. There is certainly a time when an athlete must decide if he wants to work to get better or just have fun. But whoever signed up for getting worse while not having fun? The "more is better" approach, where athletes are chronically pushed on 5-, 6-, and even 7-day per week programs is worse than useless. Mental toughness may be worth the price of physical stagnation, up to the point where somebody gets injured.

All the glory and applause given to training, willpower, dedication, and hard-nosed coaching leaves little opportunity for us to hear the stories of drop-outs and injuries that are largely due to a lack of intelligent planning. They are stories of ibuprofin and arthroscopic debridement. They are stories of well-intentioned but unwell PEOPLE dragging themselves around day to day, beating their head against a wall, wondering why they're seeing such little return for all their efforts toward something they use to love.

Those stories do exist.

I see them most days in the clinic.

And I was one of them.

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It's Gotta Be The Shoes

2010-09-12T09:50:00.000-07:00

I've had much to say about the limitations and (sometimes) foolishness of common fitness products these days. It's for good reason, because of all the claims for simple, easy, and comfortable substitutions for the "problem" of disciplined, patient, and thought-out effort. While I'm no big fan of programs, supplements, braces, supports, and splints that promise the world to aspiring athletes, I really don't want to be known as the Fitness Nazi.

No Reps For You!

So here's one on the other side of all the marketing hype and junk fitness products, based on legitimate biomechanical principles.A recent study published in the Journal of Strength and Conditioning Research looked at the effect of certain footwear on vertical leap.

Following the lead of a few other investigations, researchers measured the vertical jump while subjects wore (a repeated measures design) standard shoes and "experimental" shoes that place the foot into slight dorsiflexion. If you were standing in the experimental shoes, your heel would be about a half inch lower than the ball of your foot.

The vertical jump of the the group of "generally fit but not elite" women being tested was almost two inches higher when wearing the shoes. This is a pretty drastic improvement. What's more, the researchers also gathered data while the subjects ran. The jumping shoes had no adverse effects on running economy, pain, or perceived exertion. So there were no drawbacks in this population of people, at least for the time being tested.

It's ironic that most high falutin' high tops rest the foot in the opposite direction (about 4 degrees of plantar flexion), which has been suspected of contributing to the acquired ankle inflexibility and knee pain seen in basketball players. Isn't it cool to think that a little tweak of the ankle may produce an immediate increase in vertical jump without the body "paying" for it elsewhere?


As compared to typical hoops shoes,		flat old school may be better for the health of your knees and vertical jump.

"Little" being the key word here. A little scientific evidence from a little tweak, without major complications, will get hundreds of thousands of people suddenly up and jumping more, which tends to create an increase in vertical jump. At the same time, if the shoes catch on and are bought up in those numbers, there will be problems.

I mean, can you imagine these things being picked up by Reebok and a multi million dollar ad campaign? The average Joe looking white kid is suddenly throwing down in traffic.

The body almost always pays for any extreme additions or subtractions, and even a subtle tweak risks the chance of pushing underlying movement dysfunction (like say, those who are already restricted in dorsiflexion) over the threshold to injury and pain. Poorly conditioned (okay, fat) boys and girls will wonder why their heels are sore and they're not hitting their heads on the (basketball) rim. Some men and women who were just hungry for a little performance edge will get a big serving of tendinopathy from the increased load to the achilles.

And still, the concept is cool. The shoes hold promise as the first product of its kind, well beyond shoes, that may legitimately help you get more air.

Promise, with reservation.

Discomfort: Priceless

2010-09-07T21:10:00.000-07:00

There's really nothing comfortable about our basement. This man cave is not equipped with a high-def TV or EZ chair, X-box or pool table. Walk upstairs and help yourself, because there's no bar or mini fridge.

The Green Room out back.

But there is a barbell. And a bench, a few adjustable dumbbells, several hundred pounds of weight plates, a 90's-era CD player, and gravity. The workouts often can't be contained, blowing out through the back door. The Green Room offers graded surfaces, rocks, obstacles (including kids) to accommodate plenty of running, jumping, hitting, and throwing. The "natural" climate control is just perfect, especially when the days are not sunny with a high of 75.

