Stability

There are many approaches to "core" training from standing on stability balls to plain ol' sit-ups. Others argue about belly button in vs. rigidity. Without getting into the discussion right now a great "core" exercise is the front plank with a "twist". Leaning on elbows and toes, lift one leg without moving the remainder of the body. Do a search via google or youtube. Qualifying score = at least 30s. Problems = weakness or dysfunctional fascial chain. If you can't hold it 5s get it looked at by a therapist. If you can hold 5s but not 30s, build up to 30s by doing repetitions of 5s, preferably 5-6 reps.

Disease and dysfunction

"Disease is a drama in two acts. The first one happens in the gloomy silence of the tissues, with the lights off. The pain or other symptoms only arrive in Act Two."

- R. Leriche, MD

Thoughts?

Relative Strength Training

Strength may be defined in relative terms or absolute. Relative strength refers to strength levels related to body weight. On the other hand absolute strength is strength regardless of body weight. To illustrate, the world record total in Olympic Weightlifting for the 105 kg class is 436 kg. The same record for the 77 kg class is 378 kg. In terms of absolute strength the heavier weightlifter is stronger but relative to body weight the lighter weightlifter is stronger.

Why is this important? Most functional activities and many sports (running, wrestling, MMA, gymnastics, etc) require high levels of strength without extra mass (i.e. relative strength). To prioritize this type of strength use lower repetitions (6 or less), more sets and longer rest periods. To illustrate, a sample squat workout is written below.

Front squat: 6,4,2,6,4,2. Rest 3-4 min between sets.

* 6,4,2,6,4,2 means a set of 6, rest 3-4 min, increase weight, do a set of 4 reps, rest 3-4, increase weight, do a set of 2 reps, rest 3-4 min drop weight to 1st set + ~2.5%, then do a set of 6, etc.

Chicken or the egg - Motivation or Action

I always thought that the motivation to engage in a task was required before action took place. However a respected colleague and friend of mine once noted that "sometimes action preceeds motivation." It seemed simple but it was very insightful. Think of the person that you want to be. Then take steps to be that person. Each step builds confidence, which in turn leads to greater motivation. Do it, don't wait for it!

Priorities

How do you decide where you will focus your energy each day/week/month...etc.? In working with people I find that most people run into trouble when they haven't clearly defined their values. Values are things that are important to you. Some examples of values may be family, education, freedom, money, etc. Awareness of the important things in life allow you define your goals and therefore your energy. If you struggle with getting through the day, feel unproductive or guilty or have difficulty in making a decision try it out; write down what's important and then see how you split your energy in the run of a day. Chances are you have a conflict in your value system or you have not explicitly stated what's important to you.

After you've defined your values the next question becomes "Is it an ends value or means value?" For example, money is a means value...it's a means to an end. Have a look at your list again. It's a great exercise for reflection. I'll go back to this again in the future.

Cycling Presentation

This past Saturday, November 13, I had the opportunity to do a presentation on physical preparation for cyclists @ Wildwood Cafe in Bridgewater, NS. In addition to being an avid cyclist, Aaron, along with his wife Mary, run an excellent restaurant. One of the fantastic things about Wildwood Cafe is that Aaron and Mary create a personal relationship with every single person that walks in through the door. If you're in the Bridgewater area check out their place @ 425 King St. Aaron also posts daily specials on Facebook.

On a similar note one of the attendees @ the presentation on Saturday was Justin Pickens, owner of Active Edge Therapeutics (http://activeedge.wordpress.com/) . Justin is a Registered Massage Therapist in Bridgewater. It was my first time meeting Justin and it was great to have him there. He had some excellent input for those attending the seminar. If you need a massage be sure to give him a shout. He has a strong interest in dealing with athletes.

And for those interested, I'm doing a presentation on Running Injuries on Saturday, November 27 @ 1pm for the Bridgewater Triathlon Club @ HB Studios. Feel free to stop by. It's the BTC's AGM after the presentation.

Contemporary Medical Acupuncture

What is it?
A peripheral nerve stimulation technique with fine solid needles +/- electricity that is used to induce physiological changes on the activity of the nervous system and its effectors (Elorriaga, A).  As a western trained health care professional acupuncture is used as part of conventional medicine rather than a complete “alternative medical system”.

How does it work?
It acts by stimulating the nervous system through the nerves.
How can it help you?
The most common application of acupuncture is for pain relief, particularly musculoskeletal pain. However, the Contemporary Acupuncture Program at McMaster University teaches that acupuncture is used to facilitate modulation of neurological activity at multiple levels of our nervous systems. In fact this acupuncture approach is implemented in the treatment of Olympic and professional athletes throughout the world. In addition to musculoskeletal pain, acupuncture may be used to treat stress related problems, headaches, functional bowel or bladder problems, menstrual or menopausal symptoms, allergies, sinus problems, etc. This list is not exhaustive.

