No Such Thing as Muscle Memory

This muscle memory that everyone tells me about.  I'm not exactly sure what it means?  Who came up with this concept/term?

I've been told that if you return back to training after a brief absence, your muscles will "remember" what to do and how to perform.  They will "remember" how to hypertrophy (get bigger). 


Here is the thing...your muscles are not smart.  In fact, I'd say your muscles are quite stupid.  They have no memory, and they do not remember how to do things. 

You do however, have a brain and nervous system.  Your brain is quite clever.  Your brain stores movement patterns, your brain "remembers" how to perform complex tasks.  Your brain is connected to your muscles by nerves.  Your brain receives feedback from your muscles about length and tension, as well as sends signals to your muscles to undergo contraction (and relaxation). Your brain is responsible for balance, coordination, speed and movement (being drunk is a great example of how movement and coordination is controlled by the brain...not that I condone experimenting to prove my point!)

The brain is like the guy pulling the strings on the marionette.  The muscles simply do what they are told! 


There is no such thing as muscle memory.  Muscles are not smart...but your brain is quite clever!

How did I injure myself? (And how do I avoid doing it again?)

The definition of injury is quite simple:


When the applied load becomes greater than the tolerance a tissue can stand, you sustain injury.  















This may be easier to understand if we use a simple example.  Let us pretend that we had two different branches or sticks.  One of the sticks was from an older tree and one of the sticks were from a sapling (or a younger tree). 

If we take the older branch and bend it, there becomes a point in that branch that will "snap" if the applied load goes beyond the tolerance of the branch to bear that load.

Let's take a look at the younger branch.  You would likely find that it is more flexible and can tolerate more bend than the older branch.  Thus, you can apply more force (load) through the smaller branch before it "snaps" or breaks (and quite often a younger branch will not break right through, only partially through). 

This comparison is similar to how different tissues in the body withstand applied loads (forces) through the body.  If you have ever broken a bone, it is because the force through that bone had gone beyond the tissue tolerance.  The same could be said if you have ever sprained an ankle.  The stretch (applied load) on the ligaments of the ankle go beyond the tolerance for the ligament, it tears or breaks.
The definition of injury can be applied to any tissue in the body.  From cartilage (vertebral discs, meniscus in the knee, or articular cartilage), every ligament, bone, joint capsule, nerve, muscle, tendon etc.

The answer to how to avoid injury?  Don't overload the tissues in your body!  Make sure that any movement you do is within a safe capacity (this also includes sitting and stress on back!)  

The Empathetic Doctor: Suffering for Empathy

empathy  em·pa·thy (ěm'pə-thē)
n.

1.  Direct identification with, understanding of, and vicarious experience of another person's situation, feelings, and motives.
   
    
   
   
   
   
   I understand that pain is a subjective symptom.  It is difficult to quantify pain.  It is definitely easier to understand someones pain if you have experienced the same or similar pain that a person is suffering from.  
   
   
   I have been athletic for most of my life.  I am fortunate to have been relatively injury free for most of my sporting career.  I have had a few broken bones, a number of sprained ankles, and a hand full of concussions.  I am still involved in athletics and am dealing with a few more aches and pains than I did when I was younger.  I currently suffer from a minor meniscus tear in my knee that may require surgery in the future, I have a small rotator cuff tear in my shoulder (from years of pitching in baseball with poor mechanics), and am currently dealing with a high ankle sprain (from a hockey game I played a few days ago). Dealing with these injuries helps me better understand what someone with knee pain, or shoulder pain, or an ankle sprain would go through, as well as what would be expected for treatment and recovery. 
   Though it is never fortunate when one suffers an injury, I believe I am fortunate to have experienced what these injuries feel like.  I believe that this makes me more empathetic towards patients who have suffered or are currently suffering from these types of "aches and pains."  I deal with athletic (and non-athletic) patients who suffer from similar complaints.  In fact, some of them find it quite surprising that when I explain their symptoms to them while they are describing what their problem is! 
   
   
   I believe that it is important in the health care field to show empathy to patients.  I'm not saying that you should suffer for the benefit of the patient, but it does help understand what a patient must go through when they suffer from pain.

The Crossfit Conundrum: Good or Bad?

Before I start, I should qualify that this is not a hack against Crossfit or a promotion of Crossfit.  It is my opinion based on some of the stuff I've read, some of the stuff I've tried and some of the stuff I've seen.  I have tons of friends who do Crossfit and a number of friends who are actually Crossfit coaches.  I have also been to and experience Crossfit first hand and did enjoy my workouts. 

