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Thursday, March 29, 2018

Friday Food: Power Bites

Life is busy and with that having something that is healthy to take along with you to work or school can be a challenge.  Often your options for grab and go at work or from the store really aren't all that healthy (even if the vending machine claims them to be).  Here is a very simple and extremely easy recipe that you can make up in bulk in order to take with you and have ready to go when you need a snack but still want to not throw your diet off.

Ingredients:

  • Two scoops chocolate or vanilla protein powder
  • 1/3 cup natural peanut butter
  • 1/4 cup raw oats
  • 2 tbsp honey

The Game Plan:

  1. Blend all ingredients together in a bowl.
  2. Mix this all together and form bite sized balls.  You can also add in dried fruit (cranberries are a big one) or additional nuts or dried coconut to this recipe as well.

Source: Shaw Academy

How to Efficiently Warm Up

Introduction:

Warming up prior to exercise is as old as time. However, warming up inadequately is a common phenomenon (no, 5 pull ups or 10 minutes on the treadmill to start your workout does not count as a good warm up). Specifically, many recreational athletes, high school athletes, clinicians, and other fitness programs have a lack of structure or specificity to their respective warm ups for themselves and/or clients. The following is sub-10 minute warm up that breaks down and addresses each of the key parts of the body's mechanical and neural systems to get you ready to move and function better. 

Breakdown: 

A proper and efficient warm up works best if you focus on the body parts and positions that you will be utilizing during the upcoming workout. The components of this warm up will include 1-2 exercises of each of the following categories: self-myofascial release/foam rolling, stretch, corrective exercise, activation, movement, and CNS prep. Total time: maximum of 10 minutes.

Self-myofascial release/foam rolling (SMR): It has been found that there are acute flexibility and performance gains from as little as a few minutes of foam rolling (Peacock et al., 2014). Additionally, there is also research that shows that foam rolling is not dose dependent, meaning that more is not necessarily better. So let's save some time and make this quick. Pick 3 body parts relevant to your workout and roll each/each side out for 30 sec. 

Stretch: I'd recommend that this be a dynamic stretch or something similiar like proprioceptive neuromuscular facilitation (PNF) stretching that Joel has recently talked about with hamstrings here. There are many different variations of PNF stretching, personally I think the contract-relax method (contract the muscle being stretched and then relax and sink deeper into a stretch) can be easily and quickly translated to many different body parts without the use of a partner. Today's science and research has been leaving static stretching in the dust so it seems, so let's leave it there. Pick 1 dynamic or PNF stretch relevant to your workout and do it for 5 contractions with a 15 second hold after each contraction.

Corrective Exercise (CE): If you're like me, you'll say that you'll just do your much needed corrective exercises (exercises to fix bad habits and movement patterns aka prehab exercises) before bed or during some other down time during the day... and it never happens. So I started to incorporate 1-2 of these exercises in my warm up. "Becoming a Supple Leopard" by Kelly Starrett is a great resource to find variations for your problem areas. I incorporate 1 exercise of a problem area of mine, usually hip internal rotation and 1 exercise specific to my movement patterns for the day. Examples: side-lying T-spine rotations, side-lying clamshells, and banded ankle patterns. 2 sets of each exercise; 8-10 reps. 

Activation: Here we are, back to the under-appreciated activation patterns of the body. Here we will perform an exercise to wake up the 'mind-muscle' connection. For lower body dominant workouts, I like to go with bird-dogs or banded glute bridges. For upper body workouts: straight-arm banded pull downs, single-arm planks, alternating shoulder touches in a high plank position, etc. Perform 2 sets of 10 (each side if an alternating exercise). If you missed my article on muscle activation and it's importance on movement, check it out here.

Movement (Mvmt): This is where we incorporate some resistance into the warm up. These exercises should/could include a light barbell/kettlebell and/or bodyweight resistance, etc. keeping it specific to the movement pattern of the day. Lower body focus examples: bodyweight/kettlebell squat, lateral lunges, overhead squat (personal favorite), etc. Upper body examples: push ups, pull/chin ups, inverted rows, etc. These movements help to increase the blood flow to the muscles and facilitate correct movement patterns, further prepping you for your workout. Pick 1-2 exercises; 2 sets of 8-10 with minimal to no rest. 

CNS Prep: If you haven't been woken up yet, don't worry this next exercise will do it for you. Plyometric training has been considered an activator of the central nervous system (CNS) similar to power training and beneficial to performance when used as a warm up (Masamoto et al., 2003). Statistically significant performance benefits were seen with minimal repetitions, specifically 2 depth jumps or 3 double leg tuck jumps. Examples of plyometrics that could be used here: broad jump, vertical jump, squat jumps, tuck jumps, depth drops, kettlebell swings, etc. Perform 1 set of 3 reps. 

