I recently sustained injuries to both my shoulders, probably as a result of overuse and chronic trauma (apparently, throwing someone on top of you instead of over you via Morote Seoi hurts your shoulders).  Over the past couple of months, I’ve managed to nurse at least one shoulder back to health, with the other well on the way.

Some of my classmates and clients are amazed that I’ve been able to do this without going to physical therapy.  But it’s really not a mystery.  What did I do?  Liberal application of ice, heat, and meaningful (read: heavy enough to challenge) exercise for the support muscles of the shoulder.

When you sustain an injury, the first impulse you have is to rest it.  You’d avoid movements that hurt in attempts to give the injury enough time to get better, hoping that things will work out at some point.  Well, while it’s important to manage pain, decrease swelling, and allow enough time for your body to repair itself, the reality is that you can’t avoid usage of your joints (at least, not unless you plan on consigning yourself to complete bed rest).

Problem #1: By avoiding usage of the joint, you impair the joint’s function.

Problem #2: By impairing the joint’s function, you allow the joint to get weaker.

Problem #3:  A weaker joint is less capable.  So you end up either using it less (see problem #1) or continuing on as if nothing happened and risking further damage to the joint (see problem #2).

In physical therapy literature, this sequence is referred to as “the downward spiral of pain” – by limiting function as a response to pain, a patient gets worse and worse until he’s virtually non-functionally.  Interestingly enough, the only way to interrupt this cycle is to perform corrective exercise to strengthen the muscles surrounding the injury site.

The true role of PT in rehab is to strengthen the muscles that support the damaged joint. All the bells and whistles that are done to you as a patient (modalities) serve to decrease inflammation and pain, either pre-emptively (so you can exercise) or post-emptively (so as to control additional pain and swelling resulting from exercising the injured area).  You can see the sense in this – without icing a swollen joint, for example, you’d have very little active motion in the joint (not to mention tons of pain when you do try to move it).  Bring down the swelling, turn the volume down on the pain, and you can meaningfully exercise.

Unfortunately, this isn’t what most people go to PT for.  They’re in it for the modalities: A little stim to ease lower back pain; an ice massage for patellofemoral syndrome; some wet heat for a sore neck.  There’s nothing wrong in seeking relief from pain.  What ultimately matters, however, is obtaining pain relief for the long-term, and that’s only going to happen if you progressively improve strength.

Am I saying to eschew the services of a professional when you’re hurt?  To take matters into your own hands and treat yourself?  No.  But what I hope to point out (to those of you who are engaged in some sort of rehab program, anyway) is that the yardstick for improvement is still the same – if you’re not getting stronger, you’re not improving.  Do what’s necessary to make it possible for you to strengthen the injured area via corrective exercise, but remember that the corrective exercise is the keystone your recovery hinges upon.

Why care about where your elbows are on a press?  Or how wide your stance is on leg press?  Or whether or not you maintain a proper (neutral) arch in your spine when deadlifting?

Little insults over time add up.

Have you ever sprained your ankle?  Even if you didn’t need crutches, you (naturally) hobbled around, putting more weight on your non-injured side.  And perhaps to your amazement, you began to get pain in the muscles or joints of the non-injured side.

All because one side of your body took a little bit more of your weight (which you move around all the time, I might add) for a prolonged period of time – perhaps as short as a matter of days.

What if you (knowingly or not) always pressed harder with your dominant arm?  Or allowed your knees to drift in ever so slightly on each rep of leg press?

It’s worth taking a critical look at your form (and rejiggering your weight loads if necessary).

One of the most important concepts you need to pin down when working with weights is the concept of “plugging up all the leaks.” This refers to what most trainers would call stabilization – tightening up your musculature so as to become resistant to change of position or condition.  Without stabilization, some of the force and effort you exert against a weight “leaks” out.  By properly stabilizing your body (i.e., contracting your muscles in the correct manner), you minimize loss of force and are able to apply as much pressure as possible to moving the weight from Point A to Point B.

By far, the most common area (especially for newbies) to “leak” is at the shoulders.  What we’ll explore today is the concept of creating a frame with your shoulders; in other words, properly stabilizing your shoulder girdle so as to maximize force application.

What’s the proper position for a strong shoulder frame?  Briefly:

1. Shoulders down. Your shoulders should be down, not shrugging up by your ears.
2. Shoulders back. Pretend as if you’re pinching a Mont Blanc fountain pen between your shoulder blades.
3. Chest up. Raise your chest by arching your back slightly.  No need to overarch your lower back.

