Tuesday, December 8, 2009
Thoughts on Low Back Pain - When in Chronic Pain Hell
Follow @mcphoo
Tweet
THis post started life as a reply to someone having "horrible back pain". I'd seen three of these "what can i do about my low back pain" in one day. No kidding it's one of the biggest reasons that stop folks from working or working out. It is hell.
The point of this post is to offer what may be an alternative perspective about back pain that says it mayn't be about the back; it may be about pain processes in the brain, and if we work with a model of pain, and of movement, even chronic stuff like the seemingly unsurmountable of low standing back pain can unwind. Let me further preface this by saying, in no way am i saying the pain is "all in one's head" or not real. It's real, alright. The shape of that reality, however, may be richer that we initially may think.
Going Chronic This post is motivated by the fact that a lot of folks ask about low back pain issues after they've had them for awhile. They've gone from acute - a sudden sharp pain brought on by a specific movement pretty predictably - to something chronic that can be a constant presence, as well as flaring up from time to time, but without a specific acute area that's sharp. It's a nasty thing that can, when flaring, debilitate a person. It is the proverbial monkey on the back, and it can make ya cry. I could go on and on.
In such advice-seeking experiences, many folks recommend chiros, phyiscal therapists, massage, exercises for the low back muscles and so on. All these things can bring benefit. In my experience though, if that back pain has been going on for months/years we're talking chronic, manually therapy has a much harder time addressing this. In my own experience, muscle work like yoga and kettlebells has brought some relief - more so than manual therapies - but not eliminated the problem.
The following offers some other ideas for dealing with low back pain - both at an early and definitely at an ongoing stage. The focus is really on models of pain as opposed to particular back issues.
context
First of all some context: me: like most folks with low back stuff - compressed l4/l5, long history of chronic back stuff. Chiro, pt, acupuncture, orthotics, heel lifts. shots and surgery offered - na thanks.
On the more physical approaches, as said, Yoga therapy worked a bit better than anything else; kettlebell swinging really helped but still chronic flare ups. Both these approaches were based on the theory that the muscles in the back are potentially weak or out of balance and needed to be rebuilt. As said, helped a lot but the chronic flare ups were not addressed; ROM still limited by pain etc. So rebuilding alone is not (at least for me) a complete answer.
Like a few who've been dealing with low back pain for awhile, a lot of money has already been spent for treatments that would hold for only a short time getting off the table. likewise there are models of back pain that suggest it's related to promarily to an emotional state - like anger or job dissatisfaction. Treat the anger; get rid of the pain. I'd encourage folks who are interested in this to investigate further with work like John Sarno's Mind/Body connection, where back pain is seen as psychosomatic, and an example of "Tension myosititis syndrome"
aside. I'd note that the first key study, the Boeing Prospective Study, widely studied and critiqued, that first suggested that the only consistent correlation with back pain was job dissatisfaction was done with shop floor workers (people who spend a lot of time on their feet). When the study was re-run with people who work at desks and also have high incidence of back pain that specific correlation did not, alas hold (pdf). What did hold is that, as we know about pain now, context plays a not insignificant role in pain creation/management. Or as some put it, psychosocial AND biomechanical issues can promote causes.
Work in what pain is, and how it works in the brain, however, shows that pain is toujours deja multi-factorial, and highly context dependent. BUT work in pain also shows that as it does manifest itself in very real neural adaptations. More on this below around "central wind up."
Breakthrough with the Percpetual Systems
During the six days of the Z-health R-phase certification, i had a couple sessions with Eric Cobb. He looked at not only movement (what Z-health is perhaps best known for) but vision and balance stuff as well. The experience was huge and transformative.
Since then i and colleagues have worked with TONS of athletes with chronic low back issues and have been able to help them move through the chronic-icity. How does this approach succeed where so many have not?
getting to the nervous system
Z-health puts the nervous system first by focusing on proprioception, and visual and vestibular perceptions of the world. The approach of nervous system first (aka threat modulation) always seems to have immediate benefit. The main approach is to check a person's responses to movement, and also visual and vestibular cues. The approach is critically largely active on the part of the participant, likewise invoking motor learning in grooving pain free patterns.
To summarise some reasons for this integrated approach:
low back: location of pain receptors for ANY pain event?
Here's something else about low back stuff. Lots of folks have compressed disks or degenerated discs, or scoliosis and have NO pain - so, especially when the pain becomes chronic - is the site of pain the source of the pain? maybe not.
site of pain mayn't be source of pain
Here's why: The back is a hugely important and highly stressed area of the body. An anthropologist colleague of mine swears it's an example of terrible/incomplete evolution. In some models of the body, the back like a big X - things cross from the right side on the lower body up to the left side of the upper body. So the low back again is a HUGE junction for LOTS of information.
As pain goes up, ironically sometimes with repeated poking via movement during an acute stage (that wretched "train through pain" thing), the number of nociceptors (the nerves that detect noxious stimulus) go up; mechanorecpetors that signal movement/position go down or get shut down. Normally, when mechanoreceptive stimulation more or less outnumbers nociceptive stimulation, the pain signal is effectively drownd out. That effect, in other words, can get broken.
AND what's worse is that there seems to be evidence that MORE nociceptive nerves sprout with increased immobility: the more we might reflexively try to protect our back by not moving it, the more we may be contributing to signaling that will continue to amp up any pain signal.
rewiring the back over time to be THE pain receiver
What these changes amount to with chronic pain, or as pain goes chronic is sometimes refered to as neural chunking or central wind up (more here and here). In other words, at this point, any pain/stress signals from anywhere may just start to manifest in the low back - that's become our response zone. That doesn't mean the pain is not happening; just that the brain/nervous system is now routing pain signaling through that super sensitive place. and it has been super sensitized, and so it may well be amplifying what's happening, too.
It's because of all this neuro-chemical soup (to use david butler's analogies from the Senstive Nervous System) happening that sometimes looking for issues in a back joint is not going to "unwind" the pain issue.
So to all you folks who have tried everything and are frustrated and in low back hell? may i recommend considering an active/neurologically sensitive approach? In brief, this means in part, begin to move. But also check what else may be inhibiting good movement.
As to the first part of that suggestion, if you'd like to see the research, Mike Nelson did a nice piece a year ago looking at the literature on why lumbar motion is such a good tonic for the back.
