Saturday, February 25, 2006

Too Dangerous for Women...from a Medical Point of View

I digress from more professional topics to express some personal frustration. I just watched a video clip of an ABC Nightly News segment that profiled the US women's ski jump team. Yes, female ski jumpers do exist. The US has two of the top three ranked women in the world. But the FIS (The International Ski Federation) feels the sport is "too dangerous" for women "from a medical point of view." Hello, McFly?

But women still don't even swim the 1500m (but they swim the 1650 yards in NCAA competition and 1500m in USS competition), don't speedskate the 10,000 m--and remember, the women's marathon was only added in 1984. We are so fragile....

I wonder what we'd find if we measured the forces the female freestyle aerial skiers deal with and compared them to those of the ski jumpers? Or the mogul skiers. The freestyle people drop virtually straight down 4-5 stories. Did anyone else see and hear the the Aussie freestyler blow her 7 month-old ACL replacement during the first round of jumping?

Instead, the IOC has found room to invite male and female half-pipe snowboarders into the Olympics. And we are treated to the antics of the baggy-ass uniformed, iPod-wearin', hot-dogging "extreme athletes" who go for "method air" during their routines. Sorry, dudes and dudettes, but I don't believe a "sport" belongs in the Olympics if the athlete's boxer shorts and ass hang out of the uniform, and he/she can listen to an iPod during an actual competition. Call me old-school, but these people can hardly speak in complete sentences (despite NOT being out of breath) and spend way too much time flashing what look like gang signs for the camera after their runs. In my opinion, this sport and many of its athletes are like Fat Albert during summer: no class.

Send the half-pipe snowboarders back to the X-Games where they belong and let the female counterparts to the male ski jumpers join the Olympic program. These women get some real air.

Friday, February 17, 2006

Pediatricians and Resistance Training

After the recent discussions regarding the BFS program (Bigger, Faster, Stronger) and some of the less desirable practices in youth resistance training, I thought it was time to discuss the other end of the spectrum: MD's and their opinions on resistance training. These people are the bane of my existence and they set back good, appropriate use of resistance training techniques with young people 100 years or more. They also hurt the Olympic sport of weightlifting in this country, but that discussion is for another post.

I would encourage anyone who deals with strength and conditioning to check out the American Academy of Pediatrics Position Statement on "Strength Training by Children and Adolescents" which appeared in the Pediatrics in June of 2001. It is a real eye-opener as to how much these people DON'T know. The review of literature is pathetic, with the most recent reference being 1996. I found it interesting that they do not even acknowledge the NSCA's (National Strength and Conditioning Association) position paper on the same subject (1996) even though they site articles written by some of the same academic professionals that contributed to the NSCA's paper.

These particular excerpts bother me the most:

Strength training (also known as resistance training) is a common component of sports and physical fitness programs for young people.

Strength training can improve an adolescent athlete's performance in weight lifting and power lifting. Strength training is a common practice in sports like football in which size and strength are desirable. Despite theoretical benefits, scientific studies have failed to consistently show that improved strength enhances running speed, jumping ability, or overall sports performance.6,10

Evidence that strength training programs help prevent sports-related musculoskeletal injuries in preadolescents and adolescents is inconclusive.11 Furthermore, there is no evidence that strength training will reduce the incidence of catastrophic sports-related injuries.

Young people who want to improve sports performance will generally benefit more from practicing and perfecting skills of the sport than from resistance training.

First, there IS a distinction between strength training, resistance training and weight training, but the AAofP doesn't appear to understand that. Second, age-appropriate resistance training is not just about BIGGER, FASTER, STRONGER or maximal efforts or bodybuilding--as this paragraph suggests. Third, too much sport-specific practice and competition are the things that are HURTING young athletes. Young men experience overuse and fatigue-mediated injuries and young females experience non-contact injuries because they are not strong enough to control their own bodies for the level of sport they play. These kids need more recovery and general physical preparation; not more sport practice and play.

