Showing posts with label bone health. Show all posts
Showing posts with label bone health. Show all posts
Sunday, August 1, 2010
Bendy bits should bend in full range of motion, speed and control, right? So what's this mobility/stability dichotomy?
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Mobility/Stability. I confess i don't get what's meant or how this increasingly popular distinction between mobility and stability came to be seen as useful. I'm prepared to believe it's my problem, and sometimes as writing helps me work out such issues, forgive me while i lay out where the gaps seem to be in my understanding of the framing of movement as mobility/stability rather than simply a notion of movement, and ability to control ranges of motion at ranges of speed.
Here we go: Of late i've seen a number of intelligent people assert with what seems like good reasons that some joints are seemingly a priori meant to be "stable" while others are meant to be "mobile." Consider the fist article in this set kicked off by Mike Boyle, a well respected and established trainer, called A Joint by Joint Approach to Training. In this pieces, and many related articles, work by Stuart McGill on the low back is cited: in particular, McGill's findings that flexion is the root of most low back evils, and that sitting is the worst place to be of all. This is pretty compelling stuff. Seems to make sense.
But then there are seeming contradictions within this: in his discussion of the knees, not the back, Boyle sites McGill's reason for low back pain that it isn't perhaps so *much* flexion, but overuse. When other stuff - like the hips - get stuck, the back pays. So in that sense - the lumbar spine and knees should be stable, but the hips should be mobile?
The problem i find in this is that the arguments seem to suggest that pretty much all the time the lower spine should be stiffened up and the thoracic spine and hips loosened up - for instance. Mike Boyle goes so far as to ask "is spinal rotation even a good idea" He quotes a lot of work by a physical therapist name of Shirely Sharman who in her view suggests that the abs are there to stop so much rotation of the lumbar spine then that's what they should be doing. Boyle's issue seems to be that too many trainers concentrate on lumbar stretching when, citing Sharman "rotation is even dangerous" at the lower spine. He points to sprinter coach Bob Ross who did isometric work with his spinters in the abs, abandoning other forms of spinal movement work and how that was a positive thing for results.
Ok, but what do most sprinters do? Run. In pretty much straight lines. So maybe holding the spine in line and upright for 10-30secs is a good idea. In that case. That particular sport-specific constraint doesn't come up.
Rather, Boyle says he's chucked a lot of exercises designed to extend trunk range and seems to find less complaints of low back pain in clients since doing so. And that's cool. I'm not sure, however, that that means that that work has made his client's backs more stable - it just may mean that stretching a body part beyond its comfortable range of motion is painful or causes neuroligical shut down by pushing inappropriately, and that stopping doing something that hurts will reduce pain?
In other words, i'm just not sure that eliminating a set of kind of questionable stretches is therefore "decreasing mobility" or "increasing stability" - it may just be avoiding inducing threat.
And as for rotational work, surely the lack of it is one of the greatest weakness of most of us who train especially or exclusively at lifting heavy things? We tend to stick to pretty a given plane of motion for a movement, and forget about diagonal and especially rotational movements.
One of the funest ab exercises is surely the russian twist (seated) or the Full Contact Twist with the bar stuck in the corner on the floor and the other end in the athlete's hands, arms extended, arc'ing back and forth?
Pavel Tsatsouline writes of the FCT in Bullet Proof Abs:
So for truly "functional" movement, isn't it better to train strength in rotation, as well as across a range of movement planes? In other words, why not focus on building strength across the entire range of motion of the joints so that we can be - as pavel puts it - bulletproof? And that bulletproofness seems to mean being able to rotate, bend and recover as needed - and as the joints give us the degrees of freedom to accomplish that movement?
The Kneee/ACL injury- not about stability or mobility? The ACL (and MCL) are the ligaments most often torn (or pop) in knee injuries. One might say that that's because the knees are not stable enough. Indeed, again Mike Boyle tends to make this case in his Joint by Joint article. But he also seems to move away from actually saying the knee needs stability by deeking out to say the problem is that the knees pay for lack of hip mobility. I'm not sure what the bottom line is here? He digresses into back pain rather than a discussion of the knee.
Gray Cook comes in to help in his Expanding on the Joint-by-Joint approach saying,
I'm not making a joke here or being sarcastic. I'm really not sure what "the knees have a tendency towards slopiness" means in terms of real movement. All those ligaments are actually loose? Or does that mean one's leg muscles in say a squat aren't firing so the knee comes in (the Valgus knee). That's not really a knee issue though, is it? That's poor form such that the person hasn't been taught to work a better squat pattern, or hasn't worked on what may be inhibiting a good squat movement? And so they're putting strain on their knees by failing to keep good position. Too much load, and absolutely perhaps issues in the ankle and hip and upper back that need to be addressed.
But i'm not really thinking about such a static movement as the squat. Really I'm thinking of the mighty number of girls who have ACL injuries in sports in the states these days. One theory (gathering momentum) has it that the girls who have ACL injuries showing up in basketball don't have a way to balance their increasingly higher (as going through puberty) center of balance. Intriguingly, the comments from the researchers is not to increase strength training (for more core or knee stability) but to increase their prorioceptive (body awareness) training.
The suggestion is not unlike studies on sensory-motor balance training with athletes to see if progressive balance work could help reduce ankle injury - another common problem for field and track athletes. They found that, effectively, progressively training for the sprain through this program helped the nervous system not go into panic, and predicted injuries would be less.
To take a lessen from martial arts as well where one practices for the fall pretty regularly, how much attention is given to working with an athlete on end range of motion work - not just balance work but what might be loaded balance work at the place where we rarely go in our training - that end range where recovery from a sudden lapse or accident is hard and where injuries occur? Is that augmenting mobility, stability or does it matter?
I go back to Boyle and Cook on the knees and back to their facesaying that these joints tend towards slopiness, and yet McGill (quoted by Boyle) saying no no, the low back in people with pain have stronger extensors than those without. So there's a lot of muscular strength around the low back already. The spine is *not* weak here (and by extension, one would say not sloppy if so much strength can be turned on?)
What's Going On? Where is this taking me? I'm hoping that Gray Cook's new book Movement will anser a lot of these queries. I'm looking forward to getting it, because right now the mobility/stability dialectic seems more problematic than helpful - at least to me. Here's why - and here's where i struggle with this as a model.
All the joints in the body have a pretty much well-scoped ranges of motion, right down to what the usual degres of movement are in each one. So why not simply be able to move all of these joints in these ranges of motion with strength and control as demanded by whatever that movement is - especially at the most vulnerable end ranges of motion?
Movement vs Mobility/Stability? Why not talk, therefore, just about "movement" (as Cook's book title suggests) rather than "mobility/stability." Is the question not really can one, for instance, hold a position for one particular movement or relax it for another? The knee needs not only to support the hinge with strength and power in say a basketball jump shot, but also needs to support the roll in with equal aplomb from standing to the ground - either when making a lunging tennis shot, or losing one's footing on a football pitch or simply getting pushed or in a fight getting from standing to knees to grapple quickly?
Perhaps there's an historical context i'm missing - Boyle talks alot about the "last decade" with too much stretching going on in the trunk and so life got too caught up on flexibility? Dunno, as i own i missed that part of the discussion not being in the space at that time. But maybe that's not it, either, as Paul Chek's Movement that Matters
and his "primal patterns" seems to have been in play since at least 1999 (ie the last decade, plus), and that is likewise focused i think on movements?
Mobile when? Stable when? But again, i'm not claiming expertise of that period - it's a genuine question - it's just that i can't find the value add in framing our bodies as there's supposed to be stability here and mobility there, and if we get this thing more stable and that thing more mobile (implicit seems to be "all the time") then everything is Functional. Mobile when? Stable when? Are we talking averages? That on average of all possible movements, these joints are more often than not needing to be stable rather than mobile? And so we need to train for the average use case, rather than the range of uses?
Can you see why i'm a wee bit flustered? It's not a dichotomy that helps me when i'm working with clients to talk about stability or mobility because i guess i'm not sure what they really mean when put in operation. Our model reflects our practice, i guess, and i'm struggling with the mobility/flexibility as a model.
For me, mobility seems pretty good on it's own: mobility is the ability to voluntarily and actively control a given range of motion. For me, in my practice, it seems pretty important simply that we be able to control that movement through all ranges of motion, and all speeds, equally. If folks have restricted ankle mobility, not only does that potentially need to be opened up but strengthened as well. Strength and ROM seem to work together.
It then seems pretty important that if there's a gap somewhere we have the tools to be able to help find a way to address that weakness. And as Cook also notes, since the site of an issue is not necessarily the source of the issue, the source of a weakness may be, as we've seen above, proprioceptive rather than musclo-skeletal, too. In other words, mobility and enhancing control of mobility seems sufficiently descriptive of the kinesthetic. And beyond this, if we do accept the site is not the source of an issue necessarily, it seems we need to take into account whatever other systems may be operating on us. From somato-sensory, to affect, to nutrition to, anything that plays on the 11 organ systems in our body.
For a bit of context, beyond the CSCS, RKC and Z-Health Certifications, i hold both the FMS qualification and the CK-FMS certification. One has to pass the FMS exam before getting to the CK-FMS quals. It's a fascinating course, and i'm looking forward to doing it again this fall because Gray Cook is teaching it with Brett Jones, and i'm sure two years after taking it initially, it will have evolved, and i certainly know a bit more than i did then, and Gray Cook has a lot of cool things to say. I am keen to learn more about this physiological piece. I confess anatomy is, to use Cook's phrasing again, the weaker link in my chain.
So i recognize i would benefit by being more au fait with kinesiology/physiology (hence more recent posts exploring things like the amazing shoulder, and kinesiology books used to assist practice with willing folk).
This article is not meant as a criticism of Boyle or Cook. I'm just saying, right now, i'm not grokking the mob/stab distinction. It seems to me both too extreme - these joints need to be mobile; these stable - and too unspecific - generally? specifically? Now maybe we're both saying the same things: have full range of motion and be strong in all ranges of motion and so be able to control all ranges of motion at all speeds. That would be cool. Then again, i'd say why not just say that? Since mob/stab can start to be heard as prescriptions: the thoracic spine MUST be mobile the lumbar spine MUST be stable.
I'm also saying that i agree with neurologists who talk about the somato-sensory system, and how that's just as improtant to be integrated into any discussion of movement, too.
So, as said, i'm perfectly prepared at this point to believe that the misapprehension is mine. That we are all on the same page. Just putting out there where i'm struggling. Perhaps some of y'all can relate, or have passed through this vale and come to a conclusion on the other side with more knowledge and insight. Look forward to meeting you there.