This doesn't necessarily mean huge movements, but it does mean, it seems, working towards full range of motion work in the back - and of course muscular work can be hugely beneficial for a number of reasons here to support that mobility (controlled movement) - but without that specific attention to ROM - something back muscle work alone does not necessarily afford - the benefit mayn't be complete.
Additionally, it may be critical to connect that proprioceptive signaling (nociceptors and mechanoreceptors that modulate signals that get interpretted as pain or not) with the rest of the perceptual systems: vestibular and visual.
Speaking for myself, it was not until my mobility work got hooked up with what turned out to be visual rehab work that my back pain started unwinding. Not this is necessarily the case with everyone, but with me, once the visual work got going, the speed of the unwinding was profound. I mean super rapid, overnight kind of profound.
Release. For anyone who's had low back pain, or has it now, you know what a prison it can feel like: will i ever be able to put my socks on without pain? pick something up from the ground without pain? drive or get in or out of a car without pain? sit and work without pain? bathe without pain?
Speaking for myself, yes. Before working with this approach, i used to get pain-free moments when i'd bend over to pick something up, and there'd be no pain. Nothing. normal. It was like a miracle. The number of times this happened over a decade i could count on one hand. i remember once starting to cry because it felt so incredible and i knew it wasn't going to last, and i so wanted it to last. Perhaps some of you can relate to that?
Understanding Pain and the Role of Movement to Reclaim Life
So, what all the above is speaking to is two things: getting a handle on what's happening with
pain, and getting an approach to movement/nervous system communication that can start to rewire the very neurological and brain-based experience of pain. In the book Explain Pain, this is largely David Butler's advice: learn how pain works; learn how to move.
To this i have only added what z-health refines a wee bit: movement is a great way to talk to the nervous system. Remember that visual and vestibular issues may also be contributors to pain, so find a way to check that and engage them in one's movement rehab practice.
Doing It for Herself/Himself
What is a movement rehab practice that will also check the visual and vestibular?
Best approach: see a movement specialist for a Movement Assessment (what that is). In this list, preferably look for someone with either S or T certifications (or both), or a master trainer.
Likewise, if someone's not close with the qualifications, i do video consults, too (use the email link on this post to request info).
Secondary & Complementary approach: get a joint mobility program into your life. Moving each joint through a range of motion is an amazingly good way to talk to the nervous system. here's more on why and if you scroll down to "dig in" there's some recommended places of guided packages for that, eg the "level 1" kit.
The best part is, really, when we have an better understanding of how pain works, and how the nervous system works in terms of proprioception, vision and the vestibular sysetms, there's a path to start unwinding that. AND YOU DO IT FOR YOURSELF so it sticks.
The big take away seems to be that especially chronic low back pain is frequently not about the joints - pain is way more interesting and intriguing it seems than that, but it does make sense that the low back is where so much chronic pain gets filtered.
Moving towards an active, neurologically centered approach, based on an understanding of pain, may well offer the breakthrough that you seek.
The best part is, you will know, more or less on the spot, if this practice offers you the relief you seek, and each practice session will only enhance that benefit. Really - that's just how fast the nervous system works. Tweet Follow @begin2dig
Going Chronic This post is motivated by the fact that a lot of folks ask about low back pain issues after they've had them for awhile. They've gone from acute - a sudden sharp pain brought on by a specific movement pretty predictably - to something chronic that can be a constant presence, as well as flaring up from time to time, but without a specific acute area that's sharp. It's a nasty thing that can, when flaring, debilitate a person. It is the proverbial monkey on the back, and it can make ya cry. I could go on and on.
In such advice-seeking experiences, many folks recommend chiros, phyiscal therapists, massage, exercises for the low back muscles and so on. All these things can bring benefit. In my experience though, if that back pain has been going on for months/years we're talking chronic, manually therapy has a much harder time addressing this. In my own experience, muscle work like yoga and kettlebells has brought some relief - more so than manual therapies - but not eliminated the problem.
The following offers some other ideas for dealing with low back pain - both at an early and definitely at an ongoing stage. The focus is really on models of pain as opposed to particular back issues.
context
First of all some context: me: like most folks with low back stuff - compressed l4/l5, long history of chronic back stuff. Chiro, pt, acupuncture, orthotics, heel lifts. shots and surgery offered - na thanks.
On the more physical approaches, as said, Yoga therapy worked a bit better than anything else; kettlebell swinging really helped but still chronic flare ups. Both these approaches were based on the theory that the muscles in the back are potentially weak or out of balance and needed to be rebuilt. As said, helped a lot but the chronic flare ups were not addressed; ROM still limited by pain etc. So rebuilding alone is not (at least for me) a complete answer.
Like a few who've been dealing with low back pain for awhile, a lot of money has already been spent for treatments that would hold for only a short time getting off the table. likewise there are models of back pain that suggest it's related to promarily to an emotional state - like anger or job dissatisfaction. Treat the anger; get rid of the pain. I'd encourage folks who are interested in this to investigate further with work like John Sarno's Mind/Body connection, where back pain is seen as psychosomatic, and an example of "Tension myosititis syndrome"
aside. I'd note that the first key study, the Boeing Prospective Study, widely studied and critiqued, that first suggested that the only consistent correlation with back pain was job dissatisfaction was done with shop floor workers (people who spend a lot of time on their feet). When the study was re-run with people who work at desks and also have high incidence of back pain that specific correlation did not, alas hold (pdf). What did hold is that, as we know about pain now, context plays a not insignificant role in pain creation/management. Or as some put it, psychosocial AND biomechanical issues can promote causes.
Work in what pain is, and how it works in the brain, however, shows that pain is toujours deja multi-factorial, and highly context dependent. BUT work in pain also shows that as it does manifest itself in very real neural adaptations. More on this below around "central wind up."
Breakthrough with the Percpetual Systems
During the six days of the Z-health R-phase certification, i had a couple sessions with Eric Cobb. He looked at not only movement (what Z-health is perhaps best known for) but vision and balance stuff as well. The experience was huge and transformative.
Since then i and colleagues have worked with TONS of athletes with chronic low back issues and have been able to help them move through the chronic-icity. How does this approach succeed where so many have not?
getting to the nervous system
Z-health puts the nervous system first by focusing on proprioception, and visual and vestibular perceptions of the world. The approach of nervous system first (aka threat modulation) always seems to have immediate benefit. The main approach is to check a person's responses to movement, and also visual and vestibular cues. The approach is critically largely active on the part of the participant, likewise invoking motor learning in grooving pain free patterns.
