Creatine has been long been known for its ergogenic aid when it comes to performance. Whether it comes from enhanced recovery or from helping add some muscle through higher intensity training, the studies are out there. There has been some research coming out about cognitive benefits of supplementing creatine and the potential benefit of utilizing creatine for post concussive recovery could be significant. This article does a great job breaking down ideas of where creatine and cognitive function can go.
What They Did:
This was a review article of the potential effect of creatine on cognitive function. Not only in long term cognitive health but potentially in the recovery from different types of traumatic brain injury.
What They Found:
Authors believe that a high creatine content may theoretically enhance brain function, through facilitation rapid energy provision during times of accelerated ATP turnover. Theoretically, supplementing creatine could provide this benefit.
What It All Means:
The authors have concluded that higher levels of creatine supplementation may be the way to go when it comes to trying to optimize outcomes for health. This could potentially look like supplementing at a "loading" rate of 20g/day as you might do in the early phases of supplementation for the first week of using creatine for muscle concentration. The authors realized that that creatine could exert its influence in situations whereby cognitive processes are stressed, in particular acutely.
The long term effects of supplementation could show promise with traumatic brain injury and other cognitive issues. There is hope that the potential for supplementing creatine could help in the recovery from injuries like concussion. Not only is it easy to supplement and get proper dosages but it is also fairly inexpensive. The research to follow is going to be big and could really help people be in a better spot in their recovery process.
Limitations:
This study did a pretty good job overall going though the literature and trying to figure out what the best way is to supplement creatine is for the best cognitive function.
Reference: Dolan, E. Beyond muscle: the effects of creatine supplementation on brain creatine, cognitive processing, and traumatic brain injury. European Journal of Sports Science. 19: 1. 2019. 1-14
A lot of jobs require time behind a desk on a computer. There have been many attempts at making computers more ergonomic to help prevent aches and pains that come along with being at them for extended periods of time. This video gives some ideas you can try to implement if you are stuck using a laptop that can help save you from neck strain, shoulder pain and a whole host of other things that can be just plain annoying.
Check it out.
Things It Helps:
-Neck Strain
-Anterior Shoulder Problems (rounded shoulder)
-Helping Wrist Pain
When you hurt your should via contact it often occurs at or near end ranges of motion. When we are focusing on determine return to play and contact there are several things we take a look at to ensure that it is done safely. We look at strength and the ability to try and use that force in 'functional' movement. Are we doing the best job we can though when we test people out? This article takes a
look at some new ideas.
What They Did:
This was an editorial article discussing new ideas for testing shoulder strength and max ranges of motion. The data collected and referenced is a small sample size of athletes that they testing strength on. Researchers tested force production with a plyometric push up as well as isometric contraction at end ranges of motion in flexion, scaption and abduction.
What They Found:
So far the testers are finding the the PPU and ASH test are reliable. Finding reliability means that the test is getting consistent results in finding differences in strength in affected sides vs. non-affected sides. In specific cases the ASH test and PPU test have proven very beneficial in determining if an athlete is ready to return to full participation.
What It All Means:
This is a unique way in looking at shoulder strength and how it is applied not only plyometrically but at end ranges of motion. Utilizing this information can help determine if an athlete with an injured shoulder is completely ready to return. Testing at end ranges of motion isn't something that we normally incorporate into the functional testing to determine return. Often shoulder injuries occur at the extreme end ranges of motion and without having strength and stability. Utilizing both a plyometric test and strength at the end ranges can help bring more evidence to ensure safety.
Limitations:
The authors reference this during the article but this testing is just at the beginning. They do mention the test being reliable which is great but more testing and outcome measures will be needed in order to make it a potential 'standard' in shoulder testing.
Reference:
Ashworth, B. Force awakens: a new hope for athletic shoulder testing. Br J Sports Med, 0:0.
Author Greg McKeown says the most fitting defintion of essentialism is "less but better." Basic Value Proposition: "Only once you give yourself the permission to stop trying to do it all, to stop saying yes to everyone, can you make your highest contribution towards the things that really matter."
This was an extremely interesting topic and while the episode I took it from was focused on cleaning out your life from 'to-do' lists and things that don't help propel you forward. I wanted to try and take this concept and bring it into the world of health and improving what you're looking to do moving forward.
There is one thing I'd change about the line above. "Only once you give yourself the permission to stop trying to do it all, stop stop saying yes to everyone and EVERYTHING, can you make your highest contribution towards the things that really matter." The world has too much information that and that can make it near impossible to know where to start (we realize it is iron ic as we run a blog of health information but we digress).