Crossfit Gym

Regular Gym

So let me start with the good!  I think the Crossfit movement is a great thing!  It is nice to see that people are getting away from your traditional body building mentality and moving to what I would call more "functional" movements.  It is great to see the movement away from big expensive, restrictive machines and towards free weights and movements.  I really think that if fitness is a goal, Crossfit is a great way of improving fitness! 

Here is my thoughts about the downside of Crossfit.  I have concerns about people doing complex movements (sometimes with heavy weights) to and sometimes beyond fatigue.  Its at this point where injuries typically occur.  In some cases, even experience Crossfitters lifting heavy loads to fatigue can suffer injuries.  I also worry about the risk/benefit of some of the exercises.  For instance, do the benefits of doing handstand pushups really outweigh the risks (maybe I do, but no one has explained it to me yet!) 


I also have concerns about the accessibility.  Anyone can go online and look up the Workout of the Day (WOD).  It may call for extremely high volume or max weights.  This should be fine for someone who is experience, but for a novice lifter it could be disastrous.  To Crossfit's credit, they have programs for novices who want to come try Crossfit.  They have coaches who are able to help you with mastery of lifting techniques.

I do like the culture that Crossfit has to offer.  It is appealing to groups of people of similar caliber, and can get quite competitive.  For many people, the challenge of competing against your friends helps to push your workouts. 

The bottom line is that if your training is enjoyable, you will be more likely to continue on with it.  So Crossfit-ON!  But please do so safely!

Dr. Google...I think I have...

So you suffer from a bit of a headache, some nausea, fatigue, feeling chills at times, some neck pain, a bit of tingling in the fingers and some abdominal pain.  Punch your symptoms into the computer and Dr. Google diagnoses you with:

Fibromyalgia
Complex Regional Pain Syndrome
Hypothyroidisim
Diabetes
Chronic Pain Syndrome
Hypertension
Meningitis

and...and...and

With all this information, how can someone accurately self diagnose themselves?  Don't get me wrong, I think that knowledge is helpful, but if fallen into the wrong hands it can be a detriment and not an aid.

Something to think about when talking about symptoms.  The definition of SYMPTOM is an objective change that cannot be observed or measured.  Look at the list of symptoms:  Headache, nausea, fatigue, tingling, pain; none of these can be measured (accurately).  I believe this is why sometimes when you present with pain, some practitioners will tell you that "its all in your head." There is no good way to measure.

When you go to your doctor, they are looking at SIGNS that go along with common symptoms.  SIGNS are objective changes that can be observed by clinician.  For example, neck "pain" may go along with reduce range of motion in the neck indicating some type of joint dysfunction.  A headache may go along with an elevated body temperature or fever indicating a local or systemic infection (that can also be measured by doing blood tests and looking at a blood cell count).

Before you go jumping to conclusions about what you may be suffering from, maybe its time to check in with a health care professional to get a second opinion.

Pulled muscle: What does that mean?

Whether is a hamstring, calf or low back, most people have suffered from a "pulled muscle."  But what exactly does that mean?  The medical term muscle "strain" is more commonly used among practitioners, but it is still vague and highly variable.

It would be so much easier to figure out what happened to a muscle if we could just cut someone open and have a look.  But it is kind of frowned upon.  Though there are some techniques such as diagnostic ultrasound and magnetic resonance imaging (MRI) that can aid in the diagnosis of a muscle strain, they can be costly and wait times are often lengthy.  Without imaging, clinicians and practitioners can go by clinical signs and symptoms as well as relying on clinical experience.

Crudely put, a strained (pulled) muscle is a muscle that has undergone some damage.  There are a hand full of grading systems including a more recent "structural" or "functional" grading system, but here is a simplified grading system (it is actually quite old) that can help visualize what is going:

Grade 1 (Minimal): Tear of a few muscle fibers with no fascial damage

Grade 2 (Mild):  Tear of a moderate number of muscle fibers with no fascial damage

Grade 3 (Moderate): Tear of many muscle fibers with partial tear of fascia

Grade 3 Tear including fascia near musculotendinous junction

Grade 4: (Severe):  Complete tear of muscle and fascia

With that being said, a muscle can be strained (or tear) in a number of different spots.  The most common spot for a muscle to tear is the musculotendinous junction (where the muscle meets the tendon).  It is considered the "weak link" in the chain.  It can also be torn in the muscle belly (middle of the muscle) or even at the attachment of the tendon to the bone (called the enthesis).