Attempting to make physical exercise soft and cushy misses the point. The body adapts to both comfort and discomfort. While discomfort deepens us, smoothie bars and cardio theaters and fancy chrome exercise gadgets are blood letting for the anemia of modern times. Discomfort grants us the opportunity to develop will and grit that's readily transferable to everyday life.

Time is a gift. So if you sit indoors for the majority of your work day, please don't drive (sitting) to a climate controlled gym to sit or recline back on some resistance exercise gadget, crunching your pelvis even further toward your rib cage. I don't care how well it isolates the lower obliques. Unless you're older than 70 or with a serious disability, swear that you'll never be seen reading a magazine while riding a recumbent bike, especially People Magazine.

[Sure, it was a cool down.]

If you're going to work out, for heavens sake, WORK out. Learning the joy of misery suddenly gives you time for a fitness program. Fitness doesn't even mandate an electrical outlet, much less your own TV and PlayStation (like the ridiculously equipped for a roster of 14 Dallas Mavericks training facility). If you have gravity and some ledges, rocks, or steps, you have plenty of gear for a solid level of fitness.

In general, the less fancy gear you need to exercise, the better. Therefore, yoga mats are probably a good return on investment. As is lifting barbells and other heavy things. And while I'm no fan of distance running, I have to hand it those who willingly engage prolonged periods of the most fundamental push against gravity. That's why they call the natural, exercise-induced rush of endorphins a "runner's high," and not a "Thighmaster's high" or even a "Cable Cross Overer's high."

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Mike has embraced this particular odd form of discovery and made the journey his own. I think it shows.

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How dare any fitness or infommercial person try to sale us on "quick and easy," stealing away what's priceless? Comfortable exercise never delivers the full dose. While we can't derive a mathematical relationship between discomfort and "benefit," such a formula is certainly worth considering in the context of an individuals abilities and goals.

Of course this can be taken too far. I don't recommend Fight Clubs because the side effects are pretty awful. And not everyone should prepare for a solo climb of K2, or even deadlift 400 pounds, intentionally bloodying their shins with the knurling of a barbell (as I once witnessed at the now defunct Slippery Rock University Barbell Club).

But I am asking for a some middle ground here.

Speaking of bloody shins...

This is not the counterfeit discomfort of masochist ascetics. A recent accidental drop of a heavy dumbbell on my toes caused me to doubt that the purposeful infliction of pain holds much positive psychological value. Though the extreme saints, mystics, and barbell nut cases may disagree, I would argue that "gift" discomfort always comes riding on a productive act where pain is not the primary intent.

THIS video: 300 framers per second, Kyle Wagner probes the limits of discomfort.

Embrace and deliberately manipulate discomfort as a controlled variable. Most of us should progress slowly and focus on the journey. As an alternative, you can ramp discomfort from practically 0 to 60 in mere seconds, like this:

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I'm all for the basement. It's ridiculous how much happens down there. I, personally, have never felt a place as comfortable as my basement floor.

Ahhhh...the floor!

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Thanks to those who got down(stairs) with discomfort:

Mike M, Mike S, Mike H, Dave T, Andrew C, Eric B, GG M, Amy G, Marie V, Ben C, Cort, Rose, Ryan H, Tim B.

The blogger, finding discomfort.

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Eat. Play. Love. (Part II)

2010-08-29T21:49:00.000-07:00

The premise is that Ben probably BEGAN working on his hops a LONG time ago...

Shortly after moving to Harrisburg, Amy and I strolled purposefully through Sofas Unlimited. We stressed over color coordination and texture. Nobody needed a drink or had an emergency pee. In those days we cared, really cared, about our sofa, love seat, and over sized chair.

Now days, the precious furniture takes a beating at the hands and feet of four little ones. Especially on rainy days. Obedience is a top priority to us (no jumping on others sofas or on ours until we say). Furniture is not. And it's more convenient and less costly than 4 memberships to MiGym.