To summarise some reasons for this integrated approach:
- it works with the nervous system - the body's governing system (what runs joints and muscles)
- it is active rather than passive (about the differences between the two, with video): you are moving yourself rather than being manipulated, which fires of thousands more signals in the body to learn new patterns than manipulations so benefits stick.
- it works in large part on threat reduction: the latest work on pain says pain is an action signal. it means change something. finding the right thing to change is part of the assessment process. i've yet to work with anyone who hasn't had immediate and significant pain reduction (or elimination) and that only improves as they continue to do the work FOR THEMSELVES.
low back: location of pain receptors for ANY pain event?
Here's something else about low back stuff. Lots of folks have compressed disks or degenerated discs, or scoliosis and have NO pain - so, especially when the pain becomes chronic - is the site of pain the source of the pain? maybe not.
site of pain mayn't be source of pain
Here's why: The back is a hugely important and highly stressed area of the body. An anthropologist colleague of mine swears it's an example of terrible/incomplete evolution. In some models of the body, the back like a big X - things cross from the right side on the lower body up to the left side of the upper body. So the low back again is a HUGE junction for LOTS of information.
As pain goes up, ironically sometimes with repeated poking via movement during an acute stage (that wretched "train through pain" thing), the number of nociceptors (the nerves that detect noxious stimulus) go up; mechanorecpetors that signal movement/position go down or get shut down. Normally, when mechanoreceptive stimulation more or less outnumbers nociceptive stimulation, the pain signal is effectively drownd out. That effect, in other words, can get broken.
AND what's worse is that there seems to be evidence that MORE nociceptive nerves sprout with increased immobility: the more we might reflexively try to protect our back by not moving it, the more we may be contributing to signaling that will continue to amp up any pain signal.
rewiring the back over time to be THE pain receiver
What these changes amount to with chronic pain, or as pain goes chronic is sometimes refered to as neural chunking or central wind up (more here and here). In other words, at this point, any pain/stress signals from anywhere may just start to manifest in the low back - that's become our response zone. That doesn't mean the pain is not happening; just that the brain/nervous system is now routing pain signaling through that super sensitive place. and it has been super sensitized, and so it may well be amplifying what's happening, too.
It's because of all this neuro-chemical soup (to use david butler's analogies from the Senstive Nervous System) happening that sometimes looking for issues in a back joint is not going to "unwind" the pain issue.So to all you folks who have tried everything and are frustrated and in low back hell? may i recommend considering an active/neurologically sensitive approach? In brief, this means in part, begin to move. But also check what else may be inhibiting good movement.
As to the first part of that suggestion, if you'd like to see the research, Mike Nelson did a nice piece a year ago looking at the literature on why lumbar motion is such a good tonic for the back.
This doesn't necessarily mean huge movements, but it does mean, it seems, working towards full range of motion work in the back - and of course muscular work can be hugely beneficial for a number of reasons here to support that mobility (controlled movement) - but without that specific attention to ROM - something back muscle work alone does not necessarily afford - the benefit mayn't be complete.
Additionally, it may be critical to connect that proprioceptive signaling (nociceptors and mechanoreceptors that modulate signals that get interpretted as pain or not) with the rest of the perceptual systems: vestibular and visual.
Speaking for myself, it was not until my mobility work got hooked up with what turned out to be visual rehab work that my back pain started unwinding. Not this is necessarily the case with everyone, but with me, once the visual work got going, the speed of the unwinding was profound. I mean super rapid, overnight kind of profound.
i remember once starting to cry because for a moment - i was out of pain - i knew it because could put on my socks without my back killing me - it felt so incredible and i knew it wasn't going to last, and i so wanted it to last...
Release. For anyone who's had low back pain, or has it now, you know what a prison it can feel like: will i ever be able to put my socks on without pain? pick something up from the ground without pain? drive or get in or out of a car without pain? sit and work without pain? bathe without pain?
Speaking for myself, yes. Before working with this approach, i used to get pain-free moments when i'd bend over to pick something up, and there'd be no pain. Nothing. normal. It was like a miracle. The number of times this happened over a decade i could count on one hand. i remember once starting to cry because it felt so incredible and i knew it wasn't going to last, and i so wanted it to last. Perhaps some of you can relate to that?
Understanding Pain and the Role of Movement to Reclaim Life
So, what all the above is speaking to is two things: getting a handle on what's happening with
pain, and getting an approach to movement/nervous system communication that can start to rewire the very neurological and brain-based experience of pain. In the book Explain Pain, this is largely David Butler's advice: learn how pain works; learn how to move.To this i have only added what z-health refines a wee bit: movement is a great way to talk to the nervous system. Remember that visual and vestibular issues may also be contributors to pain, so find a way to check that and engage them in one's movement rehab practice.
Doing It for Herself/Himself
What is a movement rehab practice that will also check the visual and vestibular?
Best approach: see a movement specialist for a Movement Assessment (what that is). In this list, preferably look for someone with either S or T certifications (or both), or a master trainer.
Likewise, if someone's not close with the qualifications, i do video consults, too (use the email link on this post to request info).
Secondary & Complementary approach: get a joint mobility program into your life. Moving each joint through a range of motion is an amazingly good way to talk to the nervous system. here's more on why and if you scroll down to "dig in" there's some recommended places of guided packages for that, eg the "level 1" kit.
The best part is, really, when we have an better understanding of how pain works, and how the nervous system works in terms of proprioception, vision and the vestibular sysetms, there's a path to start unwinding that. AND YOU DO IT FOR YOURSELF so it sticks.
The big take away seems to be that especially chronic low back pain is frequently not about the joints - pain is way more interesting and intriguing it seems than that, but it does make sense that the low back is where so much chronic pain gets filtered.
Moving towards an active, neurologically centered approach, based on an understanding of pain, may well offer the breakthrough that you seek.
The best part is, you will know, more or less on the spot, if this practice offers you the relief you seek, and each practice session will only enhance that benefit. Really - that's just how fast the nervous system works. Tweet Follow @begin2dig
PDF
Monday, December 7, 2009
Supplement Curmudgeon: Does that DO anything for you?
Follow @mcphoo
Tweet
I've recently come to the conclusion that i think i've become a training supplement curmudgeon. Anytime i see someone on an associated forum asking about where they can get a good brand of glutamine or even bcaa's but especially anything nitric oxidyish, i find my eyeballs rolling.