Performing all of these exercises as a fluid circuit with minimal rest will give you the increased heart rate, blood flow, and muscle activation you need to carry into the actual workout. Slight modifications may be made such as adding an upper and lower body variation of each category if you are doing a full-body workout. Below I have posted a sample of what I do for my warm-up. 

Olympic Lift focused Warm Up:
SMR: T-spine, Lats, Pecs; 30 sec/muscle each side
Stretch: Internal Rot.; PNF 5 second contraction, 15 sec stretch x5
CE: Side-lying hip IR & Side-lying T-Spine Rotation; 2x8ea
Activation: Bird dogs; 2x8ea 
Mvmt: Overhead Barbell Squat; 2x8- light weight, form focused
CNS: 3 Tuck Jumps

Lower Body Warm Up:
SMR: Quads, Hamstrings, Adductors; 30 sec/muscle each side
Stretch: Quads, Hamstrings; PNF/Dynamic Stretch
CE: SL RDL + Hip ER ; 2x8ea
Mvmt: Kettlebell Goblet Squat 2x8
CNS: Alternating Split Squat Jumps 1x3ea

Upper Body Warm Up:
SMR: Trigger Point Upper Trap (Tennis Ball), Lats, Pecs; 30 sec/muscle each side
Stretch: Doorway/Wall Pec Stretch; PNF
CE: Quadruped T-spine Rotation, 
Mvmt: Pull Ups, 2x3-5; Push Ups, 2x8-10

References: 

Masamoto, N., Larson, R., Gates, T., & Faigenbaum, A. (2003). Acute effects of plyometric exercise on maximum squat performance in male athletes. The Journal of Strength & Conditioning Research17(1), 68-71

Peacock, C., Krein, D., Silver, T., Sanders, G., Von Carlowitz, K. (2014) An acute bout of self-myofascial release in the form of foam rolling improves performance testingInternational Journal of Exercise Science, 7(3):202-211.

Wednesday, March 28, 2018

Study Spotlight: The Effects of Compression Garment Pressure on Recovery after Exercise

By: Joel Luedke


Utilizing compression has been something we have been a big fan of for awhile.  When we have referenced it before as we talked about general recovery as well as helping to control extra inflammation.  This is especially true when it comes to traveling and helping your body continue to evacuate extra swelling and preventing it from pooling in your lower legs.  We have no used it a lot for recovery from exercise and performance and that is what this study takes a look at specifically.  Could there be another great use for compression?


What They Did:
Forty five (45) participants were in this study and they were matched for body mass and randomly but equally divided into a high-compression group, low-compression group and a sham ultrasound group.  In the compression groups the participants worse the garments for 72h post exercise while participants in the sham group received a 10 min sham ultrasound.  The muscle damage protocol consisted 5 sets of 20 depth drop jumps.
The following measures were assed before the exercise protocol and again at 1, 24, 48 and 72h post-exercise.

  • Perceived muscle soreness
  • Maximal voluntary contraction (MVC)
  • Countermovement jump height (CMJ)
  • Creatine kinase (CK)
  • C-reactive protein (CRP)
  • Myoglobin (Mb)


What They Found:
Recovery of maximal voluntary contraction and counter movement jump height was significantly improved with the high compression garments.  A significant time by treatment interaction was also observed fro jump height at 24h post exercise.  There were no significant differences observed for parameters of soreness and plasma CK, CRP and MB.

What It All Means:
As we mentioned above, compression garments have been used for along time in recovery from injury and the control and movement of inflammation.  This study now gives more supportive evidence to show that you could utilize the same compression to help you recovery from strenuous exercise.  The benefits that compression could provide you is restoring muscle function faster which can allow for increased performance if there was a repeat bout of exercise needed for competition, practice, and/or training.

These results are promising in the fact that utilizing compression is very simple and relatively inexpensive on the spectrum of options when it comes to aiding recovery.  A good pain of compression socks or leg sleeves can be purchased for $30-$50 and they last for quite a long time if cared for.  If you're looking to try and get your performance back quicker we highly recommend taking a look at using compression along with using it for other benefits throughout the day or with travel.

LINK:
Mueller Compression Socks
Mueller Compression Leg Sleeves

Source: Hill, J.  The Effects of Compression-Garment Pressure on Recovery After Strenuous Exercise.