No furniture or bones have been broken yet. I'm just not up for the battle of going gently on the furniture, a relentless, thankless battle indeed. Perhaps we'll prioritize the sofa some day. But not right now. What a shame when furniture is outdated and demoted to the basement without having taken some hits.

Bear in mind that I'm a PT/trainer guy and not an interior decorator or furniture person. It's understandable if furniture is important to you. But for the kid's sake, have a horseplay couch in the basement. If you find it hard to let go of the whole furniture situation, go ahead and cheat by just starting with a 10-year old ugly couch. Think of your ugly old basement horseplay couch as an investment in their future.

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Side note, as ironically, I had to pause to address my 4-year old after he literally rolled out of his bed while asleep.

Risk is inherent in almost everything. Video games can become addictive. Kids ride in vehicles every day. I'm sure there are stories of kids getting horribly injured by falling from furniture. I don't know those stories, but there are many kids in close proximity to many couches, so I'm sure they exist. The key idea here is relative risk.

Horse play on a couch has it's relative risks and rewards.

Encourage (OR discourage) it at your child's own risk.

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What do couches have to do with athleticism? As stated in Part I (below), athletic potential in adolescence and adulthood has much more to do with acquiring an early love of physical activity than it does with genetics. The fundamental elements of athleticism are tied directly to natural sensitive periods in the development of the nervous system. The actual existence of these critical periods for motor development has been academically debated, but it makes sense and fits my personal observation.

Couches are the perfect gear for tuning little brains to spatial awareness, movement synchronization, and rapid acceleration and deceleration. Cushions awaken the smallest ones to the consequences of gravity.The process occurs conveniently and naturally, with far more stimulation than standing around waiting for a turn during "practice."

So leap. Chase. Hang. Lift. Throw with one and two hands. Any activity that your old aunt Edna yelled at you for doing in the sitting room is probably what kids should be doing. And often!

The best fuel for young athletes is frequent servings of a wide variety of physical activities. That's why starting them young does not have to mean soccer camp for toddlers and after school gymnastics. There are certainly worse things that 3- and 5-year olds can be doing with their time. But what I'm suggesting has little to do with organized anything. Quite the opposite, in fact.

Think couch.

I'm not saying that learning to cooperate and work as a team is without value. Those are needed lessons, but they are not lessons in motor control. Waiting your turn is probably a concept that should be introduced in the home and classroom before it's attempted during active times. We should expect a 12-year old to be patient and organized on the field during play time, but not a 6-year old.

Luke had to wait his turn.

So protect the kids, but don't hover. Let them learn about their body and gravity while the stakes are relatively low. Far more than any coach or trainer, you know how to challenge your little one in a way that also sets them up for success. And make it fun.

Mom and dad, be active yourself and look to praise their attempts at physical achievement. Encourage the horseplay, to some extent. Help them see their body as a performance machine good for more than sitting in front of electronics for 44 hours per week (the reported average for kids).

[Above] The author succeeds as an active model for the kids, but fails as a show boat.

On that note, send the kids outside. A lot. This link includes a referenced compilation of the benefits to being outside as well as many problems associated with the fundamental move of childhood to the indoors.

The brothers getting some fresh air.

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Lastly, point the little athletes toward the best finish line. You can train an athlete to run faster, but let's just go ahead and say that it probably won't make them a super star someday. Or content.

His Super Bowl ring is not what's making him happy right now.

Athletics truly helped keep me out of trouble and doing my homework. They still help me to get through long days, working as a father and a PT. The real value in training and competing is in the journey toward wellness of the body and mind. Lets set our children up for the love of physical activity without plastering them with commitments. Should they decide to pursue athletics, the foundation of higher level skill will be in place. '

The Promised Land is not some championship destination flowing with champaign and money. Anyone who is fed, loved, and given the opportunity to play is IN the promised land. And there, if you find that sweet spot between having fun and working hard...

....ooooh! You can let go of all the rest.

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From Over At The High Calling

2010-08-17T08:34:00.001-07:00

www.highcallingblogs.com

This is the first of five legs in our Pilgrimage series. Today we’re led by physical therapist and High Calling member, Bob Gorinski.

