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.

Tip of the day:

My client Joanne passed along a neat-o Jedi magic trick for defeating the night time leg cramps so prevalent in older folks (I’ve no doubt many of you out there over the age of 50 know what I’m talking about).

The Cure:

Press your thumb into the little divot under your nose (the infranasal depression) as hard as you can stand for about a minute or so.  Amazingly, this should bring you instant relief.

What’s the science behind it?  I’m afraid I’ll have to content you with an Eastern Medicine explanation.  There’s an acupressure point located right smack dab in the infranasal depression called “Ren Zhong“.  It’s used (not surprisingly) to relieve cramping, as well as treat shock and abdominal conditions.  According to a bibliography review on the Medical Acupuncture page, it’s the most widely used emergency point in acupuncture.

Hope this helps.  Post stories to comments.

edit 6/26: I just realized Ren Zhong means “person center” (your center).  Heh.

A client of mine remarked about NJ governor John Corzine’s speedy recovery from his horrific vehicular accident. She said,

“Well, if I did 4 hours of physical therapy a day, 7 days a week like he did, I’d get better just as quickly .”

No, she wouldn’t have. You can bet your bottom dollar that while the PT helped some, it was Corzine’s mental state, motivation, and overall insanity that brought him back to his duties so quickly (hey, he was CEO and chairman of Goldman Sachs in a former life).

If you’re like most exercisers, you spend a great deal of time researching what the best diet or nutrition is. You’re concerned with putting together the perfect exercise program. You read about meal timing, macronutrient ratios, undulating periodization, and myostatin. And yet, there’s likely one thing that would never cross your mind at all – rest.

Rest. It’s almost a forbidden word in American culture (at least in the non-stop town I work in, good ol’ New York City). In a training context, it’s assumed that like other things, more exercise is better – more reps, more sets, more workouts, more weight…

…well, more weight generally is better. But the other stuff deals with recovery issues; in other words, rest.

Understand this: Exercise is merely the stimulus for change. It is not the agent of change – your body is.

Example: Pick up a heavy dumbbell and begin to curl it. Curl it until you can no longer even lift it. Then set the dumbbell down.

Is your biceps muscle stronger now?

No – in fact, it’s weaker. Strength training is a systematic process of weakening (damaging) muscles, so that the body “fixes” them and ends up making them stronger afterwards. All you’re doing with the exercise is causing trauma to muscle tissue, which your body will repair and reinforce (if a strong wind knocked down your fence, wouldn’t you reinforce the fence posts so that it wouldn’t happen again?). Only after this repair process occurs are we actually stronger.

Most folks don’t give themselves enough time to allow this recovery process to occur. The scientific consensus is that 48 hours is a good time frame for muscle recovery from an intense work bout (after 48 hours, muscle glycogen is fully replenished – the fuel tanks are topped off). However, some newer research involving mRNA suggests that full recovery doesn’t occur until closer to 72 hours post-workout.

Whatever the actual case may be, allowing at least 48 hours between strength training bouts will ensure that your muscles are adequately recovered to receive their next bit of “gentle coaxing and persuasion” to become bigger and stronger.

Skip a day, get results faster – what a compelling concept.

Had to take the day off today, because I’m sick. Whilst staying home in wonderment of my body’s inability to respond to my CNS commands, I thought to myself that over the weekend I had repeatedly broken one of the Cardinal Rules of Strength Training.

Namely, “Don’t Work Out When You’re Sick.”

The reason, of course, is that exercise is a stressor. Exercise is not what causes adaptation to occur; in other words, what doesn’t happen is – you lift the dumbbell 10 times, volia, you get stronger right then and there. Conversely, your body is temporarily weakened by your efforts in the gym. An incredibly complicated series of events occurs where your body works to make itself stronger – first, to “fix the damage” from your workout, then to overcompensate for it.

It is analogous to someone living in Florida in the height of hurricane season. Hurricane 1 sweeps into Tampa, creating damage in your house – cracks, leaks, etc. Once the danger has passed, you assess the damage and patch up all the cracks. You fill up holes where the leaks come through. In your infinite wisdom, you decide to reinforce the walls and windows so that next time that hurricane passes over, the house will sustain minimum damage. So you end up with a stronger house than before (that is, until Hurricane 2 sweeps through with double the power of Hurricane 1). So you repatch the house again. And so forth.