What do we know about longitudinal responses to stuff that
shows these refined fractions do anything marvelous? As far as i know the assessment of glutamine from 2002 that unless you're training at altitude, or have GI distress from malto/dextro carbs, it's a good thing to use, has only been reaffirmed (see overview 2007). And yet it keeps showing up in formulas of stuff.
Likewise there are legions of studies to show that BCAA's are wonderful, but when compared with plain old Whey, whey rules. It also seems that if there were any remaining doubt about creatine monohydrate vs creatine ethyl esther, this year's research has raised sufficient questions about CEE to say CM is once again affirmed as the winner. Again.
And as for nitric oxide supplements, i'm willing to own that i may be wrong, but the resaerch has only shown that without it, protein synthesis does not occur - if NO is chemically surpressed. Having more of it present doesn't - again as far as i can tell from extant research - increase protein synthesis. There are other ways to get a pump - though it's not clear getting a pump aids protein synthesis either.
Supplements That Support What we Want to Do: Work.
As far as i can tell, the supplements that seem to have the best value are those that support energy production, and then support protein synthesis. So, we seem to know that after 20 years of research, creatine monohydrate is good for grinding out a few more quality intense reps. Nice.
We also seem to see promise in Beta Alanine for energy production and some recent studies have looked at *perceived* fatigue reduction in athletic contexts like football games. Rather surprising, but interesting. Worth looking at.
After this, the most research seems to be around getting some carbs and proteins into a person after a workout (carbs are needed for protein synthesis if muscle building of any kind is the aim). But even here, nutrient timing is not established unequivocably, but the nutrient requirements are. And here, it seems things closer to a food - like whey vs bcaa's - may have better effect.
These are the basics. Now, there's all sorts of stuff out there to give one's workouts a boost - to get charged up to go GRRR. But again, as far as i can tell, the two main ingredients in such combinations usually come down to caffeine and/or l-tyrosine (sometimes taurine). Tyrosine i do like once in awhile in lieu of caffeine. But what is the point of this? Why does one need/want to get caffenated to work hard? As work earlier this year showed, one actually gets substantial performance benefits from surprisingly small amounts of caffeine (not coffee. alas, there's a difference).
Reality Check
About two years ago, determined to explore the range of possible ways to get my teeth into my workouts, i ordered as many ingredients as i could see listed on most t-nation type products like power drive, surge, or products like Xtreme ICE etc. I chatted with folks at precision nutrition's forum about various CNS stacks like this one by john berardi for competition/heavy training schedules.
Yes i gave these a go. I honestly don't know if they did much for my workouts. I think the tyrosine is a great perker upper and focuser, sometimes surreally so -but - and this is the really deep part - how often do i work out when i actually need to be more in the zone of my workout? like i won't complete it without that? Or, should i not do so (hasn't happened in ages), it would make a difference in the not even grand but rather immediate scheme of things?
My workouts are generally pretty pre-planned: eg today is medium day of RTK; tomorrow will be VWC. A good sleep will enable each better than anything else, i'm finding, more than priming with coffee, taurine or anything else. What am i missing? Am i missing something?
Going Clear: personal realities
About a week ago i gave away a shed load of supplements from DMEA, chocomine, and related cns stack ingredients listed above, and even including a bag of maltodextrin. The latter was because i knew it was produced from corn in the US that is GMO'd sourced, and since seeing Food Inc, i do not want to go there. But more on that anon.
It was shortly after this, i saw word of a new product from t-nation called Anaconda.
"The only question is, are you that serious?" the ad asks. - Where one is already Huge and into working out three times a day. No. i guess i'm not that serious, if that's what serious means.
And that's sorta what my supplement curmudgeonliness has come down to:
what will work to best support what i ACTUALLY do, as opposed to imagining the scenario for which most of these supplements are designed - with a mix of science perhaps and a lot of speculation - to support? Because of course to state the obvious, taking supplements won't make it so, where IT is whatever the body comp goal is.
For me, the complexity is now at about is there really a benefit to taking the protien/carbs (and i happen to add creatine then so i don't forget it) right before and right after the workout or not? And if not, does it really matter? is that what's going to be the real difference between me adding another fraction of an inch of mass to my arms or not? Hard to see from this vantage point that it would.
Getting Real is Sometimes More Challenging than Getting Intrigued
When we get into health and fitness it seems we work so hard to get the details perfect. There's a certain satisfaction, isn't there, to things being just so. The gymboss timer is set for exactly 36/36 for those intervals or 8/12 or whatever. I have been just as particular. To the point of ripping the skin off my hands in doing snatches in a VWC set lest pausing to tape up so i can actually get through the workout break the stride. I must get through the workout without pause.
It's taken awhile for the Voice to come through the noise to say "Why? "
Indeed, what real difference will it make to my fitness goals if i stop to wrap? what real difference will it definitely make if i don't?
Metabolic Flexibility
Listening to Mike T Nelson talk this summer at the Sustenance course about Metabolic Flexibility has helped me start to get my head around the awesome adaptability of our embodied selves. If we ain't got it raw, our bodies will try to manufacture it. If we don't have it right NOW our bodies will find mechanisms to find what it needs. In fact the more non-predictive we become in our patterns potentially the more robust our systems will be - that's just a guess.
So i guess i've gotten either rather skeptical about supplementation or way more relaxed about thinking one supplement will help, for instance, unlock a "hard" workout.
I keep thinking about Clarence Bass: he likes creatine (and that only after quite a period of personal testing and validating with research) and he likes whey protein powder and he is the daddio of whole foods lean eating. He may be a sample size of one but lots of folks using his approach seem very happy with their body comp and health.
Me, i like creatine - and do notice a difference between creapure, the nice pure german stuff, and generics. I like a hydo whey for post workouts, along with a nice mix of non-gmo starchy carbs and electrolytes. I personally tend to do half before a workout and half right after for convenience, and i personally seem to feel better than delaying on that.
The jury is out for me on taurine, tyrosine, beta alanine and citruline malate - though again the science seems promising on those last two.
Sleep that knits up the unraveled sleeve of care
One of the biggest things for me of late has been the difference uninterrupted sleep makes, and investigating that - and how regular nutrition/daily diet is related to that, and the benefits from that, vs just about anything else. That sounds rather boring though in comparison to a CNS stack, doesn't it? I'm not sure it's a lack of seriousness; more a oh let's get real-ness perhaps.
