Wednesday, November 3, 2010
Cola Drinking Frequency Associated with Risk of Metabolic Syndrome
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Metabolic Syndrome (MetS) is a condition we hear about increasingly that relates usually to pre-diabetes (type II), obesity and other factors that create a perfect storm of mainly lifestyle-oriented disease.
A recent report that looked at a survey of near 18000 people in Norway shows a pretty strong correlation between something as simple as cola consumption and MetS.
The simple take away is: drinking more than one glass of cola a day, coupled with ANY of the risk factors associated with MetS means the likelihood of getting MetS goes up significantly. The post discusses the study and concludes with a few possible strategies & resources.
The abstract of the study follows:
What does this result mean? The authors looked at two measures of Metabolic Syndrome. First, they used the MetSRisk requirements whicn = obesity + any 2 of the following: increased triglycerides (fatty acids ), low HDL cholesterol (usually refered to as the good stuff cholesterol - but really it's ratios of high and low that are important), increased blood pressure, high fasting blood glucose (this latter as i understand it can happen when insulin (a hormone) is out of whack trying to its job to get the glucose from consumed carbs shoved into the cells for use as energy, and it's not working very well).
The authors note that they could not measure fasting glucose rates in the study, so they suggest that the strength of the association they see may well be UNDERestimated, based on reality.
What does Frequency Mean?
Here's how the study measured frequency of intake by creating three main groups:
The authors show that "the frequency of cola intake in model 1 was significantly (p < 0.001 for most) associated with all of the single MetS-related risk factors, with the compound risk estimate of MetSRisk, and with the complete MetS." Right - but how much does that risk go up?
The authors find that the differences bewteen group 1 (rarely/never) and group three (more than 1 glass of cola a day) go up a lot, across all ages and genders:
Waist Circumference and Cola. The authors also actually saw that waist circumference is more strongly associated with cola than BMI. This finding is a rather nice one since so many of us rather question the whole BMI measure. Waist circumference seems a much clearer one to assess.
Take Away
The authors make clear that what they have seen is evidence of an association between cola frequency and MetSRisk. That doesn't show (yet) that there is a causal relationship. That is, they're not saying that someone who kicks back a can of coke daily will be at risk of MetS. What it does suggest however is that the presence of a daily cola intake greater than a glass, along with any of the other MetSRisk factors is a pretty good indicator of trouble ahead. As the authors put it in their discussion of results:
Practice: Awhile ago i proposed mc's change one thing sure fire diet based on the z-health sustenance course work.
In the diet, the approach is to change one thing, one step at a time and an example is to start with one less cola a week, to get to one less a day and so on, building on success. This approach is also inspired by Martha Beck's 4 day win
: create strategies that someone feels are so easy they can't fail.
It seems that for folks struggling with weight loss and feeling like they're doing good things for themselves, thinking about reducing that cola intake may be a great path towards health success.
Readers of b2d know that for those a little more interested in nutrition knowledge and practice, i've found precision nutrition another great place to learn and to build one better habit at a time. Here's a free 45 page overview.
Best with your practice. If you're looking for a coach to help with this process, please shout. Qualifications are over in the about box.
Citation
Survey: please also fill in the begin2dig reader survey if you have a moment. Tweet Follow @begin2dig
Metabolic Syndrome (MetS) is a condition we hear about increasingly that relates usually to pre-diabetes (type II), obesity and other factors that create a perfect storm of mainly lifestyle-oriented disease.A recent report that looked at a survey of near 18000 people in Norway shows a pretty strong correlation between something as simple as cola consumption and MetS.
The simple take away is: drinking more than one glass of cola a day, coupled with ANY of the risk factors associated with MetS means the likelihood of getting MetS goes up significantly. The post discusses the study and concludes with a few possible strategies & resources.
The abstract of the study follows:
Appl Physiol Nutr Metab. 2010 Oct;35(5):635-42.
The Oslo Health Study: Soft drink intake is associated with the metabolic syndrome.
Høstmark AT.
Section of Preventive Medicine and Epidemiology, University of Oslo, Box 1130, Blindern, 0318 Oslo, Norway (e-mail: a.t.hostmark@medisin.uio.no).
Abstract
It has been reported that the frequency of cola intake (COLA) is positively associated with serum triglycerides and negatively associated with high-density-lioprotein (HDL) cholesterol, both components of the metabolic syndrome (MetS). The question now is whether noncola soft drink intake (NCOLA) is associated with MetS. Among the 18 770 participants in the Oslo Health Study, 5373 men and 6181 women had data on COLA and NCOLA and risk factors for MetS (except fasting glucose). Main MetS requirements are central obesity and 2 of the following: increased triglycerides, low HDL cholesterol, increased systolic or diastolic blood pressure, and elevated fasting blood glucose. The MetSRisk index was calculated to estimate many MetS components. Using regression analyses, the association between COLA (NCOLA) and MetS (MetSRisk) was studied. In young (aged 30 years), middle-aged (aged 40 and 45 years), and senior (aged 59 and 60 years) men and women, there was, in general, a positive correlation between COLA and MetSRisk, and between COLA and single MetS risk factors, except HDL cholesterol, which was negatively correlated. A less consistent picture was found for NCOLA. By regression analyses, after adjustment for sex, age, time since last meal, and use of sugar-sweetened soft drinks, a positive association between COLA (NCOLA) and MetSRisk (MetS) was still found. However, when also controlling for cheese, fatty fish, coffee, alcohol, smoking, physical activity, education, and birthplace, only the association with COLA remained significant, irrespective of the presence or absence of sugar. In conclusion, the self-reported intake frequency of soft drinks can be positively associated with MetS.