When used appropriately and effectively, strength/resistance/weight training is about the following:
  • controlled overload to create stability around a joint
  • "grooving" good sport-related movement patterns
  • increasing functional neuromuscular control of acceleration / deceleration forces
  • proper body mechanics for optimal power production and prevention of injury

There is very good evidence to support the use of resistance training for increasing sport-specific performance and reducing injury. Tim Hewett PhD in Cincinnati has done some of the best. Look here for some references.

Resistance training isn't just about meat-head muscles and gut-busting max lifts. It's about body awareness, alignment, movement AND strength. It's about making the scaffolding of the human body sturdy, stable and coordinated so you perform better and you handle the physical demands of your sport tasks.

I wish physicians would stick to what they really know. I thought the Hippocratic oath was to do no harm. Statements like this hurt.

Monday, February 13, 2006

Nutrition Literacy

As with exercise, there are lots myths and just plain bad information about dietary habits. And there are gurus who make lots of money selling to the bad habits and desperation of millions of people. The information they sell and promote often has no real effect on health or could even be detrimental to health.

Nutrition science is no better. Every week a new study comes out that contradicts the magic bullet that was found last week.

I'm sure many of you have seen the headlines or heard of the recently released study that supposedly found that low fat diets have no effect on cardiovascular health or decreasing risk of cancer. Wow, what a waste of $415 million dollars to study basically the same diet in two groups of people who had already been eating the SAD (standard American diet) for over 50 years. No wonder it didn't show much of anything.

It is not about getting 5 servings of fruits and vegetables a day. It is not about getting enough protein. It is not about counting calories or portions. It is simple: eat well. Just like we need to move well. Learn to move; learn to eat food that naturally contains the things that are good for us and reject the food that is not. It is not rocket science. It is behavioral science. We cannot reduce food to supplements or synthetic substitutes; just like we cannot reduce movement in the context of gravity to work on machines or 20 minutes of super-slow resistance training 2 days a week. One must attend to their health behaviors on a daily basis. Over time, it DOES matter.

Here are a few resources for anyone who would like to read/listen to some solid research and good advice on good eating habits.

Joel Fuhrman M.D. has a great blog.

Howard "The Mad Cowboy" Lyman has a great website and two very readable books that tell the tale of a cattle rancher who decided he needed to change to a plant-based diet. He was the guy sued (with Oprah) by the Texas Cattlemen for libel. Howard won. You can find his website here.

For the top-dog of research on nutrition and health, get T. Colin Campbell's "The China Study." This book will give you insight into the history of nutrition research and the fascinating data derived from the largest epidemiological study ever on nutrition and its impact on health.
You can see and listen to him here.

Friday, February 10, 2006

Hex Bar Deadlifts: Another Perspective

I was just about to write about my use of hex bar deadlifts when my friend Vern Gambetta brings them up in his most recent post.

I would like to share an alternative view on the hex bar deadlift. I think it is a fabulous exercise and I use it as a staple in my own training, and with many of my patients. I first learned to use the hex bar from Derrick Crass, physical therapist and '84 and '88 Olympian in weightlifting. With 5 kg and 10 lb bumper plates, we used this exercise to rehab patients of all shapes and sizes. And we used it for the kids in the performance program. We did not promote it as a maximal lift, ever!

In fact, I use it in my beginner 9th grade weight training camps to help teach squatting technique. Many young boys have ankle and hip flexibility issues. They cannot squat well and so we must have an alternative (along with bodyweight squats and medball squats) to help them achieve functional flexibility, as well as learn how to maintain a neutral spine position with the squatting movement. The weight is very light (65 lbs or less) and can be put up on small blocks if the kid cannot get into a good position from the floor.

And sometimes we need squat alternatives if kids cannot rack the bar appropriately for a front squat, or they cannot keep a neutral spine with even an empty bar on their upper traps. Sometimes only a few reps with the empty hex bar helps to "groove" a good squatting motor pattern. Only then are these kids allowed to squat with a bar or allowed to use the hex bar from the floor.

I find it very easy to teach technique with the hex bar, as the bar does not have to pass in front of the knees. (I will say I have never used traditional deadlifts with patients or with anyone other than weightlifting athletes.) I can help the kids get into position, talk to them about ankle flexibility and really show them how their partners are keeping a neutral spine or not.

