Inflammation… What’s going on?

Inflammation is part of the body’s response of vascular tissues to harmful stimuli. Signs of acute inflammation are pain, heat, redness, and loss of function. Inflammation is a protective attempt by the organism to remove the stimuli and to begin to heal (if something hurts there is a reason and you should fix it). Progressive destruction of the tissue would compromise the survival of the organism. For that reason, inflammation is closely regulated by the body (Our bodies are capable of a great deal of pain… if you feel it, your body is SCREAMING at you that something is wrong).

Prolonged inflammation, or chronic inflammation, leads to a change in the type of cells at the site of inflammation. There is a simultaneous destruction and healing of the tissue from the inflammatory process because your body is attempting everything possible to remove the harmful stimuli.

Tendinitis, or inflammation of a tendon, should be reserved for tendon injuries that involve larger-scale acute injuries accompanied by inflammation (common ones include achilles tendinitis, patellar tendinitis). Tendinitis injuries are common in the arms and legs (including the rotator cuff attachments for all of you shoulder pain athletes), and are less common in the midsection. Research has shown that there may not be an actual “inflammation” of the tendon and therefore a better term would be tendinosis, which is damage at the cellular level caused by microtears in the connective tissue in and around the tendon. Characteristics of tendinosis include degenerative changes in the collagenous matrix, hypercellularity, hypervascularity, and a lack of inflammatory cells. Symptoms vary from aches or pains and local joint stiffness, to a burning that surrounds the whole joint. With this condition, the pain is usually worse during and after activity, and the tendon and joint area can become stiff the following day as muscles tighten from the movement of the tendon. Tendons are very slow to heal if injured. Partial tears heal by the rapid production of disorganized type-III collagen, which is weaker than a normal tendon. Recurrence of injury in the damaged region of tendon is common (give it time to heal). Treatment of tendon injuries is usually conservative (physical therapy, rest and gradual return to exercise). Resting assists in the prevention of further damage to the tendon. Ice/heat, compression and elevation are also frequently recommended. Initial recovery is typically within 2 to 3 days and full recovery is within 4 to 6 weeks.

It is thought that tendinosis is NOT due to an inflammatory disorder; therefore, NSAIDs would be non effective. Research has shown that steroid injections have not been shown to have long term benefits. If it is NOT an inflammatory issue, then a mild pain reliever would be just as effective in reducing pain and allowing an injury to heal as steroids and NSAIDs. Instead of medication, Vitamin E has been found to increase the activity of fibroblasts, leading to increased collagen fibrils and synthesis, which seems to speed up the regeneration and increase the regenerative capacity of tendons. Soft Tissue Mobilization (manual therapy) has been shown to speed the healing of tendons by increasing fibroblast activity, also. One case study showed STM resulting in full recovery of an athlete suffering from chronic ankle pain and fibrosis, after an unsuccessful course of surgery. The most conservative and perhaps most successful treatment is eccentric strengthening which aids in remodeling damaged tendon tissues.

Eccentric strengthening focuses on slowing down the lengthening phase of the muscle process (action of lowering the dumbbell in a bicep curl, slowly) in order to challenge the muscles, which leads to stronger muscles, faster muscle repair and increasing metabolic rate. Eccentric movement provides a braking mechanism for muscle and tendon groups that are experiencing concentric movement (shortening) to protect joints from damage as the contraction is released (protecting joints in the down phase of a pull up, setting down heavy groceries without breaking the eggs, etc). Eccentric training is good for casual and high performance athletes, patients looking to rehabilitate certain muscles and tendons, and the elderly.

Take care of your tendons. This is a ruptured Achilles. Notice how thick the tendon is… takes a lot of poor mechanics to do something like this!

For more information about tendon injuries or how to repair and heal damaged tissues contact Laura at pediatricandsportspt@gmail.com

The Squat

Contrary to popular belief, the squat is a very functional movement and our bodies are designed to be able to comfortably sit at the bottom of a squat for an extended period of time. Take a two year old for example… he could play here for hours.

