Philly.com Sports Doc
POSTED: TUESDAY, NOVEMBER 25, 2014
If you’re a power lifter or body builder, please stop reading. If you’re a high level athlete, please read with an open mind. Now for the rest of us… My patients ask me all of the time, “What can I do in the gym?” For me, it’s not what you can and can’t do but what you should or shouldn't do.
Why do I say that? Here are just a few of the injuries we've seen in the office from doing the wrong things in the gym: a middle aged women who tore her ACL doing jumping jacks onto a plyometric box, a 60 year old who tore his meniscus when he was forced into deep knee flexion during yoga, and a broken tibia from the bar hitting her leg during Olympic lifting. It’s not that some people can’t do these things; it’s just that most of us shouldn't be doing them.
Here are my top 5 things you should avoid at the gym.
1. Deep squats
I always have this debate with strength and conditioning coaches. Why do they have their athletes squat past 90 with resistance? It’s not functional except for maybe wrestlers and football lineman, and even with them, is it worth the risk of injury? For the rest of us who are just trying to stay in shape it is a recipe for knee pain and meniscus tears. Deep squats put significant strain on the knee ligaments, significant pressure on your patellofemoral joint (knee cap), and it puts your meniscus at significant risk for tearing.
Let’s talk about the meniscus tear more specifically. As we squat down, the knee not only flexes but the femur glides posteriorly on the tibia. From about 90 degrees and beyond, we are putting almost all of the pressure on the posterior horn of the meniscus. Now just add a little rotation and pop, there goes your meniscus. And we know that our menisci start to degenerate over time (starting at about 35-40) placing us at even greater risk for a meniscus tear. Do the theoretical benefits of deep squatting out weigh the risks, absolutely not! So let’s please stop at 90 degrees.
2. Dead lifts
This is another exercise where I also debate people on the risk/benefit of the exercise. Yes, it’s a great exercise to strengthen your hip extensors (glutes and hamstrings) but it’s an even better way to injure your back. Repetitive flexion activities have been shown to be a significant factor in back injuries, specifically bulging and herniated disks. Even if you perform the exercise with perfect mechanics, which none of us do all the time, you’re still setting yourself up for a problem. Just like the meniscus in the knee, the discs in the spine start to degenerate with age. Combine this with an exercise that puts significant strain on the posterior annulus of the disc and you’re in for a lifetime of intermittent back pain. Instead of dead lifts, let’s focus on exercises that will still strengthen your hip extensors with less risk of injury. Lunges, step ups, bridging, and squats above 90 can all accomplish this while limiting the risk of low back injury.
3. Overhead presses
Overhead military press, dumbbell shoulder press, etc., all put your rotator cuff at risk for injury. Every time we lift our arms over head we have the potential for some impingement of our rotator cuff under our acromion. Now add weight and we’re just tempting fate. There is also a common theme with all these problematic exercises I’m writing about: our tissue starts to wear down and degenerate with age.
This is once again true for the rotator cuff. So why do an exercise to strengthen our shoulders that puts our rotator cuff at significant risk for injury? If you want to strengthen your deltoid you just need to do some pushing and pulling exercises. Overhead exercises aren't functional and the risk of injury just isn't worth it. Don’t try to “isolate” your shoulders and instead strengthen them functionally with pushing and pulling exercises such as push-ups and incline pull-ups on the smith press or TRX.
4. Bench press to your chest
I don’t like the bench press because it’s not a functional exercise, but that’s another discussion. The risk with bench press is that when your elbows break the plane of your chest, you’re putting significant strain on the stabilizing structures of the shoulder, specifically the labrum and capsule. Now add heavy weight and it’s a labral tear waiting to happen. And like everything else, the labrum degenerates over time. Clicking in your shoulder? It’s probably a labral tear. If you have to bench, keep the weight reasonable and don’t let your elbows break the plane of your chest. Better yet, do a standing cable column press as it is a much more functional position; just don’t go too deep and your shoulders will thank you.
5. Anything with heavy weights
I’ll be the first to admit that I loved lifting heavy weights when I wrestled in college. It was always a competition of who could bench and squat more. Looking back, bench pressing did nothing for me as a wrestler as I should have been doing more pulling exercises. After two shoulder surgeries, a hip labral tear which has likely progressed to arthritis (no MRI as I don’t want to know), focal arthritis in my knee as well numerous other chronic injuries, my joints wish I had focused on functional training and not weight lifting.
There is starting to be a paradigm shift in the strength and conditioning world. People are turning away from weight lifting and focusing on functional training and injury prevention. Stanford University’s director of football sports performance Shannon Turley is on the forefront of this movement. Instead of having freshman players hit the weight room when they get to school, they focus on regaining flexibility, improving core stability, and relearning correct movement patterns. He has had to write letters to NFL scouts about his program and why his players don’t have a record setting combine bench press but excel on the field and are injury free.