If you have any questions feel free to drop me a line or post a comment. I've also included a link to the Contemporary Medical Acupuncture Program at McMaster University.

http://fhs.mcmaster.ca/acupuncture/

Overhead Squat Assessment

The overhead squat is a great functional movement assessment tool. To do it take your feet shoulder width apart, toes pointing straight ahead and arms straight overhead in line with the ears. The squat down to at least thighs parallel to the ground. Video tape yourself if able. Where do you break down?

Beginning at the bottom, if the feet turn out get your hips checked for muscle weakness, particularly abduction and extension. A health professional can check specific tissues. Also check your range of motion/tension in the calves, hamstrings and side of the hips (think lateral side of these tissues). You may find trigger points or tight bands. Check both sides. If one side is tighter use a foam roller first and then stretch it out (I use an acupuncture needle and myofascial release techniques for lasting changes). If both are tight do it bilaterally. Otherwise stretch the tight side so it's equal to the "loose" side. You may find that some muscles are tight on one side and a completely different set are tight on the other side.

Check it out and do it before the next time you do your exercise.

Stress

A couple of my colleagues passed this article along to me. It's relevant to many in this day and age.

http://www.theglobeandmail.com/news/national/time-to-lead/work-life-balance/how-stress-affects-the-human-body/article1765389/?cmpid=rss1

What can you do about it? 2 simple things that you can control are exercise and nutrition.

Exercise has been shown to have a positive influence on stress. Be aware, however, that exercise is a form of stress and therefore requires a period of recovery. Exercise in excess may lead to increased levels of cortisol as well. It's especially relevant to athletes who participate in long distance events due to their high volume of training. So be sure to alternate periods of rest with periods of high volume (Same goes for work for that matter). Same concept of Yin and Yang. Excess of one depletes the other. On a related note I read an interesting research article in the British Medical Journal: Acupuncture in Medicine about 6 months ago that showed that medical acupuncture helps restore immune system function that is depleted following intense exercise.

Healthy eating is also a great way to control stress. Many people try to control stress with eating. Insulin and stress are tied together so it only makes sense. Stress is fight or flight and the body loves its sugar in periods of stress so of course it needs to refuel after stress. As such eat meals to control insulin. Include healthy fats (fish oil, olive oil, avocado, nuts), protein and vegetables with each meal. Add fish oil (EPA, DHA) to your daily food intake. Have a search on medline. It's good stuff! Fiber also helps control insulin levels so get some of that by eating more vegetables and/or a fiber supplement (ground flax seed is cheap).

Physical preparation

How do you prepare to succeed at sport (life)? There is an old saying in physical preparation that goes something like "the high of the peak is proportional to the width of its base". It's similar to building a house...build a good foundation before completing the remainder. What does this mean? Avoid early specialization. If you have a child expose them early on to each and every physical activity in spite long term aspirations. It's lays the foundation for better motor skill development later on. If you're an athlete plan out your training and cross train physical qualities prior to specializing (e.g. strength, power, flexibility, aerobic endurance, anaerobic endurance, etc.). If you participate in a "regular" job switch positions often. If the opportunity doesn't exist create it and/or engage in different activities outside of work.

The variety leads to better physical development and brain development!

Is it all about the drugs?

My first experiences with reading about performance enhancing drugs were in the muscle mags and the Russian strength training literature. In university I read Speed Trap by Charlie Francis, which seemed to imply that everyone was using drugs and, in fact, you had to use drugs to compete at the Olympic level. It seems that the hunt is on for those taking performance enhancing drugs and even those prescribing performance enhancing drugs.  The Tour de France has had a rough go of it for a while now. Since the Balco incident baseball has gotten a bad rap. Is it the fact that people take it or that they lie about taking it?

http://www.telegraph.co.uk/sport/othersports/cycling/lancearmstrong/8063187/Lance-Armstrong-investigation-could-be-as-significant-as-BALCO-says-WADA-director.html

http://www.huffingtonpost.com/2010/09/30/alberto-contador-tests-po_n_744711.html

http://www.citytv.com/toronto/citynews/news/international/article/96807--toronto-sports-doctor-indicted-in-buffalo

Thoughts? Comments?

EXSTORE - Functional Assessment and Treatment

In my 2nd blog I spoke about Dr. Lombardi from the Hamilton Back Clinic. I just spent the past 3 days at his clinic learning the Functional Musculoskeletal Assessment approach - EXSTORE. Fantastic! The EXSTORE approach allows me to specifically identify the underlying dysfunction, which I treat using a combination of medical acupuncture and soft tissue/myofascial release work. During my time there I was able to treat a variety of clinical conditions using these techniques. For example, in 2 cases of frozen shoulder we were able to increase range of motion and stability by treating the wrist and in a case of neck pain we were able to change function by treating the ankle!