We are born with the ability to do a “perfect squat.” So, when do we begin to lose the, in my opinion, most functional movement we are innately born to do? We lose the muscle function required to squat and stand back up, we lose the flexibility to sit all the way in the bottom of the squat, we lose the joint mobility to comfortably sit in the natural position, and we have a significant reduction in core stabilization to keep the chest up while squatting. What is sad is that we HAVE to squat all day. We sit in fancy office chairs; get in and out of cars; have plush couches that contour to your curves, we have a porcelain hole so that we don’t have to ‘pop a squat,’  and with ALL of these modern items you have to squat in some form or fashion to get in and out of them. The problem is they all limit the range of motion required to sit, and give an advantage to the muscles so you can compensate without using the proper muscles and mechanics to stand up. Imagine a lady standing up with her feet too far apart and her knees touching together. She has no glut activation, she is probably leaning on one hip more than the other, her weight is shifted onto her toe which causes shearing through the knee cap, and the only thing active trying to get her up is her quads. I have mentioned this before; our joints are designed to last over 100 years. Let’s fix some mobility issues and reduce artificial joints my friends!!

I am going to analyze the most basic errors I see on a day to day basis and address SOME of the mechanical/mobility corrections needed for each major movement dysfunction.

THE DUCK FOOT SQUAT

Though he is doing many things correctly here, you can still see that his knees are significantly inside his toes. The main reason for this dysfunction in a squat is decreased ankle mobility. He lacks the dorsiflexion in the ankle to keep his toes facing forward (or at most 20-30 degrees out) and to keep the weight through the heels at the bottom of the squat. What this will do with repetitive motion is apply a significant amount of shear and tension through the inside of the knee. It will also make it very difficult to activate the gluts, our bodies LARGEST, STRONGEST, SEXIEST muscle whose action is hip extension (standing up), applying even more stress to the quads and knees. If this is you at the bottom of your squat, work on ankle mobility. I put weights on each side of an athlete’s toes while squatting the other day. He was not happy with me because he was unable to turn out like he was doing ballet and made his squats exceptionally difficult, but it also gave him the kinesthetic awareness of what he was doing wrong because he honestly thought he was squatting properly. I would rather him struggle to correct bad form now than worry about potential risks from sheared knee caps and collapsed ankles leading to bone spurs, instability through the outside ankle and a fallen arch.

TOES FORWARD / KNEES IN

This is the most commonly made error in the squat from a physical standpoint, a joint health perspective, and lastly for the poor gluts. If the knees come in AT ALL, that means there is limited to no glut activation and the LARGEST, STRONGEST, SEXIEST muscle is getting the shaft. Do this for me know; stand up; squeeze your butt; now try your hardest to pull your knees together. If your butt is tight, you CANNOT. This is a quad dominate squat meaning that the athlete begins the motion by shifting the weight forward onto the toes. It is very hard to activate the gluts mid-squat so after the initial move has started the health of the squat gets worse and worse. In order to try to get deep the athlete has to come way up onto the toes, is very off balance, and shoots the butt way back to stand up. To fix this squat: posterior chain work. Learn how to activate the gluts, back extensors, hamstrings, and abductors.

GOOD MORNING SQUAT

This squat is hard to analyze from a general perspective, but can vary from person to person as to why the hips stay so high as the chest drops down into the squat. Midline, core stabilization will be the main focus here as keeping the chest high is all core work. There will most likely be some mobility issues through the hips (front/back) and low back causing difficulty sitting down into the squat. Also ankle dorsiflexion comes into play, as athletes with decreased mobility through the ankle feel like they are going to fall backwards the deeper they go into the squat. Though this is not an ideal position, the fact that the weight stays back on the heels is crucial as this takes the load off of the knee and keeps it in the larger muscle groups of the posterior chain.

ON THE TOES (Typically accompanied by knees in)

This is by far the WORST squat and why squats have a bad rap today. There is such a dramatic increase in the shear of the knee cap into the grooves of the femur and tibia when squatting with all of the weight shifted forward onto the toes and sitting deep. The knee is about a foot in front of the toes and again there is no glut activation to keep the tension in the posterior chain and off of the quads and knees. It will be nearly impossible to do any type of loaded squat (front/back/overhead) with this type of squat and the cartilage in your knee will scream at you every time you bend down. If you have a job that requires a considerable amount of squatting, learn how to squat properly, until then kneel instead. It will add years to your knee joints and prevent any cartilage damage from progressively getting worse.