EXOS, formerly Athlete’s Performance, is the provider for strength and conditioning for the Men’s U.S. National Soccer team. Their approach to sports performance is to fix an athlete’s problems/weaknesses. There is little return in trying to improve quad strength in soccer players who already have super strong quads. Instead, you’ll see more gains by focusing on correcting their weaknesses such as limited hip mobility and glute med weakness. Even though we’re not professional athletes, let’s take a page out of their training programs and try to fix our deficits such as flexibility, core strength, and movement patterns and leave the heavy weights on the rack.
As I’m writing this, I’m envisioning the comments that I’ll be getting. But as I always tell my patients, “Is it better to look good or to feel good?” Let’s move away from working out the way we always have and start thinking about our long term health, as many of the exercises we do are counterproductive to our overall goal of living a healthy, happy, and pain free life.
Philly.com Sports Doc
Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation Posted: Wednesday, December 4, 2013, 6:00 AM
The core: it’s the buzzword in rehab and fitness circles. Everyone talks about how important it is for treating low back pain and for athletic performance. But what is it really and what are the most effective ways to strengthen it?
It is important to know that the core is not just your abs. To date, there is no definitive definition of what truly is the core. A May 2010 study by Escamilla et al. described the core as “the lumbopelvic-hip complex, which involves deeper muscles, such as the internal oblique, transversus abdominis, transversospinalis (multifidus, rotatores, semispinalis), quadratus lumborum, and psoas major and minor, and superficial muscles, such as the rectus abdominis, external oblique, erector spinae (iliocostalis, spinalis, longissimus), latissimus dorsi, glute maximus and medius, hamstrings, and rectus femoris.”
As you can see, that covers a lot of muscles including ones that directly affect the upper and lower extremities as well as the lumbar spine and pelvis. These muscles are important for both movement and stabilization of the pelvis and spine.
Which muscles are most important to strengthen and which exercises are most effective? There is still great debate on all of this. Research is starting to show that it is important to strengthen the core as a stabilizer versus a mover. This means exercises where the trunk is stable and static (ie. planks vs. sit ups). A 2002 article by Cholewicki and VanVliet in the journal Clinical Biomechanics reported that “no single core muscle can be identified as most important for lumbar spine stability” and “no one muscle contributes more than 30 percent to overall spine stability.”
How do we contract/activate the core? There are numerous techniques used to facilitate activation of the deep core musculature: abdominal hollowing, abdominal bracing, draw-in maneuver, and posterior pelvic tilt just to name a few. None of these has been shown to be the most effective at core activation, even with EMG studies. The key is to contract the deep abdominals, including the pelvic floor. You should feel your abdominals tighten above and below your belly button as well as in your love handle region (obliques). The Kegel exercise, which is used to contract the pelvic floor, is another good way to activate your core musculature. However you achieve this core activation, you have to maintain it throughout the repetition/exercise duration. If you’re holding your plank for 2 minutes, you probably lost your core control at about 30 seconds.
So, let’s put it all together.
Phill.com Sports Doc
POSTED: Thursday, August 15, 2013, 6:00 AM
Justin Shaginaw, MPT, ATC, Aria 3B Orthopaedic Institute, Athletic Trainer - US Soccer Federation
Gatorade, Powerade, Accelerade, Lucozade, Sqwincher, EFS, Recharge, All Sport, Levelen… as you can see there are endless sports drinks on the market. These drinks say they can increase performance, decrease cramping, and speed recovery. What does the research say?
Pre-activity sports drinks
There are numerous pre-activity sports drinks on the market that claim they improve performance through numerous methods including increased energy, maintaining hydration, and adding to carbohydrate stores. Let’s look at the main components, (caffeine, carbohydrates) and see what the research shows.
We all know how that our morning cup of coffee helps start the day off on the right foot. But does it help to run faster or cycle longer? A 2012 article in the Journal of Strength & Conditioning Research showed “that acute ingestion of a caffeine-containing energy drink can enhance resistance exercise performance to failure and positively enhance psychophysiological factors related to exertion in trained men.”
There are numerous articles that support the use of caffeine performance enhancing supplement. Keep in mind that more is not better when it comes to caffeine and there can be negative side effects of excessive caffeine consumption. So please speak with your physician or a nutritionist about how much caffeine is safe and effective. And for NCAA athletes please consult your school’s athletic trainer as you can test positive if you’re over a certain limit.
Carbohydrates are thought to have a role in pre-, during, and post-exercise performance and recovery. Pre-activity carbohydrates are thought to top off one’s energy stores. A study in the Journal of Strength and Conditioning Research in 2013 showed that pre-activity “sports drinks allow higher stroke frequency during play, with decreased rates of perceived exertion” in tennis players.
