Thursday, September 17, 2009

Now writing for the Examiner; Maryland Personal Trainer

I am moving over to the examiner.com to write as the Baltimore Weightlifting Examiner. My column over there will entail 3-4 short articles a week about various fitness related topics including strength training, nutrition, and supplementation.

This site will be revamped soon, but for now, you can follow me there! Thanks!

Saturday, September 12, 2009

Working Around Low Back Injuries Part 4; Maryland Personal Trainer

In the last part of this series, I will discuss working around the SI joint in the gym.


The sacroiliac joint, as depicted above, is where the sacrum attaches to the ilia.

Just like the lower back, SI joint can hurt for a variety of reasons. Some SIs hurt with compression while some hurt with extension. Some injuries will hurt with rotational forces as well. For example, if only the right side of the SI joint hurts, single leg work on the right side might actually cause more pain than a bilateral movement like a squat. You will need to experiment at first and figure out the nature of your injury and choose exercises accordingly.

With that said, with SI injuries, make sure you avoid putting excess pressure directly on the SI itself. When doing a seated exercise, make sure your spine is neutral and your pelvis is not in a posterior tilt. When bench pressing, make sure that your arch is not causing extra pressure on the top of your butt.

Additionally, since the glutes have attachments on the sacrum and illium, sometimes glute and hamstring heavy exercises are not appropriate. If your injury hurts with glute contraction, your options become more limited.

The safest bet (as I have frequently mentioned before, I know) is the trap-bar deadlift (assuming the injury is not recent and you can handle the compression). The trap-bar deadlift results in less compression than a typical back squat or deadlift, and since the weight is held by at the sides, hyper-extending the spine is hard to do.

Glute-ham raises are also another option, assuming they are pain free. This is a great bilateral exercise that hits the hamstrings and glutes hard while minimizing compressive force and rotational torque.

When all is said and done, figure out whether your injury is related to compression, extension, or rotational forces about the SI. For compression related injuries, an approach similar to working around flexion-related low back pain is appropriate. For extension injuries, an approach similar to working around facet joint injuries is appropriate. And for pain with rotational torque, stick to bilateral work and limit your single leg exercise choices to those that are pain free.

Conclusion

Just because you have a back injury does not mean you have to stay out of the gym. Figure out what type of movement causes your back pain and act accordingly. One thing to consider is that you do not need to have a current back injury to apply these strategies. If you have a history of recurring back pain associated with flexion or extension, you can follow the tips outlined in this series to avoid recurring injury. Building muscle, losing weight, increasing strength - these are all life-long pursuits. You only get one spine, take care of it.

Thursday, September 10, 2009

Working Around Low Back Injuries in the Gym Part 3; Maryland Personal Trainer

In part 3 of this series, I will discuss working around extension-related back pain. In order words if this:


hurts your back, you have extension-related back pain. Usually this is the result of a facet joint injury. Facet joints are technically the articulations between the superior and inferior articular processes of two vertebrae. Just think of them as the connection point between some of the projections off of the back of the spine. Here is a picture:



The thing about facet joints is they have a habit of being very sensitive. When the spine goes into extension, like the first picture above, force builds up at the facet joints which can lead to pain. Facet joint injuries are most common in younger lifters, as a general rule (but certainly not always the case), weight-trainers 30 and under are more likely to complain of facet joint pain whereas trainees over 30 are more likely to complain about flexion-related pain.

Working around facet joint injuries in the gym involves avoiding extending the lumbar vertabrae. Note, this is not the same as the exercise commonly dubbed the "back extension" but rather describing the situation shown in the first picture.

When selecting exercises for a facet injury, minimizing compressive force is not the #1 priority since usually the discs will be unaffected by this type of injury. As mentioned earlier, exercises that can result in excess extension should be avoided.

Oftentimes when dealing with facet injuries, it is not the exercise itself but the way the exercise is performed that needs to be changed. An example would be the deadlift. Many lifters, especially working with heavier weights, lean back at the top of the deadlift:

 

This places some load on the facet joints and is simply not appropriate for someone with a facet injury. By focusing on hip extension and ending the lift without lumber hyperextension, the facet joints can be spared. The top of a deadlift in this situation would look like this:



The problem with this type of deadlift is that while the form may be textbook, when lifting maximal loads, like the lifter in the first picture, deadlifting is hardly textbook. When you are holding 400+ lbs like the person in the first picture, some leaning back is necessary or you would simply fall forward. That is why for someone with facet joint injuries, I prefer to use the trap bar deadlift for some of the heavier work. Since the center of mass of the trap bar is directly in line with the lifter's foot, there is no need for back extension at the top.

Other Lifts to Watch For:

Again, with facet joint injuries, back extension should be avoided. Just like with the deadlift, any movement where a majority of the weight is in front of you can result in some back extension. This includes holding a bar in a front squat or zercher squat grip. At the top of these lifts, a small amount of extension is necessary to stay balanced. Other deadlifting variations where the bar is in front of the legs can be problematic.

Standing movements also can cause a lot of extension. Standing Overhead Military Presses or even heavy curls can throw the back into extension. To work around this, choose a different exercise or lower the weight and tighten up the form.

Additionally (and often overlooked), pressing movements can be an issue. The bench press is frequently overlooked for its role in facet joint injuries. When bench pressing, it is common to form an arch on the bench to create stability. This allows the lifter to support more weight.



As mentioned on CriticalBench (where I snagged this pic), a good arch can significantly improve your bench pressing abilities. However, a tight arch like in the picture above can be very painful for someone with a facet joint injury. In this situation, simply laying on the bench normally with the feet relaxed (or even propped up a bit, I know, the horror) is more appropriate for repetition work.

But What If You Want to Put Up Big Numbers?