Thursday, March 22, 2018

Friday Food: Shrimp & Scallop Dumplings

We have had the privilege to get overseas into Asia and have some absolutely amazing food while we were there.  Not a whole lot beats the freshness that we got to experience when it comes to seafood.  By far the best that we have had.  Here is our futile attempt to get something out there that could at least give a taste of the great food we had and to bring it back home.

Ingredients:
  • 8 ounces scallops, minced
  • 4 ounces raw shrimp, peeled, deveined and minced
  • 1/2 cup minced scallions
  • 1 tbsp minced fresh ginger
  • 3 garlic cloves, minced
  • 2 tbsp reduced-sodium soy sauce
  • 2 tsp toasted sesame oil
  • 1/4 tsp freshly ground pepper
  • 36 round (gyoza) dumpling wrappers
  • 2 tbsp canola oil, divided
  • 3/4 cup water, divided

The Game Plan:
  1. Combine scallops, shrimp, scallions, ginger, garlic, soy sauce, sesame oil and pepper in a large bowl.
  2. Organize your work area with a bowl of cold water, your stack of dumpling wrappers and a floured baking sheet to hold filled dumplings.
  3. Work with one dumpling wrapper at a time, dip your finger into the water to moisten the edges of the circle.  Spoon about 1 1/2 tsp of filling into the center.  Fool the wrapper over to form a half circle.  Pinch the edges together to seal.  Repeat with remaining wrappers and filling.  Cover the wrappers and finished dumplings with moist paper towels to prevent drying.
  4. Preheat oven to 200degF
  5. Mix 1 tbsp canola oil with 1/4 cup water in a large nonstick skillet and place over medium heat; bring to a simmer.  Carefully arrange one-third of the dumplings in the skillet so they are not touching; cover and cook until the dumplings puff up and are light brown on the bottom, 4 to 5 minutes.  Carefully flip the dumplings with tongs and cook for 1 minute more.  Transfer the dumplings to a baking sheet and keep warm in the oven.
  6. Repeat the procedure with another 1/4 cup water, the remaining 1 tbsp canola oil and half the remaining dumplings.  Cook the final batch of dumplings in the remaining 1/4 cup water, adjusting the heat as necessary to prevent scorching.  (There will be enough oil left in the pan for the final batch).

Step Back: Do you have Neuromuscular Control?


Introduction: Neuromuscular control (also, often referred to as dynamic neuromuscular stabilization), defined as an unconscious trained response of a muscle to a signal regarding dynamic joint stability, is one of the most overlooked/under-assessed aspects of training and/or rehab. In other words, it is the subconscious activation of deeper, more stable muscles that then allow us to perform other movements in a safer or more efficient way. This has been thought to be an underlying cause of both acute (i.e. ACL tears, etc.) and, probably more often, chronic injuries (i.e. low back, hip, knee, foot, and shoulder pain, etc.). Personally, this is something I struggled with while I was dealing with nearly annual hip flexor strains due to a lack of proper activation of my glutes and deep abdominals.  

Poor neuromuscular control of these deeper, more stable muscles can lead to fatigue and/or faulty movement and activation patterns of the more powerful, larger muscles. For example, poor activation of the gluteus medius and maximus may more commonly display as hamstring, TFL, or knee symptoms/injuries; lower trapezius may cause shoulder pain and upper trap problems; and lack of deep abdominal activation could be the common denominator for a plethora of injuries as the core is connected to nearly everything in the body somehow or another. Upper and lower cross syndrome is a common learning tool many clinicians abide by; a tight (tonic) muscle, usually it is accompanied by a weak (phasic) muscle. The common muscles involved are displayed in the diagram below. The good thing is that we can assess and address these activation patterns with specific exercises.




The following are the common poor activation sites followed by how to assess on yourself and, if you find that you have limited activation of that muscle group, how to address the pattern.


Glutes: May be the cause of many underlying problems such as, but certainly not limited to: knee valgus (specifically during squats) & pain due to the association with the knee angles and glute medius strength; low back pain; hip pain; and more specifically ACL tears.

Assess
First method, perform a set of glute bridges (10-20) and be honest with where you feel “the burn”. If you feel it in more in the hamstrings vs the glutes, you may have a poor activation pattern of the glutes. If normal glute bridges don’t produce the desired burn, upgrade to a single-leg glute bridge and assess again. 
Another option, lying prone, have another person palpate the proximal hamstring, glute max, and both ipsilateral and contralateral erector spinae at the same time (yes, it takes a little planning and particular hand placement). From this position perform a leg extension and have the person tell you the order in which these specific muscles fire. Correct activation patterns should be: glute max, hamstrings, contralateral erector spinae, then ipsilateral erector spinae, respectively. However, often times it turns out to be the ipsilateral erector spinae, or even the thoracolumbar/shoulder girdle that starts the movement pattern1. If your pattern does not follow the former order, you may have some glute neuromuscular training to work on.