As you can imagine, it is difficult to come up with a diagnosis (exactly where the muscle is torn) which makes it difficult to come up with a prognosis (length of time for recovery).  For example, a grade 1 muscle strain at the muscle belly may warrant a prognosis of day to day (about a week for recovery with treatment) whereas a grade 1 muscle strain at the musculotendinous junction may require 1-3 weeks of rest and treatment before returning to activity. 

The important thing with muscle injuries is correctly assessing the problem so you can come up with the correct treatment protocol and provide an accurate prognosis for recovery.

Pulled pork is essentially Grade 4 muscle strain! 

Obsession with Abs?

Its beach season again!  And every year, I observe an increase in the number of  people doing a variety of ab exercises at the gym. Why the obsession with abs?  Who decided they need to be aesthetically pleasing?  Is aesthetics more important that function? 

 There are a ridiculous number of crazy abdominal exercises with an attempt to increase the definition or (dare I say...) "tone" of abdominals.  Most of these exercises are done at the expense of "shredding your back/spine" (remember...that thing in your back that many of your core muscles attach to?)  through repetitive flexion.

One thing to consider that the abdominal muscles (or core muscles as a group) are composed mostly of slow twitch muscle (as are most postural muscles).  This means they are great for endurance, but not great for producing power or speed.  So training with repetitive fast movements is more to a detriment than a benefit.  Slow twitch muscle does not respond as well to increased loading, so adding weight to abdominal exercises will marginally increase hypertrophy of slow twitch muscle. 

So is it possible to train your abdominals without bending your back?  You better believe it!  There are heaps of great exercises (that you are probably already doing).  Everything from push ups, squats, deadlifts, lunges, planks, wood chops, pull ups, boxing/fighting (punching and kicking), and yoga are all great examples of core exercises that can still give you definition without "breaking" your back!

Fat Burning: Should you "feel the burn" when you work out?

You hear it shouted in the gym, "feel the burn! Only 10 more reps!"  What does it actually mean and should we really feel the burn?  Is that the fat we are burning?

What is this "burn" that everyone is talking about?  Well, its your muscles inability to keep up with increased energy demands.  The body typically produces energy through aerobic metabolism (using oxygen.)  This is what is happening right now as you are sitting reading this. If you start to exercise or higher intensity activity, your body will start demanding more energy.  When your body starts demanding more energy than it can produce, your anerobic system kicks in.  Your anerobic system allows you to produce energy without oxygen.  However, there is a cost...you can build up metabolic byproducts, one of which is lactate (and pyruvate).  Now, its a bit of a misconception that the lactate/lactic acid/pyruvate is what causes muscle fatigue and burning, but it is a way to measure how much your anerobic system is working and how efficient your aerobic system is at getting rid of it.  Your aerobic system uses the metabolic byproducts from the anerobic system as fuel for recovery from exercise.  This is why you often see professional hockey players doing post game interviews while they are riding a stationary bike.  This uses their aerobic system to "flush" out some of the lactate!

Now the irony is that most people looking to "burn fat" during their workouts.  If you are working out at a high intensity, you are using the anerobic system (no oxygen).  If you are using the anerobic system you ARE NOT USING FAT AS FUEL!  The anerobic system uses sugar as fuel.  The, in the body, this sugar is "blood sugar" or stored as glycogen.  Only the aerobic system uses fat as fuel.  So if you are doing high intensity exercises like spin, step or kettlebell classes, you are probably burning more sugar as fuel than fat.  The best aerobic (using oxygen) exercises are long duration low intensity exercises such as long walks/jogs etc.

I'm not saying that you should not do high intensity workouts.  I'm sure you have seen many people be quite successful at losing fat by doing high intensity exercises.  This happens because you will recover from exercise using your aerobic system (using oxygen), and your aerobic system is the one that burns fat as fuel!

The Lower Abdominal Exercises: Are they helpful?

So you go to the gym and everyone is doing all of these crazy abdominal exercises.  Different versions of side bending, crunching, leg lifting, hanging twists, all in the attempt to "shred" different parts of their abs (to be perfectly honest, they are "shredding" their low back...and not in a good way.)

I was in discussion with a few people trying to understand where this epidemic of abdominal exercises.  Are there really any abdominal exercises that can help sculpt the "lower abdominals?" 

If you were to ask me if there was a way to "stress" the lower abdominals to a greater extent, I would not fully disagree with you.  However, if you believe you are "isolating" the lower abdominals, I would vehemently disagree with you.