Know what i mean? anyone? Tweet Follow @begin2dig
What do we know about longitudinal responses to stuff that
shows these refined fractions do anything marvelous? As far as i know the assessment of glutamine from 2002 that unless you're training at altitude, or have GI distress from malto/dextro carbs, it's a good thing to use, has only been reaffirmed (see overview 2007). And yet it keeps showing up in formulas of stuff.Likewise there are legions of studies to show that BCAA's are wonderful, but when compared with plain old Whey, whey rules. It also seems that if there were any remaining doubt about creatine monohydrate vs creatine ethyl esther, this year's research has raised sufficient questions about CEE to say CM is once again affirmed as the winner. Again.
And as for nitric oxide supplements, i'm willing to own that i may be wrong, but the resaerch has only shown that without it, protein synthesis does not occur - if NO is chemically surpressed. Having more of it present doesn't - again as far as i can tell from extant research - increase protein synthesis. There are other ways to get a pump - though it's not clear getting a pump aids protein synthesis either.
Supplements That Support What we Want to Do: Work.
As far as i can tell, the supplements that seem to have the best value are those that support energy production, and then support protein synthesis. So, we seem to know that after 20 years of research, creatine monohydrate is good for grinding out a few more quality intense reps. Nice.
We also seem to see promise in Beta Alanine for energy production and some recent studies have looked at *perceived* fatigue reduction in athletic contexts like football games. Rather surprising, but interesting. Worth looking at.
After this, the most research seems to be around getting some carbs and proteins into a person after a workout (carbs are needed for protein synthesis if muscle building of any kind is the aim). But even here, nutrient timing is not established unequivocably, but the nutrient requirements are. And here, it seems things closer to a food - like whey vs bcaa's - may have better effect.
These are the basics. Now, there's all sorts of stuff out there to give one's workouts a boost - to get charged up to go GRRR. But again, as far as i can tell, the two main ingredients in such combinations usually come down to caffeine and/or l-tyrosine (sometimes taurine). Tyrosine i do like once in awhile in lieu of caffeine. But what is the point of this? Why does one need/want to get caffenated to work hard? As work earlier this year showed, one actually gets substantial performance benefits from surprisingly small amounts of caffeine (not coffee. alas, there's a difference).
Reality Check
About two years ago, determined to explore the range of possible ways to get my teeth into my workouts, i ordered as many ingredients as i could see listed on most t-nation type products like power drive, surge, or products like Xtreme ICE etc. I chatted with folks at precision nutrition's forum about various CNS stacks like this one by john berardi for competition/heavy training schedules.
80mg caffeine
--CNS stimulation
300mg of green tea extract
--CNS stimulation
3g Tyrosine - (OR 1.5g N-acetyl-L-Tyrosine)
--Epi and Norepi precursor formation (but precursors must form neurotransmitters and these neurotransmitters must be released - the green tea and caffeine assist in NT release)
1g of Lecithin (or Choline) - (OR 100-200mg DMAE)
--AcH precursor formation (but, same as above, these precursors must be released)
15mg Policosanol
--Increases AcH release, decreases AcH breakdown in NM junction, and increases AcH binding affinity (all leading to decreased reaction time)
*10mg Vitamin B6*
--Potentiates the effects of the other ingredients
Yes i gave these a go. I honestly don't know if they did much for my workouts. I think the tyrosine is a great perker upper and focuser, sometimes surreally so -but - and this is the really deep part - how often do i work out when i actually need to be more in the zone of my workout? like i won't complete it without that? Or, should i not do so (hasn't happened in ages), it would make a difference in the not even grand but rather immediate scheme of things?
My workouts are generally pretty pre-planned: eg today is medium day of RTK; tomorrow will be VWC. A good sleep will enable each better than anything else, i'm finding, more than priming with coffee, taurine or anything else. What am i missing? Am i missing something?
Going Clear: personal realities
About a week ago i gave away a shed load of supplements from DMEA, chocomine, and related cns stack ingredients listed above, and even including a bag of maltodextrin. The latter was because i knew it was produced from corn in the US that is GMO'd sourced, and since seeing Food Inc, i do not want to go there. But more on that anon.
It was shortly after this, i saw word of a new product from t-nation called Anaconda.
"The only question is, are you that serious?" the ad asks. - Where one is already Huge and into working out three times a day. No. i guess i'm not that serious, if that's what serious means.
And that's sorta what my supplement curmudgeonliness has come down to: what will work to best support what i ACTUALLY do, as opposed to imagining the scenario for which most of these supplements are designed - with a mix of science perhaps and a lot of speculation - to support? Because of course to state the obvious, taking supplements won't make it so, where IT is whatever the body comp goal is.
For me, the complexity is now at about is there really a benefit to taking the protien/carbs (and i happen to add creatine then so i don't forget it) right before and right after the workout or not? And if not, does it really matter? is that what's going to be the real difference between me adding another fraction of an inch of mass to my arms or not? Hard to see from this vantage point that it would.
Getting Real is Sometimes More Challenging than Getting Intrigued
When we get into health and fitness it seems we work so hard to get the details perfect. There's a certain satisfaction, isn't there, to things being just so. The gymboss timer is set for exactly 36/36 for those intervals or 8/12 or whatever. I have been just as particular. To the point of ripping the skin off my hands in doing snatches in a VWC set lest pausing to tape up so i can actually get through the workout break the stride. I must get through the workout without pause.
It's taken awhile for the Voice to come through the noise to say "Why? "
Indeed, what real difference will it make to my fitness goals if i stop to wrap? what real difference will it definitely make if i don't?
Metabolic Flexibility
Listening to Mike T Nelson talk this summer at the Sustenance course about Metabolic Flexibility has helped me start to get my head around the awesome adaptability of our embodied selves. If we ain't got it raw, our bodies will try to manufacture it. If we don't have it right NOW our bodies will find mechanisms to find what it needs. In fact the more non-predictive we become in our patterns potentially the more robust our systems will be - that's just a guess.
So i guess i've gotten either rather skeptical about supplementation or way more relaxed about thinking one supplement will help, for instance, unlock a "hard" workout.