Now that is the million dollar question. If you have a facet joint injury, particularly if you have been weight training with it for the long term, I am not saying that these exercises are completely forbidden. If you want to build an impressive bench press, I would recommend performing your repetition and assistance work without a tight arch, but still practice arching and use it for your maximal sets (assuming it is pain free). Many lifters develop painful facet joints after frequent arched benching and deadlifting. Oftentimes, when these techniques are performed sparingly, such as for testing a rep max or performing a maximal set, they will not cause the lifter any pain. Every person is different though, so if it is still causing you pain, find out why this is the case and fix it. 

That is it for this edition, I will wrap up this series tomorrow by covering working out around sacroiliac joint pain.

Tuesday, September 8, 2009

Working around Low Back Injuries in the Gym Part 2; Maryland Personal Trainer

In the previous installment of this four part series, we talked about what exercises were and were not appropriate for training around a lower back muscle strain. In part 2 of this series, I will discuss working around back pain in flexion.

One of the primary causes for back pain in flexion (bending forward) is a herniated or bulging disc. The main risk factor for a herniated disc is poor lifting technique, age (being older) and sitting a lot (the more you sit, the more likely you have a herniated disc). These are rare in children and young adults - these populations typically have pain in extension rather than flexion.


In the picture above, the left side of the picture is a depiction of the front of the spine. When flexing the spine (by rounding the back), the herniation is excacerbated as more fluid is forced out of the disc. However, disc herniations are not the end of the world. Studies have estimated that 70% of the population in the United States has an asymptomatic (pain free) disc bulge or herniation. As a result, disc pain can be a tricky thing. However, there are three main things you want to minimize avoid: flexion (as we already discussed), shearing force, and compressive force. The less we make the disc work, the better off it fares.

Before working out with any sort of disc injury, make sure your doctor has cleared you for exercise. 

Minimizing Back Flexion, Shearing and Compressive Forces

Take a look at the picture of the spine above. This is the neutral alignment of the spine. When weight training, especially if you have a herniated or bulging disc, it is of utmost importance to avoid leaving neutral spine under load. If you are working with a physical therapist or other professional, he may mobilize the spine at some point. However, spinal stability is always the first priority for anyone with a recent disc injury; so flexion under load (i.e. while lifting) should be avoided at all costs.

The spine is great at handling compressive force (force travelling from the top of the discs to the bottom) but it can not handle much shearing force (force moving posterior to anterior or vice versa; across the bone). Shearing forces are very high a flexed spine as the erector spinae do not have the appropriate angle of pull to counteract it, so again, avoid flexing the spine while lifting.

Additionally, movements that involve rotation, lateral bending, flexing at the hip can produce shearing forces. As a result, at least while under load, try to avoid movements that involve bending forward or involve twisting or bending of the spine.

Any movement that hip flexion and significant erector spinae involvement is capable of creating high levels of compressive force. Back squats and traditional deadlifts can be very troublesome for people with a history of back pain in flexion.

Appropriate Exercises

Lower body: Someone with a history of back pain in flexion should make ample use of single leg movements. For adding weight, dumbbells are always the preferred method for adding weight. Reverse Lunges, Bulgarian Squats, Split Squats, Single Leg Squats are all great ways to work the legs when working around this type of back pain. 

For someone further along in the recovery process, front squats and trap-bar deadlifts are great ways to use more weight while minimizing compressive forces in the spine.


Core: When working with this type of back pain, exercises such as the plank, side plank, cable hold, and any exercises which emphasizes resisting movement rather than creating it will result in much less compressive force than a traditional abdominal movement like a sit-up or crunch.

Upper Body: Just like with the erector strain, bent over rows and seated rows can potentially be problematic. Use dumbbells and chest-supported versions to reduce stress on the injured areas.

That is it for part 2. For the younger audience, I will cover pain in extension in part 3, which will be up tomorrow.

Monday, September 7, 2009

Working around Low Back Injuries in the Gym Part 1; Maryland Personal Trainer

Sometimes, training the lower body while dealing with a recent back injury may seem impossible. However, it does not need to be. Here are some things to consider when working around injuries:

Type of Back Injury
  
There are four main types of lower back injuries: muscular pulls, pain in flexion, pain in extension, and sacroiliac joint injuries. As always, when working with an injury, make sure a doctor has cleared you for exercise before trying anything out. In part one of this four-part series, I will discuss working around muscular strains in the erector spinae.

Muscular Pulls:

Strained muscles are a common injury in the erector spinae muscle group. This can be caused by a lot of things such as the erectors trying to do too much work, not properly warming up, or simply moving in a range of motion with which the nervous system is not comfortable.

 The Erector Spinae

For training around this injury, you should try to load the erector spinae as little as possible. The erector spinae have two main functions - the lower portion of the erector spinae group keeps the lumbar spine in place when the lumbars are subjected to shearing force (such as when the body body is bent over), while the upper portion helps extend the back. When dealing with an erector sprain, we generally want to avoid both of these situations.

Side Note: Now, I am not saying that the best course of dealing with a muscular strain is to not work out the muscle group at all until it heals completely. I am aware the lighter loads can stimulate blood flow and improve recovery. The purpose of this article is for discussing how to train the lower and upper body at high intensities when working around strained erectors.

Training the Lower Body:

Since we are trying to avoid both back extension and shearing force, lower body work should focus on keeping the torso upright. Most single-leg (unilateral) work, particularly lunge variations such as reverse lunges, split squats, bulgarian squats are all appropriate (as long as they are pain free). If one movement irritates your strained muscles, try a different one or lower the weight.

Training the Upper Body:

When training the upper body after an erector strain, you should avoid exercises which require forward bends, such as bent over barbell rows. Additionally, any movement which requires erector action to stabilize the body (such as a seated row or a standing curl) may not be appropriate. Replace the seated row with a chest supported t-bar row. 
Any machine that you can use with a chest support will significantly decrease erector spinae involvement.