Best,
mc Tweet Follow @begin2dig
Here we go: Of late i've seen a number of intelligent people assert with what seems like good reasons that some joints are seemingly a priori meant to be "stable" while others are meant to be "mobile." Consider the fist article in this set kicked off by Mike Boyle, a well respected and established trainer, called A Joint by Joint Approach to Training. In this pieces, and many related articles, work by Stuart McGill on the low back is cited: in particular, McGill's findings that flexion is the root of most low back evils, and that sitting is the worst place to be of all. This is pretty compelling stuff. Seems to make sense.
But then there are seeming contradictions within this: in his discussion of the knees, not the back, Boyle sites McGill's reason for low back pain that it isn't perhaps so *much* flexion, but overuse. When other stuff - like the hips - get stuck, the back pays. So in that sense - the lumbar spine and knees should be stable, but the hips should be mobile?
The problem i find in this is that the arguments seem to suggest that pretty much all the time the lower spine should be stiffened up and the thoracic spine and hips loosened up - for instance. Mike Boyle goes so far as to ask "is spinal rotation even a good idea" He quotes a lot of work by a physical therapist name of Shirely Sharman who in her view suggests that the abs are there to stop so much rotation of the lumbar spine then that's what they should be doing. Boyle's issue seems to be that too many trainers concentrate on lumbar stretching when, citing Sharman "rotation is even dangerous" at the lower spine. He points to sprinter coach Bob Ross who did isometric work with his spinters in the abs, abandoning other forms of spinal movement work and how that was a positive thing for results.
Ok, but what do most sprinters do? Run. In pretty much straight lines. So maybe holding the spine in line and upright for 10-30secs is a good idea. In that case. That particular sport-specific constraint doesn't come up.
Rather, Boyle says he's chucked a lot of exercises designed to extend trunk range and seems to find less complaints of low back pain in clients since doing so. And that's cool. I'm not sure, however, that that means that that work has made his client's backs more stable - it just may mean that stretching a body part beyond its comfortable range of motion is painful or causes neuroligical shut down by pushing inappropriately, and that stopping doing something that hurts will reduce pain?
In other words, i'm just not sure that eliminating a set of kind of questionable stretches is therefore "decreasing mobility" or "increasing stability" - it may just be avoiding inducing threat.
And as for rotational work, surely the lack of it is one of the greatest weakness of most of us who train especially or exclusively at lifting heavy things? We tend to stick to pretty a given plane of motion for a movement, and forget about diagonal and especially rotational movements.
 |
| Pavel Tsatsouline demonstrating the Full Contact Twist in Bullet Proof Abs |
Pavel Tsatsouline writes of the FCT in Bullet Proof Abs:
The best exercise for transferring the hip power into the shoulder, with a high interest yield, is the Full Contact Twist. This exercise was originally developed in the Soviet Union for shot put conditioning.
The then-nameless twist came to kickboxers' attention when a famous Russian shot putter failed to talk his way out of a mugging. This mild mannered man got annoyed when one of the attackers cut him with a blade. He ruptured the punk's spleen with a single punch.
Igor Sukhotsky, M.Sc., formerly a nationally ranked weightlifter and an eccentric sports scientist who took up full contact karate at the age of fort-five, popularized the twist among Russian fighters. This renaissance man noticed that the twist not only had increased his striking power, but also had toughened his midsection against blows by toning it up. Sukhotsky was so impressed with the Full Contact Twist, that he added it to his super abbreviated strength trainingIt's interesting that Sukhotsky came to the value of rotation - moving across planes of motion - in moving from a more linear sport of weighlifting to the more richly plane-crossing Karate. It's also intriguing that it is a life event - a mugging - that fostered interest in this movement.
routine which consisted of only four exercises: squats, bench presses, deadlifts,
and good mornings.
So for truly "functional" movement, isn't it better to train strength in rotation, as well as across a range of movement planes? In other words, why not focus on building strength across the entire range of motion of the joints so that we can be - as pavel puts it - bulletproof? And that bulletproofness seems to mean being able to rotate, bend and recover as needed - and as the joints give us the degrees of freedom to accomplish that movement?
The Kneee/ACL injury- not about stability or mobility? The ACL (and MCL) are the ligaments most often torn (or pop) in knee injuries. One might say that that's because the knees are not stable enough. Indeed, again Mike Boyle tends to make this case in his Joint by Joint article. But he also seems to move away from actually saying the knee needs stability by deeking out to say the problem is that the knees pay for lack of hip mobility. I'm not sure what the bottom line is here? He digresses into back pain rather than a discussion of the knee.
Gray Cook comes in to help in his Expanding on the Joint-by-Joint approach saying,
"The knee has a tendency toward sloppiness and therefore could benefit from greater amounts of stability and motor control. This tendency usually predates knee injuries and degeneration that actually make it become stiff."He also states
Knees are simple hinge joints. They’re supposed to flex and extend, and when they rotate too much or move valgus or varus too much, we start seeing problems with the knee. Does the knee need to be mobile? Yes, but once it’s mobile, it needs to be stable enough to stay inside the proper plane of movement where its functional attributes are possible and practical.Now Gray Cook is a knowledable phyiscal therapist who knows a lot about movement and how joints operate. He's also worked with a ton o' athletes and helped them restore function when others were ready to cut them open and write them off. So it's with respect that i wonder what's meant by 'mobility" with a "simple hinge joint"? What does a stable knee joint mean? That the femur stays attached to the tib/fib bones on the minisci? That it doesn't slide off to one side when it goes to bend? What?
I'm not making a joke here or being sarcastic. I'm really not sure what "the knees have a tendency towards slopiness" means in terms of real movement. All those ligaments are actually loose? Or does that mean one's leg muscles in say a squat aren't firing so the knee comes in (the Valgus knee). That's not really a knee issue though, is it? That's poor form such that the person hasn't been taught to work a better squat pattern, or hasn't worked on what may be inhibiting a good squat movement? And so they're putting strain on their knees by failing to keep good position. Too much load, and absolutely perhaps issues in the ankle and hip and upper back that need to be addressed.
To take a lessen from martial arts as well where one practices for the fall pretty regularly, how much attention is given to working with an athlete on end range of motion work - not just balance work but what might be loaded balance work at the place where we rarely go in our training - that end range where recovery from a sudden lapse or accident is hard and where injuries occur? Is that augmenting mobility, stability or does it matter?
I go back to Boyle and Cook on the knees and back to their facesaying that these joints tend towards slopiness, and yet McGill (quoted by Boyle) saying no no, the low back in people with pain have stronger extensors than those without. So there's a lot of muscular strength around the low back already. The spine is *not* weak here (and by extension, one would say not sloppy if so much strength can be turned on?)
What's Going On? Where is this taking me? I'm hoping that Gray Cook's new book Movement will anser a lot of these queries. I'm looking forward to getting it, because right now the mobility/stability dialectic seems more problematic than helpful - at least to me. Here's why - and here's where i struggle with this as a model.
All the joints in the body have a pretty much well-scoped ranges of motion, right down to what the usual degres of movement are in each one. So why not simply be able to move all of these joints in these ranges of motion with strength and control as demanded by whatever that movement is - especially at the most vulnerable end ranges of motion?
Movement vs Mobility/Stability? Why not talk, therefore, just about "movement" (as Cook's book title suggests) rather than "mobility/stability." Is the question not really can one, for instance, hold a position for one particular movement or relax it for another? The knee needs not only to support the hinge with strength and power in say a basketball jump shot, but also needs to support the roll in with equal aplomb from standing to the ground - either when making a lunging tennis shot, or losing one's footing on a football pitch or simply getting pushed or in a fight getting from standing to knees to grapple quickly?
Perhaps there's an historical context i'm missing - Boyle talks alot about the "last decade" with too much stretching going on in the trunk and so life got too caught up on flexibility? Dunno, as i own i missed that part of the discussion not being in the space at that time. But maybe that's not it, either, as Paul Chek's Movement that Matters
and his "primal patterns" seems to have been in play since at least 1999 (ie the last decade, plus), and that is likewise focused i think on movements?Mobile when? Stable when? But again, i'm not claiming expertise of that period - it's a genuine question - it's just that i can't find the value add in framing our bodies as there's supposed to be stability here and mobility there, and if we get this thing more stable and that thing more mobile (implicit seems to be "all the time") then everything is Functional. Mobile when? Stable when? Are we talking averages? That on average of all possible movements, these joints are more often than not needing to be stable rather than mobile? And so we need to train for the average use case, rather than the range of uses?
Can you see why i'm a wee bit flustered? It's not a dichotomy that helps me when i'm working with clients to talk about stability or mobility because i guess i'm not sure what they really mean when put in operation. Our model reflects our practice, i guess, and i'm struggling with the mobility/flexibility as a model.
For me, mobility seems pretty good on it's own: mobility is the ability to voluntarily and actively control a given range of motion. For me, in my practice, it seems pretty important simply that we be able to control that movement through all ranges of motion, and all speeds, equally. If folks have restricted ankle mobility, not only does that potentially need to be opened up but strengthened as well. Strength and ROM seem to work together.
It then seems pretty important that if there's a gap somewhere we have the tools to be able to help find a way to address that weakness. And as Cook also notes, since the site of an issue is not necessarily the source of the issue, the source of a weakness may be, as we've seen above, proprioceptive rather than musclo-skeletal, too. In other words, mobility and enhancing control of mobility seems sufficiently descriptive of the kinesthetic. And beyond this, if we do accept the site is not the source of an issue necessarily, it seems we need to take into account whatever other systems may be operating on us. From somato-sensory, to affect, to nutrition to, anything that plays on the 11 organ systems in our body.
For a bit of context, beyond the CSCS, RKC and Z-Health Certifications, i hold both the FMS qualification and the CK-FMS certification. One has to pass the FMS exam before getting to the CK-FMS quals. It's a fascinating course, and i'm looking forward to doing it again this fall because Gray Cook is teaching it with Brett Jones, and i'm sure two years after taking it initially, it will have evolved, and i certainly know a bit more than i did then, and Gray Cook has a lot of cool things to say. I am keen to learn more about this physiological piece. I confess anatomy is, to use Cook's phrasing again, the weaker link in my chain.
So i recognize i would benefit by being more au fait with kinesiology/physiology (hence more recent posts exploring things like the amazing shoulder, and kinesiology books used to assist practice with willing folk).
This article is not meant as a criticism of Boyle or Cook. I'm just saying, right now, i'm not grokking the mob/stab distinction. It seems to me both too extreme - these joints need to be mobile; these stable - and too unspecific - generally? specifically? Now maybe we're both saying the same things: have full range of motion and be strong in all ranges of motion and so be able to control all ranges of motion at all speeds. That would be cool. Then again, i'd say why not just say that? Since mob/stab can start to be heard as prescriptions: the thoracic spine MUST be mobile the lumbar spine MUST be stable.
I'm also saying that i agree with neurologists who talk about the somato-sensory system, and how that's just as improtant to be integrated into any discussion of movement, too.