Address: 
Grab yourself a mini-band and place it right above the knees. Bodyweight squats, making sure the knees in line with the toes and aren't caving in is a good place to start. Follow that up banded side-lying clamshells, and standing or side-lying banded hip abduction exercises (be wary not to let the contralateral hip drop, or cave-in, while performing this exercise aka keep the pelvis neutral).

Deep Abdominals: Our deep abdominals, specifically the transverse abdominis, when contracted help create intra-abdominal pressure tensioning the thoracolumbar fascia in the low-back in turn stabilizing the spine. It is interesting to note that the thoracolumbar fascia also provides a connection from the hips to the upper extremities via the latissimus dorsi muscles, therefore a connection to possible shoulder pain with poor activation of this muscle group. The deep abdominals also provide a connecting point for the upper and lower body as the transverse abdominis runs from along the bottom rib to the iliac crest which helps explain the hip pathology issues. 

Assess: 
Lie on your back with knees bent (hook-lying as seen in Figure 1A below), palpate your anterior superior iliac spine (ASIS) and then fall off the ridge of that anterior and medially to feel for your transverse abdominis (remember this is the deepest abdominal muscle so you may need to apply some pressure). Keeping your fingers there on both sides, completely relax the core muscles with a normal breathing pattern. Then to assess, breathe in a way that “brings your belly button to your spine” and feel to see if your transverse abdominis has contracted (spongy/muscular feeling under your fingers). If you can feel it, great! Now try that same thing in standing. If there was no contraction or a minimal contraction, you can try the same thing in a side-lying position.2 

Another method would be to raise the legs individually keeping the knee bent, while in the same hook-lying position. If you feel a deep abdominal contraction prior, or simultaneous with the leg elevation, that is a good thing. The core should be bracing your body for the movement. However, if the core is not activating with that movement, excessive stress may be placed through the hip flexors and/or the low back muscles.

Address: 
The following exercises are from a study done by Dr. Noelle Selkow, ATC in which she and her colleagues found that doing these progressions 2x/week for 4 weeks improved both activation and strength of the transverse abdominis (a key deep abdominal muscle).3

Exercise 1: Hook-lying “abdominal drawing in maneuver (ADIM)” with weekly progressions (Figure 1); 3x10 max contractions with 10 sec hold (15 sec rest).


Exercise 2: Side-Bridge with weekly progressions (Figure 2); 3x10 max contractions with 10 sec hold (15 sec rest).


Exercise 3: Quadruped progression, or more commonly, bird-dog progression (Figure 3). Week 1: 3x10 max contractions with 10 sec hold (15 sec rest). Week 2: Alternate arms every 2 sec during contraction. Week 3: legs extend every 2 sec during contraction. Week 4: opposite arm/leg extension alternating every 2 sec during contraction


Another simple way to address the deep abdominal work is to work on a 90/90 breathing technique as demonstrated here by Dr. Zach Long from Barbell Physio. 



Lower Trapezius: Many shoulder pathologies (impingement, rotator cuff, frozen shoulder, etc.) stem from an inadequate ratio of upper to lower trapezius activation, with the latter being the muscle that is often “forgotten about”. Without adequate force coupling between these two muscles, the scapula is more often out of a desired position which leads to pinching, aching, etc. within the shoulder joint.
Notice lower trap arrow pointing down and 
toward the spine

Assess: 
Lying prone with arms in a “Y” position as seen to the right (insert picture), attempt to pull the scapula in the direction of the arrow (down and in towards the spine). If you can do that, keep the scapula set in that position and attempt to elevate the arm 1-2 inches. Any limitation, either not able to set the scapula or failure to keep it set, may indicate a lower trap activation issue. 

Another way to assess is to perform shoulder abduction and watch in the mirror to see if your upper trap is shrugging the shoulder up. If so, attempt to pull the scapula down and back using the lower trap and relaxing the upper trap. 

Address: 
Exercises for this activation pattern include the general I, Y, T, & A’s on a bench, bent over, or on a stability ball; band or cable face pulls; and rows, lots of horizontal rows. The key to these exercises are to keep the scapula set (pulled down and back) allowing for better humeral movement and decrease compensation patterns. Also, just working on overall better posture and limiting the rounded shoulders and the more recent "text-neck"/forward head posture. 