Exercises to Avoid:

Squats - Squatting variations, even single leg squats, can result in significant erector spinae involvement. While front squats are generally prescribed for many lower back pain issues, the barbell front squat is not appropriate for recent lumbar strains. While this lift results in less compressive force than a back squat, the nature of this injury is not related to lumbar compression. Due to the bar placement, a front squat demands significant spinal erector involvement, making it a poor choice for someone with a recent lumbar strain.

All Deadlift variations (even single leg deadlifts) - these simply require too much erector involvement, both from the lower and upper portions of the erector spinae.

Barbell Rows - For the same reasons as the deadlift.

Seated Row - Your erector spinae generate the force necessary to stablize your body while performing a seated row, so these are not appropriate for recent sprains.

Exercises performed while standing  - Depending on the nature of your erector strain, standing exercises such as curls and overhead press may or may not irritate the strain. This will require some trial and error to figure out, as it is highly variable dependent upon the nature of your injury.

Conclusion

An erector spinae strain is no reason to stay out of the gym. Simply by modifying your exercise selection you can get a full workout in despite your unfortunate injury. Tomorrow I will cover part 2 - dealing with pain in flexion.

Saturday, September 5, 2009

Stretching, Force Relaxtion, and Creep - How Stretching Can Cause Ligament Damage


Ligaments are a type of connective tissue that contributes greatly to the structural integrity of the body. Ligaments are known for tying bones together and are particularly important because they contribute significantly to joint stability.


 Ligaments of the Shoulder


Ligaments rupture after they are stretched too much. Generally, this is the result of a traumatic collision. However, ligaments can be over-stretched and weakened simply by overzealous stretching due to their unique properties.

First off, ligaments exhibit a trait known as force relaxation (1). When ligaments are stretched and the stretch is held at a given length, the ligament will stretch out and slowly give less and less resistance to the force. As a result, holding a moderate intensity stretch for a long period of time can potentially result in more ligament lengthening than a brief intense force.

Secondly, ligaments also exhibit creep (1). When a ligament is stretched with a constant force, and the force is maintained, it is continually stretched. Once a ligament reaches a given length (dependent on the ligament), failure occurs. When a ligament fails (torn, ruptured, or stretched beyond its capacity) it is irreversibly damaged.

Sometimes, stretching can result in ligament damage based on the properties of force relaxation and creep. Here is how it plays out:

1. A stretch is being held that is putting stress on the ligament. The ligament begins to stretch out and provide less and less resistance (force relaxation).

2. The person stretching feels like they can go further (since the ligament is resisting less) and he increases the stretch back to the same force he used at the start. Since the force is being maintained, the ligament continues to stretch (creep).

3. As this pattern continues, eventually the ligament can be stretched too far.

A ligament may can be deformed without tearing or rupturing it. This may result in joint instability due to less contribution from the damaged ligament. Though ligaments can heal, they have a poor blood supply and generally never reach pre-injury levels of strength. Since serious ligament injury does not heal well, both ligament tears and significant joint instability are oftentimes treated surgically.

Solution

The first thing you should do is that when you stretch, make sure you are actually "feeling it" in the muscle rather than in the ligamentous tissue. For example, when stretching the hamstrings, you want to feel it actually in the hamstring rather than behind the knee. Bend the knee some until you hit the target spot. If you are stretching out the external rotators of your hip, make sure you actually feel it around your hip rather than in your knee.

Secondly, save the static stretching for after a workout. Ligaments can handle more load and are more resilient when warmed up. Additionally, extra blood and fluid in the target area as a result of working out will make it easier to stretch.

At the end of the day, its important to remember that ligaments only can handle ~10% change in length before undergoing permanent damage, while muscle length is largely regulated by neural activity. This is why I like Z-Health so much - improving proprioception is much more effective than stretching for decreasing excessive muscle tension.



References

1. Enoka, R.M. (2002). Neuromechanics of Human Movement. Champaign: Human Kinetics.

Tuesday, August 18, 2009

Posture Correction: A Waste of Time?

One of the most popular topics in the health and fitness field today is posture and posture correction. Everyone wants "perfect posture." There are entire websites devoted to it and even more exercise programs that guarantee the delivery of perfect posture. Oh and the products! The ball chairs, the unstable shoes, what wonderful inventions! But before we get carried away, what exactly is perfect posture anyway? Is posture training even necessary? I do not think so.

Not Functional.

Now before you think I am off my rocker, here is some food for thought, first mentioned to me by Dr. Eric Cobb (of Z-Health fame): How many of you actually hurt when doing absolutely nothing? Who hurts when just standing there or lying down?

People complain of shoulder pain when bench pressing, back pain after cleaning or yard work, or hip pain when sprinting, yet to this day, I have never had anyone come in and say to me "Hey Colin, when I stand really still and do not move at all, my knee hurts." It just does not happen.

Which is strange, because nearly every client that comes to me wanting to improve posture does this because he thinks that improving his posture will take his aches and pains. Or someone else wants to improve her posture because she thinks it will help her move or perform better. Man, if only my shoulder blades were pulled back a little bit more, I would be able to dunk a basketball, run a 4.3 40, and bench press twice my body weight!

The problem I have with "posture correction" training is there is no ideal posture. Yep, I went there - and this is corroborated by research. For example, in Stuart McGill's Low Back Disorder: Evidence Based Treatment and Prevention, McGill notes that there appears to be no ideal posture for sitting, and the best seated posture is actually a rotation through different ways of sitting. This ensures that the load of supporting the body's weight is shared among different tissues. On the other hand, a static posture loads the same tissues repetitively, which over time can lead to pain and so-called "wear and tear."

The other problem I have with actively trying to correct posture is that posture should be an unconscious event. The brain chooses the way it feels the most comfortable to stand or sit, and in order to change what is considered comfortable, movement patterns need to be changed. Trying to fix caveman tendencies by thrusting your chest out and pulling your shoulder blades back is simpy going to move feelings of tightness and irritation from the supraspinatus and shoulder to the rhomboids and neck.