What does this result mean? The authors looked at two measures of Metabolic Syndrome. First, they used the MetSRisk requirements whicn = obesity + any 2 of the following: increased triglycerides (fatty acids ), low HDL cholesterol (usually refered to as the good stuff cholesterol - but really it's ratios of high and low that are important), increased blood pressure, high fasting blood glucose (this latter as i understand it can happen when insulin (a hormone) is out of whack trying to its job to get the glucose from consumed carbs shoved into the cells for use as energy, and it's not working very well).
The authors note that they could not measure fasting glucose rates in the study, so they suggest that the strength of the association they see may well be UNDERestimated, based on reality.
What does Frequency Mean?
Here's how the study measured frequency of intake by creating three main groups:
For beverages, there were 5 levels: 1, rarely–never; 2, 1 to 6 glasses per week; 3, 1 glass per day; 4, 2 to 3 glasses per day; and 5, 4 or more glasses per day. For the intake frequency of colas and noncolas, the midpoint in each frequency interval was used to calculate a rough approximation of intake per week. To obtain a reasonable number of subjects, the population was divided into 3 intake groups: never–rarely (1999 men; 3302 women); 1 to 6 glasses per week (2302 men; 2086 women); and ≥1 glass per day (1072 men; 793 women).Results on Risk Matching
The authors show that "the frequency of cola intake in model 1 was significantly (p < 0.001 for most) associated with all of the single MetS-related risk factors, with the compound risk estimate of MetSRisk, and with the complete MetS." Right - but how much does that risk go up?
The authors find that the differences bewteen group 1 (rarely/never) and group three (more than 1 glass of cola a day) go up a lot, across all ages and genders:
going from group 1 (intake never–rarely) to group 3 (intake ≥1 glass per day), there was a mean increase in SumRisk points of 16.5% in young men (p < 0.001, 1-way ANOVA, with Bonferroni correction), 11.9% in middle-aged men (p < 0.001), and 11.1% in senior men (p = 0.006). Corresponding percentage increases in the 3 age groups of women were 11.1% (p < 0.001), 12.2% (p < 0.001), and 10.8% (p < 0.001).
Also, intriguingly, the study makes clear that whether or not the cola had real sugar or not didn't make a difference. Diet cola in other words doesn't change the association.
Fig. 1. Relationship between the frequency of cola intake and MetSRisk. Group 1, intake never–rarely; group 2, intake of 1 to 6 glasses per week; group 3, intake of ≥1 glass per day. Number of subjects in cola intake groups 1, 2, and 3, respectively, was, for young (30 y) men, 368, 836, and 433; for middle-aged (40 + 45 y) men, 884, 1009, and 465; and for senior men (59–60 y), 747, 457, and 174. Corresponding numbers in women were 770, 814, and 314 (30 y); 1511, 959, and 370 (40 + 45 y); and 1021, 313, and 109 (59–60 y); mean values, with SE, are indicated. Note the broken axes and the variation in range for the MetSRisk score between age groups.
Waist Circumference and Cola. The authors also actually saw that waist circumference is more strongly associated with cola than BMI. This finding is a rather nice one since so many of us rather question the whole BMI measure. Waist circumference seems a much clearer one to assess.
Take Away
The authors make clear that what they have seen is evidence of an association between cola frequency and MetSRisk. That doesn't show (yet) that there is a causal relationship. That is, they're not saying that someone who kicks back a can of coke daily will be at risk of MetS. What it does suggest however is that the presence of a daily cola intake greater than a glass, along with any of the other MetSRisk factors is a pretty good indicator of trouble ahead. As the authors put it in their discussion of results:
It seems reasonable to assume that the complete MetS takes a long time to develop, presumably several years. Accordingly, preceding the appearance of the complete MetS, metabolic disturbances, reflected in the level of 1 or more MetS-related factors, such as waist circumference, body mass index, serum lipids, and blood pressure, are likely. In keeping with this assumption, the results of this study show a direct relationship between cola intake and many single MetS-related risk factors, as well as the compound variable MetSRisk.What may also be deducible is that, if at risk of MetS, to un-cola oneself may be a great start at backing away from MetS. How do this? how about one really tiny super guaranteed not to fail one step at a time?
Practice: Awhile ago i proposed mc's change one thing sure fire diet based on the z-health sustenance course work.In the diet, the approach is to change one thing, one step at a time and an example is to start with one less cola a week, to get to one less a day and so on, building on success. This approach is also inspired by Martha Beck's 4 day win
: create strategies that someone feels are so easy they can't fail. It seems that for folks struggling with weight loss and feeling like they're doing good things for themselves, thinking about reducing that cola intake may be a great path towards health success.
Readers of b2d know that for those a little more interested in nutrition knowledge and practice, i've found precision nutrition another great place to learn and to build one better habit at a time. Here's a free 45 page overview.
