Tuesday, August 2, 2011

the importance of massage as a tool for the trainer/physio

I can't help but emphasis the importance of massage as a diagnostic tool for the trainer or the physio. It enables a better understanding of your client's muscle tension and his readiness for the level of workout intensity required. An experienced trainer/physio will be able to find out if the client is on his way to getting a strain or a pull just by palpating the muscle.

Manytrainers/ physios i have observed try to stay away from massaging their clients because of the hard work required . They would rather put their clients immediately in a machine or on a foam roller to ease the tension. Regrettably, this takes away one of the most effective ways to improve client rapport and a valuable tool in injury prediction and prevention.

Wednesday, April 6, 2011

3 reminders this week and it is only Wednesday

1) When working with female clients, don't treat them as if they are the weaker sex. They should be able to do normal push ups and pull up progressions. Granted that their upper body is weaker than that of a male, but normal teaching progressions should be adhered to.

2) Just been reminded that focusing on hip stability when warming up and doing plyos is more important for females than males because of the inherent disposition to knee valgus that can cause knee problems.

3) When a client has fainting spells, please check for vertebral artery occlusion! Carl has a client who gets fainting spells when he gets up from prone or supine position. Did the vertebral artery occlusion test and it was a positive. Did ART on the superior oliques, orbitals, rectus capitis and temporalis. Cleared up the fainting spells significantly but will need to do this on a wekly basis for the client at this point of time. phew!

Thursday, March 31, 2011

Three things I learnt over the past week

1) The nutritional value of organic fruits and commercial fruits are the same. The issue is that commercial fruits have pesticides and hormones which can cause lots of health problems including cancer.

2) Barefoot running is great. It is a self-limiting exercise as your feet will hurt after awhile. It will hurt sooner if you run with wrong mechanics. Running with shoes allow you to run longer without pain and with wrong mechanics which results in the overuse injuries due to heel strike and repetitive stress.

3)Farmers knew centuries ago that to make cattle fat, put them on a low fat, low protein and high carbohydrate diet. Isn't that what we are told to get healthy and lean?

Tuesday, March 29, 2011

In every action, there is a postive and a negative reaction

I have been preparing for my King Sports International Level 1 and have come across this wonderful and enlightening statement. " In every action, there is a postive and negative reaction".

To give an illustration, imagine the training program of an endurance runner. He runs longer distances to create that "aerobic base" (if there is such a thing). He increases the volume of his training rather than the intensity as he believes that running longer and not faster is the key to winning in an endurance event. The positive effect is that he can run longer distances but the negative effect is that there will be increased injury risk due to repetitive stress.

Another illustration would be the footwear issue. You buy a running shoe with excellent padding. However, due to the increase in padding, you run with your heels rather than the balls of your feet. This repetitive impact causes plantar fascitis, IT band and patella femoral issues.

In order to reduce the negative impact of training, focus on injury prevention. I.e. get a coach to advise you on running mechanics. Focus on increasing intensity rather than volume as endurance is a function of recovery ability.



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Wednesday, March 23, 2011

The smoke alarm syndrome

If you are suffering from injuries due to cumulative stress / repetitive stress, i.e. patella femoral, plantar fascitis, non acute back and neck pains etc, going to see a doctor to seek symptomatic pain relief is only a temporary solution. As in my previous articles, pain site is hardly the source of the pain. Consuming painkillers and panadols will only help you relieve the pain temporarily. Resting it may not work as well as the trigger points and fascial adhesions are still present and requires manual soft tissue intervention.

Seeking symptomatic relieve is like removing the batteries from the smoke alarm. There is a fire in the house but the alarm is not working because the batteries are taken out. Without a doubt, removing the batteries from the smoke alarm is a foolish thing. So is seeking symptomatic relieve for pain which is clearly cumulative in nature.

If you are suffering from cumulative injuries, go get soft tissue treatment and get advise on proper corrective exercises to prevent it from happening again. This will help you enjoy your sport for longer without performing it in pain or on medication.