So, as said, i'm perfectly prepared at this point to believe that the misapprehension is mine. That we are all on the same page. Just putting out there where i'm struggling. Perhaps some of y'all can relate, or have passed through this vale and come to a conclusion on the other side with more knowledge and insight. Look forward to meeting you there.
Best,
mc Tweet Follow @begin2dig
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Tuesday, July 27, 2010
Head Shift: Why not look for More Time to Move rather than as Little as Possible?
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Maybe we should seek to move more rather than the least amount possible in a week. Maybe that's a much better place to be. Let's consider why that might help us out in so many parts of our lives, and the research that supports it. This proposal is set against popular approaches to fitness. Lots of folks celebrate ways for us to "take less time" to work out. After all, there's more to life than being in the gym. For sure. And i'm all for efficiency and elegance in all things. A stupid workout may just be a stupid workout: when you take an hour, make it a beautiful hour.
But what i've been thinking about really is that we are so wrong wrong wrong when we take what i'm increasingly seeing as the "brains with bodies" approach to movement: we seek to find the smallest slice of time during the week for our movement, like that's the least important part of our day, a chore to be got rid of. As exciting and necessary as flossing one's teeth.
But we are not just brains with bodies that like the neighbour's dog we are burdened with having to take for a walk once a day when they're on holiday. How many of us make excuses like we don't have time to move - to walk, to run, to pick stuff up and put it down, to play a game? Our bodies are often constructed culturally as burdens rather than collaborators in our life's work and pleasure.
And sure those "workouts in 6 mins" or 20 mins or whatever are all trying to get folks "at least doing something" - but again, maybe that's just the wrong message to be sending. In whose interests is it for us to be just well enough to keep going to work and not costing a health plan or workers comp for down time?
Movement is Smart(er) - no really.
As i do more work on movement and the way we are wired, it's increasingly clear that the opposite is true: we owe it to ourselves, cognitively and physically to find any time we can to move; in as many ways and at as many speeds as we can. When we don't use parts of our brains, the circuits re-route to what we do use. This is verified in the past 20 years of neurology.
We are use it or lose it systems. Our bodies adapt all the time. And this is systemic. What we don't use - like bone mineral density - gets taken away. Seriously, no joke. Likewise when we don't move joints in their ROM they start to osify or go arthritic in the unused portions.
The above use it or lose it paradigm may still be read as we are enslaved by our bodies and so we must find the shortest most optimal path to do the least amount of work to get the most benefit. And that, too, seems to be a way way wrong and unhealthy and unhelpful life attitude. Phooey, i say.
Consider this: life may be more fun and brilliant if we see our bodies as part of who we are.
Skilled movement practice, for instance, lights up our brains in MRIs. There is increasing evidence likewise that movement enhances intellectual performance. Studies done with kids show especially the earlier "exercise" starts, the greater the intellectual benefits [2007, 2009a, 2009b ]. But at the other end of the scale, movement has been seen to help elderly at risk of observed cognitive decline, recover function, too [2010a]. Likewise, general memory function endurance is assisted by exercise/movement, and enhances brain plasticity [2010].
Indeed, the studies have become so rife connecting movement with intelligence that there's even a popular press book out right now called Spark: How exercise will improve the performance of your brain
. The book summarizes a lot the findings and puts together cognitve enhancing exercise programs.
Inert = Loss of Comepetetive Edge
It seems pretty clear now that for those of us who are "knowledge workers" we are also actually doing ourselves a competitive disservice by staying as innert as possible, moving as little as possible - whatever that means. But again - that may sound like a threat, and the body/burden thing raises its head. We imagine scenes from Gattica and forced treadmill running and heart rate monitoring.
Moving, though, if we take it that that's what we're designed to do, is something we can do everywhere at anytime - or at least we can so imagine. In the work environment, there are desks that let us stand or sit; working at whiteboards that let us stand and walk around. These facilitate movement. And no i'm not a fan of treadmill desks. They may burn calories but can play havok with gait, visual and vestibular systems - juries way out and tending to no. Lord, if we got beyond the "calorie burn" as the only reason to move it move it, we wouldn't have to worry about desks.
Example of Action Work. A colleague of mine has only a standing desk in his office, and otherwise has many rehab balls (usually pretty squishy) for lounging. No chairs. He gets up in the middle of meetings and paces. He's also a dancer, not just a field leading computer scientist. It's great. That's movement. He bikes to work and his main moving gig is his folk dancing. That's healthy. Multiplanar movement. Awesome. AND HE ENJOYS IT - he loves to dance. It's part of his life; not something that he must do. He actually shapes his "real job" schedule around his weekly dance classes. And boy is he smart. Sharp sharp, that one. Connection? As we've seen, research suggests it helps.
I wrote about awhile ago how pick up games of five a side football were about the best blend of strength workouts one could get and got lots of comments from colleagues about how much they enjoy that kind of thing "when it happens" - maybe we need to make it happen.
Perhaps we need to fall in love with being in our bodies? Want to take them out on dates. Play dates. Learn to enjoy treating them/ourselves to what turns on the happy hormones and helps us feel better. Which is another cool thing: the more we move, the better we tend to feel overall - again, cognitively as well as in terms of general wellbeing. Stress gets blown off better; food gets processed better. We feel better about ourselves
Five+ Hours a week - to be happy with ones body?
John Berardi of Precision Nutrition has worked with hundreds (or thousands now) of clients for years. His take away has reinforced that folks who move it a minimum of five hours a week seems to correlate most strongly with greatest self-satisfaction with body image. My sense is increasingly that five+ hours a week correlates with more kinds of wellbeing than just body comp.
Now some of us can't imagine five whole hours a week just getting our body to move. We want to do the intervals or the whatever that are at most 3 sessions per week for 20 mins. And heck, i've written about working out for just 6 mins a week that has equivalent effect as hours of cardio, or elsewhere 660secs a week to show a considerable difference for overweight geeks. The theme is always "it only takes this teeny weeny amount to have an effect" - so why do more, right? Like we're off the hook then. I mean if all we need is 6 super intense minutes, the rest be dammed. We can get back to the screen.
What Systems Are Measured in Minimal Movement Studies?
But what's the effect? cardio vascular well being. Heavens knows that's important. But what about the rest of us? The respiratory and cardiovascular systems - the two most often discussed in health as part of "aeorbic fitness" - are only two of eleven physiological systems in the body. That leaves nine more to go. Consider the skin, skeleton, muscles, nervous system, hormones, lymph, sex, waste, digestion. What do they need? Turns out movement is pretty good for all of them.
To give one example, breathing is a big pump for lymph circulation and flushing. Exercise helps work breathing, so that has an impact on immune function. Movement, especially loaded work and c/v work, we know helps fascilitate nutrient uptake, and hormonal balance like insulin sensitivity. Stop/start movement like socer or weight lifting is great for our use-it-or-lose-em bones. Indeed we know that joints literally start to seize up from lack of movement in full range of motion, or develop pain conditions like RSI from overuse of one movement direction unbalanced by the others in that joint/muscle combination. It's amazing that we don't all keel over with *only* 20mins, 3 times a week of some kind of activity
Being Embodied Can be Fun
Brad Pilon made an observation on facebook lately
As an antidote, Frank Forencich at exuberant animal has an entire blog dedicated to movement/play. At the recent zhealth strength and sustenance course, we learned so many ways to move - including not moving but different forms of concentrics - or exhausting mircro movements - that it seems movement can be got from just about anywhere. And since one of the pay offs of movement can be endorphin rushes, finding any excuse to do it may just be the best thing in the world.
Also before the strength and suppleness course, we played frisbee at the end of the day. An hour of catch and a game of Ultimate each night and you've bagged your 5 hours without even thinking about it. The challenge is now to implement something similar back in Normal World.
Changing Perspective; New Discoveries.
Einstein is attributed with saying something to the effect that we can't solve our problems with the tools that created them. Easy for Mr. Paradigm Shifter I invented Relativity and topped Newtonian Physics guy to say, perhaps, but it's a salutory thought.
In this case, the fast food head space that wants what it wants now and for the minimal effort in order to go do something else - to not pay attention to what we eat; to not pay attention to how we move - is the problem, and trying to find a solution for our emotional (stress), physical and nutrional whiles with the least effort/time possible is entirely the wrong paradigm.
Maybe the paradigm shift is - what do i need to change to move the MOST i can during the day, the week, now? Related might be: What do i need to do to get the most pleasure from the best food today, to be present to being here as much as possible, to have the best rest tonight to concentrate the most i can on what i do now and later?
We're fully integrated, physical creatures, though our world is increasingly designed to shape us as brains with bodies. Abandoning that belief and moving towards the Movement Light as much rather than as little as possible feels and performs, it seems, a whole lot better - across all the rest of what we do, too, don't you think?.
Refs
Maybe we should seek to move more rather than the least amount possible in a week. Maybe that's a much better place to be. Let's consider why that might help us out in so many parts of our lives, and the research that supports it. This proposal is set against popular approaches to fitness. Lots of folks celebrate ways for us to "take less time" to work out. After all, there's more to life than being in the gym. For sure. And i'm all for efficiency and elegance in all things. A stupid workout may just be a stupid workout: when you take an hour, make it a beautiful hour.But what i've been thinking about really is that we are so wrong wrong wrong when we take what i'm increasingly seeing as the "brains with bodies" approach to movement: we seek to find the smallest slice of time during the week for our movement, like that's the least important part of our day, a chore to be got rid of. As exciting and necessary as flossing one's teeth.
And sure those "workouts in 6 mins" or 20 mins or whatever are all trying to get folks "at least doing something" - but again, maybe that's just the wrong message to be sending. In whose interests is it for us to be just well enough to keep going to work and not costing a health plan or workers comp for down time?
Movement is Smart(er) - no really.
As i do more work on movement and the way we are wired, it's increasingly clear that the opposite is true: we owe it to ourselves, cognitively and physically to find any time we can to move; in as many ways and at as many speeds as we can. When we don't use parts of our brains, the circuits re-route to what we do use. This is verified in the past 20 years of neurology.
We are use it or lose it systems. Our bodies adapt all the time. And this is systemic. What we don't use - like bone mineral density - gets taken away. Seriously, no joke. Likewise when we don't move joints in their ROM they start to osify or go arthritic in the unused portions.The above use it or lose it paradigm may still be read as we are enslaved by our bodies and so we must find the shortest most optimal path to do the least amount of work to get the most benefit. And that, too, seems to be a way way wrong and unhealthy and unhelpful life attitude. Phooey, i say.
Consider this: life may be more fun and brilliant if we see our bodies as part of who we are.