Best with your practice. If you're looking for a coach to help with this process, please shout. Qualifications are over in the about box.
Citation
Høstmark, A. (2010). The Oslo Health Study: Soft drink intake is associated with the metabolic syndrome Applied Physiology, Nutrition, and Metabolism, 35 (5), 635-642 DOI: 10.1139/H10-059
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Tuesday, November 2, 2010
b2d survey now online: please share your views - it's fast and easy
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Hi all,
just put up a wee survey about your b2d experience (here) to help make b2d a better place. It's pretty quick to fill out, but any time one spends is a precious gift. Thanks for your time.
Thanks for your participation.
mc
ps - based on feedback from early survey results i've dug and dug to figure out how to turn on full posts in the RSS feed - these are now on. Hope you enjoy. Tweet Follow @begin2dig
just put up a wee survey about your b2d experience (here) to help make b2d a better place. It's pretty quick to fill out, but any time one spends is a precious gift. Thanks for your time.
Thanks for your participation.
mc
ps - based on feedback from early survey results i've dug and dug to figure out how to turn on full posts in the RSS feed - these are now on. Hope you enjoy. Tweet Follow @begin2dig
Sunday, October 31, 2010
A coffee replacement drink: from the home of kenneth jay
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Today Kenneth Jay of ThreatModulation introduced some of us to a drink to which his partner had introduced him. He says one of the biggest effects of the beverage is that his high octane desire for coffee (can we say tripple shots) has gone way way down. I got to try it today, and yup, it was very satisfying as well as alleviating that urge to splurg on coffee coffee coffee.
here's the recipe as i understood it - and as kenneth generously let me practice is with some of his fresh ingredients:
Variations in proportions suggest themselves, but with all the goodness of ginger (values, science)
that is
That recipe misses the pop of the cayenne and doesn't specify proportions. If one wanted a more intense experience - charleton heston seeing the face of god type intense - i'd contemplate simply adding in wasabi. Kenneth suggested one might also time travel with that combination. Which direction wasn't clear.
Anyway, recommended easy, fresh concoction for to have a go. Let me know what you find.
Related Posts:
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here's the recipe as i understood it - and as kenneth generously let me practice is with some of his fresh ingredients:- fresh ginger, julienned
- fresh lemon slices - i used about a half of a small
- caynne pepper powder - i used a big pinch
- honey - i used a tablespoon
- hot water - i think it was a little better than a liter
- steep for about three minutes - maybe it was five
Variations in proportions suggest themselves, but with all the goodness of ginger (values, science)
that is
Add in the zing of the healing cayenne pepper and the fresh tartness of the powerful lemon against the sweetness of the honey, well it'll clean your pipes to be sure, and does have that satiating effect. I'm hoping to try this back home with manuka honey (the mystery of manuka - and more claims for its theraputic value). Indeed along with some other intriguing beverages, there's a manuka variant of this drink on a NZ wellness site. NZ is the home of that manuka bush that is the flower for this honey.
That recipe misses the pop of the cayenne and doesn't specify proportions. If one wanted a more intense experience - charleton heston seeing the face of god type intense - i'd contemplate simply adding in wasabi. Kenneth suggested one might also time travel with that combination. Which direction wasn't clear.
Anyway, recommended easy, fresh concoction for to have a go. Let me know what you find.
Related Posts:
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Monday, October 25, 2010
50% Lower cal MIXED carb with Moderate Protein better than Higher Carb alone for Greater Endurance
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Want to stay out on your bike longer? There's a nice new study that has entered the energy drink fray, returning to the question of what's a ratio of protein to carbs that's optimal? In this case one measure of optimal is Time to Exhaustion or TTE. Also checked is optimal for what level of effort (below or near ventilatory threshold or VT). Turns out that half the calories (of the right blend of carb types with protein) can give greater, go longer, harder results.
The authors of this study manipulate a couple of variables in interesting ways. First, they decide they want to reduce the total amount of calories in the beverage - so lower the carbs in particular. But then, they want to look at a carb blend rather than just one carb type. So their target is a maltodextrin-dextrose-fructose blend. And then they want to add in some protein, since many studies have shown previously that throwing in some protein seems to have a better endurance effect than carb alone (a few recent examples cited below)
The authors say they were motivated by the desires of cyclists who actually want a lower cal beverage for restoration while on a ride. That makes the question simple: can a better blend of the basics achieve the same or better effect than a higher cal beverage for endurance?
That these authors are asking this question at two distinct ventelatory threshold percentages is also pretty unique.
Here's the abstract:
What's rather interesting to me is not only the lower calories but the carb/protein ratio. Previously, it was asserted that a 4 to 1 ratio of carbs to protein was best for endurance types doing post exercise recovery. Now, these folks aren't really assessing recovery; they're looking at being able to go longer and greater intensity on the bike. And for that a 2:1 ratio of their mixed carb blend is doing the job.
There was speculation back in a 2009 chocolate milk study (thomas09) that checking similar markers, the reason that choclate milk and just plain carb (gatorade) beverage did better than a 4:1 custom drink (endurox) is that chocolate milk has a diverse mix of carbs. Indeed, the authors site another relatively recent study by Currell and Jeukendrup (currell08) that looked at the role of blending carb types and saw an 8% boost in using blended rather than single source carbs for cycling time trials. Similarly a carb/protein blend seems to mean better muscle protection (saunders07).