To summarize: The workout doesn’t make you stronger/fitter/more conditioned. Your body’s recovery from the workout does.

It’s a small intellectual distinction, but it is an important mental shift to go through, because your outlook on exercise changes.

It also helps to prevent you from working yourself into illness, sometimes.

I did get my third stripe in Jiujitsu, though.

There’s no other reason for a post of this nature – you guessed it, I hurt myself.

The particular offender this time? Snowboarding.

Step 1. Determine the nature of the injury. Identify the anatomical structures involved, the circumstances surrounding the incident. Interview the hurt individual, if possible, to determine what other complications may be anticipated.

During late spring riding, snow turns to slush. It gets heavy, hard to work with. Heavy, slushy snow requires a tremendous amount of metabolic work to plow through (it has been compared to skiing/riding through cement). But even more insidiously, in terrain parks and other heavily trafficked areas, the snow melts, due to the heat of the sun’s rays and the friction created by hundreds of skiers and snowboarders passing through the same lines. In a terrain parks, this causes a buildup of “goo” in a puddle right in front of a kicker, unavoidable if one intends to hit the kicker. Aside from looking messy, this goo has the tendency to kill every last bit of speed one possesses as one travels over it (since the goo sticks to the snowboard/ski, increasing friction, etc.) . Not too good if you need X amount of speed to, say, clear a jump.

And so it was with my injury – last kicker of the last run (always happens on the last run!). There was a giant goo puddle in front of the kicker, which robbed me of much of my speed. I spun a quick (for me) 360 hoping to make it, and my front edge clipped the tabletop, tweaking my back somehow (I think I was in spinal extension and majorly rotated). I was able to scrape the rest of my board around, avoiding a fall, but the damage had already been done. I rode down to the base in extreme pain, with my legs getting weaker and weaker by the moment. Once down, I barely got my bindings undone and immediately lay down.

I have hurt my back before (an “undiagnosed” disc issue at about the level of L5-S1) and this particular injury presented the same symptoms as the previous injury to the same spot. I had intense radiating pain from the level of L5-S1, some pain radiating into and around my right quad/adductor region, and general weakness in both legs.

Step 2. Manage pain: place subject in neutral anatomical position, or a position that minimizes pain . Begin to bring down swelling by adminstering anti-inflammatories or icing the injured area.

I lay down on one of the tables at the base area. My brother-in-law was kind enough to get an ibuprofen tablet out of the first aid kit in my backpack (be prepared, kiddies) and I took it immediately. I didn’t really feel like lying down in the slush, but I suppose in lieu of an ice pack, it would have worked just fine.

Step 3. Rest. R-I-C-E. Rest some more. Seek professional assistance – a doctor for diagnosis, PT for rehab.

I didn’t really do so well on this step:)

I did rest. I did allow Sairalyn and our friends to do things for me (sometimes) while I allowed my back to rest. I did take off one whole day of work.

I didn’t see a doctor. I’m really dumb; don’t follow my example. See a doctor, take days off, let friends and family do things for you. Rest your injuries.

More to follow…

Day 7 of my return to Brazilian JiuJitsu training, and it appears that the effect of DOMS lingers on. I suppose it will subside soon enough.

DOMS = Delayed Onset Muscle Soreness. Just fancy physiologist talk for that unrelenting muscle ache one gets approximately 48-72 hours post-exercise.

No one’s been able to pinpoint what exactly causes muscle soreness, but here are a few theories that have been popped around:

1) Microscopic tearing of muscle fibers at the cellular level, AKA, “microtears.”

2) Overproduction of prostaglandins as a result of lactic acid accumulation and tissue swelling.

3) Overheating of the muscle tissue (Type III and IV nerve endings – the kind that transmit DOMS pain – are sensitive to high temperatures, like the kind that occur during intense muscular contraction).

4) Acute spasm of musculature resulting in reduced blood flow and motor unit impairment AKA “trigger points.”