Conclusion: Sometimes lifting the heaviest weight isn’t always the most beneficial workout. Hard to believe, right? If you’re having nagging injuries, chronic pain, or are in the business of preventing injuries (prehab), assess yourself for these 3 common muscle patterns. A factor that I didn’t mention in the “address” sections is that in addition to learning to activate and strengthening the muscle, you should also work to stretch the “tight” muscle groups in reference to the Upper or Lower Cross diagram. For example, a weak lower trap should be strengthened but the pecs, upper traps, and levator scaps should also be stretched. 20 minutes 2x/week could have you feeling better, moving better, and training better for the long haul. 


References:
1.  Lehman, G. J., Lennon, D., Tresidder, B., Rayfield, B., & Poschar, M. (2004). Muscle recruitment patterns during the prone leg extension. BMC Musculoskeletal Disorders5, 3. http://doi.org/10.1186/1471-2474-5-3
2. Richardson C, Jull G, Hodges P. Therapeutic exercise for lumbopelvic stabilization: a motor control approach for the treatment and prevention of low back pain. Edinburgh: Churchill Livingstone; 2004
3. Selkow, N. M., Eck, M. R., & Rivas, S. (2017). TRANSVERSUS ABDOMINIS ACTIVATION AND TIMING IMPROVES FOLLOWING CORE STABILITY TRAINING: A RANDOMIZED TRIAL. International Journal of Sports Physical Therapy12(7), 1048–1056.

Tuesday, March 20, 2018

Study Spotlight: PRP Injection in Reducing Recovery Time in Acute Hamstring Injuries

By: Joel Luedke


This was a small review article that took a closer look on what information was out there to show how the use of Platelet Rich Plasma (PRP) injection could potentially aid in the recovery of acute

hamstring injury.  There has been quite a bit of thought about this and some places or made it part of their protocol to try and enhance recovery for their athletes.  Along with this there has been speculation on what part of the procedure could be causing increased or enhanced recovery.  We touch on that more in the 'What It All Means' portion.

What They Did:
The authors of this review found three (3) randomized control trials (RCT) that focused on the utilization of PRP for the treatment of actor hamstring injuries.

What They Found:
From the the three RCT trials that the authors reviewed they found that one of the three showed benefit in utilizing PRP injections along with a rehabilitative program compared to just a rehabilitation program alone. These improvements occurred by reducing pain, increased indications of regeneration via ultrasound and decreased recovery time.  The other two studies (which were larger in scale) did not show an increased benefit to adding PRP injections.

What It All Means:
When utilizing some of these new treatment ideas you have to keep a lot of different things in mind.  When the research isn't always there to support exactly how it works you have to weight the pros and cons and also look at different options that could produce the same results potentially. Without more evidence to support PRP it can be hard to recommend because it isn't supported through insurance and because of that the price can get extremely high very quickly.

There has been some thought that when there is benefit given from the PRP it could be due to the fact that we are inserting a needle into the injured area and due to that irritation/stimulation of the tissue you can get a healing effect.  While you may may not to try something as new as PRP we could look to other forms of similar stimulation.  A great option for this could be trigger point dry needling.  You can get the stimulation of the needle into the tissue which could help give the response you are looking when it comes to trying to help the hamstring issue.  This is much more cost effective and something that is easily repeatable for several treatments.

Be careful on how quickly you jump into new treatment options while still having an experimental mindset.

Source: Manduca, M.  Effectiveness of PRP Injection on Reducing Recovery Time of Acute Hamstring Injury: A Critically Appraised Topic

Sunday, March 18, 2018

Mobility Monday: PNF, High Posterior Chain Mobilization


Upper hamsring pain can be really a huge pain in the.....well I think you can put it all together with that.  There are so many things that can contribute to what causes this pain and with that so many options to help treat it.  This is a really simple and easy way to get the prices started of treating yourself.  PNF stretching is a very simple way to help get things moving in your body and work with your nervous system to help relax and release tightness within your body.  Give this one a try along with working through some soft tissue in your glute.


Things It Helps:
-Tight Hamstrings
-Lower Glute Pain/Tightness
-Potential "Sciatica' Nerve Issues

Thursday, March 15, 2018

Two Truths and a Lie: Fasted Cardio


I'm Trent Napp, a student in the Doctor of Physical Therapy Program at the University of Wisconsin-La Crosse. Formerly, I received my Exercise Sports Science Degree from UWL along with a Biology Minor in 2017. I'm excited to bring content and a new clinical perspective to this page. Let's get started!  