I keep thinking about Clarence Bass: he likes creatine (and that only after quite a period of personal testing and validating with research) and he likes whey protein powder and he is the daddio of whole foods lean eating. He may be a sample size of one but lots of folks using his approach seem very happy with their body comp and health.
Me, i like creatine - and do notice a difference between creapure, the nice pure german stuff, and generics. I like a hydo whey for post workouts, along with a nice mix of non-gmo starchy carbs and electrolytes. I personally tend to do half before a workout and half right after for convenience, and i personally seem to feel better than delaying on that.
The jury is out for me on taurine, tyrosine, beta alanine and citruline malate - though again the science seems promising on those last two.
Sleep that knits up the unraveled sleeve of care
One of the biggest things for me of late has been the difference uninterrupted sleep makes, and investigating that - and how regular nutrition/daily diet is related to that, and the benefits from that, vs just about anything else. That sounds rather boring though in comparison to a CNS stack, doesn't it? I'm not sure it's a lack of seriousness; more a oh let's get real-ness perhaps.
Know what i mean? anyone? Tweet Follow @begin2dig
Wednesday, December 2, 2009
Z-Health relative to T'ai Chi, Qigong or any other Movement Oriented Practice
Follow @mcphoo
Tweet
The question has come up, and reasonably so, about 
z-health practice relative to any other mobility approach. The questions go something like this: is Z-Health supposed to replace movement practice X, be as good as X, an alternative to X?
Here's my take on these questions: yes and no. Let me explain what i mean. Movement is great. Anything that has us moving in a healthful way is good. So doing Z-Health as a regular movement practice is fabulous. But if someone already has a movement practice, do they need Z-health?
Joint by Joint Specificity. In movement approaches with which i've had any experience (t'ai chi; qigong) the focus has been on the movement in general rather than on the particular range of motion or quality of movement at a particular joint involved in the full movement. One of my favorite examples of such movement is Steve Cotter's excellent series on the Tea Cup pattern:
And then there's this fabulous turn of the last century look at indian clubs with kids:
These are excellent examples of mobility work - especially as shown for the upper body.
So why Z-Health Mobility Drills? Z-Health's drills move joint by joint so that a person can focus on each joint's movement. For instance, with many versions of shoulder drill to be able to check the joint's entire range of motion, it becomes easier to see where there may be specific challenges to a movement. For instance, trying to do shoulder circles that reach behing a person, without the torso torquing back along with the shoulder suggests that may be a place for some work to get better control of that *part* of shoulder motion.
Joint by Joint Assessment. In R-phase, each of these movements are assessed in "neutral stance" - standing upright - in order to focus specifically on the joint action. In I-phase, these basics are translated to movements that can be applied to sport-specific/life type movements (more on i-phase templates here). For instance, it may be that a person has found in R-phase that their thoracic mobility seems pretty free. However, their sport requires them to turn around while running to leap up and catch a football, and their reach seems a bit restricted when turned around and extending the arms. Z-health i-phase says, ok, let's assume that position, and see what's happening in the movement - how's the thoracic freedom there? let's practice it from that position.
Speed Z-Health also suggests that beyond controlling these joint by joint movements at one speed they need to be controlled at all speeds. To this end, z-health uses four speeds - where speeds test different attributes of movement from strength to control of form.
Eric Cobb leading cross body figure 8's in Neural Warm Up I (about)
What these specific joint by joint movements enable, therefore, beyond a mobility practice, is a way to assess, support and enhance performance of one's chosen endeavor, whether that's playing football, lifting a load, or dealing with carpal tunnel syndrome from desk jockying, because each joint movement can be explored, and its effects on a whole movement assessed.
Sport Specific Assessment Checks. For example, if a deadlift doesn't feel that great on a given day, I-phase drills offer mobility checks in that sport-specific, deadlift position. For example, suppose the weirdness is felt just as the bar comes off the floor. The person can hold that position and work through wrists, elbows, thoracics, and/or hips and so on, doing drills for one or all of these joints, doing a test for effectiveness, and then re-trying the move.
Sometimes all it takes to improve a movement is to open up the joint mobility of a particular movement to help it become smoother. These drills afford a direct route to working the joints from that sport-specific position which may be more challenging to determine with a tai chi movment. Therefore, the mobility drills offer an immediate way to assess and tune movement practice. These simple but highly specific joint-by-joint drills afford this kind of specific, testable assessment at any time. And sometimes, that's enough.
Visual and Vestibular Work. Here's something else that assessments in z-health offer, and are explored either in one-on-one's with trainers (listing), or at the Z-Health workshop (overview here) and these are visual and vestibular practices and assessments.
Sometimes, a performance issue is not related solely to muscles and joints, but to vision or balance as well. In the Nerual Warm Up I & II and in the S-Phase DVD's especially, there are suites of vision drills, and working up to S-Phase, balance work as well. By learning about visual and vestibular practices, and how these co-ordinate with mobility work to improve movement quality on-the-go, one's athletic practice may be further enhanced.
Complementary Action. This is just a brief overview of a few ideas in Z-Health and how they can complement an athletic endeavor. R, I and S offer mobility, vision and balance work on their own to complement sports/athletic work. Where one already has a full body mobility program, because of the specificity of the proprioceptive, visual and vestibular drills offered, in particular the joint-by-joint drills, it is possible to pin point areas of practice that may benefit from specific focused drills.
Related Posts
z-health practice relative to any other mobility approach. The questions go something like this: is Z-Health supposed to replace movement practice X, be as good as X, an alternative to X?Here's my take on these questions: yes and no. Let me explain what i mean. Movement is great. Anything that has us moving in a healthful way is good. So doing Z-Health as a regular movement practice is fabulous. But if someone already has a movement practice, do they need Z-health?
Joint by Joint Specificity. In movement approaches with which i've had any experience (t'ai chi; qigong) the focus has been on the movement in general rather than on the particular range of motion or quality of movement at a particular joint involved in the full movement. One of my favorite examples of such movement is Steve Cotter's excellent series on the Tea Cup pattern:
And then there's this fabulous turn of the last century look at indian clubs with kids:
These are excellent examples of mobility work - especially as shown for the upper body.
So why Z-Health Mobility Drills? Z-Health's drills move joint by joint so that a person can focus on each joint's movement. For instance, with many versions of shoulder drill to be able to check the joint's entire range of motion, it becomes easier to see where there may be specific challenges to a movement. For instance, trying to do shoulder circles that reach behing a person, without the torso torquing back along with the shoulder suggests that may be a place for some work to get better control of that *part* of shoulder motion.
