Friday, March 16, 2018

Ice Age: Rethinking Icing Injuries and Sore Muscles

I remember when I went to the nurse in high school for a medley of ailments, and it seemed like no matter what the symptom was, a pack of ice was the associated prescription. Headache? Put ice on it. Muscle pain? Put ice on it. The building was on fire? Throw ice on it. Okay, the last one was a pretty lame joke, but somehow ice became a panacea in my nurse's eyes. It seems that in the sport and exercise world, such is also the case.

Ice Baths for Recovery

I just started watching Game of Thrones,
and I couldn't resist using this meme...
The most common use of ice that I hear people tout is its recovery healing powers. Are torturous ice baths as effective as we make them out to be?

We have evidence of the early Egyptians using early forms of cryotherapy in 2,500 BCE to treat a medley of ailments. Fast forward to 2018 and you see people immersing themselves into futuristic-looking cryotherapy chambers filled with liquid nitrogen. As you can imagine, extensive research on the subject has been done since ancient Egyptian times.

Now, one study done by Fonda and Sarabon (2013) did find that participants who utilized whole body cryotherapy reported feeling less sore than those with no intervention. While this is more qualitative rather than quantitative evidence, it does show the potential for a decrease in the perception of DOMS with cold immersion.

Hausswirth et. al. tested runners and also found a reduction in pain and subjective fatigue 24 and 48 hours after their runs in participants using cryotherapy chambers. While this is also a qualitative measurement, researchers also found an increase in strength when compared with the control group (2011).

Contrarily, Costello et. al. measured MVC (maximal voluntary contraction of a muscle) 24 hours after an eccentric exercise protocol and found no significant differences in muscle soreness in participants who were immersed in -110° C temperatures and those who weren't immersed (2012). 

Overall, the current body of research does seem to suggest that cold immersion can help reduce subjective measurements of fatigue and soreness in athletic populations, but the verdict is still mixed as far as I'm concerned. Many of the measurable, physiological markers of recovery were unchanged, but the participants simply reported feeling better. My thought process is that a lot of the attributed markers of recovery are due to a placebo effect. Effectively, if you feel like an ice bath helps you feel like you're being active in the recovery process, then keep on as you were. It may not be efficacious, but it's worth a try!

Ice Baths for Treating Injury

Going back to my high school nurse who would use ice as a cure-all, many people still assume that icing is the best protocol for soft tissue injuries. Let me start by saying that ice works as an anti-inflammatory and also a vasoconstrictor (meaning your blood vessels constrict). The downside here, is that we societally regard inflammation as a negative thing, when it is in fact your body's line of defense. Inflammation is necessary to jumpstart the healing process. The more blood flow you get to an area, the quicker the repairing process can start. Gary Reinl, author of the book "Iced" which covers this topic more in-depth, notes "the inflammatory cells remove debris and recruit cytokines and other growth factors toward the injury site." As such, swelling and inflammation are not symptoms to fear or reduce in this case. He goes on to say, "In a healthy healing process, a proliferative phase consisting of a mixture of inflammatory cells and fibroblasts naturally follows the inflammatory phase. The fibroblasts build a new extracellular matrix and persist into the final phase of repair, the maturation phase, where, if all goes well, functional tissue is laid down. The key point is that each phase of repair is necessary for the subsequent phase."

Additionally, the University of Pittsburgh Medical Center (my alma mater) noted that "…ice may not be the best treatment for aching muscles — in fact, it could even be detrimental to recovery" (2011). The British Journal of Medicine reached a similar conclusion, stating that "ice is commonly used after acute muscle strains but there are no clinical studies of its effectiveness" (2012).

Summing it All Up

Icing injuries has become a staple in workout and recovery protocols for people all across the globe for ages. As it turns out, the effectiveness as icing for both decreasing muscle soreness/damage and for aiding in the healing process of an injury seems to be unfounded. The body of research denouncing the usage of ice on both accounts seems to outweigh the papers that support its application.

I personally don't use ice in either instance, and I believe that rest, sleep and proper nutrition can be some of the most effective recovery strategies! Next time you go to jump into the ice bath or wrap an injury in a bag of ice, ask yourself why, and decide whether or not it's actually going to help you or potentially hinder you.

