Month: October 2016

Understand the line of reasoning.

Patient: My neck hurts. Sometimes I have headaches or numbness down my arm.

Healthcareperson: Well sit down here so I can crank your neck  as far as it will go, every which way. Yeah. No. Seriously.

— 2 weeks  and 4 “treatments” later —

Patient: It feels a little better but not for very long. I’m still hurting.

Healthcareperson: You need maintenance adjustments.

 

Neck adjustments (manipulations or “cracking”) can cause major, even life-threatening injury. Are you aware of VAD stroke? Here is the first portion from Wikipedia:

Vertebral artery dissection (abbreviated VAD) is a dissection (a flap-like tear) of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. After the tear, blood enters the arterial wall and forms a blood clot, thickening the artery wall and often impeding blood flow. The symptoms of vertebral artery dissection include head and neck pain and intermittent or permanent stroke symptoms such as difficulty speaking, impaired coordination and visual loss. VAD may occur after physical trauma to the neck, such as a blunt injury (e.g. traffic collision), strangulation or manipulation,

Did you notice that they include manipulation as a physical trauma to the neck?

While the occasion of severe injury or death due to forceful neck manipulation is relatively rare, it can and does happen.

But what most definitely  is NOT rare, is hearing clients in my office describe how indiscriminate cracking of their neck has made their neck pain, headaches, and arm pain/numbness much worse. Is this cranking on the cervical spine helpful or necessary? The clear answer is “No.”

[I was going to put a youtube link to cervical manipulation. But these days, there are no simple neck cracking videos. Now there are entire compilations of the shenanigans, literally volumes of 8- to 10-minute videos of nothing but ridiculous and mostly unhelpful neck cracking. Go find them if you like.]

Physical therapists often apply mobilizing forces to the neck and upper back. The vertebrae may or may not crack. But cracking is not magical and it’s not the end-goal. And before even gentle neck manipulation, the patient undergoes an evaluative process that includes”pre-manipulative” testing. This takes more than a few minutes, but easily allows us to determine whether or not a manipulation is safe and even necessary.

BEFORE YOU EVER HAVE SOMEONE FORCEFULLY “ADJUST” YOUR NECK…

1. You should have underwent a thorough medical history and physical examination. This typically involves a series of tests that gently stress the neck in order to determine how your body respond to various mechanical forces.

2. If neck manipulation is warranted, the professional should do so with the MINIMAL force necessary to provide the desired outcome. This typically involves a common-sense application of gentle to moderate forces prior to forceful thrusts and “adjustments.” This is common sense from the standpoint of effective treatment with less risk of injury or pain exacerbation.

**With a gentle and systematic approach, we often find that the heavy-handed cracking is not necessary. You may realize that a little neck traction and -targeted- stretching get the job done just fine, and without long-term reliance on the healthcare provider.

3. Keep in mind that neck adjustments whether gentle or forceful, are far from a cure-all. In fact, your problem could be coming from segments of the neck moving too much (rather than too little), and all the forceful movement will only make the problem worse. In fact, this is 90% of people in all the neck manipulation videos. Just by looking at them, it is easy to tell that the problem is the moving too much with poor alignment, not from moving too little.  To get better and remain better, you may need more strength/stability or flexibility in specific areas involving the shoulders and spine.

4. Independence is the goal! Although most problems require some time to improve, nobody should have to rely on the healthcare professional for regular, long-term neck manipulations. Again, needing repeated adjustments is good evidence that the adjustments are not addressing the problem in the first place.

There are thousands of ideas and resources regarding speed training. Nearly every single conceivable physical movement has been recommended as THE secret to increased running speed.

Therefore, you definitely should…

lift weights/stretch/pilates/agility ladder/yoga/dance/run for “aerobic base”/on and on… to gain speed.

And sure – many exercises and methods CAN potentially help an athlete increase his or her running speed, especially when there is a relatively low level of baseline fitness. But what are the BEST methods for taking a decent athlete to the next level?

Lift weights…how? What exactly should be stretched? How much strength/flexibility/agility/conditioning is enough?