Joint by Joint Assessment. In R-phase, each of these movements are assessed in "neutral stance" - standing upright - in order to focus specifically on the joint action. In I-phase, these basics are translated to movements that can be applied to sport-specific/life type movements (more on i-phase templates here). For instance, it may be that a person has found in R-phase that their thoracic mobility seems pretty free. However, their sport requires them to turn around while running to leap up and catch a football, and their reach seems a bit restricted when turned around and extending the arms. Z-health i-phase says, ok, let's assume that position, and see what's happening in the movement - how's the thoracic freedom there? let's practice it from that position.
Speed Z-Health also suggests that beyond controlling these joint by joint movements at one speed they need to be controlled at all speeds. To this end, z-health uses four speeds - where speeds test different attributes of movement from strength to control of form.
Eric Cobb leading cross body figure 8's in Neural Warm Up I (about)Sport Specific Assessment Checks. For example, if a deadlift doesn't feel that great on a given day, I-phase drills offer mobility checks in that sport-specific, deadlift position. For example, suppose the weirdness is felt just as the bar comes off the floor. The person can hold that position and work through wrists, elbows, thoracics, and/or hips and so on, doing drills for one or all of these joints, doing a test for effectiveness, and then re-trying the move.
Sometimes all it takes to improve a movement is to open up the joint mobility of a particular movement to help it become smoother. These drills afford a direct route to working the joints from that sport-specific position which may be more challenging to determine with a tai chi movment. Therefore, the mobility drills offer an immediate way to assess and tune movement practice. These simple but highly specific joint-by-joint drills afford this kind of specific, testable assessment at any time. And sometimes, that's enough.
Visual and Vestibular Work. Here's something else that assessments in z-health offer, and are explored either in one-on-one's with trainers (listing), or at the Z-Health workshop (overview here) and these are visual and vestibular practices and assessments.
Sometimes, a performance issue is not related solely to muscles and joints, but to vision or balance as well. In the Nerual Warm Up I & II and in the S-Phase DVD's especially, there are suites of vision drills, and working up to S-Phase, balance work as well. By learning about visual and vestibular practices, and how these co-ordinate with mobility work to improve movement quality on-the-go, one's athletic practice may be further enhanced.
Complementary Action. This is just a brief overview of a few ideas in Z-Health and how they can complement an athletic endeavor. R, I and S offer mobility, vision and balance work on their own to complement sports/athletic work. Where one already has a full body mobility program, because of the specificity of the proprioceptive, visual and vestibular drills offered, in particular the joint-by-joint drills, it is possible to pin point areas of practice that may benefit from specific focused drills.
Related Posts
- Z-Health Article Index
- General Fitness articles
- Kettlebell practice articles
- interview with Brett Jones about Indian Club Swinging
- Kali Sticks, Indian Clubs and Rannoch
Tuesday, December 1, 2009
Eye Position to support Rowing Stroke. Awesome Efficiency
Follow @mcphoo
Tweet
I've written before (kb front squat | arthrokinetic reflex) about what i've learned in z-health about connecting eye movements with actions: up for extension; down for flexion. Feeling rather thick in retrospect, i finally applied this reflexive approah to the rowing stroke phases, where i use Kenneth Jay's VWC translated to a water rower rather than KB's with the 36:36 protocol (vwc overview if this thing's new to you).
Smooth? By looking down coming into the catch and looking (not head tilting but using my eyes) up just before pushing back into the power stroke, here's what i noticed: the drive was WAY (i mean WAY) smoother. The funny part is i felt that i had more smoothness than muscle - like part of the effort was so much easier but my muscles were still fatiguing appropriately. It's weird to describe.
xeno muller talking breathing when rowing with the Water Rower
If you try it give it a go: see if you can feel the difference between rowing without thinking about eye position, and then trying with eye position.
Avoiding Back Collapse. It's important (at least for me) to avoid total flexion collapse which is a place it's real easy to degrade to: rowing with a slumped back. Good form has good back neutral throughout, uses the hips and has only some flexion at the end of the drive, complemented by good extension going into the recovery - reaching more with the arms and bending at the hips (like a kb snatch) than curving over.
The eye-up also helped get into good hip and back extension for both the end of the drive and coming back into recovery. I may play next session with keeping eyes neutral rather than down for the recovery, and just up for the drive.
The Eye's Do It. So if you row regularly or as part of your cardio/endurance regimen, consider eye movements.
And heck if you're just getting into rowing or want to consider it, take a look at xeno muller's channel. His stuff is v.good. And ok, yes if you're thinking about putting a rower into your life, sure no one ever got fired for getting a concept II, but just *listen* to the water rower in Xeno's vids. Sweet machine; great great movement. Tweet Follow @begin2dig
Smooth? By looking down coming into the catch and looking (not head tilting but using my eyes) up just before pushing back into the power stroke, here's what i noticed: the drive was WAY (i mean WAY) smoother. The funny part is i felt that i had more smoothness than muscle - like part of the effort was so much easier but my muscles were still fatiguing appropriately. It's weird to describe.
xeno muller talking breathing when rowing with the Water Rower
If you try it give it a go: see if you can feel the difference between rowing without thinking about eye position, and then trying with eye position.
Avoiding Back Collapse. It's important (at least for me) to avoid total flexion collapse which is a place it's real easy to degrade to: rowing with a slumped back. Good form has good back neutral throughout, uses the hips and has only some flexion at the end of the drive, complemented by good extension going into the recovery - reaching more with the arms and bending at the hips (like a kb snatch) than curving over.
The eye-up also helped get into good hip and back extension for both the end of the drive and coming back into recovery. I may play next session with keeping eyes neutral rather than down for the recovery, and just up for the drive.
The Eye's Do It. So if you row regularly or as part of your cardio/endurance regimen, consider eye movements.
And heck if you're just getting into rowing or want to consider it, take a look at xeno muller's channel. His stuff is v.good. And ok, yes if you're thinking about putting a rower into your life, sure no one ever got fired for getting a concept II, but just *listen* to the water rower in Xeno's vids. Sweet machine; great great movement. Tweet Follow @begin2dig
Saturday, November 28, 2009
Why DHA/EPA of Omega 3's (like fish oil) are Anti-Inflammatory - Q&A with G.Fear, RD
Follow @mcphoo
Tweet
Perhaps you've heard that one of the benefits of omega 3's like fish oil or algae oil is good for among other things, anti-inflammation. Some folks tend to blend things like glucosamine as well with fish oil to enhance anti-inflammation around joints in particular. Have you ever wondered why this stuff works or what the difference is between glucosamine, omega 3's and even what eric cobb refers to as Vitamin I, the NSAID Ibuprofen?