So, that's good evidence to say let's just go with a blend rather than re-validating that carb blends are better.
One might ask why there were only two treatment conditions in the study: a CHO only drink at 6%, a mixed carb plus protein drink at half the calories. What about the mixed carb drink at half the calories, since we see from related research that mixed is better than straight carbs? The researchers had already done the related studies. They state:
Another nice thing about the study is that the researchers used trained athletes, which means that we're not having to account for level of fitness as a variable. Even food logs for the three days leading up to the trial were assessed. The finding - 50% fewer calories - for extended time to exhaustion when working hard is compelling. As the authors note:
Citations
Related Posts
Want to stay out on your bike longer? There's a nice new study that has entered the energy drink fray, returning to the question of what's a ratio of protein to carbs that's optimal? In this case one measure of optimal is Time to Exhaustion or TTE. Also checked is optimal for what level of effort (below or near ventilatory threshold or VT). Turns out that half the calories (of the right blend of carb types with protein) can give greater, go longer, harder results.The authors of this study manipulate a couple of variables in interesting ways. First, they decide they want to reduce the total amount of calories in the beverage - so lower the carbs in particular. But then, they want to look at a carb blend rather than just one carb type. So their target is a maltodextrin-dextrose-fructose blend. And then they want to add in some protein, since many studies have shown previously that throwing in some protein seems to have a better endurance effect than carb alone (a few recent examples cited below)
That these authors are asking this question at two distinct ventelatory threshold percentages is also pretty unique.
Here's the abstract:
J Strength Cond Res. 2010 Oct;24(10):2577-86.So, great, a lower cal (50% lower) blend of carbs and protein (about 2:1) of their mixed carb +pro beverage does just as well as a higher cal protein drink when moseying along, BUT it kicks statistically significant butt when going near or at VT.
The effect of a low carbohydrate beverage with added protein on cycling endurance performance in trained athletes.
Ferguson-Stegall L, McCleave EL, Ding Z, Kammer LM, Wang B, Doerner PG, Liu Y, Ivy JL.
Exercise Physiology and Metabolism Laboratory, Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA.
Abstract
Ingesting carbohydrate plus protein during prolonged variable intensity exercise has demonstrated improved aerobic endurance performance beyond that of a carbohydrate supplement alone. The purpose of the present study was to determine if a supplement containing a mixture of different carbohydrates (glucose, maltodextrin, and fructose) and a moderate amount of protein given during endurance exercise would increase time to exhaustion (TTE), despite containing 50% less total carbohydrate than a carbohydrate-only supplement. We also sought post priori to determine if there was a difference in effect based on percentage of ventilatory threshold (VT) at which the subjects cycled to exhaustion. Fifteen trained male and female cyclists exercised on 2 separate occasions at intensities alternating between 45 and 70% VO2max for 3 hours, after which the workload increased to ∼74-85% VO2max until exhaustion. Supplements (275 mL) were provided every 20 minutes during exercise, and these consisted of a 3% carbohydrate/1.2% protein supplement (MCP) and a 6% carbohydrate supplement (CHO). For the combined group (n = 15), TTE in MCP did not differ from CHO (31.06 ± 5.76 vs. 26.03 ± 4.27 minutes, respectively, p = 0.064). However, for subjects cycling at or below VT (n = 8), TTE in MCP was significantly greater than for CHO (45.64 ± 7.38 vs. 35.47 ± 5.94 minutes, respectively, p = 0.006). There were no significant differences in TTE for the above VT group (n = 7). Our results suggest that, compared to a traditional 6% CHO supplement, a mixture of carbohydrates plus a moderate amount of protein can improve aerobic endurance at exercise intensities near the VT, despite containing lower total carbohydrate and caloric content.
What's rather interesting to me is not only the lower calories but the carb/protein ratio. Previously, it was asserted that a 4 to 1 ratio of carbs to protein was best for endurance types doing post exercise recovery. Now, these folks aren't really assessing recovery; they're looking at being able to go longer and greater intensity on the bike. And for that a 2:1 ratio of their mixed carb blend is doing the job.
There was speculation back in a 2009 chocolate milk study (thomas09) that checking similar markers, the reason that choclate milk and just plain carb (gatorade) beverage did better than a 4:1 custom drink (endurox) is that chocolate milk has a diverse mix of carbs. Indeed, the authors site another relatively recent study by Currell and Jeukendrup (currell08) that looked at the role of blending carb types and saw an 8% boost in using blended rather than single source carbs for cycling time trials. Similarly a carb/protein blend seems to mean better muscle protection (saunders07).
So, that's good evidence to say let's just go with a blend rather than re-validating that carb blends are better.
One might ask why there were only two treatment conditions in the study: a CHO only drink at 6%, a mixed carb plus protein drink at half the calories. What about the mixed carb drink at half the calories, since we see from related research that mixed is better than straight carbs? The researchers had already done the related studies. They state:
Martinez-Lagunas et al. recently compared the effects of a 4.5% CHO plus 1.15% PRO, and a 3% CHO plus 0.75% PRO beverage, to a traditional 6% CHO beverage and found that there was no difference in the times to exhaustion between the treatments. This suggests that the efficacy of the supplements was maintained despite the reduction in total CHO and total energy content with the substitution of a small amount of protein (ml). Based on these findings, we sought to determine if a lower CHO, lower calorie beverage containing a moderate amount of protein could be optimized using a mixture of CHO sources (glucose [dextrose], maltodextrin, and fructose) rather than a single CHO (dextrose).