It’s hard for me to imagine a pilgrimage or journey without movement. As a physical therapist and trainer of athletes, I help a wide variety of patients achieve new limits in movement. I play bio-mechanical detective, attempting to solve problems in the function of muscle, nerve, and bone.

Most of my clients are on a serious journey toward change in their physical form and function. And do they ever ask questions about health and fitness products, many of which guarantee results. Fast!

Why aren’t the orthotics fixing my heel pain? When can I pitch again? Will protein drinks help me lose weight?

I offer straightforward opinions and evidence-based answers. But often I simply don’t know. It’s challenging enough to keep pace with advances in rehabilitation and sports performance, much less the latest claims in homeopathic supplements and mattress technology.

“Optimal,” “comprehensive,” and “transformation” are permanent buzz words in the health and fitness industry. Transformation, really? Not even yoga is comprehensive. And sorry, Chuck Norris, but the Total Gym is still just a gym, and rarely do gyms help a person achieve peace.
Physical therapists pride themselves on treating causes of pain and dysfunction instead of symptoms, yet the root causes sometimes go quite deeper than we can dig.

Filling the hole

While there’s plenty that I don’t understand about the human condition, a decade in the clinic has shown me that even intelligent people buy into good and bad fitness products in order to fill a hole elsewhere.

Middle-aged moms imagine that getting into their college jeans is a realistic and worthwhile fitness goal. Couch potatoes think PTs and orthopedic surgeons can fully atone for years of bad decisions. Desk jockeys assume that simply being in a gym is equivalent to the inevitable discomfort of getting fit.

Similarly, fitness fanatics believe that glucosamine and more exercise is the solution to their repetitive overuse injuries. (Even PTs – ahem - take ibuprofen when the best prescription for aches and pains is a few days of rest.) And then there is greed, bitterness, and many other conditions less apparent yet more physically damaging than a soft midsection or flat feet.

In all seriousness, who has ever ab-crunched or low-carb-dieted their way to contentment?

Holistic means…

If (as the apostle Paul writes to Timothy in I Timothy 4:8) Godliness has value for all things – holding promise for this life and the life to come – then the body certainly stands to benefit from spiritual exercise. That makes a lot of sense, and I don’t think we have the capacity to will ourselves to any kind of transformation. Sooner or later, the body tells the truth.

But be careful now. If the body were always a testimony to the spirit, then we could identify spirit-filled people by their physique. Of course that’s not the case. The lives of my kindest, gentlest patients have taught me that an (apparently) strong spiritual life does not fix the genetic and life circumstances we’re dealt. By no means are injuries and the wear and tear of life always earned with laziness or neglect. I’m pretty sure that even the saints get arthritis.

The truth is that whole people are far beyond PTs, nutritionists, doctors, and the guy in the Facebook ad selling Acai Berry. While we can be helpful or even critical in handling the details, we know that a fit body requires more than diet and exercise. That’s why the “just” plans for health and fitness are always a lie: Just seven minutes of exercise per day. Just two pills before major meals. Just one spinal adjustment per month….

Even the oddest fitness products sell because they’re supported by an “expert” in a white lab coat (or a sports bra) and promise a “new you.” They look kind of fun and cost only three installments of $39.99. Yet being made new transcends the scope of physical medicine. It’s why I never make promises with my treatments. Besides, who is an impatient, chronically late, caffeine- and activity-addicted PT like me to guide anyone in mastery of life?

Health is a lifelong journey that demands daily attention; the kind of attention that costs more than the price of diets and exercise gadgets. Fit bodies are a worthwhile pursuit that can easily be forged into idols. At the same time, exercise and effort is a blessing from above that helps us manage the hard realities of our life and times.

As much as I’d like to prescribe what people need most, I’m fearful of writing Jesus into my medical plan of care. I wouldn’t want it to be another quick fix. What I can do is take the posture of washing feet. That just may be the best bio-mechanical and spiritual response toward wellness there is.

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