Skilled movement practice, for instance, lights up our brains in MRIs. There is increasing evidence likewise that movement enhances intellectual performance. Studies done with kids show especially the earlier "exercise" starts, the greater the intellectual benefits [2007, 2009a, 2009b ]. But at the other end of the scale, movement has been seen to help elderly at risk of observed cognitive decline, recover function, too [2010a]. Likewise, general memory function endurance is assisted by exercise/movement, and enhances brain plasticity [2010].Indeed, the studies have become so rife connecting movement with intelligence that there's even a popular press book out right now called Spark: How exercise will improve the performance of your brain
. The book summarizes a lot the findings and puts together cognitve enhancing exercise programs. Inert = Loss of Comepetetive Edge
It seems pretty clear now that for those of us who are "knowledge workers" we are also actually doing ourselves a competitive disservice by staying as innert as possible, moving as little as possible - whatever that means. But again - that may sound like a threat, and the body/burden thing raises its head. We imagine scenes from Gattica and forced treadmill running and heart rate monitoring.
Moving, though, if we take it that that's what we're designed to do, is something we can do everywhere at anytime - or at least we can so imagine. In the work environment, there are desks that let us stand or sit; working at whiteboards that let us stand and walk around. These facilitate movement. And no i'm not a fan of treadmill desks. They may burn calories but can play havok with gait, visual and vestibular systems - juries way out and tending to no. Lord, if we got beyond the "calorie burn" as the only reason to move it move it, we wouldn't have to worry about desks.
I wrote about awhile ago how pick up games of five a side football were about the best blend of strength workouts one could get and got lots of comments from colleagues about how much they enjoy that kind of thing "when it happens" - maybe we need to make it happen.
Perhaps we need to fall in love with being in our bodies? Want to take them out on dates. Play dates. Learn to enjoy treating them/ourselves to what turns on the happy hormones and helps us feel better. Which is another cool thing: the more we move, the better we tend to feel overall - again, cognitively as well as in terms of general wellbeing. Stress gets blown off better; food gets processed better. We feel better about ourselves
Five+ Hours a week - to be happy with ones body?
John Berardi of Precision Nutrition has worked with hundreds (or thousands now) of clients for years. His take away has reinforced that folks who move it a minimum of five hours a week seems to correlate most strongly with greatest self-satisfaction with body image. My sense is increasingly that five+ hours a week correlates with more kinds of wellbeing than just body comp.
What Systems Are Measured in Minimal Movement Studies?
But what's the effect? cardio vascular well being. Heavens knows that's important. But what about the rest of us? The respiratory and cardiovascular systems - the two most often discussed in health as part of "aeorbic fitness" - are only two of eleven physiological systems in the body. That leaves nine more to go. Consider the skin, skeleton, muscles, nervous system, hormones, lymph, sex, waste, digestion. What do they need? Turns out movement is pretty good for all of them.
To give one example, breathing is a big pump for lymph circulation and flushing. Exercise helps work breathing, so that has an impact on immune function. Movement, especially loaded work and c/v work, we know helps fascilitate nutrient uptake, and hormonal balance like insulin sensitivity. Stop/start movement like socer or weight lifting is great for our use-it-or-lose-em bones. Indeed we know that joints literally start to seize up from lack of movement in full range of motion, or develop pain conditions like RSI from overuse of one movement direction unbalanced by the others in that joint/muscle combination. It's amazing that we don't all keel over with *only* 20mins, 3 times a week of some kind of activity
Being Embodied Can be Fun
Brad Pilon made an observation on facebook lately
"Obesity. We concentrate on nutrition and exercise, but some other things are going on too. Did you know that 'sporting goods sales' have been steadily declining for the last several years? Why buy a soccer ball when you can buy fifa 2010? Hockey? that's what the Wii is for right? Bikes & skateboards? Too dangerous. There's excuses for it all, but still..lack of play time may be one of the biggest factors." July 23, 6:56 pm, 2010
Also before the strength and suppleness course, we played frisbee at the end of the day. An hour of catch and a game of Ultimate each night and you've bagged your 5 hours without even thinking about it. The challenge is now to implement something similar back in Normal World.
Changing Perspective; New Discoveries.
Einstein is attributed with saying something to the effect that we can't solve our problems with the tools that created them. Easy for Mr. Paradigm Shifter I invented Relativity and topped Newtonian Physics guy to say, perhaps, but it's a salutory thought.
In this case, the fast food head space that wants what it wants now and for the minimal effort in order to go do something else - to not pay attention to what we eat; to not pay attention to how we move - is the problem, and trying to find a solution for our emotional (stress), physical and nutrional whiles with the least effort/time possible is entirely the wrong paradigm.
Maybe the paradigm shift is - what do i need to change to move the MOST i can during the day, the week, now? Related might be: What do i need to do to get the most pleasure from the best food today, to be present to being here as much as possible, to have the best rest tonight to concentrate the most i can on what i do now and later?
We're fully integrated, physical creatures, though our world is increasingly designed to shape us as brains with bodies. Abandoning that belief and moving towards the Movement Light as much rather than as little as possible feels and performs, it seems, a whole lot better - across all the rest of what we do, too, don't you think?.
Refs
Castelli DM, Hillman CH, Buck SM, & Erwin HE (2007). Physical fitness and academic achievement in third- and fifth-grade students. Journal of sport & exercise psychology, 29 (2), 239-52 PMID: 17568069Tweet Follow @begin2dig
Eveland-Sayers BM, Farley RS, Fuller DK, Morgan DW, & Caputo JL (2009a). Physical fitness and academic achievement in elementary school children. Journal of physical activity & health, 6 (1), 99-104 PMID: 19211963
Chomitz, V., Slining, M., McGowan, R., Mitchell, S., Dawson, G., & Hacker, K. (2009b). Is There a Relationship Between Physical Fitness and Academic Achievement? Positive Results From Public School Children in the Northeastern United States Journal of School Health, 79 (1), 30-37 DOI: 10.1111/j.1746-1561.2008.00371.x
Baker LD, Frank LL, Foster-Schubert K, Green PS, Wilkinson CW, McTiernan A, Plymate SR, Fishel MA, Watson GS, Cholerton BA, Duncan GE, Mehta PD, & Craft S (2010a). Effects of aerobic exercise on mild cognitive impairment: a controlled trial. Archives of neurology, 67 (1), 71-9 PMID: 20065132
Berchtold, N., Castello, N., & Cotman, C. (2010b). Exercise and time-dependent benefits to learning and memory Neuroscience, 167 (3), 588-597 DOI: 10.1016/j.neuroscience.2010.02.050
Sunday, May 23, 2010
Building & Protecting Bone: Odd Angle Exercise, Resistance, Movement (and shaking) Work
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A fear for many women is that as we age, we seem to be more vulnerable to the "Help Help, i've fallen and i can't get up" hip fracture and related. Awhile ago, i wrote about bone building, and what's known about strategies to keep it together and enhance it. Quick review: bone builds in response to demand. Woolf's law is "use it or lose it" - our bone is "remodeling" all the time. So while calcium, magnesium, zinc and vitamin d are all important, these nutrients alone don't really go into bone building mode unless there's demand on the bones. That means load. Likewise, even with strong bones, we don't stay upright if our movement is compromised by various aches and pains.
A new research survey on non-invasive approaches to bone building puts these points together in a really nice review called "Physical approach for prevention and treatment of osteoporosis" The nice thing is it's free.
Summary: Here's a summary of the approaches that look good for building up bone mineral density:
BONE BUILDING
Resistance training - that's good but it's also site specific. In other words, lower body work helps the lower body (hip/pelvis); upper body work helps the upper body (including the critical spine).
Impact Training - this is stop and start and "odd angle" activities like soccer or squash (not running so much), but also for the more frail, even dancing and ball games have been proposed as ways to help keep demand up on bones.
Combinations. Meta analysis of research suggests that the best approach, unsurprisingly is a mixed approach of resistance training and impact training. Fortunately such practice can be fun and have bone building effect.
Vibration. the next time someone pooh poohs force plates, you might want to suggest that they've been shown - repeatedly - to help build up bone. It's not a HUGE gain, but it could be an excellent modality for the initially infirm:
BALNANCE - Physical and Hormonal
T'ai Chi - does nothing for bone building at all, BUT helps get on with movement and balance and the breathing can help destress, so hormonally very helpful in supporting staying safe. Research has mainly focused on T'ai Chi for these effects, but it might be interesting to consider that other approaches that emphasize mobility, balance, de-stressing, and the whole sensory motor apparatus might not benefit here too?
BUILDING & REPAIR
New & Approved. The review also considers several other forms of "physical agents" like Low Intensity Pulsed Ultrasound (LIPUS) that has been shown to stimulate bone repair. Electrical stimulation has also now been approved by the FDA for "bone repair."
Experimental. Pulsed electro magnetic fields (PEMF) is a newer approach, nothing conclusive there yet. Low Level Laser Therapy is also being trialed in animal models, but again nothing yet in human studies.
Role for Movement Practice & Assessment?
Where we seem to be at is that concern about bone mineral density has two components: first is to ensure practices for maintianing and building BMD, but second is the development of practices to help people feel stable and mobile rather than vulnerable to falls - improving range of motion, visual accuity and balance. It's not just Range of Motion - thought that's important - it's the whole sensory-motor awareness package.
It doesn't matter if we're younger or older - we can have issues with our movement that can compromise our ability to respond with agility to a tricky situation. The entire functional movement screen program is based on the premise that there's no point building strength on top of dysfunction, hence the screen for movement issues.
But likewise, we can have issues with our balance or visual accuity or our brains ability to perceive our selves clearly in motion. Indeed, i've written quite a bit about the benefit of just kicking off our restrictive shoes to get more info to the brain about where we are in space, and how doing so has pretty big benefits for movement and also feel of one's own mobility (as the feet move more and better, it seems so do other joints).
So it seems pretty basic that as part of our quest for better bone health, a related quest for optimizing our body's ability to move in space is pretty important. I've said before, this awareness development is part of why i like I-Phase so much: it's prepping the body for the Real.
In other words, as we build better bones, there's a real benefit in openning up our body's awareness of itself in space, and simultaneously, it's ability to respond better to what's happening.
Simple example: better range of motion combined with better practice of movement into multiple positions, and better balance and visual processing means the brain has more knowledge about its being able to Zig rather than having to Zag around that wet spot on the floor, and thus, us not going for a tumble.
Stronger bones PLUS less risk of falling in the first place (and not being able to get up) - that seems to be more a complete package.
Conclusion: Why is osteoperosis such the women's issue?
One advantage that guys have is the size of their muscles puts more load on their bones so that the bones are under more demand. More demand on the bones, more continued adapting to load.
Women have not been encouraged to do as much manual labour or high resistance workouts as guys.
Similarly our formal worlds are increasingly desk bound, so less movement is part of our daily lives. As we age, this decrease in multi-plane motion seems to increase. Let us say phooey to this increasingly restricted mode of being.