The present investigation demonstrates that consuming a beverage containing a mixture of different carbohydrates, a moderate amount of protein and fewer calories than a traditional, higher single-carbohydrate supplement during endurance exercise can extend exercise TTE, especially when exercising at or below the VT.Sometimes less really is more.
Citations
CURRELL, K., & JEUKENDRUP, A. (2008). Superior Endurance Performance with Ingestion of Multiple Transportable Carbohydrates Medicine & Science in Sports & Exercise, 40 (2), 275-281 DOI: 10.1249/mss.0b013e31815adf19
Ferguson-Stegall L, McCleave EL, Ding Z, Kammer LM, Wang B, Doerner PG, Liu Y, & Ivy JL (2010). The effect of a low carbohydrate beverage with added protein on cycling endurance performance in trained athletes. Journal of strength and conditioning research / National Strength & Conditioning Association, 24 (10), 2577-86 PMID: 20733521
Martínez-Lagunas V, Ding Z, Bernard JR, Wang B, & Ivy JL (2010). Added protein maintains efficacy of a low-carbohydrate sports drink. Journal of strength and conditioning research / National Strength & Conditioning Association, 24 (1), 48-59 PMID: 19924010
Saunders MJ, Luden ND, & Herrick JE (2007). Consumption of an oral carbohydrate-protein gel improves cycling endurance and prevents postexercise muscle damage. Journal of strength and conditioning research / National Strength & Conditioning Association, 21 (3), 678-84 PMID: 17685703
Thomas K, Morris P, & Stevenson E (2009). Improved endurance capacity following chocolate milk consumption compared with 2 commercially available sport drinks. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme, 34 (1), 78-82 PMID: 19234590
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- but why not MOVE MORE
- coaching nutrition - how to
Sunday, October 24, 2010
Unpacking a mystery: when shoulder pain may be all (or largely) in the wrist (a t-phase assessment story)
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Pavel tells the joke about asking people in a weight room "so those of you who have had a shoulder injury, raise your hands" - half the people raise their hands; the other half can't.
Various types of shoulder issues are super common, and the usual go-to place is that the cause must be a rotator cuff tendon issue. But at least in my case, turns out it may be something very different: a muscle imbalance. That is, some muscles getting overworked with others getting underworked, resulting in other muscles not doing their jobs, and other muscles and associated tendons getting a bit worn out from having to do another muscle's job to pick up the slack. What's remarkable is how much immediate relief there can be once this issue is identified and actively addressed. So this is a bit of a story of unpacking that mystery through a lens that says always remember the site of pain mayn't be the source of pain.
Personal Case Study
A while ago i did a few posts about the latest work on tendonopathies and healing them, and a festival of posts on the amazing shoulder as a system in the body ( shoulder girdle part 1, gleno-humeral joint part 2), and then there was one about stopping reps in a set before they stopped us. These posts were largely motviated by my ongoing ache in my arm/shoulder. And i must say i was getting just a wee bit frustrated that i wasn't getting anywhere. This is the story of finally getting somewhere.
In the beginning: Seeing the MD. back in may/june the doc i first saw when my pain was at peak suggested what i had was a supraspinatus (top rotator cuff muscle) tendinitis. Ok.
Now i'm studying anatomy, and from what i could tell, all that muscle does is assist lifting the arm up to the side (like making airplane wings with ones arms). The things that hurt however were putting my coat on, when the arm reaches back to stick the arm into the jacket, and then when going the entire other way - crossing arms over to pull off a sweater. Ok, so maybe that's from a puffy supraspinatus getting jammed into the acromium of the shoulder (shown right) when the arm extends or internally rotates when abducting (emptying a pitcher). That seems pretty classic. And a week's worth of nsaids DID let me put my coat on again. So there seems to have been something going on there. But that wasn't all. Cuz it still hurt.
The Post MD Analysis, July 2010
In July, i'd asked a very competent movement scholar and chiropractic student to take a look at me, and we were rather flumoxed. He got as far as suggesting, based on loads of assessments, that perhaps it was lower trap related as doing some lower trap work seemed to bring some relief - he suggested that i spend some time with some drills focusing on lower trap work from Secrets of the Shoulder, which i did.
Time Passes - things shift/get worse. Intriguingly, the pain changed, but did not go away; my strength progress was bottoming out. My press was not only totally buggered on the left, the pain was getting triggered when doing my right press. Not good for a gal who wants to press a 24kg kettlebell for reps.
The other thing? Where it really seemed to hurt was at the top-ish of the arm. And then the pain radiated down into the biceps. Maybe supraspinatus pain refers into the arm, i wondered.
But here's another thing: both the insertion of the supraspinatus (the attachment point furthest away from the middle of the body) and the origin of the long head biceps tendon (the attachment point of the muscle closest to the middle of the body) are very close to each other. The supraspinatus inserts at the superior facet of greater tubercle (or tuberosity) of the humerus (at the top of the upper arm bone). The long head of the biceps brachii passes over a notch in the humerus to attach to the supraglenoid tubercle - a part of the surface of the scapula that the humerus abuts in the shoulder.