Sounds simple, no?  Well, it can be – but for most folks, communicating with the specific muscles that perform these three actions while lifting a weight is nigh impossible, at least at first.  If you find yourself lifting your shoulders up or collapsing your chest, a helpful procedure is to first identify those muscles that control shoulder stabilization, and practice using using them until you find it easy to communicate with those muscles.  Here’s a nifty way:

First, position yourself in a wall push-up position.  Keep your body rigid.

Next, you’re to perform scapular protraction.  Keeping that rigid push-up position, keeping your arms straight, push your arms into the wall, as if to push your arm bone out of the shoulder socket.  Then, return them back to the starting point.  Repeat.  Confused?  Watch this guy perform shoulder protraction.

Next, you’re to perform scapular retraction.  From that same push-up position, again keeping your arms straight, pull your shoulder blades back, as if to touch them together.  Then, bring them back to the starting point.  Repeat.  This fellow does them hanging, but you should be able to put two and two together.

Performing protraction and retraction helps you identify and communicate with the muscles that control shoulder movement, and make it easier for you to figure out how to maneuver your shoulders into the proper frame – shoulders down; shoulders back; chest up.

By keeping your shoulders in this frame, not only do you “plug up the leaks” at the shoulder, allowing you to apply more force to moving the weights properly, you take the strain off of the feeble rotator cuff muscles, protecting your shoulder from injury.  Framing, as you can imagine, is a very good thing.

Use these methods next time you perform upper body work, especially pushes.  And don’t let me catch you slumping those shoulders ever again.

Ask someone about “exercise-related injuries” and what you’ll get most often is a hazy description of some traumatic event:

“I fell in a hole jogging and tore my Achilles.”

“I blew out my knee and ankle going for the rebound.”

“Pulled a groin muscle playing jai-alai last week.”

Accidents do happen, and some sport activities are certainly higher risk than others (**cough cough jiujitsu cough).  But what most commonly happens is not nearly as spectacular.

Most commonly, the injury sequence is as follows:  You grab a pair of dumbbells, sit on the bench, and focus.  You get yourself into position, start to slowly and purposefully curl the dumbbells up, and *ping* – you’ve just torn your biceps tendon.

Or, how about this: You perform a workout.  All goes well.  Then, the next morning, you find it impossible to get out of bed because your back has become an unresponsive morass of pain.

Not nearly as sexy as, say, getting your MCL torn by a Thai kick.  What happened?

I read a great post from Seth which I will now quote completely out of context:

“You can stretch a rubber band for a long time. But then it breaks.”

Translation: It wasn’t any one thing you did that caused the injury.  Rather, trauma accumulated over time until finally whatever it is you broke, broke.

Many people who sustain a back injury (i.e., herniated disk) do so not because they attempted to pick up a grand piano, but because of something far more mundane (e.g., they bent over to pick up a pencil, sneezed, etc.).  How could the “straw that broke the camel’s back” be so insignificant?

Answer: Over the course of your lifetime, you damage the structures that hold your body together (bone, muscle, soft tissue, etc.).  Like the microscopic fissures that accumulate and eventually overwhelm large structures like bridges, the microtrauma you sustain in your limbs and joints build up, until even a small insult (one that a healthy joint or tissue could easily have resisted) is too much for the damaged soft tissue to bear, and *pop*.

An all-too common example: You’re a runner; you have been all your life. You’re entering your fifth decade of life, and things aren’t holding together so well anymore – you tire more easily, recover more slowly, things hurt. So you decide to take up weight training at your local Y, since you know all the great things strength training can do for you. You set up a leg press machine with a conservative weight and carefully load yourself in. Things go smoothly until the 6th rep, when you get a weird twinge in your back. The next morning, the pain is so severe that you consider yourself lucky that it only took you 43 minutes to get out of bed.

You could say the strength training exercise hurt you. But what’s more likely is that the accumulated trauma of thousands and thousands of pounds of force over the course of years weakened your support structure (bones, muscles, connective tissue) and you would have been just as likely to injure your back picking up a full basket of apples while apple picking with your 9 year-old nephew.

Not to say that you can’t hurt yourself by dropping a dumbbell on your foot, or getting roundhouse kicked in the face.  But most of the major, lifestyle-changing “injuries” that cause people to forego exercise (herniated disc, arthritis, etc.) are degenerative conditions, which begs a question – why exercise in a manner that hastens that degeneration?

This is probably one of the most common questions I get from clients. Or, more likely, it’ll come in the form of a statement, as in:  “I know I should probably stretch after our sessions.  Right?”