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Simple ways of adding variety and injury resistance to an endurance athlete's training program

Endurance athletes should add in some variety to their training by including the following;

1) Hill Sprints

2) Jumps and skipping

3) Interval training on a slide board for lateral work

Sprinting and jumping help to open up joints in the chest, shoulder, hip and ankles as it promotes greater extension and rotation of the joints. This will help lubricate the joints and improve range of motion. In sprinting and jumping you get more hip involvement as you are required to go into greater hip extension and flexion which will work to fire your gluts and psoas which are primary hip extensors and flexors. In jogging, your hips rarely go into extension and flexion and this results in a greater development of the secondary hip extensors and flexors namely the hamstrings and quads respectively.

Working on the gluts and hamstrings in the sprint and jump will go a long way in preventing synergistic dominance of the secondary muscle groups which will usually result in cumulative injuries (TFL pain, hamstring pulls, groin strains, IT band syndrome etc) if not properly looked after.

As in sprinting, jumps and skipping forces you to be in the chin tuck, chest out and neutral spine position. In jogging, you can still maintain the head forward slouched position similar to your deskjob posture. Getting out of the deskjob posture is vital in promoting spinal health.

Lateral work is a good change from your usual linear jogs as it puts more demand on the glut medius which is an important hip and knee stabilizer. At the same time, you get a good cardio workout which is what you are after anyway

Monday, March 21, 2011

Should clients with shoulder injuries continue with overhead activities?

Recently, i have been getting a number of 'shoulder problem' clients. almost 90% of them had to do with an inhibited subscapularis which resulted in an elevation of the glenohumeral joint therefore causing the acromium to impinge the supraspinatus. It doesn't help that tight pec minor causes an anterior tilit of the scapular which reduces the sub-acromial space. In such cases, foam rolling the external rotators and anterior serratus will not help one bit since the subscap is right under the ribs behind the scapular.

I suggest doing some stretches followed by light activation work of the subscapularis using light dumbell prone internal rotation and anterior serratus (AS) wall slides to activate both the subscap and AS before going into your weight routine. This may help alleviate the pain.

If it is an unstable AC joint, you might want to get some taping done to stabilize the joint and do elevated or basic side bridges to strengthen the joint.

However, if it still hurts, refer out. Get a qualified soft tissue therapist to help you release trigger points and adhesions in the subscap, pec minor and infraspinatus. Mulligans technique and taping are great for resolving instability in the AC joint but proper corrective work is still required to strengthen the ligaments in the joint.

Once you are better, i would suggest redesigning your workout program to have at least a 3 : 1 pull to push ratio i.e. do more deadlifts, pull ups and rows to push ups and shoulder presses. Shoulder and bench presses should be done in neutral grip at least until the shoulder pain has been eliminated. It is good practice to deload one week of the month with neutral grip presses to give your shoulder joint a 'break".

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Sunday, March 20, 2011

The pendulum always swings to the extreme

I find it amusing that people are actually skipping fruits in the quest of weight loss because of the evils of fructose. Yes, some fruits are high in fructose i.e. apples but they have soluble and insoluble fiber as well as vitamins and minerals to help in their digestion and slow the release of glucose into the blood stream.

I would think that looking the Glycemic index as well as the Glycemic load is a better way of examining the food that we eat. Anyway, unless you are in a figure competition and trying to find ways to sharpen your physique and fine tune your already low carb diet, getting rid of fruits is an exercise in futility. don't miss the forest for the trees. Fruits are high in anti-oxidants i.e. lutein, revesterol etc which the body needs for immunity, anti-ageing etc.

For my clients, simple strategies and guidelines work fine and have a greater success rate. I believe in giving nutritional guidelines rather than meal plans as plans are hard to follow and is 90% of the time never adhered to.

My guidelines include;
1) Front load your calories - Eat more in the morning, least in the night.
2) Have at least 5 regular meals a day - smaller portions of carbs help to regulate
blood sugar levels
3)minimise your grains i.e. bread, rice, noodles, corn, wheat
4)Fish oils should a staple - from 10 to 15 grams a day of high quality fish oils.If your fish oil does not have a 2:1 ratio of EPA to DHA and make up at least 550mg of EPA DHA, it is most likely of low value.
5)Substitute your grains with vegetables and whole fruits.
6)No fruit juice but vegetable juice is good
7)No soft drinks

You can further break down your individual body type into thyroid dominant, testosterone dominant and insulin dominant.