5) Some mysterious magical properties of the muscle rebuilding process.

So much for science, eh? Here are some decidedly unscientific ways to reduce muscle soreness:

1) Get a massage.

2) Get a hold of some OTC painkillers.

3) “Hair of the Dog” – perform the same task that caused you the DOMS in the first place.

4) Do yoga.

5) Ignore it.

My weapon of choice? Always – #3. It is almost always the “cure” I recommend to clients. However, on occasion, I do recommend to others and employ for myself solution #1 – since a terrain park with kickers to huck off of isn’t always readily available.

Monophasic sleep – sleep that occurs in one unbroken stretch, i.e., the usual 7-8 hours most people get every night.

Polyphasic sleep – sleep that is broken down into sections and accumulated throughout the day, i.e., 3 hours at night, a morning nap of 1.5 hours, and a 20 minute afternoon nap. Or, the Ubersleep cycle.

For some sort of background, I have been an insomniac all my life, since I was a child. As a result, any sort of sleep system that allows the user to get by on less than the prescribed 7-8 hours of sleep per night intrigues the heck out of me. After all, having gotten by on ~5 hours of sleep per night most of my adult life, one gets to feeling rather unjustly deprived.

Lately, in the recent year, I’ve been averaging even less (~4 hours) and it has begun to show up in my performance – I get random bouts of extreme sleepiness throughout the day, and round about my “bedtime” (9pm, the time that, if I were to actually fall asleep, I would end up getting a full 8 hours), a crushing feeling of exhaustion (I’ve fallen soundly asleep at this computer numerous times, only to be awoken by Sairalyn telling me to go to bed, at which point I am completely awake and furiously resume typing run-on sentences like this one).

Throughout the years of sleeplessness I’d self-determined that so long as one was allowed “catch-up sleep” (which I’d get on the weekends, when I could sleep in longer), one could sustain themselves nearly indefinitely on sleep deprivation during the week. I devised a crude averaging system whereby I made sure to average at least 6 hours/night (or a total of 42 hours of sleep for the week).

Along comes a system that proposes to be the briefest and most efficient sleep system ever, claiming to leave the user feeling better and more energetic – polyphasic sleep. Rob Cherry sent me a link to one derivation of it – the Uberman sleep cycle – and I have to admit, it was the first time in a long time my feelings and sympathies wanted so desperately to overcome my intellect.

I mean, a system that lets you sleep 2-3 hours a day, and you end up a totally unself-conscious, primal, raw-fueled ultra-genius? Sounds like a godsend to me.

What are the potential downsides? Well, you could fall asleep and die behind the wheel or something like that, if the allegations are untrue. Individuals who are chronically sleep-deprived tend to have suppressed immune systems, inability or dampened ability to metabolize glucose, and general lack of growth hormone production. Not to mention the impairment of concentration and recall that occurs with general sleeplessness.

Dr. Claudio Stampi, who’s been featured on PBS and NPR and works with clients whose professions and/or livelihoods depend on a generally sleepless schedule (such as astronauts and solo sea sailors) advocates a sleep microcycle not unlike the Uberman schedule – 6 20-30 minute naps spaced evenly throughout a 24 hour period. Dr. Stampi (aka “Dr. Sleep”) documented an average Joe (actually, his name was Francesco) going through this sleep protocol and recorded his performances on various cognitive test given throughout the experiment. The entire 2 month long project was shown on the PBS show “Scientific American: Frontiers”. The end result? Francesco passed all tests with flying colors and apparently suffered no ill effects.

Does this mean that Rob’s stumbled upon a new dawn of super-productivity for mankind? Probably not, as the discipline required to adapt to such a spartan routine eludes most. But I know I’ll be giving it a try in the next couple of weeks…

…after all, I’ll be up anyway.

It seems that injuries are a way of life for a combat athlete. Or for a mere dabbler, for that matter. The latest incarnation of acute trauma occurred during a spirited session of grappling at the good ol’ New York Health and Racquet Club.

Here are some small lessons I’ve learned from that day:

1) A 115 pound weight disadvantage is probably too much. Just maybe.