Tuesday, January 9, 2018

3 Reasons Why Counting Calories Isn't as Easy at It Seems

Calorie counting is easily one of the most effective ways to lose weight. Flexible dieting (or “IIFYM”) has become one of the biggest nutrition crazes as of late, with fitness influencers posting the macronutrient breakdown of their meals. They weigh their portions and track their intake. While it has been proven that a caloric deficit will ultimately result in improvements in body composition, the story isn't quite so clear cut. In fact, you may be counting your intake and misinterpreting what all of that information means.

A kilocalorie, more commonly referred to as a “calorie,” is the amount of heat that is required to raise the temperature of 1 kilogram of water one degree Celsius. While we still have a lot yet to learn about the science of nutrition and digestion, there are a few ways in which your caloric estimates may be inaccurate.

Calorie labels aren't always accurate.

Your body breaks down all foods differently, depending on their chemical and nutritional profile. For example, researcher Janet Novotny and her colleagues tested the nutritional content of walnuts. She found that we metabolized about 21% less energy than was predicted by the labels. So, a serving of walnuts might say that it is 180 calories, but we are only possibly absorbing about 145 calories. That is a pretty substantial disparity in caloric intake!
Additionally, Gebauer at all tested different types of almonds (whole unroasted, whole roasted, chopped roasted, and almond butter) in equivalent quantities. Surprisingly, the body absorbed the most calories from the almond butter, followed by the whole chopped roasted almonds. Subjects absorbed the least amount of calories from the whole unroasted almonds. It seems as though the roasting process changes the structure of the almond's cells allowing our bodies to digest more of the nut. It appears that if you're looking for the greatest bang for your buck with nuts, the raw variation is far superior to a nut butter. The exact reason for this phenomenon is unknown to date.

Another study done by Carmody et. al. concluded, " substantially increases the energy gained from meat, leading to elevations in body mass that are not attributable to differences in food intake or activity levels." This means that we are able to absorb more calories from cooked meat than the equivalent amount of raw meat. Here, the cooking process alters the way it is digested and used for energy, in that our bodies can extract more chemicals from cooked food, as they do not have to work as hard to break them down. That is to say that one would expect to consume more calories from a well-done steak than from an equivalent sized medium-rare steak.

Dr. David Bauer notes that "calories are created equal, but their availability from foods is not equal." So what we do with the calories we consume is highly variable based on the processing (or lack thereof) of those foods.

Dietary fiber can influence weight loss.

The USDA recommends that women get about 25 grams of fiber per day, and men get 38 grams per day, yet some estimates report that many people only get 12-18 grams per day. A few studies have guessed that fiber can influence not only our satiety (leading to a decrease in caloric consumption), but also the size of our waists.

A study done by Du et. al. of fiber intake in European citizens over the course of  about 7 years found an inverse correlation between cereal fiber intake and waist circumference. This means that individuals who increased cereal fiber consumption had smaller waistlines. There was a less significant effect with fiber from fruits and vegetables.

Again, these changes in body composition may be due to the feeling of satiety that comes from an increase in fiber intake, but that is still poorly understood.

So, if you eat 500 grams of oats, the overall satisfaction is going to be very different than eating 500 grams of chocolate crispy cereal. You may find yourself hungry within an hour after eating the gummy worms, whereas the equivalent amount of oatmeal could keep you full for hours on end. If you're in a caloric deficit, it's ideal to choose foods that will give you the most volume for your calories. Our bodies cannot convert certain types of fiber (insoluble fiber) into energy, and thus, it isn't fully digested and you may not absorb as many calories from it.

Your gut bacteria influences the way you digest food.

Now, the science of the gut microbiome is quite new. There aren't a lot of papers (especially not using human subjects) dissecting the gut's influence on weight gain, but the current body of evidence seems to show clear differences in the microbiome of lean versus obese populations.

Research comparing the gut bacteria in lean and obese twins found that obese individuals had a smaller variety of gut bacteria than did their leaner twins. This discussion becomes one of the "chicken or the egg," in that we do not know if the gut bacteria changes due to fat gain, or if those with a specific type of gut bacteria are more prone to weight gain in the first place. Research over the next few years will dissect this topic more.

One case study of a woman who got a fecal matter transplant from her overweight daughter (yes, that's exactly what it sounds like) demonstrated considerable weight gain after the procedure. These procedures are typically done to eliminate harmful gut bacteria, but the side effect of an increase it fat mass was unexpected. Nearly 16 months after the procedure, the woman gained about 34 pounds. After another year-and-a-half, she gained an additional 7 pounds, despite participating in an exercise program and a liquid protein diet prescribed by a medical professional. She was tested for thyroid dysfunction to no avail. While this is a study of n=1, it lead some researchers to speculate that gut health may have a significant impact on body composition.