Thyroid dominant are ectomorphic individuals or what we call the skinnies. They are allowed to have more carbs in their diet as they seem to burn off what they consume quickly.

Testosterone dominant are mesomorphic individuals or what we call the naturally gifted individuals. Think of the arnies out there. A little more carbs is fine for them.

However, for the insulin dominant or endomorphic individuals (pear or apple shaped population), low carb high fat diet works best. The fat should come from fish oils, seeds and nuts, avocadoes, olives. Omega 3 intake should go above 15g. Therefore, i usually recommend liquid fish oils for such individuals where 4 teaspoons would be equivalent to 15g of fish oils.

The problem with sports medicine

Sports medicine is based on the trauma based injury model where the pain site is the pain source. Trauma is when an athlete faces an acute injury i.e. a torn ACL when he gets tackled from the side or a dislocated shoulder.

However, when the injury is due to cumulative stress, it is most likely that the pain site is never the pain source. The pain site can even be more than a foot away from the pain source. For example, a pain in the rotator cuff is usually found in the front of the shoulder. Icing the front of the shoulder will not help since the rotator cuff is mostly found on the scapular itself. Another great example would be a strained adductor where the referral pain can be in the abdomen.

Athletes mostly suffer from cumulative stress injuries. As such, going to an orthopedic surgeon will be of little help since most of their expertise is in the trauma based injury model.

If it is the athletes first visit to the orthopedic doctor, he will normally be given pain killers, anagelsics and anti-inflammatories to reduce the pain and therefore provides symptomatic relief. This does not solve the problem as getting rid of symptoms does not solve the root problem. The athlete, upon the reduction of symptoms, will continue to go about doing his usual training i.e. running which may be causing the problem.

When the pain comes back, the athlete will usually be given a jab, i.e. cortisol, at the pain source to try to get rid of the symptoms. This is still symptomatic relieve since we know that the pain source is somewhere else. The athlete, upon the reduction fo the symptoms, will continue in his usual activities.

When the pain pops its ugly head again, the athlete will be advised to go for an operation since the pain is definitely not going away so that he can 'take a look' at what is happening. When a doctor tells you that he wants to 'take a look', it means that he does not know what is happening.

Many athletes have gone throught the ingestion, injection, incision route and have the scares to show. Furthermore, they are none the better. They might even feel worse because of the scar tissues formed and the lengthy post op rehabilitation process.

Therefore, if you are suffering from any pain which is cumulative by nature, it is best to get help from a soft tissue or manual therapist to locate the root of the issue and help you recover.

Friday, March 18, 2011

What i think of the 'Biggest Loser' Reality TV Series

It is abusive. If you select another demographic of people to attend a show of this nature, it will cause a national outcry. Just imagine the reality TV show 'Biggest Gainer'. You force feed a group of skinny people to gain weight and get them to do high intensity low repetition work on a daily basis. See who gains the most weight at the end of each week. Quite sick isn't it.

Besides being abousive, getting a few 'idiots' to train the participants in such a manner really gives us personal trainers a bad name. In terms of proper coaching and training principles; zilt. the Show disregards fundamental training protocols. No exercise progressions, poor technical proficiency when lifting and injury prevention. They will not put in the statistics the number of participants who got injured and had to resign from the show.

Steady 2 pounds a week weight loss with progressive dieting and exercise is the safest option. The 'Biggest' loser is sensational but not reality.

Thursday, March 17, 2011

How do u know if you have plantar fascitis?

For endurance athletes, plantar fascitis is a perennial issue. It is an overuse injury, with the likes of patello femoral, IT band syndrome issues, which came in the late 70s as the popularity of aerobics training grew.

Do the toe walk (walk on your toes). If you feel pain, it is most liekly plantar fascitis. If it is not, and you feel tender around the inner edges of the heel at the origin of the medial longitudinal arch, it is most likely a spur.

If you have plantar fascitis, rolling a golf ball underneath your foot and getting some major foam rolling done on the calves will help. Working on hamstring control will help heel strike which in turns reduces stress on the plantar fascia. Don't forget the mobility of the big toe too as it is the toe that starts the stance.