Which brings me to my final point - I realize would just be a critic if I did not supply an alternative. Well, if people generally hurt when moving, whether it be lifting weights, performing in an athletic event, or simply doing some work around the house, then would it not make the most sense to fix movement patterns? To run a dynamic assessment instead of a static one? Now, which type of assessment is up to the person doing the assessing. There are a lot of viable options and practically all forms of movement can show one abnormality or another. A simple FABER or Thomas test takes 10 seconds and gives plenty of feedback on how well the hips are doing their job. Something a bit more advanced like gait assessment can be used to evaluate movement on the whole body level.

I am sure there are some people reading this that are thinking: "I just want better posture so I look better," which is fine. Once movement patterns improve, whether it be through dynamic joint mobility, strength training, corrective exercise, or (preferably) a combination of all three, posture will get better. The body likes to save energy, and with efficient, pain-free movement, posture corrects itself.

With that said, it amazes me that someone with back pain will see a doctor or therapist, only to have their range of motion on a few muscles tested and then receive a few static stretches to work out 'tight' muscles. A client will bring me a sheet of paper looking something like this:Client: "Yeah, my doctor says to do this every morning when I wake up and before I go to bed at night and my back will stop hurting."

Me: "So how is that working for you?"

Client: "Not very good."

It is no wonder that the US loses billions of dollars of productivity yearly to back pain.

Sunday, August 16, 2009

Mouth Guards for Weight Training; Maryland Personal Trainer

A good bit of research has been coming out lately stating that clenching the jaw when performing a physical task (such as jumping or lifting a weight) increases strength and power (1). This phenomenon has been dubbed concurrent activation potentiation and is essentially a fancy way of saying "when one muscle contracts hard (or a group of muscles), other muscles like to contract hard too".

An easy way to demonstrate this is to shake friend's hand as hard as you can. After doing the test run, retry, but this time tense up your body first. If you did it right, your strength will go up and your friend will be thoroughly impressed by your handshaking prowess.

Jaw clenching is not particularly new in strength circles. Powerlifters, Olympic weightlifters, and other strength athletes have been using tension to increase weight totals for years. However, when this new research started pouring out, so did new products.
Why weren't mouth guards this cool when I was growing up?

Enter the mouth guard for weight lifting. While mouth guards have long been a staple for contact sports, the weight lifting mouth guard was created in the same spirit as the mouth guards designed for people who grind their teeth at night and suffer from the resulting tooth damage and jaw pain. Therefore with this miraculous product you can clench your jaw during your entire workout and experience big strength gains without damaging your teeth, right? Not so fast...

So what's the catch?

My issue is that products are being marketed to the average trainee - lately I have seen people wearing these for the duration of a normal workout. The problem with jaw clenching is that even though you may recruit more motor neurons, you are also training your jaw at the same time for increased tension. Often the only demand we consider in training is that of the targeted muscle group while in reality we are always adapting on a whole-body level. No study needed - this is just the application of the SAID principle (Specific Adaptation to Imposed Demand), which is the cornerstone of exercise physiology. In short, if you regularly train by clenching your jaw, you are going to get good at creating tension in your temporalmandibular joint (TMJ), which is not a desirable adaptation.

Getting to Know Your TMJ

The TMJ is a very sensitive area because it is a hotbed of motoneuron activity. Wait, what? Basically, there are a lot of nerve endings around the TMJ because it needs to both be able to create a lot of force in order to chew food, yet have very fine control in order to help produce speech. As a result, this area is often the site of various dysfunctional muscle activity. Unconscious jaw clenching is a well documented condition known as bruxism. This can lead to tooth damage, headaches, and in severe cases, extreme jaw pain. So why on earth would it be a good idea to create voluntary jaw clenching for any extended period of time? Wearing a mouth guard during a workout in order to jaw-clench on every set to squeeze out an extra tricep pushdown is simply not a worthwhile pursuit.

The Final Verdict

By no means am I saying that jaw clenching is a bad thing to do. If you are actively competitive in a strength sport, then risking developing jaw pain for an edge on the competition may very well be worth it. Even for non-athletes, there could be some merit in jaw clenching during very high intensity sets. However, the average weight trainer has no business purchasing a mouth guard in order to clench his jaw for all 10 sets of bicep curls. It is simply a surefire way to end up with a headache and a sore jaw with little to show for it.


References

1. Ebben, W.P., Flanagan, E.P., & Jensen, R.L. (2008). Jaw clenching results in concurrent activation potentiation during the countermovement jump. Journal of Strength and Conditioning Research, 22(6): 1850-4.

Friday, August 14, 2009

Walking for Recovery; Maryland Personal Trainer

Walking is my favorite recovery method. Every day I am off from the gym, I try to get in a 30 minute walk after a good dynamic joint mobility session. Walking is a great recovery method because it increases blood flow, reinforces good movement patterns, and burns some extra calories, all without adding significant loading or volume.

However, not all walking is created equal. As crazy at it sounds, I am serious - most people just do not know how to walk. There are three things you should avoid when walking for recovery:

Elbow Walking:

Necessary?

In general, arm swing is a good thing. When walking, the foot does not strike the ground directly under the center of mass of the body. As a result, in addition to propelling your body forward, the ground reaction force produced from walking also rotates the body. As a result, we swing our arms so we do not spin in circles when we walk (1).

However, just take a look at the above picture. That stride length does not warrant that much arm swing. Additionally, "proper" arm swing is driven by the shoulder. In an efficient stride, force travels up from the foot to the opposite shoulder before reaching the elbow. The elbow should allowed to move some, but it should not be forced. Nothing about walking should be forced - it should be relaxing. And yes, carrying little hand weights when you walk will mess up your stride faster than anything.

It may sound a little goofy, but the research supports it. Stuart McGill notes in Low Back Disorders: Evidence-Based Treatment and Prevention that proper arm swing results in up to 10% less compressive force on the spine.