I feel this exercise is a tremendous lower body strength and core exercise. It does not have to be heavy! It can help one really understand what it means to "lift with your legs" even though the weight is in your hands. From an occupational standpoint, this is very important for many people. Patients and athletes who try to use their upper body to pick up the bar, or flex their torso forward and use their back, will quickly realize that, to lift effectively and safely, they must "push" the weight up with their legs and maintain an upright torso.

So, I agree with Vern that 1 RM DL's shouldn't fly in the high school weight room--with the hex bar or with the traditional barbell. BUT, the hex bar DL can be used to help teach VERY GOOD lifting technique and can serve as an adjunct lower body strength / functional flexibility exercise in a comprehensive program.

It all depends on how you use it.

Wednesday, February 08, 2006

Movement Literacy: Flexibility Part I

So the philosophy professor asks: Do I still have to stretch?

It is really a shame that the concept of “stretching” has become so seared into the fitness lexicon. By stretching I mean static stretching. There is no automatic cause and effect relationship between static stretching and healthy flexibility; or being healthy or preventing injury.

Healthy flexibility is about moving well; it is not about maximum individual muscle length.

Flexibility—by that I mean range of motion about a joint—is context dependent; and it demands some understanding of functional anatomy. It ain’t just about feeling the stretch in the muscle belly or tendon! It’s about what’s happening at the joint with respect to the other joints! The available range of motion can be dependent whether or not you are in a weight-bearing situation, what is happening at related joints, or how fast or slow you are moving. Many important muscles, like the hamstrings, work at two joints. Thus their resting length and dynamic length—and the available motion at one joint—depend upon what is happening at the other joint, and what other muscle groups are doing.

So if you require flexibility in a certain movement, and you are attempting to use static stretching to achieve that flexibility, you at least need to mimic that joint position and relationship. You need to understand why you are doing what you are doing and what elements you are trying to affect! If you can put yourself in a weight-bearing position, all the better. If you can dynamically move into and out of the position, even better. Then your body adapts and adjusts sensory information that might cause the agonist or antagonist muscles to contract, for whatever reasons.

But most people don’t understand why they need flexibility or where they need it, whether it is for activities of daily living or for sport performance. They don’t really know if they have too much or too little. They are just bombarded by the popular press that stretching is a must and they absorb that message. They cannot relate it to larger, more complex issues such as movement, posture, neuromuscular relaxation, balance, and range of motion. For most American adults and children, flexibility—stretching—is only about simple static postures that are held for a few seconds.

Unfortunately, there’s a little more to it. And that requires a little education, attention and skill. Let someone who knows, teach you to take care of your movement system.

Tuesday, February 07, 2006

Movement Literacy

Last Friday I met "The Exercise Doctor"--Dr. Gerald Larson. He used a term that I really liked: movement literacy. We both agreed that many people, old and young, don't know how to move well. Vern Gambetta knows it. We don't learn how to move in PE--we learn how to play games; we don't learn how to move in organized sports--we learn how to do specific sport-related skills. Boys have Tommy John elbow surgery and girls tear their ACLs because they are doing skills their movement systems cannot yet handle.

By the time our physicians refer us to a physical therapist, our poor movement strategies have usually caused us pain or injury, and our insurance company won't pay for the time it would take for the therapist to re-educate our bodies and minds. They just pay to address the symptoms, if that.

My idea, with Iron Maven, is to teach people how to move well, framing the idea as physical health. My first goal is to get to the adult athlete to buy into this, but then hopefully get to the average Jane / Joe. Get them to understand that moving well every day helps the musculoskeletal system stay healthy. Get everyone to understand that moving well when exercising, especially resistance training, is imperative to performance and to physical health.

Trouble is, most people have trouble appreciating this concept. For many, exercise is about looking good. For athletes, there is a lack of respect for the skills that are involved in training in the weight room. And they are skills that should be learned. But then from whom? Many people turn to personal trainers because these are the people who advertise and these are the people who LOOK fit, so obviously they must know their stuff, right? Not always so.