What we don’t know is what is the optimal amount of carbohydrates and where do we get them from. Is there one drink that’s better than another or can we just get them from a healthy pre-activity snack? There is also concern for how an athlete feels eating and drinking prior to activity. Will it make them feel bloated? Can they tolerate a sports drink but not an energy bar? The general guideline is to have some form of carbohydrates pre-activity that your GI system can tolerate well.
During Activity Drinks
These can be broken down into two categories: energy replacement through carbohydrates and electrolyte replacement to limit cramping and dehydration.
Carbohydrates during activity are thought to supplement the body’s energy stores helping to maintain performance levels over longer periods of exercise. A 2011 article in the Journal of Sports Sciences recommends “Carbohydrate intake during exercise should be scaled according to the characteristics of the event. During sustained high-intensity sports lasting about 1 hour, small amounts of carbohydrate, including even mouth-rinsing, enhance performance via central nervous system effects. While 30-60 grams per hour is an appropriate target for sports of longer duration, events greater than 2.5 hours may benefit from higher intakes of up to 90 grams per hour.” Once again, the type and amount of carbohydrates is still unknown with recommendations of what the athlete tolerates from a GI perspective being most important.
What causes cramping in athletes? Is it dehydration, sodium loss, or something else? An article in the British Journal of Sports Medicine 2013 states “Significant and serious hypohydration (dehydration) with moderate electrolyte losses does not alter cramp susceptibility when fatigue and exercise intensity are controlled. Neuromuscular control may be more important in the onset of muscle cramps than dehydration or electrolyte losses.”
For cramping, the majority of sports drinks are isotonic or hypotonic meaning they have the same or fewer electrolytes than what is in your body normally. So not only do these drinks not replace lost electrolytes but they can pull electrolytes out of the body. Exceptions to this are sports drinks like Levelen that are based off of sweat testing and replace specific electrolytes lost by the individual.
So what’s the bottom line? For the average athlete who is working out for 60 minutes or less water is just fine. If it’s greater than 60 minutes or in a hot and humid environment, a sports drink comprising of both carbohydrates and electrolytes may be beneficial. Otherwise, these sports drinks tend to be nothing more than empty calories.
Post activities drinks are comprised mainly of carbohydrates and protein. The goal is to replenish what is lost immediately post-exercise. It is assumed that this helps in recovery. However, two studies dispute this common thought process.
A 2006 study in the Journal of Sports Medicine and Physical Fitness showed that “supplementation with a sports drink during recovery showed a significant short-term subjective positive effect compared with placebo. However, no effects were seen on physical performance or signs of overtraining.”
Another study in International Journal of Sport Nutrition and Exercise Metabolism 2008 concluded that ”consuming a carbohydrate + protein or carbohydrate beverage immediately after novel eccentric exercise failed to enhance recovery of exercise-induced muscle injury differently than what was observed with a placebo drink.” What we thought was common knowledge regarding carbohydrate replacement post exercise may not be backed up by science.
Pre-activity, caffeine can have positive benefit and one should have some sort of carbohydrates 30-60 minutes before activity. During activity, most people are fine with just water unless you’re competing for greater than 60 minutes, are in a hot and humid environment, or are prone to cramping. Lastly, for post-activity recovery you can probably skip the protein drink and just head home for a healthy well balanced meal.
It can be difficult to find time to exercise. When faced with limited hours and days to work out, what is the most effective form of exercise? Weight training? Cardio?
The New York Times reported on two new studies found that it may be just as effective to do both on the same day. There has been a common thought that you need to separate strength training and cardio days in order to achieve the most benefit (known as “muscle interference” or “exercise antagonism"). It has also been thought that combining strength training and cardio may have a negative effect. These new studies show that there are similar gains combining cardio and strength training while putting in less time than when done separately. People who did cardio and strength training on the same day did half the amount of each compared to the other subjects but still had the same overall benefit.
So when deciding how to exercise when you have limited time, do your cardio and strength training on the same day knowing that you're getting the same benefit for half the time commitment.
The never ending debate, is it better to diet or exercise for weight loss? For most people, exercise does not burn enough calories to lose any significant weight. I went for a 20 minute run yesterday and my Nike plus app said I only burned 250 calories. That's about the same amount of calories in a latte. As I always tell patients, the best way to lose weight is to decrease calories. The above article from the New York Times health blog discusses a recent study stating that with weight loss there is a subsequent decrease in metabolism. This means that it's even harder to keep weight off once you lose it due to this decrease in metabolism. So what's the bottom line on weight loss, decrease caloric intake and increase caloric expenditure through exercise. And instead of calling it a diet, let's call it a lifestyle change because without changing our eating and exercising habits permanently, weight loss will always be just a temporary thing.