Not surprisingly, the answer is: It depends on the context (betcha weren’t expecting that one). 

If this were the 1970s, extortations of stretching, warming up, before and after exercise might have ensued.  However, it’s 2008, and we know better now.  We know that stretching prior to exercise does little to nothing, since cold tissues don’t stretch, and you’re likely to overstretch and compromise joint integrity in doing so.  We also know that stretching after exercise is pretty useless as well, at least for the benefits often stated: injury prevention and decreased soreness.

So what is stretching good for?

Well, if you’re like this person, probably nothing.

However, if you’re one of these guys, then yes; you should stretch. 

Confused?  Don’t be.  Here’s why:

In the sports depicted above, greater-than-normal ranges of motion (ROM) are required.  If you didn’t have the excessive joint mobility required to succeed at these sports, you can’t play the game well.  Is it beneficial for long-term joint health?  Probably not (definitely not if sufficient strength isn’t developed in the muscles that surround those joints).

If course, the weightlifter in the above example shouldn’t stretch before his max attempts.

How else may stretching be beneficial?  Injured individuals may benefit from stretching as they experience a “true” shortening of muscle and connective tissue, as a result of the injury.  This is an adaptive response, meant to protect you from greater harm (e.g., you blow out one of your lumbar discs; your lower back muscles instantly seize, effectively ”locking up” your back, preventing further movement, and further injury).  Or, in cases of trauma, the scar tissue that replaces healthy tissue is more fibrous and much less elastic, so stretching is necessary just to maintain normal ROM.

Note that this adaptive shortening is different from the “tightness” most people feel as a result of inactivity (i.e., weakness).  What seems like “tight hamstrings” isn’t tightness as a result of shortening, but results from something else.

Summary:

• If your goal is fat loss, general health, or muscle gain, then you don’t need to stretch.
• You should stretch if a) your sport demands high (read: greater than normal) levels of flexibility, or b) you’ve sustained an injury and are trying to return to “normal” ROM.

A comment by a reader over the weekend reminded me of a topic that is little understood but comes up with surprising frequency: exertional or exercise-induced headache (EIH). 

I previously blogged about EIH here but here’s the skinny on it: EIHs occur due to either increased pressure in the venous sinuses around your brain, excessive tension in your head and neck muscles, or a combination of both (it is possible that another mechanism may be at work, but those are the best explanations for exertional headaches as of rigth now).  Before you get images of blood spurting out of your ears and worry about sustaining a stroke while performing an overhead press, don’t worry.  Most EIHs are mild and transient – they cause some degree of pain acutely, and tend to leave a dull ache/pressure for a day or two afterwards, but as far as I know most cases aren’t causing any long-term damage.

What is problematic is that if the trainee doesn’t resolve the form issues that cause EIH, they may give up on strength training (or intense exercise, as any activity requiring high level of effort can result in EIH) altogether.

There are three main causes of EIH (as far as strength training is concerned), and the first is overwhelmingly the biggest factor:

1. Valsalva:

Valsalva is simply extertion against a closed glottis, i.e., holding your breath and bearing down (think #2 in the bathroom).   It’s not hard to imagine how bearing down in this manner causes blood pressure to increase, which in turn causes the pressure in the sensitive venous sinuses to increase…

The easiest “cure” for EIH is to overbreathe while lifting.  I’ll often instruct clients to hyperventilate while performing a set; that during their most intense efforts, their breathing should resemble Lamaze.  This helps by preventing blood pressure increase during a set, since trainees are unable to sustain pressure inside their abdominal cavity if they’re constantly taking breaths.  Some clients argue that it feels silly or that they feel a little light-headed afterwards, to which I normally respond, “It’s better to be a little light-headed than to have a headache.”

No, this isn’t the best method for attaining one-rep maxes, but if you’re getting EIHs then you’re not ready to try maxing out anyway.

2. Excessive neck tension:

Hand in hand with breath-holding is scrunching up the face and excessively tightening the muscles of the neck.  This creates tension in the neck and head muscles, which can contribute to a headache.  While breathing in the above manner (see #1) helps to ameliorate this somewhat, consciously relaxing the face and neck areas helps as well.

3. Incorrect posture:

Whenever possible, the spine should be kept in anatomical neutral, which is a fancy way of saying that the natural curves of the spine should be maintained and the head should be kept forward.  There’s a strong tendency (for novices, at least) to whip the head around when giving your best efforts on an exercise.  This kind of behavior should be kept to a minimum, since the more stable your torso (read: spine) is, the easier it’ll be for you to lift a weight with max effort.  A good rule of thumb is to imagine yourself holding an extra large egg underneath your chin; think of neither dropping the egg nor cracking its shell.