It will be interesting to see as the culture shifts towards it being ok for gals to work out, and as muscle tissue can be built up at any age, that perhaps hip and related fractures will become a fate of a by-gone age.
Citation:
Related Resources
A fear for many women is that as we age, we seem to be more vulnerable to the "Help Help, i've fallen and i can't get up" hip fracture and related. Awhile ago, i wrote about bone building, and what's known about strategies to keep it together and enhance it. Quick review: bone builds in response to demand. Woolf's law is "use it or lose it" - our bone is "remodeling" all the time. So while calcium, magnesium, zinc and vitamin d are all important, these nutrients alone don't really go into bone building mode unless there's demand on the bones. That means load. Likewise, even with strong bones, we don't stay upright if our movement is compromised by various aches and pains.A new research survey on non-invasive approaches to bone building puts these points together in a really nice review called "Physical approach for prevention and treatment of osteoporosis" The nice thing is it's free.
Summary: Here's a summary of the approaches that look good for building up bone mineral density:
BONE BUILDING
Resistance training - that's good but it's also site specific. In other words, lower body work helps the lower body (hip/pelvis); upper body work helps the upper body (including the critical spine).
Impact Training - this is stop and start and "odd angle" activities like soccer or squash (not running so much), but also for the more frail, even dancing and ball games have been proposed as ways to help keep demand up on bones.
Combinations. Meta analysis of research suggests that the best approach, unsurprisingly is a mixed approach of resistance training and impact training. Fortunately such practice can be fun and have bone building effect.
Vibration. the next time someone pooh poohs force plates, you might want to suggest that they've been shown - repeatedly - to help build up bone. It's not a HUGE gain, but it could be an excellent modality for the initially infirm:
A 1-year prospective, randomized, double-blind, and placebo-controlled trial of postmenopausal women demonstrated that 20 minutes of a low-level vibration applied during quiet standing can effectively inhibit bone loss in the spine and femur. Placebo subjects lost 2.13% in the femoral neck over 1 year, whereas treatment was associated with a gain of 0.04%, reflecting a 2.17% relative benefit of treatment. In the spine, the 1.6% decrease observed over 1 year in the placebo group was reduced to a 0.10% loss in the active group, indicating a 1.5% relative benefit of treatment (40).
BALNANCE - Physical and Hormonal
T'ai Chi - does nothing for bone building at all, BUT helps get on with movement and balance and the breathing can help destress, so hormonally very helpful in supporting staying safe. Research has mainly focused on T'ai Chi for these effects, but it might be interesting to consider that other approaches that emphasize mobility, balance, de-stressing, and the whole sensory motor apparatus might not benefit here too?BUILDING & REPAIR
New & Approved. The review also considers several other forms of "physical agents" like Low Intensity Pulsed Ultrasound (LIPUS) that has been shown to stimulate bone repair. Electrical stimulation has also now been approved by the FDA for "bone repair."
Experimental. Pulsed electro magnetic fields (PEMF) is a newer approach, nothing conclusive there yet. Low Level Laser Therapy is also being trialed in animal models, but again nothing yet in human studies.
Role for Movement Practice & Assessment?
Where we seem to be at is that concern about bone mineral density has two components: first is to ensure practices for maintianing and building BMD, but second is the development of practices to help people feel stable and mobile rather than vulnerable to falls - improving range of motion, visual accuity and balance. It's not just Range of Motion - thought that's important - it's the whole sensory-motor awareness package.
It doesn't matter if we're younger or older - we can have issues with our movement that can compromise our ability to respond with agility to a tricky situation. The entire functional movement screen program is based on the premise that there's no point building strength on top of dysfunction, hence the screen for movement issues.
But likewise, we can have issues with our balance or visual accuity or our brains ability to perceive our selves clearly in motion. Indeed, i've written quite a bit about the benefit of just kicking off our restrictive shoes to get more info to the brain about where we are in space, and how doing so has pretty big benefits for movement and also feel of one's own mobility (as the feet move more and better, it seems so do other joints). So it seems pretty basic that as part of our quest for better bone health, a related quest for optimizing our body's ability to move in space is pretty important. I've said before, this awareness development is part of why i like I-Phase so much: it's prepping the body for the Real.
In other words, as we build better bones, there's a real benefit in openning up our body's awareness of itself in space, and simultaneously, it's ability to respond better to what's happening.
Simple example: better range of motion combined with better practice of movement into multiple positions, and better balance and visual processing means the brain has more knowledge about its being able to Zig rather than having to Zag around that wet spot on the floor, and thus, us not going for a tumble.
Stronger bones PLUS less risk of falling in the first place (and not being able to get up) - that seems to be more a complete package.
Conclusion: Why is osteoperosis such the women's issue?
One advantage that guys have is the size of their muscles puts more load on their bones so that the bones are under more demand. More demand on the bones, more continued adapting to load.
Women have not been encouraged to do as much manual labour or high resistance workouts as guys.
Similarly our formal worlds are increasingly desk bound, so less movement is part of our daily lives. As we age, this decrease in multi-plane motion seems to increase. Let us say phooey to this increasingly restricted mode of being.
It will be interesting to see as the culture shifts towards it being ok for gals to work out, and as muscle tissue can be built up at any age, that perhaps hip and related fractures will become a fate of a by-gone age.
Citation:
Lirani-Galvão, A., Lazaretti-Castro, M. (2010). Physical approach for prevention and treatment of osteoporosis Arquivos Brasileiros de Endocrinologia & Metabologia, 54 (2) DOI: 10.1590/S0004-27302010000200013
Related Resources
- What is z-health
- ck-fms - what is it
- the other side of the gym: developing sensory motor performance
- DO YOUR SHOES PASS THE TWIST TEST?
Thursday, April 29, 2010
Football (er, soccer): best for coach potatoes seeking health, fat loss, muscle?
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What to do if wanting to move off the coach and into health? If a guy - especially a guy just starting up a fitness program - wanted to do just one thing that would help drop fat, build muscle (and muscle mass), improve endurance, enhance bone mineral density, improve cholesterol levels and blood pressure, it's football (what north americans call soceer).
Really. Better than HIIT, than running, than resistance training alone, football seems to be the Big Pill solution. The only potential downside is that levels of injury may be higher than hitting the weight room or stationary bike. Overall, the cost/benefit analysis may make football the Healthy Choice. As the authors say in the abstract:
Blood Pressure and Heart Rate
Over 12 weeks, men who trained for an hour, two or three times a week, on the football pitch, comparable to endurance training of same lenght and duration. Football also showed up as better than strength training, to the level thought to have significant health benefits. Risk of death from heart attack goes down with bett blood presure too.
The footballers also have a lowered resting heart rate, and lowered heart rate during submax runs. They also have lower heart rates in intermittent exercise. Compared with groups who did resistance training alone, that didn't happne. This indicated both central and peripheral adaptations. That's great.
Vo2Max
A quality near and dear to the hearts of many people is VO2max. Playing football over 12 weeks had the same effect (13% improvement) as "using continuous training" (eg running) for the same time, or HIIT for less time. BUT what's particularly cool is that the football group continued to have an imporvement after the first four weeks of ball play. Runners did not. It also seems that just playing some extra small sided games had the same effect as additional interval running susseions for experienced players. Playing a game is likely more enjoyable than running repeats, too.
Fat Burning (& other metabolic impacts)
Here's the kicker. How does football do for fat burning? Fat oxidation during low to moderate intensity goes up. muscle enzyme activity up, muscle fiber conversion from IIx to IIA up (good). LDL/HDL ration changed signficantly - for the good.
Now here's an interesting comparison: neither low intensity aerobics for 12 weeks, nor high intensity intermitent running or strength training lead to changes in cholesterol. What does show benefit is higher intensity work. Football vs just running seems to hit the sweet spot. Runners do have similar weight loss - just not these other perks to the same degree.
A result i find peculiar is a claim that
Lean Body Mass
12 weeks of football, not only does fat go down, and cholesterol change, lean body mass goes up. The study authors look at related work to say heh, this should be good for glucose tolerance. Indeed, there's one study the authors site that when 12 weeks of football & dietary advice was given to a bunch of 47-49 year olds with type 2 diabetes, glucose tolerance was "markedly improved" (a similar trial without that advice showed no difference. hmm)
Musculo-Skeletal fitness
Soccer is stop and go. I've written before about how such action has been shown to be good for bone mineral density. Seems its good for muscle too. Again, comparing with interval and steady state running where there was no muscle fiber change, football does it all. The cool result is that 12 weeks of football got similar results to "14 weeks of heavy resistance training in young men" These kinds of changes just don't seem to happen in regular endurance training. But they do happen across ages in football.
Bone Mass
I admit i am partial to work on bone mineral density. It's a big deal for gals in particular, and we know that muscle size plays a not inconsiderable role for keeping the bones working. But so does the type of axial loading on the bones.
Here's the latest: go lift or do stop and start sports
Perceived Exertion
How tired are we after an activity? A lot of this experience is assessed perceptually against physiologic markers. Guess what? footballers repport lower poop'dness, despite work done. Play is good.
Injury
All good things come at a price? After last week's exegisis on ankle injuriers in sport, this question of injury level is not inconsiderable: what happens when someone gets off the coach and wants to get back int the game?
Most of the comparisons about footbal are with other on-your-feet activities like running, or very different work like lifting. Alas, no comparisons have (yet) been done with Kettlebells. The point is, when looking at injury, these are the places of comparison: how does football compare with say running?
Stay away from match play and risk of injury seems to be lower.
Just to put the icing on the cake, it seems the study authors would like it to be known that runners are sucks:
Citation:
Krustrup, P., Aagaard, P., Nybo, L., Petersen, J., Mohr, M., & Bangsbo, J. (2010). Recreational football as a health promoting activity: a topical review Scandinavian Journal of Medicine & Science in Sports DOI: 10.1111/j.1600-0838.2010.01108.x Tweet Follow @begin2dig
What to do if wanting to move off the coach and into health? If a guy - especially a guy just starting up a fitness program - wanted to do just one thing that would help drop fat, build muscle (and muscle mass), improve endurance, enhance bone mineral density, improve cholesterol levels and blood pressure, it's football (what north americans call soceer).
Really. Better than HIIT, than running, than resistance training alone, football seems to be the Big Pill solution. The only potential downside is that levels of injury may be higher than hitting the weight room or stationary bike. Overall, the cost/benefit analysis may make football the Healthy Choice. As the authors say in the abstract:
Taken together, recreational football appears to effectively stimulate musculoskeletal, metabolic and cardiovascular adaptations of importance for health and thereby reduces the risk of developing life-style diseases.Let's take a look at the attributes the authors reviewed. To begin with, they considered studies of men who have been sedentary and then got into some kind of training protocol.