If you're a health professional Dr. Lombardi is offering an Advanced MSK workshop in January.
http://www.hamiltonbackclinic.com/workshop1.htm

Feel free to post comments or drop a line if you have questions.

Is a specific amount of time required to manipulate fascia?

According to the link below it would seem so!

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WHF-5046W41-1&_user=10&_coverDate=10%2F31%2F2010&_rdoc=1&_fmt=high&_orig=search&_origin=search&_sort=d&_docanchor=&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1fa688bff76d8ed265aec482551c0b61&searchtype=a

The study used a qualitative measure to identify the length of time required to modify fascia in patients with low back pain. Interestingly the average time was almost 3 and 1/2 minutes at one location! The technique used in the study was based on a technique called Fascia Manipulation. It was developed by an Italian PT by the name of Luigi Stecco. If you remember a few posts back I mentioned the technique in relation to the kinetic chain. That's because Stecco has developed his concept around lines of fascia throughout the body similar to the concept of Anatomy Trains. However there are some distinct differences. Stecco treats specific points using a friction type maneuver away from where the patient feels the pain. It's probably the most evidence based technique available given that he has published several peer reviewed articles on its efficacy.

I have both of his books. Both are of excellent quality and require dedicated reading time. The first book, Fascial Manipulation for Musculoskeletal Pain, is heavy with the technical aspects of fascia whereas the second book, Fascial Manipulation Practical Part, is as the title states. It describes the chains and points within the chains. Interesting side bar is that Stecco notes that many points correspond to acupuncture points.

A dynamic assessment!

The image below is from the PEO Model by Law, M et al. (1996). It illustrates an assessment approach that I like to use regardless of the area of practice. I also use it as an education tool for clients when I provide educaion on where performance is breaking down.



The model illustrates the interaction between the person, in a given environment, completing a particular activity or occupation. The interaction between the 3 areas lead to a person's occupational performance (or functioning) in their chosen activity. Person factors include the physical, the emotional/cognition or spiritual beliefs. The environment includes things like the physical, cultural and socio-economic factors, among others. And, of course, occupation is the task or activity that the individual is engaged in.

As an assessment approach it's useful because it illustrates the dynamic nature of functioning and moves away from the cause-effect mentality. It may also help identify whether it's best to use a remediative approach or a compensatory approach* (or both). For example, a client experiences a physical injury, which means the person circle moves away from the mid line thereby reducing the likelihood of successful performance in the desired activity. Now we have a several options

- use a remediative approach to treat the MSK injury to increase performance and/or
- change the demands of the activity to make it easier and/or
- change the environment to compensate for the injury.  

The choice of strategy, of course, will be influenced by medical history, client goals/expectations, flexibility to make changes, etc.

For the same reasons above I use the PEO Model as an education tool. In my experience clients find it useful to see how the environment and the activity are potential sources to enable or constrain performance as opposed to just focusing on a remediative approach.

I hope you give it a try and find it a useful tool.

* To clarify a remediative approach would focus on fixing the underlying impairment (i.e. repairing a broken leg). A compensatory approach provides an alternative method of accomplishing a goal (i.e. change the activity).

Are you afraid of the dark?

I make a point of stopping by http://www.optimumperformancetraining.blogspot.com/ to see what is going on. In addition to great workouts he usually has a link to something health and lifestyle related. The blog is developed by James Fitzgerald (aka OPT). I'm lucky enough to count James as a good friend. Anyway the other day he had a link to this study

http://www.pnas.org/content/early/2010/09/30/1008734107.abstract

The summary is "These results suggest that low levels of light at night disrupt the timing of food intake and other metabolic signals, leading to excess weight gain. These data are relevant to the coincidence between increasing use of light at night and obesity in humans."

The study links the use of some light while sleeping to disrupting circadian regulation of homeostasis. This study reinforces the importance of sleeping in complete darkness as opposed to allowing any light in the room. From a lifestyle perspective it also demonstrates the importance of keeping a regular sleep routine. In addition to the latest research examining sleep in relation to obesity, other research is examing the role of sleep in concentration and memory. For instance, sleep deprivation has been linked to driving accidents and memory consolidation has been linked to different phases of the sleep cycle.

No doubt about it we need sleep to perform at our best! How many hours of sleep do you get per night? And are you afraid of the dark? Do you have trouble sleeping?

October is National Occupational Therapy Month - What is Occupational Therapy?