The following is part of a discussion with Georgie Fear, RD (of AskGeorgie.com), author of the awesomely easy and tasty Dig In recipe book.
The discussion took place on Precision Nutrition's Forum a little over a year ago. (by the way, this exchange is typical of the kind of discussion at PN - here's more about Precision Nutrition if you're interested).
So, the question was to unpack fish oil, glucosamine and NSAIDS. To begin, so how are fish oils anti-inflammatory?
Overall, another take away is that upping the ratio of Omega 3's to Omega 6's (eg eggs) may be a good idea for well-being.
Related Posts:
The following is part of a discussion with Georgie Fear, RD (of AskGeorgie.com), author of the awesomely easy and tasty Dig In recipe book.
The discussion took place on Precision Nutrition's Forum a little over a year ago. (by the way, this exchange is typical of the kind of discussion at PN - here's more about Precision Nutrition if you're interested).
So, the question was to unpack fish oil, glucosamine and NSAIDS. To begin, so how are fish oils anti-inflammatory?
Georgie Fear:So now you know! Taking omega 3 sources rich in EPA like fish oil is a Good Idea for healing and inflammation processing. For folks taking Algae Oil for omega 3 content, algae is higher in DHA than EPA. Work has also considered the effects of DHA on inflammation, and it's looking very good here too. Very new work considering DHA in the mix with EPA on COX2 in particular is strong. Likewise an article from the future (pub date 2010) equates DHA and EPA for their anti-inflammatory benefits. In other words, you can remain a vegetarian and get all these anti-inflam benefits.
Twenty-carbon long omega 6 and omega 6 fatty acids are metabolized in cells to eicosanoids, which are signaling molecules. Cyclooxygenases and lipoxygenases produce the eicosanoids from either arachidonic acid (omega 6) or eicosapentaenoic acid [EPA] (omega 3). The eicosanoids derived from omega 6 fats are potently inflammatory while those coming from omega 3 oils are antiinflammatory.
Critical Bit for Diet: Because the omega 3 and omega 6 fatty acids compete for the cyclooxygenases and lipoxygenases, the balance of omega 3 to omega 6 fats in the diet will influence the overall inflammatory or antiinflammatory effect. Skewing the diet with more omega 3's and less omega 6 produces fewer inflammatory eicosanoids, becuase the omega3s outcompete the 6s for the metabolizing enzymes.
Aspirin and other nonsteroidal anti-inflammatory agents (NSAIDS, like ibuprofen) work similarly, by inhibiting the cyclooxygenase which converts arachidonic acid to inflammatory prostagandin H2. (Ever heard of COX 2 inhibitors, like vioxx? COX = cyclooxygenase) Acetaminophen (Tylenol) has less anti-inflammatory effect, and the mechanism(s) by which it reduces pain aren't totally known. I've read that it may also involve the cannabinoid system in the central nervous system, but I'm not an expert in that so I cant give much detail.
Glucosamine is totally different. It helps mainly with osteoarthritis because it is a building block for the gycosaminoglycans which make up the cartilage in joints. Taking glucosamine can help rebuild the cartilage and cushion joints where the layer has broken down. But as far as I'm aware it doesn't act so directly on the inflammatory cascade.
mc - so fish oil is competing for the Cyclooxygenases but NSAIDS inhibit their production. is that right? Also, on another point: NSAIDS have some icky side effects - in particular water retention. hate that.
GF
Close, the omega 3's outcompete with omega 6s for the COX enzymes, while the NSAIDS inhibit the cyclooxygenases' activity altogether. (So the production of inflammatory eicosanoids is lessened. )
Of course there are more details, like COX1 vs COX2 vs COX3....hence all the different painkillers with different efficacies and side effects. The specificity of different drugs for each isoform varies.
Another anti-inflammatory group of compounds which can be obtained from foods are anthocyanins, thats what my PhD thesis research actually focuses on. I'll skip the mindnumbing detail, but the blue/purple compounds which give the bright colors to blueberries, blackberries, red cabbage, etc are also great functional foods for combating inflammation. And cancer, and diabetes...and cardiovascular disease......
There has been research done in which consuming about 10 tart cherries a day is equivalent to taking a daily aspirin. Personally, Ive seen remarkable benefits of eating fish (oil) and anthocyanin-rich foods in a few clients with rheumatoid arthritis. Not a scientific study, just my own experience. :)
mc so would you say tho that fish oil is going to "mask" an injury??
GF
No I wouldnt say so. Fish oil does nothing to your pain perception, so its not like you will be fooled into thinking an injury is gone when it isn't. It may reduce the discomfort caused by inflammation such as swelling, and in some cases, inflammation actually makes the injury worse. So perhaps taking fish oils could reduce the severity of the injury. Somewhat like applying ice and compression to a sprain keeps the swelling minimal and it heals faster than if you never iced it. [mc -hmm on the ice analogy - a b2d article in the offing about what we really do know about ice or not...]
I'd say its more part of the healing process than masking an injury.
additional thought: anti-inflammatories don't shut off ALL inflammation, (that would not be good!) they just tone it down a bit.
Timing of ingesting fish oil?
GF
The funny thing here is that fish oils don't work on such a short-term basis. Its not like taking them one day or not would make a difference that day. Fatty acids you eat all the assimilated into the phospholipid membranes of all your bodies cells- the downstream effects of the fatty acids are affected by overall fatty acid pool in your body (in this case the omega 6 to omega 3 ratio) - and that doesnt change in one day of taking or not taking fish oils.
Overall, another take away is that upping the ratio of Omega 3's to Omega 6's (eg eggs) may be a good idea for well-being.
Related Posts:
- About Georgie Fear's New Recipe Book for Lean TASTY EASY Eating called Dig In
- About Precision Nutrition on Sale till Dec 2, 2009
- Respect the Fat
- Bone Health (at nopain2.org/geekfit)
- other stuff for joint health: movement like z-health r-phase
Subscribe to:
Posts (Atom)
COACHING with dr. m.c. 