Blood Pressure and Heart Rate
Over 12 weeks, men who trained for an hour, two or three times a week, on the football pitch, comparable to endurance training of same lenght and duration. Football also showed up as better than strength training, to the level thought to have significant health benefits. Risk of death from heart attack goes down with bett blood presure too.
The footballers also have a lowered resting heart rate, and lowered heart rate during submax runs. They also have lower heart rates in intermittent exercise. Compared with groups who did resistance training alone, that didn't happne. This indicated both central and peripheral adaptations. That's great.
Vo2Max
A quality near and dear to the hearts of many people is VO2max. Playing football over 12 weeks had the same effect (13% improvement) as "using continuous training" (eg running) for the same time, or HIIT for less time. BUT what's particularly cool is that the football group continued to have an imporvement after the first four weeks of ball play. Runners did not. It also seems that just playing some extra small sided games had the same effect as additional interval running susseions for experienced players. Playing a game is likely more enjoyable than running repeats, too.
Fat Burning (& other metabolic impacts)
Here's the kicker. How does football do for fat burning? Fat oxidation during low to moderate intensity goes up. muscle enzyme activity up, muscle fiber conversion from IIx to IIA up (good). LDL/HDL ration changed signficantly - for the good.
Now here's an interesting comparison: neither low intensity aerobics for 12 weeks, nor high intensity intermitent running or strength training lead to changes in cholesterol. What does show benefit is higher intensity work. Football vs just running seems to hit the sweet spot. Runners do have similar weight loss - just not these other perks to the same degree.
A result i find peculiar is a claim that
12 weeks of intense interval training and short-term strength training, no changes were observed in fat mass (Fig. 2b), which may be related to the fact that the total energy expenditure was limited for the interval runners and that the strength training group had no changes in metabolic fitness as indicated by unchanged fat oxidation during exercise, lipid profile, capillarization and enzyme activities (Nybo et al., 2010).Study design is interesting, isn't it? As i've written about before, in work by Trapp, intervals on bikes were the one thing that showed fat loss - especially in the trunk - where steady state did not - even without tracking diet. So hmm. I'll go for total caloric expenditure did not exceed caloric intake in these runners/lifters, but it did in the football case, but i'm not ready to say "football is better than intervals for fat loss" -with fat loss as the single factor of interest. That said, there's more good stuff for football
Lean Body Mass
12 weeks of football, not only does fat go down, and cholesterol change, lean body mass goes up. The study authors look at related work to say heh, this should be good for glucose tolerance. Indeed, there's one study the authors site that when 12 weeks of football & dietary advice was given to a bunch of 47-49 year olds with type 2 diabetes, glucose tolerance was "markedly improved" (a similar trial without that advice showed no difference. hmm)
Musculo-Skeletal fitness
Soccer is stop and go. I've written before about how such action has been shown to be good for bone mineral density. Seems its good for muscle too. Again, comparing with interval and steady state running where there was no muscle fiber change, football does it all. The cool result is that 12 weeks of football got similar results to "14 weeks of heavy resistance training in young men" These kinds of changes just don't seem to happen in regular endurance training. But they do happen across ages in football.
Bone Mass
I admit i am partial to work on bone mineral density. It's a big deal for gals in particular, and we know that muscle size plays a not inconsiderable role for keeping the bones working. But so does the type of axial loading on the bones.
Here's the latest: go lift or do stop and start sports
[T]he increase in leg bone mass following 12 weeks of recreational football training was of a similar magnitude as the gains observed following strength training of the same duration, whereas neither recreational jogging nor high-intensity interval running induced changes in total or leg bone mass. In accordance, both male and female football players have higher hip and spine BMD than equally fit runners (Fredericson et al., 2007; Mudd et al., 2007). Furthermore, meta-analysis of cross-sectional studies reveals that participation in non-weight-bearing sports or physical activities with monotonous and stereotypic movement pattern appears to have little or no effect on bone mass or BMD, whereas strength-based and high-impact sports are associated with higher BMD (Egan et al.,2006).In football, small sided games with lots of turns, stops and starts seems to be optimal.
Perceived Exertion
How tired are we after an activity? A lot of this experience is assessed perceptually against physiologic markers. Guess what? footballers repport lower poop'dness, despite work done. Play is good.
Injury
All good things come at a price? After last week's exegisis on ankle injuriers in sport, this question of injury level is not inconsiderable: what happens when someone gets off the coach and wants to get back int the game?
Most of the comparisons about footbal are with other on-your-feet activities like running, or very different work like lifting. Alas, no comparisons have (yet) been done with Kettlebells. The point is, when looking at injury, these are the places of comparison: how does football compare with say running?
[One study ]Parkkari et al. (2004) "have reported an injury incidence of 7.8 injuries per 1000 h of football participation, which ranks football eight in 31 recreational and competitive sports. Running ranks 20 with an injury incidence of 3.6 injuries per 1000 h of participation, but no differentiation between the types of running has been made. ... In another study involving 31 620 inhabitants in a Swedish municipality, injury rates in persons attending a physician for an acute injury sustained during sports participation were reported (de Loes & Goldie, 1988). In this study, ice hockey and handball were found to have the highest risk followed by football. For males aged 15–59 years, the ranking was ice hockey, horseback riding, handball and football. If an injury incidence of 7.8 injuries per 1000 h of football participation is valid in recreation football in general, the implication is that the players would be exposed to one injury every 1.2 years if he carried out two 1-h sessions per week all-year round and one severe injury every ∼13 years as the severity of most injuries in recreational football is mild to moderate with approximately 9% categorized as severe injuries, defined as injuries that result in missing of work or a corresponding activity for at least 1 day (Parkkari et al., 2004).
It should be emphasized that the above-mentioned injury incidences in football are the incidence for training and match play analyzed together. However, it is well known that for elite and amateur football players the injury risk per hour of activity is approximately 5–10 times higher during match-play than training (Poulsen et al., 1991; Hägglund et al., 2003; Arnason et al., 2004) with injury incidence from two to five injuries per 1000 h of participation in training sessions.
Stay away from match play and risk of injury seems to be lower.
Just to put the icing on the cake, it seems the study authors would like it to be known that runners are sucks:
In the reviewed studies dealing with the fitness and health effects of recreational football and running, around 150 subjects have been followed over 3–4 months of training performed two to three times a week. During these studies, 5% of the footballers (n=3) and distance runners (n=3) contacted the in-house medical doctor regarding injuries, whereas 33% of the interval runners did (n=5) [note the small sample size -mc]. However, further studies are required to obtain more information about injury risk, types of injury, injury severity, etc. for various age groups playing recreational football organized as small-sided games among friends.Ok, just go play ball, already. Getting into some frienly 4 a side games, a couple times a week, seems to have so many pluses going for it's hard to imagine the down side - if everyone is rather at the same level (So great, where does one find these games?)
Field Note - General recommendation before Getting Back in the Game: get one's doctor's ok first to start a new prorgam of action, then consider getting a movement assessment to check how you're moving to reduce the risk of injury. It's also immediately beneficial to practice some sensory-motor drills to help field awareness so as to reduce likelihood of falling on self or colleague, and so actually getting more out of the game. Such drills can start with proprioceptvie awareness work. I like z-health's r-phase and especially i phase for this (overviews).
After R- and I- phase, the drills for fast turning, fast getting up off the ground, and just moving fast in the S-Phase Complete Athlete Vol 1 dvd are awesome - as are the drills for field awareness and quickness (review here). A colleague is using a lot of the z-drills to help the kids baseball team he coaches, from proprioception to visual acuity. Injury down, performance up, much?? oh ya.
Citation:
Krustrup, P., Aagaard, P., Nybo, L., Petersen, J., Mohr, M., & Bangsbo, J. (2010). Recreational football as a health promoting activity: a topical review Scandinavian Journal of Medicine & Science in Sports DOI: 10.1111/j.1600-0838.2010.01108.x Tweet Follow @begin2dig
Thursday, April 22, 2010
Eccentric Exercise - some cool ideas as to why it seems to heal certain tendinopathies (ps, ditch -itis and -osis)
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Have you been suffering with some kind of sore tendon/jointy pain? Rotator cuff area, achiles, elbow, forearm, rsi etc etc? Guess what? First we're not alone, but second, just about anything that's been tried to address it has no real evidence to support it working, especially over time. Indeed, as the authors of a 2009 review study put it, "Tendinopathy is common although pathology of this condition is poorly understood." In other words, we don't really know how this dis-ease works. The point of this article is to consider why, as these authors see it, Eccentric Exercise (EE) which has seemed to have some good, some neutral results in research, may actually be successfully addressing the effects of that pathology. So much so, that it gets rated as a good "conservative" therapy for these kinds of common, awful and sometimes career ending, painful problems.
By way of context, in 2008, the year before these authors proposed why EE might be useful, another group reviewed pretty much everything under the sun applied to tendinopathies, from NSAIDS to shock wave therapy (and anything else one's GP may recommend). THe paper has the remarkably useful title "Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon"
They write of these therapies:
It's almost as bad as the common cold: ubiquitous and no idea how to cure it.
By 2009, however, the UK group of scientists seems ready to say that EE is a good "conservative" treatment for tendinopathy. What's quite remarkable is why they're making this claim, and that's at the heart of this article.
Tendinopathy?
But first things first, just to be sure we're all on the same page, what is tendinopathy? Tendinopathy is the umbrella term that includes, among other considerations, tendinosis and tendinitis. As for the differences between these two, on a functional level, Mike Nelson puts it nicely:
Hence we circle back to the term tendinopathy to cover this not unusually mixed condition of perhaps some inflammation but in particular, "degeneration, weakness, tearing, and pain" Hence both osis (tears) and itis (inflammation) may neither be particularly pathologically accurate or diagnostically helpful. And so, tendinopathy is the new and more robust term for these conditions.
With that note in mind, let me also add that the following discussion is not meant to be a prescription of any course of action. Get yourself checked with your doctor before starting anything. In my own case i have been disappointed by the fact that the thing that has actually helped the most immediately has been taking NSAIDS - some inflammation, or -itis maybe?
After a month of other non-drug interventions, day one after finally breaking down and seeing the doc: bam - immediate reduction in the pain that was making putting on a jacket a painful experience. bugger. But ah ha, it ain't all better that's for sure. What to do next? My hope is that the following research may offer some insight into WHAT to do if not exactly how and when to do it.
Eccentric Exercise and Tendinopathy
The authors of "Eccentric exercises; why do they work, what are the problems and how can we improve them?" J D Rees, R L Wolman, A Wilson write in the abstract:
The body of the article focuses on Achilles tendinopathy (mid back of the leg - base of the calf muscles), Insertional Achilles tendinopathy (where the tendon inserts away from the calf muscles, down by the ankle where it attaches to the bone) , Patellar tendon (either side of the knee cap) in particular.