I think the best option when it comes to trying to focus on essentialism in your health is making sure you don't bypass the basics. A few examples:
Nutrition: Don't leap to the detoxes, energy producing vitamins, fat burning teas, etc. While these tools might have their time and place know basic caloric needs can trump all. Find a resource that allows you predict your energy expenditure (see below) so you can get an idea where you need to be on a daily basis and then begin to track what you use during the day. Wait until you start here before you add more things to remember in your day, keep it essential.
Aches and Pains: Disclaimer-if you are in that much pain you need to someone. These ideas are not for medical conditions or emergencies, more so the everyday soreness we might experience. That being said we don't know it is always necessary to rush off to the chiropractor, physical therapist or physician. Often times things like general low back soreness can be something more than soreness but the evidence doesn't support that getting a MRI is always beneficial. Often there are findings on those results that can make it seems things are extremely bad when keeping things basics can help. Start basic, start essential with mobility and soft tissue work and some rehab and see where you can get.
Find the essentials in what you need to do for health. Keep things as simple as possible for as long as possible to find the things that are most effective and don't cloud what is going on related to your health.
I've often tried to use the excuse that I just lifted too much and therefore I would never have the ability to have full shoulder range of motion. While that may be true for some individuals, I am not one of them and yet I still lack some shoulder range of motion that you never know when could come in handy. This group of exercises is a great way to get out and get an increase in your shoulder range
of motion. Try it out.
Things It Helps:
-Limited shoulder range of motion
-Anterior shoulder pain
-Tight lats.
Something to change it up and one that we tried a different version of at our house. A great flavor and based on the fact it came from 'My Fussy Eater' it appears to be kid approved and one that they won't shy away from.
Ingredients:
1/2 tbsp oil
1 medium onion, finely chopped
1 clove garlic, crushed or finely chopped
1 tsp cumin
1 tsp ground coriander
1 tsp smoked paprika
1/2 tsp mild chili powder
1 can (chopped tinned tomatoes)
800 ml vegetable or chicken stock
250g chopped cooked pork
1 can cooked kidney beans, drained
130g frozen chopped vegetables
1/2 red pepper, chopped
The Game Plan:
Heat the oil in a large saucepan and add the onions. Cook for 2-3 minutes until soft.
Add the garlic and the spices and cook for a further 1 minutes, stirring constantly.
Add the chopped tomatoes and stock. Bring to the boil and simmer for 5 minutes.
Use a stick blender to blitz the soup to make it smooth.
Add in the cooked pork, kidney beans, frozen vegetables and red pepper and simmer for 5 minutes.
Serve immediately with some grated cheddar cheese and tortilla chips for dipping.
Achilles tendinopathy is an extremely frustrating injury and one that can drag on for much longer than it needs to. There are lot of ideas on what the best treatment plan is for helping to expedite the healing process and those range from specific exercises to a full range of interventions. Platelet rich plasma (PRP) injections have been gaining popularity recently along with the utilizing trigger point dry needling (TpDN) to help stimulate healing. This study takes a look at comparing those two interventions
What They Did:
In this study researchers compared PRP injections to TpDN in the treatment of Achilles tendinopathy. The treatments were once a week for three weeks. Satisfactory outcomes at baseline, three months and six months.
What They Found:
It appears that it depends on the patient on whether PRP or TpDN helps the outcome of Achilles tendinopathy. In this study it was observed that it only works in a percentage of subjects but not everyone. When looking at satisfactory scores PRP showed slight superiority against TpDN, mainly
in younger participants.
What It All Means:
There are big time ranges when it comes to expense for getting either of theses interventions done. Typically PRP is going to be more expensive but it is hard to say with PRP due to no insurance billing codes that are currently available. Some practitioners are more expensive than others.
That being said, with the interventions not working for all patients it isn't something you have to jump to immediately to try and treat this injury. There are a lot of other things you could try to help in healing your Achilles issues. Rehab and self soft tissue work can be effective and is something worth giving a try to see if that gets you the effects that you need for improvement. We also would highly recommend at dorsal night splint. It's like 8 hours of healing while you sleep and sets you up to not have the initial shock of pain in the morning. If you aren't getting the results you want (or as fast as you want) you could definitely look into PRP and TpDN and see which ones works better for you.
Limitations:
This study was pretty good overall when looking directly at comparing these two. The rehab interventions after the second injection allowed the opportunity for more healing to occur. It is really hard to do a complete intervention as there are many other options you could use to help in the healing process but that could bring too many factors into the study.
Resource:
Abate, M. Platelet rich plasma compared to dry needling in the treatment of non-insertional Achilles tendinopathy. The Physician and Sports Medicine.