Strolling

A fast walk is much "healthier" then a slow walk. Efficient movement is fast, and this fast movement changes loading patterns and increases blood and fluid movement. Additionally, slow walking applies a nearly static load to the same spinal tissues, while fast walking spreads the load around, making fast walking a good therapy exercise for people suffering from back pain (2).

Treadmills

This may come as a surprise to some. Treadmills are not all that great because they encourage poor movement patterns. When on a treadmill, the treadmill moves your leg back for you, rather than having to actually rely on your muscles to do the work. Additionally, a lot of steps can be taken during a long walk, making the 30 minutes to an hour you spend on a treadmill capable of inflicting more harm then you would think.

Too many people sit all day at work, go home and sit some more, and then walk or jog on the treadmill as their only exercise. As a result, many people take way too many steps on a treadmill which ultimately leads to some funky movement patterns in the real world. Why should you care? Because poor movement leads to wasted energy, which dissipates into tissue and leads to so called "wear and tear".
Go outside. Seriously.

I am not saying that the treadmill is worthless - it just should not be relied on as a primary exercise tool. If it is too cold out or you just can not get to a place where you can walk, it works in a pinch; just try not live on it.

Conclusion

Walking is not just exercise that grandma does at the mall - even high-end athletes can benefit from walking for recovery. It is not rocket science either, just make sure you go outside, try not swing your arms like a maniac, and walk with a little speed and you will be on your way to better movement and faster recovery!

References:

1. Enoka, R.M. (2002). Neuromechanics of Human Movement. Champaign: Human Kinetics.

2. McGill, S. M. (2007). Low Back Disorders: Evidence-Based Prevention and Rehabilitation. Champaign: Human Kinetics.

Thursday, August 13, 2009

Splitting it up

My fitness blog and training log are now going to be separate entities. I will still keep my log up to date for those interested in the minutiae of my day to day workouts. I will also still post some updates on my training on the blog like when I hit a longtime goal or something similar. I will keep a link to my training log on the right hand side navigation bar as well, so it will still be easy to find!

Monday, August 10, 2009

Research Rant; Maryland Personal Trainer

One of my biggest pet peeves is when a study is claimed to "prove" something.

As a personal trainer and simply as someone who is involved in the fitness industry, every time there is a new health-related research headline in the news, I am the first one to hear about it. The conversation usually goes something like this:

Person: "Did you see the new study that proved vitamins ruin your workout?"

Me: The only thing that it proved was that you don't know what you are talking about.. It is possible that large amounts anti-oxidants could interfere with the natural inflammation process, but we would need to see a lot more research before jumping to any conclusions.

When looking at research, people like to read the introduction and the results while skipping over the methods, which is often the most important part. Just take the study above. Subjects took 1 gram of vitamin C daily. Who takes 1 gram of vitamin C a day anyway? Most multi-vitamins only weigh 1 gram as it is.


But I digress. The more important thing here is the fact that studies do NOT prove anything! Things really do not get "proved" at all, especially when it issues pertaining to the human body. The human body is just too complex for absolutes.

Researchers perform studies which become evidence, a piece of the puzzle if you will. The best a scientific hypothesis can hope for is that when once enough pieces of evidence (or studies) are stacked up, it will become generally accepted. Take creatine for example. It is generally accepted that creatine supplementation increases maximum power and strength. However, there's no "proof" that it does so because everything does not work for everyone in the same way and there are plenty of research studies which were unable to show that creatine had any effect on strength and power.

I think the media is mostly to blame for perpetuating this phenomenon. Popular news services love to say a study "proved" something, like when it was proven that puppies' behavior is dependent upon the alignment of planets.

Upset with the current alignment of planets, no doubt.

I am not trying to downplay the importance of research by any means. Sometimes single studies do make landmark discoveries. Take the Boeing Back Pain study for example, where a few thousand employees were analyzed to determine back pain risks. The researchers found that people who did not like their jobs were more likely to have back pain... a lot more likely. This study greatly advanced our understanding of chronic pain - popularizing the notion that chronic pain issues go beyond anatomical cause and effect and in the end the brain puts all the pieces together to decide what hurts and what does not. What this study did not do was "prove that people who hate their jobs will have back pain".

Conclusion

Always take studies with a grain of salt - make sure you know the whole story before jumping to any conclusions. At the end of the day, one study never proves anything - it takes a lot of work from a lot of researches to make definitive conclusions about health and performance!

Sunday, August 9, 2009

Eat Your Spinach!; Maryland Personal Trainer

Every piece of food we eat affects our body's acid-base balance. Aside from being loaded in antioxidants and fiber, green leafy vegetables are very alkaline. On the other hand, meat and grains tend to be acidic. As a society, we eat a lot more acidic food than alkaline food, which can have significant effects on health, body composition, and performance. For more information, this article does a great job explaining the science behind the acidity (or alkalinity) of food. The rest of this post is about how to get more spinach in your diet, as it is one of the most alkaline vegetables around. Here are two quick and easy ways for increasing your spinach consumption:

Spinach Salad:

One of the easiest ways to get more spinach in your diet is to use spinach leaves as salad. For a low-carb, protein packed meal, simply fill up a large bowl with spinach, add one can of tuna fish (or other meat), and top with a dressing suitable for your diet goals. Fat-free works when dieting (be careful not to get one with too many carbohydrates if you are watching those), and light ceasar mixed with olive oil (my favorite) works when strength and size are a top priority.

Blended Shake

If you have never tried this before, try not to be too quick to judge. Spinach virtually no taste when added to a blender. Also, it works with frozen spinach (which is unusable in salad and does not taste as good when cooked). This recipe is perfect if you meet any of the following criteria:

- You hate spinach
- You need to get in a meal on the go
- You do not mind getting strange looks
- You can't afford fresh spinach or it always spoils (frozen is much cheaper!)

Blend the following ingredients in the blender:

- 4 Cups Fresh Spinach (or ~1-1.5 cups frozen)
- 1 Cup Cottage Cheese (replace with protein powder if you are lactose intolerant or are restricting fat)
- 2 tablespoons natural peanut butter
- 8 ice cubes
- 1 tablespoon of flax seed
- artifical sweetener, to taste

Tastes better than it looks!