Introduction: 
Fasted cardio can be seen everywhere: the local YMCA, Instagram models and bodybuilders, the college rec center, etc. The idea that waking up early in the morning and headed straight to the gym without even looking at food in order to utilize fats for energy while slugging along on a treadmill, bike, or cardio equipment of choice at a low to moderate intensity for an hour or two. Why do people do this? If you ask someone at the gym, which I did, they may claim that it “helps lose fat because that’s the only energy I have to burn because I haven’t eaten any carbs yet.” Well, let’s get into how that statement shouldn’t be the reason for your fasted cardio workout.   

Forewarning: this blog doesn’t get into the pro’s and con’s of fasted cardio/morning workouts on 24 hr diet and caloric intake (for that see Dr. Jagim’s article review).

Lie: Fasted cardio will result directly in increased fat loss.
Those who are avid fasted cardio-ers explain this concept as diminished blood glucose levels reduce the body’s ability to utilize glucose aka carbohydrates as fuel and therefore will utilize fats as a more efficient fuel source. Former research had shown that consuming carbs prior to a 60% intensity aerobic exercise bout would decrease fat breakdown by reducing the ability of fatty acids to enter the mitochondria [and therefore be utilized for energy]1. This research is what many bodybuilders during their ‘cut’ hang their hat on. On the surface this seems valid, right? Who wouldn’t want to burn fat at a low effort?

Truth 1
There’s much more to the body’s energy system than just “I have less of this (Carbs), so I’ll use this (fats)”. However, we know that carbs are utilized much quicker and as a result if we are only utilizing fats during this type of exercise, the fatty acids can "build up” in the tissue and be redirected. Brad Schoenfeld (an expert in the field of exercise physiology and strength training) states in a study:
during moderate-to-high intensity cardiovascular exercise in a fasted state-and for endurance-trained individuals regardless of training intensity-significantly more fat is broken down than that the body can use for fuel. Free fatty acids that are not oxidized ultimately become re-esterified in adipose tissue, nullifying any lipolytic benefits afforded by pre-exercise fasting.”2
In other words, no matter the intensity of training, if excessive fats are broken down the body still won't be able to utilize them and will just store them again. 

Truth 2
In addition to less lipolytic effects than one may think, we see decreases in the excess post-exercise oxygen consumption (EPOC) aka what your body burns in a period of time after exercise- in fasted groups compared to non-fasted3. This same study also adds that high intensity is better at fat oxidation than low-moderate intensity, killing two birds with one stone. If your goal is to increase muscle mass, low-intensity fasted cardio may not be your best option, either (unless you’re on PEDs). It has been found that when training in a fasted state, nitrogen losses were doubled vs. a non-fasted state mostly thought to be due to a low glycogen storage level. As we know, nitrogen loss is a measurable of protein loss4. So concluding Truth #2, less calories burned in EPOC and increased protein breakdown when you're body is in an overnight fasted state. 

Conclusion and alternatives:
Although it seems like a simple solution; low carbohydrate levels result in more fat utilization, the human biochemistry is much more complex than that. Keep in mind that all of these studies are done in an experimental setting, with certain protocol and parameters. These specific studies fail to examine the effect early-morning exercise has on caloric intake the rest of the day (Dr. Jagim has expanded on this in the blog noted below). Personally, I workout early in the morning, like many, with limited food (something quick like a bagel with peanut butter, granola bars, or a shake) because it works best with my schedule.
In my opinion, it is more efficient to do a high intensity interval training (HIIT) workout that takes half the time and also increases the total calories burned in EPOC. HIIT has also shown to increase the total fat burned throughout the day. If you choose to do a HIIT workout, I’d recommend a pre-workout snack/shake, it doesn’t have to be a full meal, because the HIIT is taxing on your energy systems.2
With all this said, do what works best for you, but keep in mind what is actually happening (or not happening) physiologically, how your body responds to different exercise types, and the goals that you are trying to achieve.
See Dr. Jagim’s article review herewhich goes into depth about how fasted cardio may improve the rest of the day for a healthy lifestyle.

References
1.      Spriet LL and Watt MJ. Regulatory mechanisms in the interaction between carbohydrate and lipid oxidation during exercise. Acta Physiol Scand 178: 443-452, 2003.
2.     Schoenfeld B. Does cardio after an overnight fast maximize fat loss? Strength Cond J. 33: 23-25, 2011. doi: 10.1519/SSC.0b013e31820396ec
3. Lee YS, Ha MS, and Lee YJ. The effects of various intensities and durations of exercise with and without glucose in milk ingestion on postexercise oxygen consumption. J Sports Med Physical Fitness 39: 341-347, 1999
4.     Lemon PW and Mullin JP. Effect of initial muscle glycogen levels on protein catabolism during exercise. J Appl Physiol 48: 624-629, 1980.