Most trainers have never heard of EIH but I can bet you they’re worked with someone that had one.  It’s important to note that while they’re uncomfortable, EIH are not life-threatening and highly preventable.  If you or someone you know gets these kinds of headaches, you now know how to deal with them.

Before you put on that pair of Manolo Blahniks, consider for a moment the ramifications:

Consider the unnatural joint position you must attain with your ankle just to stand in them. Now, consider movement – the range of motion (read: flexibility) requirements are stretched even further.

Hope your joint capsule can support it.

With all that stretching going on, you’ve got to have some heavy duty joint stresses on the ankle – shearing force on the small bones of the foot, unusual compressive forces, etc.

Not only that, but there’s the rest of the body to consider as well. Such an unusual ankle position affects gait, causing your knee and hip to relate differently, and over time this can cause joint issues as well (Harvard’s Dr. Casey Kerrigan found that women who wear high heels are at increased risk for osteoarthritis of the knee due to the increased knee torque).

Not to mention the effects on your lower back.

So, what can a gal do? Suffer the consequences of high fashion, or give up chicness forevermore?

I’m not one to tell you what you can or can’t do with your life. So if you want to wear high heels, then go ahead and wear ‘em. But make sure you take these precautions as well:

1. Strength train. A stronger joint (resulting from increased connective tissue strength and improved stability from stronger leg muscles) will be better able to resist the increased forces on your foot/ankle/knee/body.
2. Wear stilettos rather than chunkier heels. Surprisingly, Dr. Kerrigan’s studies found that there was greater knee torque (read: rotational stress on the knee joint) when wearing high, chunky heels as opposed to high, thin heels (26% vs. 22%). This suggests that stilettos are “safer” than their thicker counterparts (of course, Dr. Kerrigan found that low and no heeled shoes were safest).
3. Minimize grains and starches in your diet. There’s evidence that suggests a diet high in grains and starches increases inflammation, causing a greater chance of developing arthritis. By minimizing your ingestion of these foods, you may be able to stave off joint problems caused by arthritis and continue wearing your stylish footwear.

For 4 of the last 6 days, I have subjected my body to one of the most enjoyable stresses on this planet (at least in my eyes) – training in Brazilian Jiujitsu.

Above: Harai Goshi is now my new favorite throw.

Most health and fitness professionals would look at my activity level from this past week and think, “Well, that’s great!” While from a skills-acquisition POV I’d agree, I’d immediately chastise any client of mine who did that “for the sake of being active.” You see, I advocate applying exercise as you would medicine, i.e., use the minimal dosage needed to achieve the required response.

Professional organizations like the American College of Sports Medicine would have you believe that daily or near-daily exercise is a good thing. However, new findings from the folks at the University of South Dakota suggest otherwise.

Published in the journal Hypertension, Dr. Rebecca Schultz and colleagues found that “excessive amounts” of exercise in hypertensive rats resulted in a hastening effect towards heart failure. In other words, rats with high blood pressure made themselves worse by regularly exercising.

Too much exercise isn’t a good thing, it seems, but this isn’t breaking news. Other research has found that mortality increases when exercise activity goes past a certain point. Exercise loses its protective effect if carried on too long, too often.

What guidelines should you use?

Well, there is one thing that is correlated with living longer: muscle strength. The stronger your muscles, the longer you live – and you don’t have to worry about getting too strong (too much strength doesn’t increase your chance of dying, unlike too much exercise). And luckily, the amount of strength training required to improve strength levels isn’t much – at most 2-3 hours a week (to put it in researcher language, less than 1000kJ of exertion per week).

I’m not saying don’t pursue activities if you like them and derive pleasure from them. Whatever your chosen sport is – rock climbing, running, competitive tango – if you enjoy it, then do it. But if you do it because you think you need to, then don’t. Do something you enjoy and stay off the hamster wheel, ok?

Why breathe when weight training? I mean, why not just hold your breath for the entire set and pass out at the en….oh. Guess I answered my own question.

Ask a fitness professional why you breathe during a set, and you’ll get a number of great reasons, like:

• Your blood pressure will rise sky-high.
• You’ll sustain an Exercise-Induced Headache.
• You’ll burst a blood vessel.

…all of which are proper, valid explanations. Easily understood reasons.

And yet, when the rubber meets the road, your instinct is to hold your breath, especially when things get tough. Why is that? Why would you want to rocket your blood pressure sky high?