The entire abdominal group (transverse abdominis, internal and external oblique, and the rectus abdominis) are innervated by the thoracoabdominal nerve (anterior branches from T6-12.)  To simplify, the abdominals are all controlled (collectively) by ONE NERVE source.  So if the abdominals were to turn on, the ENTIRE abdominal group would turn on.

With the abdominals being "wired" together to all turn on at the same time, shouldn't we be using this to our advantage and training the ENTIRE abdominal musculature functionally?  By functional training of the abdominals I mean using the abdominals to BRACE.  So why not do pushes, pulls, lifts, carries and drags.  Why not practice stuff you do for your sport or stuff you do for work.  Pick boxes up off the ground, carry a heavy bag, do a bunch of push ups or squats.  These are all good abdominal exercises! 

 
If you still believe that you can isolate the lower abs, I would like you to show me a "Long head of the biceps" exercise that isolates the long head of the biceps.  If you can prove to me you can isolate the long head of the biceps, I'll may believe that you can isolate lower abs (but not likely!)

The Shock Absorbers of the Spine

We have learned in traditional anatomy classes that the discs are the shock absorbers of the spine.  This is logical seeing as we know the discs are somewhat built like a jelly donut with a "squishy" jelly center.  It also makes sense as we think of the bones in the body as hard, rigid structures.  As vertebrae are bone, we would assume that they would be rigid also.


So in isolation, the disc may appear "squishy," however, we tend to forget that the discs are sandwiched between vertebrae.  What we don't often think about is how the vertebrae is constructed.  Vertebrae are composed mainly of spongy bone.  That's right, SPONGY bone!  Though the outside of the vertebrae is more rigid, the inside of the vertebrae looks like a dense sponge.  It is this property of the vertebrae that allows it to be the shock absorber of the spine. 


The structure of the disc is more fluid (or jelly like).  Fluids tend to be more difficult to compress so as our spine compresses, our vertebrae "bulge" in upon itself as the jelly pushes against the vertebrae.

Still don't believe me?  Think about it this way:  Imagine you were to eat a massive hamburger.  Think about the buns of the hamburger as the vertebrae and the patty as the disc.  The first thing you would do would be to "compress" the hamburger.  What just underwent the greatest amount of deformity (most compression?)  The "spongy" bun of course!  This is a bit over-simplified as the vertebrae aren't quiet as squishy as a hamburger bun, but it does illustrate the point.



So as your spine undergoes compression when you are running, jumping, sitting or sneezing, it is the vertebrae themselves that are the shock absorbers of the spine.   

A modern approach to abdominal training

Though you may still see people doing sit-ups and a variety of abdominal exercises at the gym, I believe the paradigm is beginning to shift.  I believe there is a greater understanding of the true function of abdominal and core muscles (not just to look good at the beach!) with the importance being to brace/stabilize the lumbar spine.

We brace inherently without even thinking about it.  Think about the last time you picked up a heavy box off the ground, or tried to push an object across the floor.  The first thing you see the person do is take a deep breath in, and watch their face go red while they strain to move the object.  Watch their breathing as they move the object.  When they get through the hard parts of the movement, they may slowly breath out, or they may stop to rest and take a full breath in and perform another repetition. 

So if this is what we do in life, why are we training the abdominal muscles to put our low backs in a flexed position? 

I often get asked what kind of abdominal exercises should I do if I should not be doing sit ups.  The modern approach to abdominal training is to just do what you are doing!  Anything where you are lifting, carrying, pushing, pulling or dragging will force you to brace.  I do believe it is important to know how to be "perfect" when you are bracing, particularly if you are performing repeated movements.  In this case, there are numerous exercises that focus on bracing such as bridging and planking. 

So if you are doing squatting, lunging, deadlifting, push ups, pull ups, sled pushes/drags then you are learning to brace. 

Arthritis and Joint pain: Are you too old for your age?

Arthritis is the most common joint condition in the world.  It is the greatest cause of disability for people over the age of 20.  Symptoms of pain, swelling, and stiffness are common and appear to worsen as we age.  This can lead to impairment and decreased quality of life.

Some common risk factors for arthritis include age, gender (females more prevalent than males), previous joint trauma, and muscle weakness.

Arthritis is a "drying" of the cartilage on joints, similar to a sponge that has been left out on a counter for a number of days.  The cartilage itself has virtually no pain receptors, so the cartilage is not the pain generator.  However, if the cartilage becomes "dry" it will wear more quickly and expose bone underneath.  Small pieces of cartilage can also break off and float around in the joint causing increased synovial fluid production causing pain and swelling.