In other words the two tendons are almost right on top of each other, and both connect with with the upper arm/scapula, so if one's sore, perhaps the other is going to bloody feel it, too? Or perhaps they'll just be hard to discern from each other.
Why is this identification of tendon proximity important? It's going to play a role shortly.
Indeed, reading about biceps tendinitis certainly seems similar to "overhead overuse" injuries for the supraspinatus rotator cuff. Reading about it also sounds pretty dam fatal: wear and tear; doom and gloom. And strengthening the the biceps doesn't seem to be the winner here.
So what we have here is pain in shoulder extension and external rotation and pain in shoulder flexion, adduction and internal rotation. Yuck. Easier to stay naked than put clothes on or off, but not functional, and not helpful athletically. Playing frisbee all summer was a great way mainly to keep my shoulder mobile-ish without load, but i more or less had to forget about my 24kg press work.
The Analysis Redux, Oct 2010
Now we come to the latest analysis this past week with a very experienced z-health movement performance specialist whom i'd been waiting to have an opportunity to see. 1st, we went over the issue, reviewing a detailed history (any stomach upset? any elbow issues? any neck pain? etc). Second, there was a look/test of some muscles between left and right sides.
What i had noticed only recently came to view here: my posterior delt was not firing fully - lots of squishy bits in it - compared to how well the right side was firing, the left lower posterior delt was like a deflated tire. That can't be good. Indeed see this post on muscle firing through the whole of the muscle for more. From here, we started to Assume the Postion(s) - the Positions of Pain and test these.
Assessment Process, close up. After setting some global baselines, we moved through many of the muscles of the shoulder, either offering them an assist or taking them out of the equation to see what helped or did not through those movements. By this careful process of elimination, we got down to a few interesting findings:
And ta da, muscles start to re-balance, pain be much more gone; i can press again.
How could this issue come to be?
It's often just a best guess with what causes anything, but one proferred explanation for my stuff especially with the wrist/finger extensors is that kettlebelling offers a lot of opportunities for loaded wrist/finger flexion, not so much for loaded wrist/finger extension work. As in anything, balance is important. So who knows? Perhaps when doing a ton of double kb work, i pushed my less strong side to follow with my stronger side and things went sufficiently out of whack to build up an inflamation and ongoing pain. This fits more of the facts than a supraspinatus diagnosis alone.
Rehab'ing
Beyond the above mentioned mobility and nerve drills, i'm doing some specific strength work. For the extensors i'm using two props: a mini jump stretch band with very light tension focusing on only enough load that i can get full to end range of motion wrist extension and wrist circles for the extension. I'm also using ironmind finger bands to practice finger extension reps. For mobility, i'm doing a lot of finger waves.
Master Class in Test/Re-assess.
This whole suit of components listed above stemming from this assessment was very much for me a master class in what we learn in z-health t-phase (about z-health): take a great history; test and retest EACH step of an analysis (i haven't detailed all the stuff that was tested that did not get a result); apply one's understanding of muscle interaction, muscle function and nerve interaction; check function to bring it back on line; when locked in, apply dynamic joint mobility and loaded dynamic joint mobility as appropriate.
Test, re-test continuosly. Analysis is a process. And as things change/improve, retesting and refining in rehab remains important.
Analysis is also a process that follows where the path leads: despite the fact that this kind of pain is supposed to be indicative of a SITS/rotator cuff injury, it may not be. I'm also intrigued to learn about how the extensors relate to balancing the shoulder in rotation. Not something that seems obvious taking a shoulder-only focus. Likewise that working the area of the biceps tendon can be so impacted by rotation when it itself is not a rotator - makes sense looking at how rotation may stretch it, but again that's following the path and testing - and also having some faith. I *knew* i felt pain through the biceps, but just never conencted this with the biceps tendon.
A note on pain and perfromance:
One of the effects of finding these muscle imbalances and nerve issues was an immediate and pretty signficiant improved range of motion. Like way - 15-20 degrees of extension in the shoulder that i didn't even know i had.
What this experience reiterates for me is that pain is a performance signal; that having pain reduces performance, and perhaps especially that optimizing what we need for performance not only reduces that pain signal but also, as a connected process, opens up performance. The two are intimitaley and it seems inextricably related.
As i've suggested before, pain it seems is just another performance inhibitor indicator like tight muscles that restrict range of motion can be. When we take time to work with a movement performance coach to walk through the process, work the problem, both relief and performance pour in. I know this all intellectually - it makes sense in terms of what we know neurologically - but from time to time a demonstration of same is a pretty vital reminder of these issues.
In my case, the focus was on identifying performance issues: squishy muscle bits in extensors; impingement of some kind around muscles/tendons; looking at strategies to help bring performance back on line, lots of active work. Et voila: pain significantly reduced.
Coda It's only been a week since i've had this assessment but the performance improvment (and consequent pain reduction) is legion in comparison to what it's been. I'm being very gentle with working back into arm and shoulder strength work, but that i can get into these ranges of motion sans pain/ROM issues is pretty fab after months of pain/limitation.
