Hill Training – Ancient and State-of-the-Art

Cemetery Hill is not the official name of the few acres of land on the western edge of Messiah College. But that’s cemetery hillwhat “they” call the place with the cemetery at the top. College students and local kids gather there to sled ride in the winter.

While walking the dog on Cemetery Hill a few weeks ago, I stopped at an elevation that was equal to the Falcon Fitness Center, nearly half a mile away as the crow flies. I could look directly into the massive second story windows. The lit rows of stationary bikes, treadmills and elliptical trainers, stood out in the dusk.

As usual, I was alone out in the chilly air. There were roughly twenty people in the bright, climate controlled fitness center.  I could not see everything inside from my vantage point, but on-line I’ve read that it offers a wide variety of cardiovascular, free weight, and resistance training machines, many of which can synch with your phone or watch or retina ( ; )) to record and track your data. There are weight plates that change resistance based off pneumatic pressure. So you don’t have to lift them in order to…lift them.

While I’ve never visited insisde The Falcon, I’ve done a fair amount of work on Cemetery Hill. This has plenty of options as well.

cemetery hill inside
Inside the fitness center, trees in the backdrop through the windows.

For a low-intensity recovery day, you walk the dog up and around the hill. For moderate cardio you walk up and jog the across. For power and agility, you perform various hops, jumps, and bounds up the hill, and walk it back down. For strength, you carry dumbbells, barbells, or do various lunges up and down. For high intensity speed work, you sprint a portion of the hill and stagger or scoot straight down to where you began. As a bonus, all but one of these training options hits the lungs and the “core.”

Now, which of these training facilities are beneficial? Both, of course. Which is better? I’m really not sure, but I imagine it’s the one you will consistently do. I suspect that a sprint up cemetery hill is better for your physical health and performance than intervals on an elliptical. Breathing in fresh, uncomfortably cold (or hot and humid) air surely provides the full dose of working out.

I suspect that Cemetery Hill is good for health and performance in the same way that eating from a cast-iron skillet is good for you, or like having a salad is better than taking a multivitamin. It’s better than a big gym like having a pet is better for the immune system than a sanitized spotless home, and in the same way that breastfeeding infants is usually preferable over formula feeding.

Cemetery Hill is a non-flashy thing of beauty. It’s serene and uncomfortable, simple and effective. Collegiate and local athletes and fitness enthusiasts should be lining up for the chance to experience it’s proprietary All Seasons Environment. But don’t count on Cemetery Hill being featured on the college’s recreation and fitness web page. There will be nobody at the base of the hill to keep hours, check you in and swipe your ID. You will likely be alone, unless you manage to bring a band of brothers and sisters who understand the value in them thar hills.

Many will continue to complain about the costs of higher education and their student loans, but that’s another matter.

Fitness facilities, training fads and generations of college students and community residents will come and go. I hope that Cemetery Hill will always be open available to challenge (and sometimes pummel) those who confront it.

cemetery hill

Knee Pain in Young Athletes: Common Bad Advice

From the American Academy of Orthopedic Surgeons:  danger-bad-advice

Osgood-Schlatter disease, a common cause of knee pain in children and adolescents, is an inflammation of the area just below the knee where the tendon from the kneecap (patellar tendon) attaches to the shinbone (tibia). Osgood-Schlatter disease most often occurs during growth spurts, when bones, muscles, tendons, and other structures are changing rapidly. Because physical activity puts additional stress on bones and muscles, children who participate in athletics are at an increased risk for this condition. 

Osgood-Schlatter Disease is certainly not the -only- knee pain suffered by young athletes. Other common causes of knee pain in this population include patellar tendinopathy and ligament sprains. But whatever the case, young people with persistent knee pain (and their parents) very often receive bad advice.

“It’s Osgood Schlatter and the doctor said that I can play through it unless I can’t.” 

“It’s a natural growing pain that will go away on it’s own. See the bump on the front of my leg?” 

“Keep going until it hurts so much that you can’t.”

“I’m tall and this puts more stress on the knee.” 

These statements are all true. But they’re not very helpful. The typical, somewhat helpful advice includes ice, ibuprofen (or other NSAID), and rest if you have to.

I have a feeling that such limited advice from very qualified medical professionals has a lot to do with the fact that:

1) Diagnostic studies (X-ray and MRI) usually show little to no structural problem at the knee, and-

2) This is a stubborn and fairly complex problem that is not fixed surgically.

So they tell the athlete that playing through will cause no further damage, and they should take some ice and ibuprofen and 4 to 6 weeks off if they must. This invariably leads to frustration for the athlete, parents, coaches, and other players on the team, as the athlete straggles along at half the effectiveness as when they’re not trying to push through pain.

“Okay Bob, what do you think they should be telling the athletes with Osgood Schlatter and other youth-oriented types of knee pain?” 

bad advice
                Yeah. Ignore it completely.

Osgood Schlatter’s Disease is a common problem in young athletes. The pain is at the knee but there are usually a number of factors causing the knee to take on additional strain. The following should be checked:

  1. What is going on at the foot and ankle in terms of mobility and stability? Are there structural issues (high or low arches, bunion deformity, etc)?
  2. What is going on at the hip and pelvis? Does the hip show limitations in flexibility or strength? Are the core muscles controlling the pelvis in order to maintain good posture and alignment of the legs?
  3. What exactly are the parameters of training, games, and practices? Can we create an optimal realistic plan that significantly mitigates (rather than cuts out completely, or not at all) the frequency and duration of high impact demands?
  4. How severe is the inflammation? What modalities or manual therapies (and yes, medications) may help calm down the pain and swelling?
  5. Does the patient and their family understand the problem in terms of thresholds? For example, an athlete may have significant core and hip weakness, flat feet, and a schedule full of games and practices for one basketball and two soccer teams. This athlete would have plenty of margin to do what it takes to bring the stress on the knee below the threshold of injury.

As far as specifics, what generally works very well to SPARE THE KNEES from ACL injury also works quite well in terms of treating Osgood Schlatters and patellofemoral pain. The typical treatment protocol is ~75% similar. Work those hip dominant movement patterns, sled pushes, and attend to the feet during running and jumping.

Knee pain in young athletes can indeed be tricky to resolve, especially when the kid truly wants to maintain their activity level. But we can do far better than shrugging our shoulders and chalking it up to growing pains.