Well, here I will attempt to summarize a few of the best practices and non-negotiables regarding speed training.

1. FORCE/body mass is KEY

Above all else, the athlete must be capable of generating a high amount of force per body mass. Force…into the ground! I’ve said it before, but many of the leading lines of coaching as well as peer reviewed research on sprinting indicates the generating FORCE is far more important than agility, leg turnover, and a host of other factors.

Now, how does one generate a great amount of force into the ground per body mass? Well, it depends.

Some athletes generate a ton of force but high body mass (or poor body composition) is a barrier to moving quickly. A clear example of this would be the typical linemen or even first basemen who may or may not need to move quickly. Most athletes will benefit tremendously from gaining some muscle mass in order to drastically increase their potential to generate force. Generating force into the ground also requires core strength. Sprinting with a weak core is like trying to shoot a cannon out of a canoe. Pilates type moves MAY help with core strength for sprinting, but far better options include deadlift variations, single leg squats and lunges, rows, chin-ups, and various planks and loaded carries.

“Quick feet” are over rated when it comes to speed. Go ahead and use the agility ladder to warm up and increase foot coordination. But “slow feet” are almost always a symptom of hip weakness. For speed, strong and stable hips and core are where it’s at.

2. Flexibility matters

Limited hip and ankle range of motion is a common barrier to achieving great speed. Again, it depends on the athlete, but stretching the ankles and hip flexors is a safe bet. Attention to detail is in order. With simple movements such as these, athletes often compensate (for a tight ankle) by letting their foot arch collapse or (for tight hips) by rotation of the pelvis and spine. These translate to “energy leaks” when sprinting.

In many instances, what appears to be “tight hamstrings” or “hip stiffness” is core weakness. Over the years, the brain has learned to effectively “hit the breaks” on hip and knee movements in order to protect the spine from injury. The solution to this is not yoga or any traditional stretching, but to challenge the athlete to maintain their spine in a neutral position while gradually increasing degrees of freedom (various directions and magnitude of movement) at the hips and knees. In practical terms, this looks like side, backward, and rotational lunges, single leg squats and dead lifts (done well!), split stance rows, tubing rotation pulls, and presses.

You absolutely can have too much of a good thing. Being hyper flexible, as seen in most yoga DVDs, is NOT GOOD for speed. Working on SPECIFIC tightness with SPECIFIC flexibility moves is worthwhile. But introducing more general slack into a system that is already moving too much is not helpful for the core stability that sprinting demands.

3. Springiness Matters

Some athletes with adequate flexibility and strength still move like a tight ball of tinfoil. The are not springy and struggle to generate force QUICKLY.

In weight lifting, long levers usually work against you. But this is not the case with sprinting where long levers are good so long as power remains high. All the strength in the world cannot substitute for a springy athlete with joints that work in synch to produce a powerful and large range of motion. This quality is best trained through plyometric and sprint training with attention to form. The details depend on the athlete, but an important cue is “move with intensity but remain relaxed.”

4. Conditioning Matters

I still think that to be the fastest version of themselves, athletes absolutely MUST be accustomed to the idea of running in a total body, all-out effort, while maintaining good form and a “relaxed but intense” mental state. Top speed sprint training is done in brief, powerful bursts with prolonged rest periods. “Conditioning” to build endurance or generally get in shape looks a little different.

This is a place that I’ve changed my tune a little, having found value in not always going -all out-.

Long distance runners can repeat 100% effort over a short sprint with little difficulty. But they almost always lack the explosive power and are not moving very fast to begin with. Strength/power athletes typically move with a high top speed but have greater difficulty repeating maximal efforts. For these athletes, submaximal sprints are worth the time and effort to practice achieving and maintaining correct form and gaining physical conditioning without the long drawn-out cardio. This is not long distance aerobic type running, but powerful efforts with focus on form and building sprint capacity.

I know from experience that hill sprints done with 101% effort leads to form break down and physical exhaustion after only two or three efforts. But doing them with 88-95% effort allows me to repeat and maintain quality efforts in a greater overall workload.