A GOOD SQUAT

So, what do we look for in a good squat?

Weight in the heels

Neutral head position

Upright torso

Toes slightly turned out

Strong lumbar

Knees pushed out (active gluts)

Hips below parallel

This squat should carry over into any form including the front squat and

overhead squat or picking a pen up from the ground. Practice each the same.

Recovery – DOs and DONTs

I had an athlete ask me the other day if she was working out too hard because she was constantly tired. My response was of course a question, “What have you been doing for recovery?” Her response; nothing. Then I asked her about her diet. She told me she eats yogurt for breakfast and has tried to stay away from carbs. Whhheeeww. No wonder you are tired.

Today we are discussing the importance of and what needs to be done to recover properly from exercise (competitive and fitness levels).

Contrary to some people’s belief, you are actually at your weakest right after a hard workout. The blood, sweat, and tears are tearing down your muscle fibers so your body has to regenerate, adapt, and make you stronger. If the body does not have time to repair, it will be difficult to see strength, speed, and performance gains. Therefore; adequate rest days are crucial from a physiological perspective, but also from a psychological perspective.

The recovery phase is when your body adapts to the stresses placed on it during training. It is when the body replenishes energy that has been lost, fluid that is now piled on the floor, and heals the damaged tissues from all the hard work you just put in. Without allowing this phase to occur, the athlete will begin seeing signs of overtraining (tired, lack of energy, general aches and pain, muscle/joint pains, a DROP in performance, headaches, poor immune system, depression, loss of appetite, loss of enthusiasm for the sport, etc.). This is when the psychological needs become just as important as the physiological from a rest and healing perspective. It is much more difficult to find the love of the sport again once you train to the point of exhaustion and udder dread of performing/competing.

Different categories of training and recovery include short and long term recovery, active recovery, complete rest, and periodization training.

Short term recovery is the hours immediately following the intense training. This is the (referring to previous post) NOT sitting at a desk for 8 straight hours without stretching after a hard AM workout. The cool down and time immediately following a strenuous training session is key to decreasing muscle soreness, improving flexibility and preventing injury.  Another MAJOR recovery piece is nutrition. If you are depleting your energy stores, you need to replenish in order to optimize protein synthesis to prevent muscle break down and increase muscle size. For the athlete that was eating yogurt for breakfast, working out hard in the morning, and then watching what she ate for the rest of the day, it was no surprise that she was exhausted and feeling beat up. She never gave her body fuel to burn, and never replenished what was lost after the training. Short term recovery also includes sleep. Our body heals itself while sleeping. If you constantly break down your muscle tissues and sleep only 4 hours a night, you are preventing the healing process from occurring and you will never see the strength gains you should based on the amount of training you put in.

I am going to group long term recovery and periodization training into one. Track and field has the easiest year round training schedule to use as an example. Though the athletes compete multiple times throughout the year (usually spring), they have a goal of peaking or having maximal performance for one meet (Nationals, Worlds, Olympics, etc.). These training cycles are planned out a year in advance and include weekly rest days, monthly rest weeks, and an increase/decrease in intensity based on the time of the year and training goals. We use this same principle at the CrossFit gym in that we go hard 3-4 days a week with 2 lighter days and a complete day of rest, also incorporating a de-load week or active recovery days where the intensity of work is way down. It is this up and down in the training cycles that allows for maximal strength gains AND maximal recovery. Based on the principle of adaptation, the body will adapt to the stresses placed on it. Trying a new skill for the first time is very hard, but over time it becomes easier and easier and you can push yourself harder and harder.