The authors' insight has been to look at where in the tendon the lesion is occuring. Is it where the tendon attaches to the bone or where it attaches to the muscle? The effects of EE in the small number of studies are all over the map, so it's hard to draw any conclusion except, it seems, that where the lesion is on the tendon seems to have a correlation between the degree to which EE will be successful. For insertional achilles, as opposed to "the main body" of the tendon, EE's not showing up as so great. With the paterllar tendons, while some studies have shown benefit, especially over CE or concentric, whether there's a difference around proximal or insertional hasn't been the focus of research in such a way as it's possible to make a distinction.
With respect to other tendinopathies - like forearms (RSI kinda stuff) and elbows, the authors write:
What are Eccentrics Doing?
Despite this rather promising but still arid, partial research landscape for EE and tendinopathy, the authors have some ideas about the mechanisms that may be at play in eccentric efforts
Another factor the authors consider is blood flow. When we see tendons illustrated in anatomy texts, they're usually white-ish. That's the lack of a whole lot of blood going through them. This limit is in no small part why tendons can take longer than just about anything else to heal. So improving blood flow to tendons - blood being a nutrient carrier - could seemingly be a big plus. The authors write
Where using the Force Mayn't Matter. All this is cool, but it doesn't explain WHY these effects are occuring from EE. In particular, something the scientists can conclude rather strongly from the work that's been carried out is that the magnitude of the force has nothing to do with it. So lifting a big weight, or lifting a lighter weight faster (F=M*A) isn't what's getting the job done.
The key question the authors ask is:
Frequency rather than Force. This is so cool - it sounds great too: that the sort of cycling on and off of the muscle (the sinusoidal loading and unloading) during the eccentric may be the biggie in stimulating that good collagen rebuilding in particular associated with EE and maybe the blood flow too. The other interesting part is that there is a possible parallel to bone remodelling here (and Woolf's law).
That is, as force is applied to a bone it will get bigger (the outer shell gets pushed out it seems, as the inner lace work architecture increases) and so stronger to respond to that demand. Davis's law on tissue seems a wee bit similar: "If soft tissue is placed under unremitting tension, the tissue will elongate by adding more material. "
Bottom line: the particular type of muscular demands to maintain control of a load in extension (force fluctuations not force magnitude) may play a particular role in remodeling tendons in these various opathies.
Whither, Voyager for Futuer EE / Tendinopathy Research?
The authors are now happy to say EE seems to have sufficient basis to be considered viable. Time to figure out how to optimize it. THey write in the Future Work section:
As an example of eccentric exercises that have been tried out among at least a small population of elbow-opathies, Mike T Nelson's developed some nice eccentrics work with a kettlebell. Well worth a look and a go.
What i've been working lately for my shoulder/painful arc thing:
Concludium
Perhaps the main take away from this summary of recent research reviews and primary work is that tendinitis vs osis is largely a non-starter; tendinopathy is where it's at. And saying that, the pathology or dis-ease of tendinopathy is not well understood, which may also explain why treatements - in particular long term ones - don't have much evidence to support their efficacy. There are some prospective treatements on the horizon, however, with eccentric exercise amongthem. This latest study on EE and tendinopathy seems to propose the best hypothesis so far as to why eccentric exercises is showing up as particularly effective for at least main body tendinopathy.
Citations:
Related Resources
Have you been suffering with some kind of sore tendon/jointy pain? Rotator cuff area, achiles, elbow, forearm, rsi etc etc? Guess what? First we're not alone, but second, just about anything that's been tried to address it has no real evidence to support it working, especially over time. Indeed, as the authors of a 2009 review study put it, "Tendinopathy is common although pathology of this condition is poorly understood." In other words, we don't really know how this dis-ease works. The point of this article is to consider why, as these authors see it, Eccentric Exercise (EE) which has seemed to have some good, some neutral results in research, may actually be successfully addressing the effects of that pathology. So much so, that it gets rated as a good "conservative" therapy for these kinds of common, awful and sometimes career ending, painful problems. By way of context, in 2008, the year before these authors proposed why EE might be useful, another group reviewed pretty much everything under the sun applied to tendinopathies, from NSAIDS to shock wave therapy (and anything else one's GP may recommend). THe paper has the remarkably useful title "Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon"
They write of these therapies:
Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Recent basic science research suggests little or no inflammation is present in these conditions. Thus, traditional treatment modalities aimed at controlling inflammation such as corticosteroid injections and nonsteroidal antiinflammatory medications (NSAIDS) may not be the most effective options. We performed a systematic review of the literature to determine the best treatment options for tendinopathy. We evaluated the effectiveness of NSAIDS, corticosteroid injections, exercise-based physical therapy, physical therapy modalities, shock wave therapy, sclerotherapy, nitric oxide patches, surgery, growth factors, and stem cell treatment. NSAIDS and corticosteroids appear to provide pain relief in the short term, but their effectiveness in the long term has not been demonstrated. We identified inconsistent results with shock wave therapy and physical therapy modalities such as ultrasound, iontophoresis and low-level laser therapy. Current data support the use of eccentric strengthening protocols, sclerotherapy, and nitric oxide patches, but larger, multicenter trials are needed to confirm the early results with these treatments. Preliminary work with growth factors and stem cells is promising, but further study is required in these fields. Surgery remains the last option due to the morbidity and inconsistent outcomes. The ideal treatment for tendinopathy remains unclear.
It's almost as bad as the common cold: ubiquitous and no idea how to cure it.
It's interesting that from that mix of "current data" strategies that look promising in the 2008 survey quoted above, the authors of the 2009 BJMS article are interested in eccentric exercises. In 2007, another group of researchers concluded a literature survey about Eccentric Exercise and chronic tendinopathy with the sad claim thatAside: And if you have a type of rotator cuff tendinopathy, and your doctor is suggesting a steroid shot? I'm motivated here as this is me. You may want to point that caregiver to this 2007 review of the lack of proven efficacy of this approach.
This systematic review of the available literature indicates that there is little reproducible evidence to support the efficacy of subacromial corticosteroid injection in managing rotator cuff disease.
the dearth of high‐quality research in support of the clinical effectiveness of EE over other treatments in the management of tendinopathies.In other words, good quality studies that would be taken as being say clinically significant are thin on the ground. They're not as rigerous as these scientists would like to see in the presciption of a protocol to treat something.
By 2009, however, the UK group of scientists seems ready to say that EE is a good "conservative" treatment for tendinopathy. What's quite remarkable is why they're making this claim, and that's at the heart of this article.
Tendinopathy?
But first things first, just to be sure we're all on the same page, what is tendinopathy? Tendinopathy is the umbrella term that includes, among other considerations, tendinosis and tendinitis. As for the differences between these two, on a functional level, Mike Nelson puts it nicely:
TendonITIS is normally from inflammation (itis). TendonOSIS is normally from messed up connective tissue.To get into a bit more detail, the intro to the 2008 survey is very helpful
Traditionally, pain in and around tendons associated with activity has been termed tendonitis. This terminology implies the pain associated with these conditions results from an inflammatory process. Not surprisingly, treatment modalities have mainly been aimed at controlling this inflammation. The mainstays of treatment have included rest, nonsteroidal antiinflammatory medications (NSAIDs), and periodic local corticosteroid injections.So for practitioners in the know, it seems the once-frequent diagnosis of "tendinitis" has gone down quite a bit - because inflammation may or may not be present, and when it is, may or may not be the main cause of pain. Also, there is an "imbalance" of protective/regenerative responses to overuse and pathological (diseease) responses. This is Mike's "messed up connective tissue."
There are two problems with this approach. First, several studies demonstrate little or no inflammation is actually present in tendons exposed to overuse [83, 96, 163]. Second, traditional treatment modalities aimed at modulating inflammation have had limited success in treating chronic, painful conditions arising from overuse of tendons. More recently, the term tendinopathy has been advocated to describe the variety of painful conditions that develop in and around tendons in response to overuse. Histopathologic changes associated with tendinopathy include degeneration and disorganization of collagen fibers, increased cellularity, and minimal inflammation [83, 163]. Macroscopic changes include tendon thickening, loss of mechanical properties, and pain [163]. Recent work demonstrates several changes occur in response to overuse including the production of matrix metalloproteinases (MMPs), tendon cell apoptosis, chondroid metaplasia of the tendon, and expression of protective factors such as insulin-like growth factor 1 (IGF-1) and nitric oxide synthetase (NOS) [10, 76, 93, 99, 154, 155, 174, 199]. Although many of these biochemical changes are pathologic and result in tendon degeneration, others appear beneficial or protective. Tendinopathy appears to result from an imbalance between the protective/regenerative changes and the pathologic responses that result from tendon overuse. The net result is tendon degeneration, weakness, tearing, and pain.
Hence we circle back to the term tendinopathy to cover this not unusually mixed condition of perhaps some inflammation but in particular, "degeneration, weakness, tearing, and pain" Hence both osis (tears) and itis (inflammation) may neither be particularly pathologically accurate or diagnostically helpful. And so, tendinopathy is the new and more robust term for these conditions.
With that note in mind, let me also add that the following discussion is not meant to be a prescription of any course of action. Get yourself checked with your doctor before starting anything. In my own case i have been disappointed by the fact that the thing that has actually helped the most immediately has been taking NSAIDS - some inflammation, or -itis maybe?
After a month of other non-drug interventions, day one after finally breaking down and seeing the doc: bam - immediate reduction in the pain that was making putting on a jacket a painful experience. bugger. But ah ha, it ain't all better that's for sure. What to do next? My hope is that the following research may offer some insight into WHAT to do if not exactly how and when to do it.
Eccentric Exercise and Tendinopathy
The authors of "Eccentric exercises; why do they work, what are the problems and how can we improve them?" J D Rees, R L Wolman, A Wilson write in the abstract:
Eccentric exercises (EE) have proved successful in the management of chronic tendinopathy, particularly of the Achilles and patellar tendons, where they have been shown to be effective in controlled trials. However, numerous questions regarding EE remain. The standard protocols are time-consuming and require very motivated patients. EE are effective in some tendinopathies but not others. Furthermore, the location of the lesion can have a profound effect on efficacy; for example, standard EE in insertional lesions of the Achilles are ineffective.So, the researchers are sitting with the 2007 surveyview that while there's some hints of promising evidence in the past about EE, it hasn't been super. They think that now, however, they have a better sense of what might be making it effective.
Until recently little was known of the effect of EE on tendinopathic tendons, although a greater understanding of this process is emerging. Additionally, recent in vivo evidence directly comparing eccentric and concentric exercises provides a possible explanation for the therapeutic benefit of EE. The challenge now is to make EE more effective. Suggestions on areas of future research are made.