Hip mobility is something that is extremely important to us and it is what we believe a keystone to helping so many other things in the body. That could be due to pain or just to increase performance but if you regain mobility and control of your hip to add strength to it there are so many things that will improve.
Both of these guys know a thing or two about mobility as one has amazing mobility and teaches it to the masses. The other is an extremely strong guy that has gone through his share of injuries and come out for the better.
Things It Helps:
-Hip Mobility (pretty obvious)
-Low Back Pain
-Knee Pain (better mechanics)
Thursday, January 10, 2019
Ankle Mobility Background & Importance
Chances are if you're reading this you've sprained your ankle once or twice (or a "bajillion" times), so let's talk about how to assess if those previous injuries are still limiting your performance. Overall ankle mobility and stability is important (see countless athletes out every day for sprained ankles). This article will primarily focus on ankle dorsiflexion, the deemed "most functionally important" of the ankle's planes of motion. Ankle dorsiflexion (DF) or the "pulling your toes to your nose" motion is something many take for granted. In an open-chain movement, it occurs as the talus slides and rolls on the superior tibia/fibula complex. Conversely, when the foot in contacting the ground (closed-chain), DF occurs as tibia and fibula "mortise" slides anterior on the proximal talus placing stretch on the syndesmosis and high ankle ligaments that connect the tibia and fibula. Multiple injuries to these structures is 1) not uncommon and 2) can lead to a build up of scar tissue leading to a gradual decrease in joint mobility (DF). Those limited in DF may see deficits in their ability to squat deeply or properly, walk or run with a normal gait pattern, or see decreased performance in their respective activities. It may be difficult to realize that your ankle DF is decreasing while it happens, but this blog intends to help you assess your DF and treat (if needed).
Compensations:
As you may know, the ankle is part of what we call the "kinetic chain" meaning ankle movement affects motion of the hip and knee and vice versa. Therefore, the reason many don't realize their DF is limited is because of the slightest compensations through the kinetic chain. The following is a list of common compensations you should watch for: decreased knee flexion (ski-boot walking), increased foot pronation (medial foot falls in), increased forward trunk lean during squats, anterior pelvic tilt, and early heel lift during gait. Remember, the body is a complex structure with a lot of moving parts so if someone (or yourself) walks into a clinic and has increased anterior pelvic tilt, for example, it doesn't necessarily mean they, or you, have decreased ankle DF.
Measurement
To test and re-test your DF, let's work through a method that's extremely easy to do yourself:
Tools needed: a wall/vertical surface and piece of paper, tape measure/ruler, and pen OR inclinometer/iPhone
Instructions for Ruler Method:
Set up in a half-kneeling lunge with 2nd toe of front foot touching the wall (Place paper under front foot against edge of wall)
Reach your front knee towards the wall trying to not allow your front foot to pronate (or collapse) and keeping heel touching the paper/ground
Progressively move your front foot away from the wall (cm's at a time) until you can just barely reach your knee to the wall with your heel still intact with the ground (right)
Mark where your 2nd toe is on the paper and measure that distance (cm) from edge of paper
Interpretation: it is thought that <9-10 cm distance indicates limited DF, or a side-to-side difference >10% if measuring for unilateral limitations
Instructions for Inclinometer/iPhone Method:
Utilizing the same set-up as above, place inclinometer or iPhone (using the measure/level app) on the midpoint between knee cap and ankle on the bony ridge of the front of your shin
Interpretation: <35-40 degrees indicates limited DF, or side-to-side difference >10% if measuring for unilateral limitations.
So, you measure and find that you have limitations, now what?
Interventions: Stretch, Mobilize, Load
I recommend utilizing the following interventions prior to squat or lower body emphasis days during your warm-up, or if there are profound deficits 1-2x/day minimum. This routine will commonly facilitate within-session changes in DF as well as allow you to then load the joint in its newly found range of motion. These interventions will most likely benefit most if performed without shoes. Stretch: Standing Gastroc/Soleus Stretch
Perform a classic "runner's stretch" with the target ankle behind and knee straight (it may be helpful to put the toes up on a 1" platform, plate, or rolled up towel to facilitate the motion coming from the ankle- not shown in video).
Bring the target ankle closer to the body center and bend the back knee slightly to facilitate a soleus stretch (again keeping the toes on a platform- not shown in video)
I don't necessarily hold these stretches for 30 seconds, I like to do 2-3 sets of 3 contract-relax series: 5 second contraction (actively DF ankle), 10 second deep stretch, repeat 3x ea. leg
Mobilize A: Foam Roll Gastrocnemius/Soleus
I recommend spending NO MORE than 1-2 minutes per gastrocnemius/soleus complex and plantar fascia per leg. Be efficient.