This recipe is pretty versatile. I hate the taste of frozen spinach and cottage cheese, but with a little bit of peanut butter and splenda/stevia, anything tastes good. You would be surprised what you can sneak into a blender without it affecting the taste of the shake.

Conclusion

Popeye was right all along. Now you have no excuse for not eating your spinach!

Saturday, August 8, 2009

Chesapeake Fitness Training is open for business - website now live!; Maryland Personal Trainer

Chesapeake Fitness Training, our training studio, is finally open for business! Our website is up at http://www.harfordcountypersonaltraining.com/. Our site lists a description of our services. Here is a picture of the facility:

Our personal training studio is located just a few minutes from exit 89 off of I-95 in Harford County, making for easy access for residents of Havre de Grace, Aberdeen, and Bel Air. As you can see, we have nice, private studio located inside a well-lit windowed room. We have a squat rack and a full dumbbell set up to 100 lbs, in addition to a prowler and some other fitness goodies. While there are some finishing touches left, the studio is now open for training, so hop over to our website and sign up for a complimentary session today (and come check out the wildlife while you are at it!):

Picture snapped from the window of our studio!

Friday, August 7, 2009

Exercise Spotlight - The Trap Bar Deadlift

The Trap Bar Deadlift is one of the best exercises around for strength and athletic development. This lift hits the hamstrings, quads, erectors and upper back. It is also great for grip strength and trap size (which is correlated with instant respect). Here is a short and sweet video demonstrating proper form for the trap bar deadlift:


If you need something to listen to on the way to work, this site also puts out regular fitness podcasts which are quite good.

I'll add that the most common mistake experienced lifters make when doing the trap bar deadlift is making the trap bar deadlift into a regular deadlift. It is typical to see more experienced lifters straighten the knees out early in the lift, effectively starting the movement with knee extension and finishing with hip extension. In a proper trap bar deadlift, the knees and hips should move fluidly and lock out at the same time.

Also, as with any deadlift, neutral spine is priority number one.

Reasons for using the Trap Bar Deadlift:

1. It works both the quads and posterior chain:

This one is a no brainer. A traditional deadlift involves little quad involvement, whereas the quads are a prime mover in the trap bar deadlift. This makes a true trap bar deadlift a "more athletic" pattern than a traditional deadlift because in both real life and on the field, the brain will select whatever motor pattern is most effective at completing the desired movement. Nearly all of the time, this results in the cooperation of joints rather than the isolation of joints in movement.

2. Less compressive spinal and shearing force

The trap bar deadlift is also a great movement because it significantly reduces the high levels of compressive and shear force imposed upon the lumbar spine during traditional deadlifts. Many lifters who have lumbar issues with deadlifting are able to trap bar deadlift pain free. Here's why:


In a simplified look at deadlifting mechanics, the longer the horizontal distance between the fulcrum (the point of rotation, in this case the pelvis/SI/L4&5 area) and where the force is being applied (in this case the bar), the more shearing force and compressive force endured by the lumbar spine.

In a traditional deadlift the moment arm is quite large, as shown in the picture below:



In a trap bar deadlift, the bar is beside the feet, which shortens the moment arm by bringing the hands closer to the hips. However, with a trap bar deadlift, the knees are able to travel forward more since the bar is not in the way, and the hips are able to slide much closer to the bar.

While not the greatest picture in the world, it should demonstrate how allowing the knees to flex more decreases the moment arm and ultimate reduces the amount of shearing and compressive force experienced by the spine.

Conclusion

I should note that I am by no means opposed to the traditional deadlift, especially if your anthropometry favors it. However, if you are not doing the trap bar deadlift, try it out. It is a great way to blast the legs and improve strength total body strength while minimizing spinal load.

Tuesday, August 4, 2009

The Best Protein Bars; Maryland Personal Trainer

In an ideal world, we would all eat healthy whole foods for every meal. However, we do not live an ideal world and sometimes life gets in the way. The fact is, at some point in your diet something is going to side track you. It might be your stressful job, your demanding kids, or even both! Having a backup meal is necessary to help you stay on track. In my experience as a trainer, the most successful dieters are the most flexible dieters.

One of the easiest back up meals is a protein bar. However, in defiance of the basic laws of economics, there are literally hundreds of competing brands of protein bars. I think so many supplement companies are able to exist is because the consumer is not aware of what is a quality bar. The easiest way to check out the quality of a protein bar is to check out its ingredients list. There are 3 main things to consider:

Type of Protein:

When it comes to protein, there are three major types - concentrates, isolates, and hydrolysates. Concentrates are lower quality; they are not as pure, have more tag along carbohydrates and fat, and are cheaper to produce. Isolates are a higher quality protein (usually 90%+ protein), resulting in less extra carbs and fat in the protein powder. Hydrolysates are usually the most pure (and expensive proteins). They are also the most quickly digested.

Soy, Whey, Milk (a combination of casein and whey), and Casein are the most popular types of protein used in protein bars. Soy concentrate is by far the cheapest protein around, and I would make an effort to avoid it at all costs. If you are vegan or lactose intolerant, soy isolate is a lot higher quality. Everyone else should look for whey, casein, or milk proteins.

Fiber

Any meal replacement needs some fiber! Make sure the protein bar you get has a few grams of fiber in it. Try to get 1g fiber for at least for every 100 calories.

Avoid Trans-fat and HFCS

While this may seem like a no-brainer, many protein bars contain some form of hydrogenated fat, high fructose corn syrup, or both. While trace amounts will not kill you, watch out for either of these items ranking high on the ingredients list.