For now, researchers believe that some individuals with less diverse microbial communities may be more likely to gain body fat, despite their dietary habits. Some individuals can slash their caloric intake down to a mere 1,200 per day and still hold on to ample amounts of body fat.

In short, even if you’re tracking your calories closely, your estimates may be 15-20% off based on the types of foods you eat and the microbes in your gut. If your weight loss is stalling, there might be more to the story than meets the eye and you may have to tinker around with your diet to yield better results. Overall, it’s helpful to consume foods in their raw, unprocessed form (when possible) as it is likely that your body will absorb less energy from them. Additionally, more fibrous foods will keep you fuller for longer periods of time. Ultimately though, your gut bacteria may be to blame for weight gain or weight loss plateaus.

Thursday, November 9, 2017

Fine-Tuning your Ab Routine

In a previous article, I noted how the range of motion of crunches is not conducive to building a strong core. Crunches will only effectively engage the rectus abdominal muscles, while some of the surrounding important core musculature is not addressed. Ultimately, it is a basic exercises that serves little purpose for individuals with more than a few of strength training experiences.

The biggest problem in many "ab" routines that I see people do is that there's no progressive overload. People will do the same handful of exercises for the same number of sets and repetitions every session, week after week. Now, imagine you did that with a back squat, or with any other movement: what if you just squatted 135 pounds for 5 sets of 5 repetitions on every leg day? You might make a little bit of progress for a week or two, but eventually you're not going to continue to make gains. Your legs won't get any bigger or stronger. The same is true for the abdominal muscles. If you're just doing 3 sets of 15 crunches, 3 sets of 20 Russian twists, etc., then guess what? Your core isn't going to get any stronger either. I watch many people do the same core exercises day in and day out, and they aren't continuing to adapt.

There are four ways to create progressive overload for strength training:
  1. Increase the number of repetitions. If you've been sticking with 3x10 leg lifts, for example, try to do 3x15 next week. This is one way to add volume.
  2. Increase the number of sets. Additionally, you can add in more sets to increase total training volume.
  3. Increase the amount of time. This is specific to isometric movements like the plank, hollow hold, side plank, etc. Try to increase the length of the hold by 10-15 seconds per week.
  4. Add load. I like to add weighted ab exercises into my programs, once the client has demonstrated competency in the non-weighted variation. Examples of exercises include weighted hanging knee raises, weighted planks, weighted sit-ups, cable chops, and weighted leg lifts.
  5. Change the exercises. Get creative. There are so many exercises out there that allow you to continue to progress. Constantly challenge yourself. I constantly post new exercise ideas on my Instagram page, such as those in the above links, so always be on the lookout for new ideas. Just when you think you have abs of steel, you find a new exercise variation to humble yourself once again.
If  you're going through the same routine multiple times per week, you may still "feel a burn," but you're not necessarily going to achieve the desired result of a rock solid core. Instead, here are my suggestions for improving your core training. Core training has to be progressed in the same way that you would continue to periodize the big strength movements. Think outside of the box and don't get complacent with your ab routine!

Thursday, September 21, 2017

Why Altitude Masks are a Scam

You've all seen those guys in the gym—the ones who look like Bane and sound like Darth Vader hopping from one exercise to the next. Maybe you've though to yourself, "what is that awesome looking gadget," or, if you're like me, something along the lines of "what exactly does this tool think he's accomplishing?"

Many Olympic marathoners utilize altitude training to take their fitness to the next level (pun intended), so it makes sense that these masks would be worth the money.

What these companies aren't telling you, however, is that the research doesn't support these absurd-looking masks. On the contrary.

The positive adaptations of altitude training include an increased red blood cell count. This is one such adaptation that will only come from prolonged exposure to higher altitudes (meaning wearing a mask for an hour a few times per week isn't going to help in that arena. I most often see people wearing these masks on exercise machines (like the bro in the photo). Even if these masks were to work, you certainly wouldn't want to wear them for an exercise that doesn't rely on oxygen for energy (anaerobic exercises).