If you are feeling any type of joint pain; back, knees, hips, shoulders, neck, etc, you will likely be referred for Xrays.  Ironically, there is a substantial amount of evidence showing that severity of Xray findings and pain are not related.  In other words, you may have terrible looking Xrays and minimal to no joint pain, or you may have severe pain with no evidence on your Xray.  This is because the pain causing tissues rarely show up on Xray.

So when do you start developing arthritis?  The best answer is after skeletal maturity (between 20-25).  Of course we can do things that advance or slow the rate of cartilage degeneration in our body.  It seems contrary, but exercise is one of the best things we can do to maintain our cartilage and reduce arthritis in the future.  In saying that, if you are not using your joints the way they were meant to be used, it will wear on the cartilage and increase the likelihood that you will get arthritis at a younger age.  For example, running and aerobic activities are known to be good for decreasing the incidence of arthritis.  However, running with poor form may wear on your cartilage and cause you knee problems sooner rather than later.

With the prevalence of arthritic conditions increasing, it is important to do what you can at as young an age as you can to preserve the cartilage you have, and decrease the chances of arthritis in the future.  Use your joints wisely and they will be kind to you!

 

The Perfect Push-up: How to learn and how to teach the perfect push up position

The push-up is a great exercise.  Most people use it as a "chest" exercise, but it requires so much more than just chest muscles.  Depending on how it is done, it is a great rotator cuff/scapular coordination, shoulder stability, abdominal brace, glute/ham, quad, exercise.  There are numerous ways to perform push-ups to help develop strength, power and endurance.  

Ouch, this would be tough on shoulders

One of the more common questions I get about push-ups is hand position.  I remember learning push-ups with our elbows abducted to 90 degrees from our shoulders, and not to go past 90 degrees o elbow flexion.  I also remember learning this type of movement while I was bench pressing and it causing shoulder pain (due to impingement) to the point where I was shown by a strength coach how to perform a proper pushing movement.  After a minor decrease in strength due to learning a new movement pattern, I ended up stronger and with much healthier shoulders.

Not a natural pushing motion.  Would you do this through a

I still see people teaching and learning pushing with "elbows out."  I see a lot of guys who bench press with a wide grip with the misconception that it is the best way to workout their chest.  The best advice I got from my previous strength coach was that to think of the push up (or bench press) as a pushing movement.  Think about pushing someone away from you or pushing a door open.  You wouldn't do it with your elbows out.  So why do we practice this in the gym?

Simply put someone on their stomach and hands go to the right place

 I ended up stumbling upon a way to get people to position their hands.  I've done this with people who are 8 years old to people who are 80 years old.  Have them start with laying face down on the ground.  Simply ask the person to push themselves up to a kneeling position.  The first thing they will do is place their hands under their shoulders in the "perfect push-up" position.  The next amazing thing they do is that a person will automatically brace their abdominals before they push themselves up. So the 8 year old and the 80 year old have just completed a push up!  Now, of course you can modify intensity and the type of push up they are doing to fit their training goals, but it start with good technique!

Concussion in Sport: The Dangers of Safety

Experiencing a few concussions over my lifetime has given me the opportunity to understand more about the process one goes through and more importantly, the signs and symptoms of concussion.  Some of my concussions have been more severe than others, but the results are much longer lasting than you would expect.

There are many factors that have contributed to the increase in the number of concussions in the past few year:  Much improved awareness about the signs and symptoms of concussion (especially weeks to months after a concussion) and return to play after a concussion, changes in the diagnostic criteria, and players in sports are much bigger, stronger and faster than they were in the past.

Possibly one of the overlooked factors is the "Dangers of Safety" in sport.  Sporting equipment and padding has evolved significantly since I started playing sports.  For instance, look at the older shoulder pads and helmets that hockey and football players use to wear and compare them to today.  One of the problems with making equipment safer is that players will feel more apt to take a risk.  This means they can be more confident in trying to make a bigger hit or a harder tackle.  As has been seen in some sports, there are players who make attempts to injury or take other players out of game.

In no way am I saying that we need to reduce the size of equipment and risk an individuals safety.  However, it may be time to get to the grass roots and teach kids how to use their sporting equipment properly and safely.

Concussions can have a long lasting impact, especially on a young child.  There is a documentary coming out called Head Games that should help spread awareness.  Have a look at the trailer

https://www.youtube.com/watch?v=zzQqEos6LVI&feature=youtu.be