Though my examples have not been specifically about children or adult training, I do want to mention that we have seen a drastic increase in the number of YOUNG children participating year round in sports. With the dream of one day being a professional baseball player, NFL star, NBC hoopster, etc, at some point, you have to ask yourself is your 6, 7, 8 year old REALLY needing to play a sport 5-6 days a week ALL year. Just like adults, children need to have specific training regimens. Yes they recover faster, yes they heal faster, but they will get beat up and burnt out just like adults. With the growing trend of year round sport, you also see an increase in burn out and children not even playing their favorite childhood sport through high school. You have to be smart about how much and how soon you begin pushing them. With that said, a balance of exercise/training and rest and recovery is what will take the child, adult, athlete, fitness guru, etc. to the next level safely, effectively, and without injury.

Pay attention to how your body feels, how motivated you are to go train, how the rest of your life is affecting sleep, nutrition, and recovery. If your body is screaming at you to sleep, sleep. If you are hungry, lethargic, depressed, look at your diet. The psychological changes are usually what will be noticed first, but ignored the fastest. If you suspect you are not recovering properly, talk to your coach, get some nutrition advice, or just simply take some time off. Get a massage. Go try a sport you have never played and be really, really bad at it. When you are mentally and physically ready to hit the training again, go for it.

CrossFit Wylie will be hosting a Paleo/Nutrition Seminar THIS Saturday at 9am. If you have any nutrition questions, I highly recommend attending. With any questions regarding training, overtraining, etc. feel free to ask!

Be smart. Listen to your body. The improvements will come.

Dynamic versus Static Stretching

Muscle flexibility may be one of the BIGGEST causes of sport related injuries (and non-sport/non-traumatic injuries) and pain I see from a physical therapist perspective and a CrossFit training perspective. If this is one of the biggest issues, I want to get down to the bottom of why the individual is tight and what is the best way to fix the dysfunctions. I recently posted about posture and how staying in certain positions for hours on end causes detrimental effects to the muscles being shortened or lengthened for that period of time. Today, I want to distinguish between dynamic and static stretching in order to undo the effects of your day job. There is a time and place for both types of stretching, but when and where do you use them?

First off, what is static stretching? A static stretch is a lengthening of the muscle while the body is at rest with a hold for anywhere from 30 seconds to 2 minutes. 30 seconds is the minimal hold required to get a physiological change in the muscle length. If performed properly, this stretch will lessen the sensitivity of the tension receptors found in the muscle allowing for a relaxation and a greater length to be gained.

Dynamic stretching is stretching while moving. For example, in a sport such as soccer where kicking is involved, in order to lengthen the muscles required to pass through the motion of kicking a soccer ball, actively go through the motion of kicking the ball in a very controlled manner to gradually increase the range of motion you get with the leg. Be careful not to exceed one’s range of motion or passive stretch ability (this becomes a ballistic, or bounce, stretch that can put too much tension on the muscle).

You have the definitions, now which one do you use and when?

 

Dynamic stretching is the preferred stretching technique for PRE exercise/competition warm ups. This stretch prepares the body for the physical exertion it is about to undergo (soccer kick).

1. Dynamic stretching promotes blood flow to the region. This allows the muscle to feel loose as compared to when stretching the same muscle statically. This in turn prevents injury to cold muscles that have not been stretched prior to activity.

2. Dynamic stretching allows for increased flexibility for more than one muscle group. For example, a leg swing involves a stretch of the hamstring, gluts  hip flexors, quads, and lower back.  Because our movement patterns for any activity we do typically involve more than one muscle group (functional activities), the dynamic stretch is more effective in respect to our normal patterns.

3. Dynamic stretching is also effective in promoting strength and stability and enhancing the nervous system, additional key components to proper muscle function.

This form of stretching prepares the body for physical exertion and sports performance.  DO IT BEFORE.

Static stretching is good POST workout/competition. Many studies have shown that static stretching reduces explosive movements and strength output; therefore, you do not want to perform a significant amount of static stretching before the activity. You have two receptors, a static and dynamic receptor. Dynamic activities (running, jumping, kicking, being athletic) use the dynamic receptor so you want to stress the dynamic receptor when warming up.

Static receptors respond and improve flexibility and cool your body down after you exercise. DO IT AFTER.

Any questions about when/where/how/why to stretch please let me know!