Well, of course, you don’t. And that’s not what Valsalva’s all about anyway.

What’s Valsalva?

Scientists, doctors, and highfalutin’ snobs like myself refer to the phenomenon of holding one’s breath and exerting as the Valsalva manuver. When holding your breath to complete a rep, you are performing a Valsalva manuver (most people perform a Valsalva daily when sitting on the throne, especially if they aren’t drinking enough water or eating fruits and veggies).

Valsalva is all about protection.

When you hold your breath and tense, you create an air pressure “ball” inside your abdominal cavity. This pressure ball serves to stabilize your spine by acting as a support beam (more like a pillar) for your spine, minimizing anterior stress when you’re trying to lift something.

Valsalva is a natural, preprogrammed instinct. It’s actually good, when you think about it – after all, if Neolithic man (or modern day Cindy Morrison) is trying to lift a humongous boulder, a little extra spine support could come in handy.

The problem arises when you sustain Valsalva for a long period of time.

That same protective pressure ball presses firmly on the large vein (the inferior vena cava) that returns blood from your legs back to your heart, cutting off bloodflow. This has two huge implications:

1. Since your circulatory system is a closed system, blood pressure dangerously rises, especially in the arteries.
2. Your heart gets minimal blood return and pumps harder and faster in a futile attempt to keep your muscles oxygenated.

If this continues, expecially under conditions of lifting heavy things, it’s no wonder athletes and amateurs alike burst blood vessels, turn beet red, and (in extreme cases) pass out and/or die (although to be fair, the majority of deaths occurred because the lifter wasn’t using the rack or a spotter, passed out during a lift, and crushed his ribcage and heart with the weight he was trying to lift). It’s clear that Valsava just wasn’t meant to be employed for a long time (more than a few seconds).

What does this mean to you? Breathe freely. Don’t hold your breath at all during a set. Powerlifters hold their breaths all the time you say? Yes – and their max attempts last no longer than a few seconds (and even then, Andy Bolton exploded blood vessels in his nose during his record-setting squat).

Breathing freely during a set will minimize impact on blood pressure, keep you focused, and prevent headaches. And, you won’t get blotchy eye, like this guy:

Above: One good reason to breathe when weight training is to avoid a subconjunctival hemorrhage (i.e., burst a blood vessel in your eye).

You’ll often hear someone complain of “tight muscles” – most commonly, the hamstrings.

“Holy crap, are my hamstrings tight”, she said as she touched her palms to the floor. Or did something like the pose to the left.

Ummm…yeah.

You know, if you can touch your entire palm to the floor, your hamstrings aren’t really “tight” – just the opposite really; you have very flexible hamstring muscles.

If your hamstrings are so flexible why do they feel so tight?

I’d posit that it’s because they’re too weak.

You see, most people think of muscles as large rubber bands – if their muscles feel tight, they stretch them so they loosen up a little. Well, the muscles do act like large rubber bands, but in a slightly different way.

They act like the bands in this second picture. In other words, they act to suspend; to hold things together – those “things” being your bones and joints.

Each of your body’s 639 muscles plays a specific role (for example, the rotator cuff muscles hold your arm in its socket). If a particular muscle group is strong, then it’s easy for it to perform its function.

However, if a muscle group is weak, then doing its job becomes much harder. So much so that it constantly “works” – it constantly contracts “tightly”, struggling to perform its duty (much as if you were to hold a full bucket of water at your side for 6 hours). While you can simply set down the water to relieve the strain in your arm and shoulder, your hamstrings can’t simply not contract while you stand (otherwise, you’d fall over). Instead, they strain to keep your body in upright posture – and while they’re doing so, they feel tight.

Maybe you’ve noticed that you get a stiff, tight neck when you’re stressed. It’s because in times of stress, you’re likely to unconsciously tighten the muscles in your neck. Sustain this contraction for a period of time, and what happens? Not surprisingly, your neck muscles begin to cramp and tighten up; perhaps you may even create or irritate some trigger points and start getting referred pain in your upper back and head.

What is there to do, then? By strengthening the muscle, you give it more ability to do its job. If a task requires 100 pounds of force and your muscle can generate 100 pounds of force, then it has to work at 100% all of the time. However, if your muscle were capable of generating 300 pounds of force, that same task now only requires a 33% effort – meaning you can do it easier and for longer periods of time.

Most people complain of tightness and pain in their necks, backs, and hamstrings. Maybe what you need is some neck, lumbar, and hamstring strength, not stretching. Perform deadlifts, not another yoga class!