2) Don’t fight when you’re exhausted (unless you have to, of course).

3) Just because you are “just rolling and having fun” doesn’t mean the other guy is too. In fact, he may actually be trying to kill you.

and most importantly (and I’ve been told this a BILLION times by everyone):

4) Don’t roll (hard) with anybody you don’t know.

Well, long story short, I can’t be mad at anyone but myself. After all, I broke the rules. So let’s walk through the mechanism of injury and see if we can’t get a bead on what happened.

How: We were in a weird north/south position, as I had him in my guard. It probably would’ve looked quite discomforting to any homophobes spectating. I was working my way to taking my opponent’s back, when he caught my leg, put me in his guard, and began cranking away (a bit of imagination is required to visualize this).

Let me interrupt for a moment here to set the stage. At this point my opponent and I had been rolling for a good five minutes; he had attempted several leg and ankle locks and failed, and also nearly caught me in an armbar. I had attempted many armbars but did not pursue them to completion because I feared I would be unable to extend his elbow under control and would thus hurt him if I used any power. I was also pretty tired at this point having played 6 straight rolls with a different opponent prior to this bout. I should’ve had a clue that my current opponent was getting frustrated in my guard when he picked me up and slammed me.

Man, I am really looking stupid at this point.

Well, now that you know the backstory, let’s get back to the north/south-double guard situation. So he is cranking away on my foot, but I’m feeling pretty safe, since he doesn’t appear to have anything, and I don’t feel any crazy pressure on my leg/knee/ankle/foot. My opponent began to transition into what I thought was a kneebar, so I rolled to take it away, thus bending my knee slightly – which put me in a great position for a footlock/toehold type thingy, since my opponent was still apparently trying to twist my foot off. As I stopped rolling along the floor, my opponent gave a mighty twist, and “POP.”

Folks, if you roll with someone and you slap a submission on them, please give them time to tap out. I’d like to mention that it hurt less than one of Francisco’s anklelocks, and he’s a purple belt that outweighs me by 80 pounds. Initially, I thought my ankle joint just popped. After the fact is when the ankle began to hurt. A lot.

The first thing that ran into my head was, “Well, there goes my chances at hitting a 540 this season.” There was some swelling, nothing incredible, and extreme tenderness. I could not support my weight on it; in fact, I could not put any weight on it. My colleagues were kind enough to get me some ice packs, which reduced the pain and swelling considerably.

So, the mechanism of injury: plantar flexion and hyper-inversion of the foot, causing some acute trauma to the lateral ligaments and connective tissue of the ankle. When I got home, I performed an anterior drawer test for the ankle, and it demonstrated some laxity. Indeed, if I plant my foot and draw my leg posteriorly (lean back on my leg), I feel unsteady, like the leg is “slipping” off of my ankle. Oh, and there’s some pain too when I do that. But aside from that, things are looking fine – the pain is minimal (unless I do what I described above), there is some minor swelling around the lateral malleolus of the tibia, and some very slight discoloration (no bruising or dark spots). I can plant my foot normally, and support all my weight on it. There is some compromised Range of Motion in plantar flexion (due to pain) and dorsiflexion (due to the swelling). I feel there has been some adaptive shortening of the Achilles tendon, but perhaps this is due to it just feeling tight.

So, my Cracker-Jack box diagnosis? I think I have a Grade 2 (partial) tear of the Anterior Talofibular ligament. I haven’t done a Talar tilt test yet because the anterior drawer test has a very high percentage of false-positive results, especially if performed less than 48 hours post-injury (which it was). Since I can ambulate without any trouble or pain, I hope it is not as severe as I think. Either way, the treatment is the same, and I have already begun to rehab it via strength training for the joint, none of which is painful, save compressive exercises(such as the leg press), which I have eliminated.

Hey, I’ve just committed a Cardinal Personal Trainer Sin – diagnosis (gasp!).

Well, it looks like a 2-4 week layoff – sigh. At least winter is still (sadly) 3 months away.

8/30/05 update – Thanks to Dr. Warden for spotting my little mistake – my ankle was in inversion and internally rotated.