I'll leave the rest to a video by Dr. Mike Reinold to show a nice little series of self-myofasical release techniques:
Mobilize B: 1/2 Kneeling Self-Mobilization with Movement:
Anchor a 1/2"-1" band behind you and assume a 1/2 kneeling lunge position with the target ankle in front.
Loop the band just below the 2 large ankle bones (malleoli) such that it stabilizes the talus. Stretch the band such that it is tight when in the 1/2 kneeling position to provide a posterior force on the ankle joint.
Maintaining heel contact and a stable foot (don't let arch collapse), drive your front knee forward in line or just outside of the foot. Avoid your knee caving in. Push the knee as far forward as possible without losing heel contact with the ground.
Perform this about 2-3 sets x 10 reps with a 2-3 second pause at end range
Notes: this may be performed with the front foot on level ground or on a 6-12" box/platform to increase the angle of pull of the band or placing a weight on the front knee to add a compressive load to the ankle (shown in videos above). If at anytime you feel a pinching sensation at the front of the ankle, make sure to back off the range of motion; i.e. don't try to push through this pain as it may indicate an anterior impingement injury. If struggling to maintain correct foot posture, here's a link to a video that Dr. John Rusin has provided to help:
Load: Goblet Squat Self-Mobilization with Movement
Keeping the band anchored behind you and looped below the two malleolin of the target ankle, step away such that the band is tight and your feet are even and shoulder width apart
Hold a moderately heavy dumbbell or kettlebell in the goblet position and perform squats with a good upright posture
Perform this about 2-3 sets x 8-10 reps
Putting It To Use:
I like to perform this circuit prior to squat or lower body lifting days in an Every Minute On the Minute (EMOM) style so that I am consistent, efficient, and don't take too much time during my warm up. What this means is that at the start of the 4 or 8 minute time period I'll do the stretches, start of the 2nd minute I'll foam roll, 3rd minute is 1/2 kneeling mobilization, 4th minute is loading and then repeat if I'm feeling extra tight for a second set. Rest during the time between an exercise ending and prior to the next minute starting.
Test-Retest: Be sure to use the measurement test before and after this mobility routine and track these changes over time. You should see immediate changes after completing these exercises as well as gradual long-term changes over time if you consistently perform this circuit.
Other Resources:
Here is a video from Squat University that does a nice job of putting this together with a few different twists of their own:
If you're looking to change up your style for dinner this weekend or having something different for lunch this could be what you're looking for. A Greek inspired dish with spaghetti squash to fill you up along with a great combination of vegetables and peas to help fill you up and fuel your day. Check it out.
Ingredients:
1 tsp olive oil
1/4 cup thinly sliced red onion
1/2 tsp minced garlic
1/3 cup unsalted chickpeas, rinsed and drained
1/2 tsp chopped fresh thyme
6 cherry tomatoes, halved
1 1/2 cups Easy Baked Spaghetti Squash
1 cup baby spinach, torn
Dash of salt
2 tbsp crumbled feta cheese
The Game Plan:
Heat oil in a medium skillet over medium-high. Add onion and garlic; sauce 4 minutes.
Add chickpeas, thyme, and tomatoes; cook 1 minute.
Add spaghetti squash, spinach, and salt; toss gently to combine.
"If you see fraud and do not say fraud, you are a fraud.”-Nassim Taleb
Now that is how you start an article. I'm not going to go so far as to just sit down and list out some suspect, even questionable practices...but we are going to talk about some ways to avoid falling victim to them.
Things that could make someone a "fraud":
Their thing is the ONLY thing. No need for anything else.
Only selling 'stuff' and you HAVE to buy certain things.
They can fix ANYTHING
Nothing to back it up (education, research, or continued learning)
Even people in the health and fitness industry have to make a living so at some point you are going to have to pay them some money. There isn't anything inherently wrong with this but there are some things to look out for. If all they are doing is selling you on something you have to have and if you don't add it to your life you won't have success. HUGE Red Flag. Anything that is only financially incentivized is something you need to stay away from.
Also be leery of someone can fix any and every problem with a specific type of treatment or specialized technique. If that were truly the case they would be world famous, see 6 people a week and you and I probably wouldn't have access to them. There are a lot of great practitioners out there but no one can treat everybody and fix everything. Things are too complex and people are too individual. If they follow it up with you HAVE to come back over and over to keep the progress, be careful on just looking for a quick fix.