My Recommendations:


My favorite bars on the market right now are the VPX Zero Impact line (pictured above). I like the Chocolate peanut butter. The taste is nothing to write home about, but with milk protein isolate topping the protein list, almond butter topping the fat list, 6 grams of fiber and 410 calories, this beefy bar is my go-to meal replacement. Vitamin Shoppe in Bel Air, MD had a sale on these not too long ago for 24$ a box. Otherwise, search around the internet for a good deal.

If 410 calories for a bar is bit too much for your current caloric needs, I like the Metabolic Drive Protein Bars by Biotest as well. There are a bit cheaper cost-wise going for 12 bars for 19$ (free shipping) and have 240 calories a serving.

If neither of these work for you, you can always try your hand at making your own protein bars. My business partner Danny posted a recipe up recently for home-made pumpkin protein bars (you can find the recipe here). Lots of fiber and protein, and they taste good to boot!

Looks weird, tastes good!

Sunday, August 2, 2009

Grass-Fed Beef; Maryland Personal Trainer

In In Defense of Food, author Michael Pollan notes that "You are what you eat eats".

I am sure by now you have heard about the wonders of fish oil, and how healthy omega-3 fats are. However, have you heard why all animal fat is not blessed with this health benefit? The difference is diet of the animal.

A supplement everyone should be taking!

As humans, we do not consider green vegetables to have a significant fat content. For cows and other grazers which eat pounds of greenery each day, these trace fats are a substantial part of their diet. Once upon a time, before corn was king, people ate animals that fed on mostly green things (or ate animals that ate animals that fed on green things). Green vegetation tends to be rich in omega-3 fats. These omega-3 fats from grass were then stored by animals like buffalo and deer as fat. When ancient man ate these animals, he too consumed high amounts of omega-3 fatty acids, which became an integral part of his composition.


Unfortunately, corn is high in omega-6 fatty acids. Animals that eat corn as their primary dietary source become rich with omega-6 fatty acids rather than omega-3 fatty acids. As a society, Americans tend to get way too many omega-6 fatty acids as it is compared to our predecessors due to the preponderance of corn in modern diet. Vegetable, corn, and soybean oils are all high in omega-6 fatty acids. As a result, omega-3 fatty acids virtually vanished from the modern human's dietary supply. Omega-3 fatty acids are needed for cell membranes and biochemical reactions in addition to making up a large amount portion of brain tissue. As a result, supplementing with omega-3 fatty acids has been linked to many positive effects such as improved insulin sensitivity and improved vascular health.

In short, grass-fed beef is healthy because it is high in omega-3 fatty acids. These omega-3s were a big part of ancient man's diet. Corn-fed beef, and other corn-fed animal fat is not considered healthy because it is high in omega-6 fatty acids, which the average person gets too much of already.

You may be thinking that if this was the case, why do we not see grass-fed beef everywhere? Well, the biggest problem with grass-fed beef is that it is expensive and typically hard to get. However, if you happen to live in Bel Air, Aberdeen, Havre de Grace, Forest Hill, Fallston, Churchville, or any other Harford County area, you are in luck! Shop Rite has grass-fed whole beef tenderloin on sale this week for 4.99$ a lb. Grass-fed beef is less fatty than normal types of beef, which makes the tender whole beef tenderloin the best grass-fed cut. When I lived in Washington, this cut was over 20$ a lb at the local grocer!

I'm no chef, but the cook in this video gives a good demonstration on how to prepare a beef tenderloin.



If you do not think you can handle a kitchen knife, Shop Rite also has grass-fed sirloin on sale as well for 4.99 a pound!

Saturday, August 1, 2009

The Deload Week - How Structured Rest Can Lead to Greater Gains

Resting Your Way to Better Results

Structured rest periods, affectionately known as a "deload" period (10$ to whoever can figure out where this word first appeared (serious)) are a necessity for any serious athlete. I really loathe the deload - I hate walking into the gym and using less weight for less reps, but it is a necessary evil. Everyone needs to manage training loads - whether they be team sport players (like football or lacrosse), weightlifters, powerlifters, bodybuilders or just fitness enthusiasts. Many top nutritionists even recommend structured breaks from dieting (I do too!). But before you take a week off from the gym and head to the buffet, it would be wise to take a look at the science first.

Deloading Theory


A popular theory about how training performance occurs is known as the Fitness-Fatigue model. In the figure below, a model of the fitness-fatigue theory is provided:

Adapted from Zatsiorsky & Kraemer (2006)

If you were not able to tell from my incredible Paint skills, the Fitness-Fatigue model essentially says that performance is the result of two factors - fitness and fatigue (not redundant at all right?). Basically, at any given time, your performance is the result of your "fitness" (which is increased via training), and your fatigue (which is also increased after training, but also by a host of other factors such as illness, stress, and sleep to name a few).

The idea is that after a workout, fitness and fatigue are both increased, but fatigue fades quicker than fitness. Essentially, this seems to be true, however, there is a catch. Generally, muscles recover from workout to workout pretty quickly. Muscles are highly vascular and receive lots of blood to help with this. However other body systems, which are necessary for high levels of performance, get fatigued and do not recover as quickly as the muscular system.

In this context, fatigue refers to all body systems. Connective tissue and the nervous system are also systems subject to fatigue. Connective tissue, like tendons and ligaments, can take a beating and may not recover fully from workout to workout. This is especially true if there is something besides working out that is acting as an irritant, such as poor or repetitive movement patterns. The endocrine system is easily overworked due to high levels of stress, whether that stress be from exercise, diet, or work! Additionally, the nerves that control the muscles simply can not go all out all the time, even if the muscles feel okay (as an example, try to max out on bench every day of the week - you may not get sore but your performance will suffer after a few days, if not sooner).

Practical Application

"A little knowledge that acts is worth infinitely more than much knowledge that is idle" - Kahlil Gibran

Now, the science lesson would be worthless without knowing how to apply it to your training. There are two questions you need to ask yourself (and answer) before planning out your deload:
1. How much fatigue am I really producing?

Here are some basic deloading guidelines to help you determine how much fatigue you are producing:

The more often you workout, the more often you will need to deload.