The body of the article focuses on Achilles tendinopathy (mid back of the leg - base of the calf muscles), Insertional Achilles tendinopathy (where the tendon inserts away from the calf muscles, down by the ankle where it attaches to the bone) , Patellar tendon (either side of the knee cap) in particular. The authors' insight has been to look at where in the tendon the lesion is occuring. Is it where the tendon attaches to the bone or where it attaches to the muscle? The effects of EE in the small number of studies are all over the map, so it's hard to draw any conclusion except, it seems, that where the lesion is on the tendon seems to have a correlation between the degree to which EE will be successful. For insertional achilles, as opposed to "the main body" of the tendon, EE's not showing up as so great. With the paterllar tendons, while some studies have shown benefit, especially over CE or concentric, whether there's a difference around proximal or insertional hasn't been the focus of research in such a way as it's possible to make a distinction.
With respect to other tendinopathies - like forearms (RSI kinda stuff) and elbows, the authors write:
A small number of studies have examined the use of eccentric exercises in the management of tendinopathy of the lateral extensors of the forearms.26–28 There is some evidence suggestive of an increase in function using EE compared with ultrasound in the treatment of lateral extensor tendons,29 and a recent study adopted an isokinetic eccentric protocol in the management of lateral elbow tendinosis and reported promising results.30 No randomised study on the effectiveness of EE on the rotator cuff has been published, although a small uncontrolled pilot study of nine patients did suggest a significant benefit of EE (patients with arthritis of the acromioclavicular joint or significant calcification were, however, excluded).31 Further trials on both tendinopathy of the rotator cuff and lateral extensor forearm tendons are required in order to evaluate EE more fully.Just my luck: shoulders with EE haven't been evaluated. Time to become an experiment of one.
What are Eccentrics Doing?
Despite this rather promising but still arid, partial research landscape for EE and tendinopathy, the authors have some ideas about the mechanisms that may be at play in eccentric efforts
The pathophysiology of tendon injury and healing is incompletely understood. It does appear, however, that in established tendinosis the tendon often does not progress into an active (or at least successful) healing cycle. EE may work by providing a mechanical stimulus to the quiescent tendon cellsThe authors propose several interesting ways in which this "mechanical stimulus" may work. The first is on that all important building block for tissue, collagen
Physical training in general has been shown to increase both the synthesis and degradation of collagen,39 and in the longer term this may lead to a net increase in collagen. Recently it has been recently elegantly demonstrated by Langberg and coworkers, by use of the microdialysis technique, that a chronically injured Achilles tendon responds to a 12 week EE programme by increasing the rate of collagen synthesis.40 In this study 12 patients (six with Achilles tendinosis and six normal controls) performed EE over a 12 week period. The EE group had increased collagen synthesis (peritendinous type I collagen) without a corresponding increase in collagen degradation. There was also a corresponding drop in pain levels (in line with other studies).That collagen production - to repair tendon degredation - is a huge and good deal. Especially that the exercise is not causing breakdown, but actual rebuilding.
Another factor the authors consider is blood flow. When we see tendons illustrated in anatomy texts, they're usually white-ish. That's the lack of a whole lot of blood going through them. This limit is in no small part why tendons can take longer than just about anything else to heal. So improving blood flow to tendons - blood being a nutrient carrier - could seemingly be a big plus. The authors write
The effect of EE on Achilles tendon microcirculation has also been studied. Achilles tendon oxygenation was not impaired by an EE programme but was accompanied by a decrease in postcapillary venous filling pressures, the authors suggesting that this reflects improved blood flow. Again this study looked only at eccentric exercise so it is not possible to determine whether this is a specific effect of EE.In other words, concentric exercise may have the same benefit on blood flow as eccentric exercise - we don't know - but what we do seem to know is that exercise (in the studied case, eccentric) keeps the blood moving, circulating rather than sitting somewhere. The anti pump? in a good way?
Where using the Force Mayn't Matter. All this is cool, but it doesn't explain WHY these effects are occuring from EE. In particular, something the scientists can conclude rather strongly from the work that's been carried out is that the magnitude of the force has nothing to do with it. So lifting a big weight, or lifting a lighter weight faster (F=M*A) isn't what's getting the job done.
The key question the authors ask is:
If the efficacy of EE cannot be explained by the magnitude of force, then what is responsible?Great Question. They have one very intersting finding about eccentric exercise - the shape of control of the muscle when it's lengthening and contracting at the same time:
Intriguingly, we observed a pattern of sinusoidal loading and unloading in EE which was not demonstrated in CE. The fluctuations in force probably reflect the difficulty in controlling a dynamic movement with a lengthening muscle; similar to the experience that it is easier to lift a heavy weight under precise control than to lower the same weight. We propose that these fluctuations in force may provide an important stimulus for the remodelling of tendon. Certainly in the remodelling of bone it is known that bone responds to high-frequency loading and appropriate mechanical signals can lead to a dramatic increase in bone density.
Frequency rather than Force. This is so cool - it sounds great too: that the sort of cycling on and off of the muscle (the sinusoidal loading and unloading) during the eccentric may be the biggie in stimulating that good collagen rebuilding in particular associated with EE and maybe the blood flow too. The other interesting part is that there is a possible parallel to bone remodelling here (and Woolf's law).
That is, as force is applied to a bone it will get bigger (the outer shell gets pushed out it seems, as the inner lace work architecture increases) and so stronger to respond to that demand. Davis's law on tissue seems a wee bit similar: "If soft tissue is placed under unremitting tension, the tissue will elongate by adding more material. "
Bottom line: the particular type of muscular demands to maintain control of a load in extension (force fluctuations not force magnitude) may play a particular role in remodeling tendons in these various opathies.
Whither, Voyager for Futuer EE / Tendinopathy Research?
The authors are now happy to say EE seems to have sufficient basis to be considered viable. Time to figure out how to optimize it. THey write in the Future Work section:
Little is known of the optimal protocol for EE. Indeed, fundamental questions remain unanswered, such as how fast the exercises should be performed and progressed. This is certainly an area worthy of future research. The specific location of the pathology within a tendon has increasingly been shown to have an effect on the efficacy of EE, and further study in this area is also suggested. Other potential areas of research include studying the effect of periodisation of training, a technique currently perhaps more familiar to athletes and their coaches than to sports medicine physicians.Goodness, that's interesting. Periodization combined with frequency may be the sweet spot for rehab. Why not? It's excellent for anti-fatigue strength building; why not repair?
As an example of eccentric exercises that have been tried out among at least a small population of elbow-opathies, Mike T Nelson's developed some nice eccentrics work with a kettlebell. Well worth a look and a go.
What i've been working lately for my shoulder/painful arc thing:
put a wee kettelbell or light db in the hand of the sore side. bring hand up to chest (with weight in it), then lift elbow so it's parallel or close to shoulder height WITH NO PAIN - only go as high as you can with no pain
- slowly abduct the hand away from the chest, and potentially rotate wrist down (like pouring a jug) - if the load feels too heavy - brings on pain - bring hand in a bit; reduce turn in wrist; then lower the whole arm (not just the elbow but this L shape you're holding) so you're working the shoulder.
that lets one do the concentric pretty much unloaded and focus on a safe eccentric.
if you give that a go for a while let me know how that feels - just don't move into pain.
Concludium
Perhaps the main take away from this summary of recent research reviews and primary work is that tendinitis vs osis is largely a non-starter; tendinopathy is where it's at. And saying that, the pathology or dis-ease of tendinopathy is not well understood, which may also explain why treatements - in particular long term ones - don't have much evidence to support their efficacy. There are some prospective treatements on the horizon, however, with eccentric exercise amongthem. This latest study on EE and tendinopathy seems to propose the best hypothesis so far as to why eccentric exercises is showing up as particularly effective for at least main body tendinopathy.
Citations:
Rees, J., Wolman, R., & Wilson, A. (2009). Eccentric exercises; why do they work, what are the problems and how can we improve them? British Journal of Sports Medicine, 43 (4), 242-246 DOI: 10.1136/bjsm.2008.052910
Andres, B., & Murrell, G. (2008). Treatment of Tendinopathy: What Works, What Does Not, and What is on the Horizon Clinical Orthopaedics and Related Research, 466 (7), 1539-1554 DOI: 10.1007/s11999-008-0260-1
Woodley, B., Newsham-West, R., Baxter, G., Kjaer, M., & Koehle, M. (2007). Chronic tendinopathy: effectiveness of eccentric exercise * COMMENTARY 1 * COMMENTARY 2 British Journal of Sports Medicine, 41 (4), 188-198 DOI: 10.1136/bjsm.2006.029769
Koester MC, Dunn WR, Kuhn JE, & Spindler KP (2007). The efficacy of subacromial corticosteroid injection in the treatment of rotator cuff disease: A systematic review. The Journal of the American Academy of Orthopaedic Surgeons, 15 (1), 3-11 PMID: 17213378
Related Resources
- b2d movement index
- why not train through pain?
- chronic low back pain - possible strategies
- What do omega 3's have to do with anti-inflammation?
- free your feet index - you might feel better.
Saturday, April 10, 2010
Your Perfect Nutrition Assistant? What would they do for you?
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So if you think about all the times when food comes into your life - meals, snacking, social occaisions, workouts - whenever - what do you wish someone would be able to assist you to do - not do for you, but offer assistance/knowledge?
I'm aksing because part of the research my group is doing is looking at exactly this question: what is a perfect nutrition assistant?
Before we design anything, we want to make sure some of our design decisions are linking up with what folks think they'd find helpful.
If you could have such a wonderful support, what would you like it to do for and with you?
One constraint: this assistant is more or less a ghost: it can't do anything physical but it can offer to show you anything or provide any information in this space you'd like
Please do post your thoughts/desires in the comments.
Looking forward to hearing your thoughts.
In the meanwhile, here's a physical assistant from Japan that is designed to help the elderly shop - including getting around the shop and remembering anything that might have been forgotten.
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What would a virtual nutrition assistant do for you? Suppose you're trying to change your body comp - lose fat; build muscle - whatever. If you could imagine the perfect coach/guide who could be with you all the time - what would they be doing? When you go to have lunch, would they tell you what was ok to eat? If you were at home, would they suggest what to make or show you how to do it? If you needed to shop, what?
I'm aksing because part of the research my group is doing is looking at exactly this question: what is a perfect nutrition assistant?
Before we design anything, we want to make sure some of our design decisions are linking up with what folks think they'd find helpful.
If you could have such a wonderful support, what would you like it to do for and with you?
One constraint: this assistant is more or less a ghost: it can't do anything physical but it can offer to show you anything or provide any information in this space you'd like
Please do post your thoughts/desires in the comments.
Looking forward to hearing your thoughts.
In the meanwhile, here's a physical assistant from Japan that is designed to help the elderly shop - including getting around the shop and remembering anything that might have been forgotten.
Related Links
Tweet Follow @begin2dig
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