Tuesday, March 13, 2018

Study Spotlight: TpDN in Upper Trap vs. Infraspinatus in Overhead Athlete w/ Shoulder Impingement Syndrome

By: Joel Luedke

Trigger points have been a highly 'researched' source of pain and problems in the body.  Why the mini quotes?  Well it can be hard to identify directly what they are and where they are.  The information that is coming out is improving but there still is a lot of work to do in order to get a really clear picture of that they truly are.

What They Did:
There were 40 overhead participants that had unilateral shoulder impingement (dx. with Neer's and Hawkins test).  They were randomly split into a group that would get TpDN into the upper trapezius or infraspinatus muscles.   There was three sessions of TpDN treatment, each separated by a 2 day break.  The outcome measures they were looking at were the change in Pain intensity (visual analog scale), pain pressure threshold (PPT) and disability in the arm, hand and shoulder (DASH).

What They Found: 
Pain and disability decreased significantly in bot groups along with PPT increasing only in the inframspinatus group.  However there was no outcome measures that showed a significant inter-group difference after treatments.

What It All Means:
What the researchers found is the using TpDN for active trigger points in the infraspinatus can be as effective as direct TpDN of active trigger points in the upper trapezius in improving pain and disabilities with shoulder pain.  This could be really beneficial as it seems to work out in terms of pain to go after the infraspinatus instead of the upper trapezius.  The upper traps can be an area of extreme tightness and pain and even with using TpDN to release those issues it can be extremely intense and also a little painful.  That does leave some questions though about how are you actually treating what you think is the pain, if it turns out it isn't the pain...

For more discussion on that here is what we have...
Where to Treat?
The results that they found in this study could be confusing.  We treated two different areas and they seem to have a similar effect on pain.  So how do we know where the pain is coming from?  This is a unique aspect of pain in that just because the pain is located in a specific spot it most commonly is just a symptom of a much bigger problem (we discuss below).  I think it would be interesting to show if this improvement could possibly come from treating both areas and if that would have a cumulative effect.

Focus on a Bigger Picture for Treatment
As much as we think we understand injury and pain I think we are only scratching the surface.  I like to think I attempt to stay relatively up to date with as much as I can with that latest happening in sports medicine and everything but the rate that the data comes out makes it impossible to keep up.  That being said even looking at a specific point of pain there are a lot of factors that could be the contributing factor.  I think that the results of this study show that pain is so multi-factorial that you have to look at multiple areas that could be having an effect.  That may occur even if the referral patterns don't quite make sense.


Overall this is a great step to adding into trying to figure out exactly where pain and issues can come from.  Don't let conflicting or confusing data slow you down.  Keep it in your toolbox and you'll never know when you need to apply it.


Source: Comparison of Upper Trapezius and Infraspinatus Myofascial Trigger Point Therapy by Dry Needling in Overhead Athletes with Unilateral Shoulder Impingement Syndrome

Monday, March 12, 2018

Mobility Monday: How DNS Solves Pain and Improves Performance


We have referenced Dynamic Neuromuscular Stability (DNS) many times in the blog and if you follow along with the Clinically Pressed podcast you know we reference it on there quite often. Here is Dr. Sean Gallagher of Gallagher performance and he does a great job breaking down exactly what DNS can do for you when it comes to helping solve pain issues but also at the time helping increase your performance.  Great video.


What It Helps:
-Restoring human basic movements
-Increasing muscle use that may have been "turned off"
-Better control and health of shoulders and hips


Check out Dr. Gallagher's Interview w/ Clinically Pressed

Also check out Clinically Pressed's Interview w/ Dr. Brett Winchester and Dr. Alex Earl

Thursday, March 8, 2018

Friday Food: Homemade Potato Chips


We reference in the newsletter about how the 'junk food' industry can tell you some lies and they have everything figured out for how you act and react to food.  This recipe should help satisfy the salt and crunch if that is something that gets you and it isn't horrible for you in the process.  Give them a try

this weekend.