5. It depends

Truly, some investigation is required for a given athlete to fully realize their speed potential. Some athletes need more of a conditioning and springiness focus while others need to gain core stability and hip flexibility. Some athletes need to simply gain some muscle and learn to move powerfully rather than drift.

Some athletes will benefit the most from getting their deadlift up one hundred pounds, while others may benefit from lightly loaded lunges emphasizing a large hip range of motion in all directions, or more of a plyometric focus emphasizing total body power.

Individual athletes present with different energy leaks that become more apparent with full effort sprinting, especially when under fatigue. Look for them!

The best conditioning program for any given athlete depends on their current physical status as well as their individual goals.

Do you have any experience or thoughts regarding speed training? Do fill us in! Figuring out YOUR best game plan is not rocket science. But it takes a little time and effort, usually beginning with a detailed physical assessment.

 

So, a guy walks in to a local GNC Nutrition Store to do some field study for his rehab/fitness blog. It was almost too easy.

“How can I help you today sir?” 

“Can I get a price on your protein powders?”

“Well, we carry…” [Salesperson points to this, that and the other products, non of them simply straight-up protein.]

“No thanks man, just straight protein.” 

The young man then offered a host of vitamins and oils that “support” whey protein. He went on to question.

“What you training for bro?”

“Oh, you mean like, my training goals?”

At that point I decided to humor him.

“I’d just like to gain some weight. And also to lose weight.”

Without hesitation he turned, walked toward a corner of the store with fat burners various vitamins and male enhancement formulas. He handed me a bumblebee looking bottle of Ripped Fuel and a purple and white container labeled Low Caloric Effervescent Creatine.

I glossed over the fine print on a few of the labels. He stood there. The awkward silence was far too much for either of us to bear. So I jumped back into conversation.

“I’m not so sure. What I really need is a supplement that will make me better at life.”

He flinched, a brief move toward the Brain Boosters. But then he paused and smirked. He was FINALLY getting it.

Athletes and parents frequently ask about supplements for performance. There are a very small handful of items that I -conditionally- recommend. But in the far majority of cases, asking about supplements is like asking a car dealer how to put a rear spoiler on a motorized scooter, or high performance tires on a mini van.

So, before you ask the question…

What supplements should you be taking?

1. What did you eat for breakfast today? If you have no time to eat a decent breakfast, then you have no business asking about supplements. There is no supplement to make up for a well rounded diet.
2. Did you repeat the same exercises week to week? Many people worry about training minutia but really need to be more consistent in mastering the basics, with a focus on perfecting movement patterns and getting more efficient (yes stronger) in a handful of the “big” exercises
3. When was your last day off ? Seriously, the rhythm of hard work and RECOVERY is key. And if you go from one activity to the next, one weight training session to the next game to the following practice, you have no business asking about supplements. No recovery can achieve what a nap (or other down time) can. “Stimmed Out”? This is a reference to the jittery and fried feeling that comes from consistent intense training and competing, often involving stimulating Pre-Workout formulas. The answer to this problem is NOT a change to a different “long-effect” stimulant or a “relaxing/recovery formula.” If you need more than a light snack or a cup of coffee to get “up” for a workout, then you should probably just take a nap.  If you do not sleep well or you have not taken adequate time off between seasons and individual workouts, then you have no business with supplements.
4. Want to get bigger? Learn how to move well, to squat, hinge/deadlift, and overhead press with precision. Train, eat, and recovery, doing what it takes to get stronger in a few key lifts.
5. Want to get smaller/leaner? Learn how to move well, to squat, hinge/deadlift, and overhead press with precision and focus on behavior change more than simply diet.

In review, before buying supplements.

1. Clarify your top priorities for training. How would you like your body and mind to change, and in what time-frame?
2. Learn how to move well. This is the foundation of effective exercise, gradually pushing your limits without getting injured.
3. Be consistent. Find a reasonable but focused training program and deliver the goods in effort.
4. Quit eating like a bird. Quit eating crap (well, 90% of the time). Don’t over-think it. Fuel the life you have been given.
5. Respect recovery! Can I bottle up some Effort & REST pills, put them on a shelf?
6. Use common sense.