What seems to have happened is that there is a path of unpacking/unwinding a problem going on towards addressing it. What is exciting to me is that the movement principles i've been studying for the past two and a half years keep working - even for difficult cases. The nervous system is a remarkable thing.
It's rewarding to get to a place of really starting to see how the application of these principles continually opens up new opportunities to support healing without creating more pain first and with such immeidate effect.
Self-critique. I am also somewhat kicking myself for not working these patterns myself: nothing was really done in this assessment that i haven't been trained to do myself - that's the plus side. The down side is that i didn't take the time to work through this for myself. I remember moaning over the phone to one of the z-health master trainers how frustrated i'd been that i couldn't see a z-health solution to this problem, and his calm reply was "did you do all of the assessments"? i figured out that there were literally about 14 thousand possible combinations of assessments and that i guess i really hadn't. It's a good thing we're not our own healers, and i'll say again, everyone needs a coach.
And one more time: analysis is an iterative process. Sometimes it will take more than one hour to get to the heart of a gnarly problem. In my case, it took two. Gosh. I'll also say that the confidence i have that this approach will help find a path through even gnarly performance problems elegantly has gone way up. As said, i see it in clients reguarly, but there's nothing like personal and direct experience to reenforce a value proposition, eh?
mc
Related Posts
Various types of shoulder issues are super common, and the usual go-to place is that the cause must be a rotator cuff tendon issue. But at least in my case, turns out it may be something very different: a muscle imbalance. That is, some muscles getting overworked with others getting underworked, resulting in other muscles not doing their jobs, and other muscles and associated tendons getting a bit worn out from having to do another muscle's job to pick up the slack. What's remarkable is how much immediate relief there can be once this issue is identified and actively addressed. So this is a bit of a story of unpacking that mystery through a lens that says always remember the site of pain mayn't be the source of pain.
Personal Case Study
A while ago i did a few posts about the latest work on tendonopathies and healing them, and a festival of posts on the amazing shoulder as a system in the body ( shoulder girdle part 1, gleno-humeral joint part 2), and then there was one about stopping reps in a set before they stopped us. These posts were largely motviated by my ongoing ache in my arm/shoulder. And i must say i was getting just a wee bit frustrated that i wasn't getting anywhere. This is the story of finally getting somewhere.
In the beginning: Seeing the MD. back in may/june the doc i first saw when my pain was at peak suggested what i had was a supraspinatus (top rotator cuff muscle) tendinitis. Ok.
The Post MD Analysis, July 2010
In July, i'd asked a very competent movement scholar and chiropractic student to take a look at me, and we were rather flumoxed. He got as far as suggesting, based on loads of assessments, that perhaps it was lower trap related as doing some lower trap work seemed to bring some relief - he suggested that i spend some time with some drills focusing on lower trap work from Secrets of the Shoulder, which i did.
Time Passes - things shift/get worse. Intriguingly, the pain changed, but did not go away; my strength progress was bottoming out. My press was not only totally buggered on the left, the pain was getting triggered when doing my right press. Not good for a gal who wants to press a 24kg kettlebell for reps.
The other thing? Where it really seemed to hurt was at the top-ish of the arm. And then the pain radiated down into the biceps. Maybe supraspinatus pain refers into the arm, i wondered.
In other words the two tendons are almost right on top of each other, and both connect with with the upper arm/scapula, so if one's sore, perhaps the other is going to bloody feel it, too? Or perhaps they'll just be hard to discern from each other.
Why is this identification of tendon proximity important? It's going to play a role shortly.Indeed, reading about biceps tendinitis certainly seems similar to "overhead overuse" injuries for the supraspinatus rotator cuff. Reading about it also sounds pretty dam fatal: wear and tear; doom and gloom. And strengthening the the biceps doesn't seem to be the winner here.
The Analysis Redux, Oct 2010
Now we come to the latest analysis this past week with a very experienced z-health movement performance specialist whom i'd been waiting to have an opportunity to see. 1st, we went over the issue, reviewing a detailed history (any stomach upset? any elbow issues? any neck pain? etc). Second, there was a look/test of some muscles between left and right sides.
What i had noticed only recently came to view here: my posterior delt was not firing fully - lots of squishy bits in it - compared to how well the right side was firing, the left lower posterior delt was like a deflated tire. That can't be good. Indeed see this post on muscle firing through the whole of the muscle for more. From here, we started to Assume the Postion(s) - the Positions of Pain and test these.
Assessment Process, close up. After setting some global baselines, we moved through many of the muscles of the shoulder, either offering them an assist or taking them out of the equation to see what helped or did not through those movements. By this careful process of elimination, we got down to a few interesting findings:
1) pain in the biceps: there's that biceps tendon going into the shoulder - address that, and guess what - pain HUGELY reduced.
2) help out the brachioradialis/extensors (esp carpi radialis perhaps) overlapping tendon/musle area, there's more relief (nerve work for the radial nerve included).
3) muscle test some of those extensors and there's squishy bits - get that fixed so the whole extensor is firing, more relief.
4) pay attention to the axilary nerve that fires the deltoids, and the posterior delt starts to come back on line (have some more work to do there but heck it's work i know how to do).