And then there are the physical therapists of the world--locked behind the doors of physician referral and insurance reimbursement. We fail to market ourselves and our skills to the apparently healthy population--something we can do in Missouri. And it is my observation that many therapists do not set a good example for the public by being healthy and fit. Would you pay money out of pocket to learn how to move well and exercise from an overweight, frumpy person with a giant Diet Coke sitting on the desk?

How do we get the average person to appreciate the benefits of movement literacy? Through what avenue? Do we have to pose as a buff personal trainer to attract their attention and then WHAM!--sneak up on them with movement instruction?

I am currently working with a retired MD (in his 80s) who is recovering from a hip fracture. He's astounded at how much he didn't know about movement and moving well. Getting out of a chair and walking safely with a cane are his goals. Now moving is literally about survival, safety and living life to its fullest. My guess is he'd recommend a little movement literacy for us all, sooner than later.

Sunday, February 05, 2006

Random Sunday musings on gray hair, KC, Steve Martin...

Well, it's Sunday morning and I'm feeling like Dan Schmatz of Yourbikesucks blog fame, sitting here at the laptop with a great cup of coffee, contemplating the frigid temps outside and the prospect of riding outside. Unlike Dan, I'm glad I don't have to go outside. I'll just hit the trainer.

Other random thoughts from the week:

1) Why are people fascinated with my hair? Yes, I have some gray hair. It's been growing out of my head since I was 20. You wouldn't believe the people who comment on it--unsolicited. I guess my youthful, fit appearance and the long gray locks create some type of cognitive dissonance that compels one to blurt out things like, "You look so young to have gray hair!" or "Is that your real hair?" or "How old are you?" I've even had complete strangers reach out and touch my hair.

2) I'm really beginning to detest professional American sports on tv. If I watch any part of the Super Bowl--it will be on because my husband will be watching--it'll be from the bike trainer or while working out in the home gym. My other thought is to head to Vintage Vinyl and trade in some CDs and browse for some more trainer tunes. Might have to snag a few old Steve Martin comedy albums. Saw a special on him the other night and he really is a wild and crazy guy--smart and funny as hell.

3) I was in the Kansas City area all day Friday. I always imagine KC to be just like STL. Not so. There is a difference, but I can't quite put a handle on it. Always good to step outside your digs and see how others view you and yours.

4) RIP and a big thank you to Betty Friedan.

More serious stuff about health and exercise later this week.

Saturday, February 04, 2006

My Husband, The High School Teacher and Coach

Many of you know my husband. He is currently the varsity swim coach and athletic director at a large all-boys private school. Life is crazy most of the time. The school does not have a pool, and he works many long hours to do his best for the swimmers and all of the other coaches and athletes at the school.

Kevin was an outstanding swimmer in high school and for the Badgers at Wisconsin. Big Ten Champion in the 200 Butterfly. As an athlete, he was driven and very competitive.

In his 22 years as a coach (11 at the University of Chicago and 10 at DeSmet), he has mellowed a bit. His 2002 DeSmet team won the Missouri state championship, but he has not had a "dynasty" by any means. His primary focus as coach has been to maximize the potential of each of his kids--as people and as swimmers. He defines success not just by victories in the pool, but by the acquisition of self-discipline, self-improvement (in the pool and in the classroom, no matter where you start), and teamwork. In the end, this is what high school and Division III athletic participation is all about. This is why we spend time with young people. It surely isn't about the money or personal accolades.

He received this email the other day. It made his day and mine.

Coach Fober
As the swim season winds down, we just wanted to personally thank your work with XXXX. Your quiet but strong leadership has really motivated him to do his best in and out of the pool. He is a pretty reserved guy with a lot of strength and depth that some people do not always appreciate. The way you manage the team with the variety of talents and issues is very impressive. You have managed to allow each boy a chance to succeed at their own level. It has been a fun season for XXXX and he is looking forward to senior swim season in the fall.
Good Luck at state!
Mr. & Mrs. X

This is what it is all about--having a positive impact on the people around us. Especially the young people.