Ingredients:

  • 2 medium Yukon Gold or Idaho potatoes, peeled and sliced into 1/8 inch slices on a mandolin or other handheld slicer
  • 3 tbsp olive oil
  • N/A Salt
  • N/A freshly ground pepper


The Game Plan: 

  1. Preheat the oven to 400degF.  Slice the potatoes into a bowl and immediately toss them with the oil.
  2. Season lightly with salt and arrange them in a single layer on a baking sheet.
  3. Bake in the oven until golden brown-about 12-15 minutes.
  4. Season again lightly with salt and pepper when they come out of the oven.
  5. Transfer to a rack to cool for maximum crispness.
Recipe via Epicurious

Monday, March 5, 2018

Guruism: Snack Oil 2.0?

By: Joel Luedke

There has been a lot of reflection going on lately for myself and also anyone that will listen to me talk (i.e. rant) about things.  I went in a little hard on the 'evidence based practice' topic and kind of revolted against it and went with 'evidence influenced practice'.  With more people making solid arguments about the evidence based continuum (EBP, clinical expertise, patient values) I backed off a little bit and tried to be open.  I still struggle with ONLY operating on evidence (not sure there is such as thing) but after more talking/ranting about all of it I came back around to the other side which can be just as dangerous as going to far in on evidence.


That is the 'guru' or 'guru-ism'.  While someone who only believes in evidence, someone who doesn't care about evidence and wants you to trust them and most often times what they are selling implicitly.   That can be a completely different and also suspect proposition.  We talk about it more here.

What is Guruism?
'Guruism' by definition is the state of being a guru.  Ok, what is a guru?  Two definitions: 1. a trust counselor or adviser; a mentor.  2. A popular or influential leader or advocate, as of a movement or idea. The first definition I really like.  Someone you can trust and put your faith in.  Perfect!  Then what is this post is all about?  That is where definition 2 comes in.  This can be where things can go astray and get people into trouble if they are just following along.

Can It Be Harmful to You?
As with anything if some is good, more is not always better.  In the world we live in today outrageous  claims and "insta-fame" seem to be the ways for people to set up their business and fame.  This is where I think a 'guru' can get you in trouble.  Someone who may not have training or real experience with whatever they are trying to sell to you but are able to make the claims that sound enticing and something that could be a 'quick fix' is attractive.  Is it truly good for you though?  Does it have your best interest at heart?

We see this a lot with workouts and diets and that can be harmful.  So many diets start and can't be maintained because they are that hard.  Very rarely can you survived on pills and shakes.  Sure you can lose weight and get started but it is not often sustainable and even as you lose weight you may also lighten your wallet more than you want.  Along with this you have to be diligent in making sure what you are consuming or participating in is healthy for you as the 'gurus' bottom line is not always in your best interest.

What to do About It?
I think the biggest thing is looking at claims that even if they sound amazing is thinking are they really to good to be true.  Do you have to pay to get everything from them?  This can be hard as a lot will entice with just enough information to want to get you hooked and then BOOM, subscriptions or pills or this specific workout and only this workout.

The other area that finishes out the thought above is are they saying only this one thing will cause the results to happen.  The best example is nutrition.  Supplements like pills and powders have their place, we aren't against them, but only in the context of a solid nutrition plan.  Just picking one things and trying to ride it out is a red flag.  Everything is so complex about our bodies that I think we would be naive to think there is only one thing that fits everyone.  Be on the look out.

Is there an Alternative?
Look for credentials and/or history of positive results. There are some people out there that are very smart that haven't gone through the traditional schooling and that is ok but that is where history and the smell test come in.  See what they have done in the past and ask yourself, "too good to be true?".  People that have the credentials don't always make things completely on the straight and narrow but it helps.  Having the experience and research background is a double threat and more often than not, a good one.


Overall we aren't out to attack anyone specifically even though we don't agree with a lot of things that are out there.  We really write these to make sure we are doing our part in trying to save people time, money, bad experiences, or potentially dangerous situations.  We have fallen victim for going in hook line and sinker and feel like we have come out for the better and at the time we feel the obligation to try and help people not make the same "mistakes".  If you ever want an opinion, let us know, we'll happily talk it out with you.

EXTRA: Clinically Pressed Short-Why Do We Go to Extremes?

Sunday, March 4, 2018

Mobility Monday: 33 Mobility Drills for You to Try


Lots of Mobility every Monday and in this video we pretty much overload you.  Here are 33 mobility exercises that you can incorporate into any part of your day or your workout.  The combination exercises are especially good for you to check out as its going to get everything to tie in together which can really unlock areas that you might not have even known were that tight.  Pick a few and give them a try.


Things It Can help:
-General whole body mobility
-ROM through your spine
-Feeling better overall in your day and movement