5) do a wee bit of hybrid minimal t-phase style kinesio taping around the long head bicpes tendon area, matched up with active dynamic joint mobility drills for the shoulder, elbow and extensors, and things start to simmer down
6) work out some of the fascial stickiness around the extenors with v.light hybrid t-phase fascial work
7) get some exercises for working the extensors in particular,
And ta da, muscles start to re-balance, pain be much more gone; i can press again.
How could this issue come to be?
It's often just a best guess with what causes anything, but one proferred explanation for my stuff especially with the wrist/finger extensors is that kettlebelling offers a lot of opportunities for loaded wrist/finger flexion, not so much for loaded wrist/finger extension work. As in anything, balance is important. So who knows? Perhaps when doing a ton of double kb work, i pushed my less strong side to follow with my stronger side and things went sufficiently out of whack to build up an inflamation and ongoing pain. This fits more of the facts than a supraspinatus diagnosis alone.
Rehab'ing
Beyond the above mentioned mobility and nerve drills, i'm doing some specific strength work. For the extensors i'm using two props: a mini jump stretch band with very light tension focusing on only enough load that i can get full to end range of motion wrist extension and wrist circles for the extension. I'm also using ironmind finger bands to practice finger extension reps. For mobility, i'm doing a lot of finger waves.
Master Class in Test/Re-assess.
This whole suit of components listed above stemming from this assessment was very much for me a master class in what we learn in z-health t-phase (about z-health): take a great history; test and retest EACH step of an analysis (i haven't detailed all the stuff that was tested that did not get a result); apply one's understanding of muscle interaction, muscle function and nerve interaction; check function to bring it back on line; when locked in, apply dynamic joint mobility and loaded dynamic joint mobility as appropriate.
Test, re-test continuosly. Analysis is a process. And as things change/improve, retesting and refining in rehab remains important.
Analysis is also a process that follows where the path leads: despite the fact that this kind of pain is supposed to be indicative of a SITS/rotator cuff injury, it may not be. I'm also intrigued to learn about how the extensors relate to balancing the shoulder in rotation. Not something that seems obvious taking a shoulder-only focus. Likewise that working the area of the biceps tendon can be so impacted by rotation when it itself is not a rotator - makes sense looking at how rotation may stretch it, but again that's following the path and testing - and also having some faith. I *knew* i felt pain through the biceps, but just never conencted this with the biceps tendon.
A note on pain and perfromance:
One of the effects of finding these muscle imbalances and nerve issues was an immediate and pretty signficiant improved range of motion. Like way - 15-20 degrees of extension in the shoulder that i didn't even know i had.
What this experience reiterates for me is that pain is a performance signal; that having pain reduces performance, and perhaps especially that optimizing what we need for performance not only reduces that pain signal but also, as a connected process, opens up performance. The two are intimitaley and it seems inextricably related.
As i've suggested before, pain it seems is just another performance inhibitor indicator like tight muscles that restrict range of motion can be. When we take time to work with a movement performance coach to walk through the process, work the problem, both relief and performance pour in. I know this all intellectually - it makes sense in terms of what we know neurologically - but from time to time a demonstration of same is a pretty vital reminder of these issues.
In my case, the focus was on identifying performance issues: squishy muscle bits in extensors; impingement of some kind around muscles/tendons; looking at strategies to help bring performance back on line, lots of active work. Et voila: pain significantly reduced.
Coda It's only been a week since i've had this assessment but the performance improvment (and consequent pain reduction) is legion in comparison to what it's been. I'm being very gentle with working back into arm and shoulder strength work, but that i can get into these ranges of motion sans pain/ROM issues is pretty fab after months of pain/limitation.
What seems to have happened is that there is a path of unpacking/unwinding a problem going on towards addressing it. What is exciting to me is that the movement principles i've been studying for the past two and a half years keep working - even for difficult cases. The nervous system is a remarkable thing.
It's rewarding to get to a place of really starting to see how the application of these principles continually opens up new opportunities to support healing without creating more pain first and with such immeidate effect.
Self-critique. I am also somewhat kicking myself for not working these patterns myself: nothing was really done in this assessment that i haven't been trained to do myself - that's the plus side. The down side is that i didn't take the time to work through this for myself. I remember moaning over the phone to one of the z-health master trainers how frustrated i'd been that i couldn't see a z-health solution to this problem, and his calm reply was "did you do all of the assessments"? i figured out that there were literally about 14 thousand possible combinations of assessments and that i guess i really hadn't. It's a good thing we're not our own healers, and i'll say again, everyone needs a coach.
And one more time: analysis is an iterative process. Sometimes it will take more than one hour to get to the heart of a gnarly problem. In my case, it took two. Gosh. I'll also say that the confidence i have that this approach will help find a path through even gnarly performance problems elegantly has gone way up. As said, i see it in clients reguarly, but there's nothing like personal and direct experience to reenforce a value proposition, eh?
Personal Practice So suggestion? If you're having hinky performance/pain issues, check in with a movement performance specialist. Here's a trainer listing. If you'd like a referal, call the office, and let them know mc suggested you ask them.Best with your practice,
mc
Related Posts
- Tendinopathy, tendinitis and Eccentric Exercise for rehab
- Ensuring that the *whole* muscle fires in a movement for real strength
- Why not move through pain
- dealing with chronic back pain
- active vs passive care/therapy
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