Now…yes, once those things are in order, I would recommend a protein supplement for busy times. Shaking a protein drink alone has been proven to provide MASSIVE gainz in feeling like you’re doing something…good. Creatine (straight) is worthwhile for mature strength/power athletes, as well as Omega-3 fatty acids and Glucosamine/Chondroitin for the middle-aged to older folks.

I’ve said it before, but you should check out Examine.com for evidence-based info with countless citations and 0 marketing hype. Here is a huge Debbie Downer: Examine.com concludes that outside of a few key supplements and practices, they ALL have a minimal effect.  Seriously check this out:  http://examine.com/blog/weve-solved-supplement-confusion/

The secret formula for wellness and outstanding fitness truly is being better at life. Some individuals perform well or look good based on youth and sheer luck. But that type of success is always hit-or-miss and fleeting.  What we all need is something that cannot be achieved with the cutting-edge supplements, perfect training principles, or even a huge deadlift.

Sorry, GNC guy.

This installment is brought to you by  Katelyn Owens, our current student at Cardin and Miller Physical Therapy in Mechanicsburg. She will soon be graduating from PT school at St. Frances, and is doing excellent work helping patients in the office.

I often witness how traditional strengthening exercises DONE WELL are truly therapeutic for alleviating lower back, hip, and knee pain. Here, Katelyn tells you why.

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When we think of performing squats for exercise, we typically don’t think much beyond the simple bending of the knees and getting low.  Like many movements we use during exercise, the squat is more complex than what you may think.

Many people confuse the squat and the deadlift, which is understandable because they are both great lower body exercises.  The muscle group we are working while squatting is primarily the quads (front of the thigh) along with the glutes (hips), while during the deadlift we’re primarily using our glutes, hamstrings, and middle to lower back.  The position of our lower leg is what makes the difference in each exercise

Our glutes are the largest muscle group and can produce the most power per cross sectional area, so why don’t we use them to our advantage?  When we are kids we have the perfect

squatting position; straight back, bending at the knees, hinging at the hip—so what changes as we age?

Well for one, many of us lose flexibility over time.  Another reason is as we age, we find ways to “cheat” from bending down at the hips and knees because at the time it’s “easier.”  We stoop down and bend over to pick up keys we’ve dropped, socks that fell, toys we stub our toes on, etc…  This stooped over posture is THE WORST posture we can put ourselves into.

When we’re young, we can get away with not using proper squatting form, but as we continue to NOT use our strongest musculature, it atrophies and weakens.  With weak glutes, we no longer have the capability to perform a powerful squat or deadlift.  When we come upon tasks, such as lifting a heavy couch, our glutes give way under the stress, we bend forward, and are more prone for back injuries such as strains, sprains, and even herniated discs.

Secondly, another compensation we unconsciously do while performing squats and/or deadlifts is called valgus collapse.   When our glutes are weak, we lose the ability to control our knee in its proper alignment which can cause pain and

structural damage of the knee.  Even some fit athletes have specific weakness throughout your hip musculature.  We want the proper alignment to be toes straight ahead, knees in line with toes, and not letting the knees “cave” in.  Valgus collapse is not only bad form, but it puts excessive pressure on your lateral meniscus, a cushion of cartilage in your knee.  It strains the ACL (ligament deep in the knee) and MCL (ligament on the inner side of the knee.

 

So before stacking on the weight for your squat or deadlift, make sure you have your knees in proper alignment, hinging at the hip, keeping your spine neutral and core tight.  You will begin to see strength gains develop throughout your hips even faster AND prevent possible injury to your knees and back due to improper form

 

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Katelyn Owens is a 3^rd year DPT student at Saint Francis University, who previously received her Bachelor’s degree in Health Science from SFU.  While at Saint Francis she acted as Chair Member of Operations for C.A.R.E. Clinic, a pro bono PT clinic who provided services for uninsured individuals.  Katelyn is most interested in pediatric early intervention and outpatient PT, and is looking forward to seeing what doors God will open for her.