If this question was posed to most the answer would logically be "you help people with work?". Well yes and no. Occupation includes work or a productive role but it also includes activities related to taking care of yourself and leisure activities. Our national body, the Canadian Association of Occupational Therapists (http://www.caot.ca/) defines occupation as "everything that people do during the course of everyday life. And the primary goal of occupational therapy is to enable people to participate in the occupations which give meaning and purpose to their lives." So in summary an OT helps you do what you want to do whether it's a sport, doing an activity with your family or being productive at work.

How do we help? Well it varies depending upon the problem and the factors involved. Occupational Therapists are university-trained, regulated health professionals with a broad education background, which allows them to assess not only the medical and physical impairments but also the psycho-social factors that affect your ability to do the activities that you want to do (http://www.caot.ca/). With the end goal of helping you achieve your goals an OT examines the activity that you want to do, your ability to complete that activity and where that activity is taking place. From that process we are able to identify where performance breaks down and work with you to develop a plan.

So if you're not able to complete an activity that you want to do or if you feel as if you're not reaching your potential in some aspect of life find an OT in your area. Remember that health is more than the absence of disease and your performance in everyday activities affects your well-being!

Next time I will discuss a general assessment approach that you will be able to apply to a problem that you may be having whether it's a mobility issue or your child getting out of hand.

The straw that broke the camel's back...

Have a look at the article in the link below.

http://www.tsn.ca/mlb/story/?id=331780

It was passed on to me by Dr. Anthony Lombardi* of the Hamilton Back Clinic. The article is about Washington Nationals Pitcher Stephen Strasburg. Strasburg recently had surgery on his right elbow and he will subsequently be out until the 2012 season. At the time the above article was written Strasburg had just injured the elbow. Interestingly it mentions that Strasburg was on the DL a month prior to the injury with an inflammed right shoulder. Dr. Lombardi followed up the article with the following:

"I am of the opinion the signs of shoulder dysfunction were there before the tear occurred. The shoulder pain 3 weeks ago played a role in shoulder stabilization and ability to decelerate the shoulder and elbow. Sensory-motor integration of throwing mechanics in used muscles then become altered and any compensation in the cocking phase of the elbow will put increase stress on the medial elbow (especially when pitchers are throwing the ball 160 km/hr). "

There are several great take home points here.
- The first is that dysfunction often exists for a long time prior to the onset of pain or "bigger" problems.
- Secondly, assessment has to go beyond the site of pain. For example, wrist pain would require assessment of the entire upper extremity, including the cervical spine and scapular mechanics. Fascial manipulation or Anatomy Trains are great places to have a look at fascial planes.
- Thirdly, the ability of a muscle to contract or move is not only based on the strength of the actual muscle doing the movement but also the opposite muscle. To use one possible scenario from the above example, imagine throwing a ball as hard as you can. Now think about what happens after you release the ball. The arm has to stop moving, which requires the muscles on the back of the shoulder to contract as they lengthen. These muscles are often referred to as the rotator cuff. Again of course this is just one example of where something may go wrong. There may be other inhibitions or soft tissue changes along the kinetic chain.

So how does this affect performance and what can you do about it? To use the above example, Charles Poliquin has developed a set of ratios that he uses for strength training with his clients. You should be able to use ~9% for 8 reps of your 1RM 14" bench press in the external rotation exercise in the link below (i.e. 100 lbs bench press = 9 lbs x 8 reps on the exercise).

http://www.youtube.com/watch?v=JK9mFQZViXc

Keep in mind that although the article in the link is about a high level athlete the same principles apply to the rest of us. For example, back pain could be coming from a bum ankle. If you are having pain or experiencing diffculty completing an activity that you want to do make sure you get someone to complete a comprehensive assessment system throughout the entire kinetic chain.

*Dr. Lombardi is an expert in the treatment of musculoskeletal injuries. He can be found at  http://www.hamiltonbackclinic.com/ . He has some great educational videos on Youtube.

Reaching your peak...

So what is peak performance? Have you reached your peak? What is it to me? Well first of all it's my business but more importantly it's a concept that requires clarity. In this circumstance the word "peak" is used an adjective. I googled the definition and found "Approaching or constituting the maximum". However I'm not fussy on this definition as it implies that a "peak" is an absolute and time limited state. A person has reached their peak or not. And then what happens after you reach your peak?

My idea of peak performance is broader without the cognitive distortion (all or nothing aka stinky thinking). Being at your peak is about an optimal state of health and well-being, which is reflected in the performance of everyday activities. It's not limited to one day or one moment. It's reflected in every moment. Simply put peak performance is being at your best. How do you do that? Well most importantly it requires living according to your strengths and values. A simple exercise; next time you have a difficult choice to make ask yourself where it fits within your values.

Until next time.