Another huge flaw in the reasoning behind wearing these masks is that they do not result in a change in barometric (atmospheric) pressure, as we would find in mountainous regions. Instead, they merely restrict your respiratory muscles, which effectively make breathing more challenging. These two things are not the same. In fact, in my opinion, limiting the efficacy of the respiratory muscles is just dangerous and foolish.

Finally, the current theory for altitude training is the "live high, train low." This means that athletes should live in higher altitudes, but train in lower altitudes so as not to impede their physical performance (obviously we cannot perform maximally at 10,000 feet above sea level). The altitude training masks directly contradict this principle, as people are not wearing them to do their household chores, but rather to do biceps curls in the squat rack. You definitely don't need to be an exercise physiologist to understand why this won't confer any added athletic benefits.

If you want to improve your aerobic capacity, avoid the scams and gimmicks. You can't take a shortcut to attain peak fitness levels (without the use of PEDs, of course), so quit throwing your money down the drain and put in the hard work. These masks will make you the laughing stock of your gym and they certainly won't provide any physiological advantage in your training.

Friday, September 8, 2017

Fixing Your Achy Wrists

Do you experience pain in your wrists while doing exercises like bench presses or planks? If so, then read on!

As I've mentioned 1,000 times (and you're probably sick of me saying it already), we always have to look distally (farther away) from the area in question. Think of your entire arms as a train. If the shoulder isn't working properly, you bet that you're gonna have elbow and wrist problems too. Take a look at the photo on the right from Thomas Myers' Anatomy Trains. You can see here that the pecs of the chest will influence the structures all of the way down to the fingers.

The number one complaint I hear from clients when doing the front squat is that their wrists hurt them. While the wrist pain is the symptom, the cause typically arises with poor shoulder mobility. If your front rack position is sub-par, your wrists now have to bear the brunt of that load. The lower your elbows are, the more wrist extension you need to compensate. In this instance, you need to work on opening up the pecs and lats to ease the stress on your wrists.

Because of this horrendous shoulder mobility, his wrists suffer.

I see similar problems arise in pressing movements. In the bench press or the overhead press, clients occasionally lack the necessary strength in their forearm flexors, so they fall into a hyperextended wrist position throughout the lift. A more "neutral" wrist position can save them a lot of discomfort. In these cases, the problem might not be mobility, but grip strength. I would have these people do exercises like hangs from the pull-up bar, plate pinches, or farmer walks to combat this. Sometimes, cueing alone can also go a long way to correct this issue.

This image from Liftbigeatbig explains different wrist positions. We never
want significant extension in pressing movements.
Ultimately, if you feel pain in your wrists you have to check out how your shoulders are moving to properly assess the issue. Shoulder instability can manifest itself in a variety of different ways. Continuing to address your wrist alone will have little to no effect. I see a lot of people working to stretch their forearms to alleviate wrist pain, but rarely do they address other possible contributing factors like shoulder stability or grip strength. Global corrections will stimulate an entire chain reaction of positive effects.

Thursday, August 17, 2017

Try this Hack to Get Bigger

While I've previously explained that stretching seldom helps improve your flexibility in the long term, there are some benefits that come from stretching. This exciting study from 2015 done by Miranda et. al. tested stretching as a means for increasing training volume (the number of repetitions performed in a set or session) in the wide-grip seated row exercise. There were two groups of participants, both of whom performed three sets to failure with two minutes of rest in between sets. The only difference between the groups was that the experimental group performed 40 seconds of a passive pectoralis major stretch at the end of their allotted rest periods. The idea here was to stretch the antagonist (opposing) muscles.

What the experimenters found was fascinating: there was a statistically significant difference in the antagonist stretching group. Those participants performed more repetitions in all three sets. Additionally, the experimental group demonstrated greater contractions in the latissimus dorsi and the biceps brachii muscles.

While this particular study only tested one exercise, it is likely that we can utilize this concept with other movements to reap similar benefits. For instance, in doing a bench press, you could stretch the latissimus dorsi. Before your set of leg curls, stretch out your quadriceps. You get the idea. This hack can help you get more training volume, which will ultimately result in greater hypertrophy (muscle growth)!

The mechanisms behind these findings are still unclear. My guess would be that stretching the antagonist muscles would allow for greater range of motion throughout the exercise, and thus, a stronger contraction in the agonist muscles. For example, the pecs have to stretch during the top of the rowing exercise. A bigger stretch in the pecs could possibly allow for the lats to generate a stronger contraction.