With all of these things you have to find people that have the information and knowledge to back it up. While traditionally that comes with college and higher education it doesn't have to. Years of experience, research and knowledge gathering along with critical thinking can be sufficient but you have to do your due diligence. Ask a lot of question, get informed on your own and you can always ask them what they would do if they were in your situation to get a better feel.
Be careful out there for frauds, while I don't want to start throwing around names (yet) I am happy to give input if you have questions (free of charge of course).
While shoulder pain while you're sleeping and/or lifting doesn't seem like it would have a lot in common you'd be surprised at how much the differing mechanisms can cause the same amount of pain. This video gives you a break down of what you can do in order to help relieve some shoulder tightness and pain. Give them a try.
We don't feature seafood often enough in our Friday Food so we wanted to make sure we got back to it. Here is a simple shrimp recipe that would taste great with you favorite greens to accompany it or with a fluffy bed of rice. Enjoy this one.
Ingredients:
1 tbsp olive oil
1 pound large shrimp (peeled and deveined)
1 tsp minced garlic
1/4 - 1/2 tsp red pepper flakes depends on your heat preference
1 tsp lemon zest
1 tbsp lemon juice
2 tbsp parsley or cilantro chopped
Salt and pepper to taste
The Game Plan:
Heat the olive oil in a large skillet over high heat.
Season the shrimp with salt and pepper to taste.
Add the shrimp and cook for 3 minutes or until shrimp are pink and opaque.
Stir in the garlic, red pepper flakes and lemon zest; cook for 1-2 minutes more.
Hamstring injuries are tough to deal with and the rehab process can be very frustrating. Anytime an intervention appears to have a positive effect on the rehabilitation outcome it is worth taking a look at and seeing if there are any areas you could apply it to your treatment and rehabilitation plan.
What They Did:
Researchers randomly assigned 37 elite athletes with an acute grade I or II hamstring strain to either a cryotherapy group or a cryostretching group. Each group received 5 sessions of supervised treatment pulse home-based intervention.
What They Found:
The objectives that the researchers looked at with the treatments were changes in pain, active and passive knee extension range of motion, along with functional status. What the researchers found was that compared to cryotherapy, cryostretching (cryotherapy followed by stretching) resulted in larger improvement of function and passive knee extension range of motion. They also found that active knee extension and pain severity were not significantly different between the two groups.
What It All Means:
Before we get into our personal take on everything this study does show that adding some stretching into the rehab protocol can help improve functional outcomes and passive knee range of motion.
We agree with adding some stretching into the rehab protocol when it comes to hamstring injury is a good idea but the hard part is trying to figure out when to add it in. We generally don't agree with adding cryotherapy to the injury process, outside of some contusion injuries, as we can't figure out when and how it makes a big difference when it comes to aiding the healing process. Movement we believe is key to start off the rehabilitation process. You need movement that is pain free but this helps you jump start your bodies process of healing.
Limitations:
There aren't a lot of limitations with this one because it is a direct comparison of two interventions. Really the biggest things figuring out where this fits in your treatment and rehabilitation plan. Again we think movement is key early and often and figuring out where to add stretching in.
Resource: Sefidashti, L. The effects of cryotherapy vs cryostretching on clinical and functional outcomes in athletes with acute hamstring strain. Journal of Bodywork & Movement Therapies.
It's that time of the year, the new year. Time for resolutions and planning big changes for 2019. While it is great to have ideas and plans and options for the new year as man of us have probably seen and experienced, they are really hard to follow through on. Here are some ideas we have come across to help keep resolutions and make them happen.
Make It Achievable
Having multiple goals/resolutions are great but having all of them being huge can lead to stress in trying to achieve them. Keep a couple grandiose ones but make many of them something that is attainable (i.e. losing 5-7 pounds a month vs. losing it all by the end of January). The feeling of accomplishment that comes with completing goals can be what you need in order to keep pushing forward and improving and moving on to the next goal.
Is It Quantifiable?
Put exact numbers and other objective measures on things. In the losing weight example set a target goal and not just "lose some weight". When there isn't something to readily shoot for it can be hard to maintain motivation and keep moving towards it. These are the goals/resolutions that never seem to last and be accomplished. "What gets measured gets accomplished." Make sure to set specific measures to it.
Set Deadlines
This idea goes along with making it quantifiable. If you have generalities with when you are going to accomplish your goal and resolution it gives you an easy way out. Setting deadlines and then making sure that someone knows that date and holds you accountable to it is going to make it a lot easier to get things done. That may be a bet that you hold to put some money into the game. It could be some other type of wager to help keep you motivated. Having set deadlines is going to help move things along and get you to places you need to in order to accomplish goals.
Happy New Year everyone and here is to accomplishing goals (we have our own we have to get after)