If you have a spur, nothing much can be done except surgery to remove it. Soft tissue work can work to a certain extent to prevent further growth of the spur. Wearing heel supports will also help in the endeavour. However, if you are suffering from acute pain, seeing an orthopedic surgeon to remove it is encouraged. It is only a day surgery and 2 - 3 weeks rest. You need the rest anyway since that is the only way to stop you running :)



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Wednesday, March 16, 2011

Knowing the Endurance Athlete

I have quite a number of endurance athletes under my watch and have observed them to have the following traits;

1) Type A personality - highly motivated and goal oriented

2) Not good at racket games - not really co-ordinated

3) Good income bracket - comfortable

4) Don't know how to look after themselves



Training mentality;

1) Volume training - the longer the run the better

2) Pain is good



Endurance Cycle;

1) Either running long distance or running to the physiotherapist

2) Either coming out of injury or injured



Best time they will listen to you talk about training for more strength, stability and mobility;

1) When they are in pain. No point talking to them at other times.



People they listen to;

1) Themselves

2) Running coach who also most likely happens to be volume oriented

3) Wifes

4) Massage therapist and Physios and only when they are in pain



I'll add more when i find out more....



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Medial Knee Pain

If you have medial knee pain, you should check if you are flat footed. A collapsed medial longitudinal arch will result in internal rotation of the tibia which will cause a valgus in the knee joint.

It is important to do exercises to teach the arch to stabilize so that it does not affect joints further up the kinetic chain. Examples of these exercises are single leg exercises such as the single leg romanian deadlift, single leg squat. If you insist on doing bilateral work rather than unilateral, just make sure that when you squat, the knees must go outside the last toe to not only ensure varus movement of the knee but also pure dorsiflexion of the ankle joint as you descend into a deep squat.

Activating the glut medius doing lateral or saggital walks with a mini band can also help in stabilizing the knee joint. Do these exercises before you start running and jumping around to ensure that the stabilizer muscles are properly activated during your routine.

For those of you using Orthotics, they are only a temporary solution. Getting the arch stabilized proprioceptively is the permanent solution.

Tuesday, March 15, 2011

Is Time Under Tension (TUT) an important training variable?

The time under tension (TUT) training variable was first popularised by Charles Poliquin. After taht, everybody jumped onto the bandwagon. Lifting weights "slow" to get the maximum soreness and "pain" seemed to be the main focus for every gym rat. I did that too and boy was it sore. I loved the pump after the workout and the soreness the next day.

However, as i got older and. hopefully, wiser, i asked myself a few fundamental questions about weight training. Is pain or the magnitude of soreness the objective of the workout or is hypertrophy and increasing strength more important? Does increase in magnitude of soreness equals increasing strength and hypertrophy? If magnitude of soreness does not necessarily mean increasing strength and hypertrophy, then what is?

It is intensity of the workout that determines strength and hypertrophy. Lifting a heavy weight explosively is the overiding factor in increasing mass and strength. Increasing intensity means that more muscle fibers are being recruited while lifting explosively fires more of the motor units in your muscle belly thus increasing the neural demands of the workout.

I think we need to get out of the mindset that pain or soreness is a determining factor in a good workout. You might get sore after a high intensity workout but level of soreness should not be a determining factor in whether you had a good workout.

Monday, March 14, 2011

Setting Goals and practicing Kettlebell snatches

Last week, i had the inspiration to challenge myself to pass the Russian Kettlebell Challenge (RKC) in Seoul 2012. It involves 100, 24kg, kettlebell snatches in 5 minutes for my weight category and other physical challenges.

I have been practicing it for the past week using a 20kg weight and practicing it for 2 sets of minutes. Dominant arm felt great but my lefty, which happens to be weakened by an old injury, didn't feel too good. At the end of the session, i had blisters on my left and a sore left arm.

My kettlebell training involves, as a start, 1 day of snatches and cleans (2 sets of 2 minutes each) and 1 day of turkish get ups (8mins) in addition to my current basic workout plan. The duration will increase, hopefully, on a weekly basis till i hit 4 minutes per set.

In my kettlebell training attempt, i realised the comfort of using pro grade KB bells. Smoother handles are a key point to prevent early blistering. I'll be looking for a pro grade new 20kg and 24kg in the next couple of months.