Static stretching before a set may be disadvantageous for power production, and thus, I do not prescribe it before movements like the clean and jerk. However, in a bodybuilding routine, there may be some added bonuses to stretching during rest periods to accumulate more total training volume.
This concept has not yet been applied to strength-based movements, but it could be an interesting point for experimentation on your own before the big lifts. Give this trick a try and see how you like it!

Thursday, June 22, 2017

The 4 Exercises that Your Shoulders Hate

It is common for a lifter to seek boulder shoulder status. While having protruding, rounded shoulders certainly looks nice, the shoulders are very vulnerable to injury. The demands of a sedentary, desk-ridden society already makes our shoulders unhappy, and if you translate this dysfunction into the gym, you're gonna have a bad time.

I have dealt with my own shoulder issues in the past, and I know just how aggravating it can be to have to modify workouts or avoid certain movements. Ultimately, I had to learn the hard way what exercises provoked my shoulder pain. Many common-place shoulder exercises can be effective for deltoid and pectoralis hypertrophy, but they also promote instability and compensation. For both myself and my clients, there are four main exercises that I avoid for the sake of sparing their shoulders:
  1. Pec flies. Regardless of whether you're using cables, dumbbells, or even the pec-deck machine, you're most likely better off without them. With this movement, many lifters tend to go well beyond the necessary range of motion to isolate the pectoralis muscles in transverse shoulder flexion. You also run the risk of sufficiently irritating your biceps tendons. Instead, they end up stretching the hell out of their anterior deltoids and forcing their shoulders into a yucky internally rotated position that makes me cringe. For chest development, I prefer to have clients do reverse grip bench press, neutral grip dumbbell bench press (with a slow eccentric focus), and Spoon presses. If you're hell-bent on keeping pec flies in your workout routine, try to minimize the range of motion so that your arms only go slightly above parallel, and make sure you maintain a slight bend in your elbows.
  2. Behind-the-neck lat pull-downs. I've addressed my feelings about behind-the-neck exercises previously, so to save you from a redundant rant, I'll give you the abridged version: these movements (especially in lat pull-downs) encourage you into flexed cervical spine and often reinforce poor shoulder movement. Very few people possess adequate shoulder and thoracic mobility to perform these. If you really want wings, stay away from these. Instead, try rowing variations, pull-ups (you add weight or go chest-to-bar if you want a greater challenge), straight arm pull-downs, and maybe the occasional Red Bull. (I couldn't resist...)
  3. Box dips. In a recent Instagram video, I mentioned that I stray away from programming dips on a bench or a box. Effectively, this variation places unnecessary stress on the anterior capsule and tendons of the shoulder. To perform these, a client must flare the elbows out excessively, while the shoulder again shifts into a precarious position. You will see this as well on bar dips, but to a lesser degree, because the athlete's shoulder and elbows are closer to his center of mass. The ideal way to do dips, in my opinion, though, is on the rings. The rings force the athlete to properly adduct his shoulder, and his arms are closest to his center of mass (thus resulting in a more mechanically advantageous position. If you're currently unable to do ring dips, stick to push-ups on the rings, and then slowly progress to a full ring dip.
  4. Upright rows. I'm sure you've heard trainers shun this exercise before. While I think it can be helpful for developing the shoulders for the right client, there are always other options. I've found that they cause more harm than good for most people, as usually the anterior deltoids are the strongest part of the shoulder. Instead, many people would benefit from training the posterior or rear deltoids with back flies to balance out the omnipresent imbalance from front to back.
In general, gym goers can benefit from fewer pushing exercises and more pulling exercises. I usually propose a 2:1 ratio for upper body pulling:pushing days. By this, I mean that you should only spend about one day per week doing bench press, push press, etc. (or at least with those movements as your primary focus), and two days with a pulling/rowing focus. The anterior deltoids and pectoralis tend to run the show (especially in men), and, thus, can cause a lot of pathologies and mobility restrictions. Your rhomboids, rear deltoids, lats, and lower trapezius can always benefit from some more love and attention.

There are plenty of safe and effective exercises that will still give you strong shoulders, such as those that I've listed in this article. You can be smart about your upper body training and avoid nagging injuries that will keep you sidelined for weeks at-a-time. Make these changes to your routine, and your shoulders will be happier in the long run!