To put it bluntly, if you only workout twice a week, you probably will never need to deload. If you work out 3 or more times a week, as your training advances, you will need to implement some form of deload.

The more advanced you are, the more often you will need to deload.

The higher your level of fitness, the more damage you will be able to inflict on your nervous system, connective tissue, and endocrine system. As a general rule, beginners most likely do not need to deload until their training plateaus for the first time (unless other issues exist). Intermediate trainees can deload once every 6-10 weeks, and advanced trainees every 4 weeks.

The higher your workout intensity or volume, the more often you will need to deload.

High intensity exercise stresses out the nervous system over time. While it feels good to hit a personal record on a lift, try walking around afterwards. After a hard lift or three, you can create a lot of fatigue despite not doing that much work. This does not just apply to weight-training - hard interval training and plyometrics are also intense activity.

Using a lot of volume, typical of some bodybuilders and distance runners, is also very exhausting. The more volume you use, the more often you will need to deload as well.

Calorie restriction induces fatigue.

This one is the easiest for people to understand. When you eat less you get tired more easily! Keeping calories low for an extended period of time is a big stressor, particularly to the endocrine system. A week or 2 break (from dieting) is generally appropriate for people after 8-16 weeks of dieting (depending on the diet plan). With an approach like carb-cycling which changes macronutrient intake based on training day, breaks from dieting are not needed as often, if at all.

As far as training goes, when restricting calories, deloading may need to occur more often than usual.

Pain may indicate fatigue

If your shoulder hurts a bit when you bench press, it might be a good idea to deload on the bench press sooner than later, and additionally change the movement to something that is more comfortable, such as using dumbbells or a neutral grip.

2. How do I go about reducing the fatigue?

The most common deloading strategy is to simply cut volume across the board for one week by 40-50%. In the gym, that means cutting your total number of reps by 40-50%. This is generally my preferred strategy for intermediate lifters. Dropping the intensity is generally reserved for more advanced lifters and is usually not necessary for beginners.

You can also deload certain movements. For example, if you have a history of shoulder pain with overhead pressing, you might chose to not overhead press during your deload week.

As an aside, the "deload week" is just for convenience sake - if you are on a 5 day training split for example, a deload of 5 days is probably appropriate.

The deload week is a great time to include work on weak parts. Spend some extra time doing light intervals, corrective exercise, dynamic joint mobility, and just walking around and being active. There is no one size fits all deloading plan. The best way to go about it is to experiment with both approaches to figure out which works best for you. Here's a hypothetical example:

A beginner with a history of shoulder pain on the bench press that trains four times a week. His shoulder is "feels better now" but still irritates him on occasion:

For beginners I generally do not think deloading is necessary. However, due to the history of shoulder pain, I would recommend deloading the bench press every 4th week or so. For example, I would lay off of the bench press entirely for the 4th week without dropping intensity or volume at all for other movements, especially rows. With the extra time from not pressing, I would focus on 'rehabilitative' work like face pulls, scapular retractions, Ys, and dynamic joint mobility.

For a real-life example on how a deload workout fits into an overall program, you can check out my training log. I just posted my deload week up yesterday.

References

Zatsiorsky, V.M. & Kraemer, W.J. (2006). Science and Practice of Strength Training. Champaign: Human Kinetics.

Wednesday, July 29, 2009

R Phase Weekend #2; Maryland Personal Trainer

Just came back from the z-health R-Phase weekend #2 certification in Denver. I am officially R and I phase certified!


While we covered a lot of material over the 3 day course, the biggest impression I could not help but carry was how valuable it is to have someone look at your form. Even good movement patterns can degenerate over time. Injuries, stress, changes in load, and a host of other factors can all alter motor patterns. If left unchecked, these compensations will become the brain's preferred pathway for executing a certain movement, and that is no way to train. Practice makes permanent!

While there is no replacement for a good coach or trainer, a workout partner is a great start. If you do not have one now, make friends with someone at your gym. If you hate your gym, try looking on a local forum. Even if your friend does not follow your exact routine, being able to grab someone to check out your form, especially on more complex movements, is a great asset. Just make sure they know what they are looking for.

If you absolutely can not get a workout partner, video taping your form is another option. Digital cameras are cheap, and many cell phones have cameras on them. Just make sure you set up the angle of the camera right. For example, if you have a history of knee valgus (knees collapsing inward) during your squat, make sure the camera is directly in front of or behind you as you will not be able to clearly see knee valgus from a different angle.

While it is not quite the same as instant feedback, it is certainly a lot better than assuming your form is good. Watching how your form has changes from video to video can also promote motor learning. So, if you do not have a training partner, find one! And even if you are not very good at making friends, you can always buy a camera.

Monday, July 20, 2009

A Healthy Sweetener Alternative - Cocoa Powder; Maryland Personal Trainer

As a personal trainer, I'm often asked for healthy ways to sweeten foods. While I am no chef, one of my favorite things to add to my post workout smoothie is a bit of cocoa powder.

Cocoa powder has been studied a lot over the last decade. Recent research has shown that consumption of cocoa powder can reduce blood pressure, improve insulin sensitivity, and improve the capacity of blood vessels to dilate (1, 2, 3). Additionally, cocoa powder makes things taste like chocolate (no research needed)!


When buying cocoa powder, there are two options - raw and processed. Thanks to the increasing popularity of organic foods, the health-conscious consumer might leap for the raw cocoa. However, I do not think that this is a good idea for most people. Not everything is for humans to eat raw (like really bitter plants, which cocoa is), so your best bet when picking a cocoa powder is an organic but processed powder. Anecdotal evidence suggests raw cocoa powder results in some digestion problems for quite a few people.

However, processing can reduce the amount of compounds known as flavanols in cocoa powder. These compounds are associated with many of the positive benefits of cocoa. Food companies such as Mars have been working on new processing techniques for cocoa powder which do not remove or damage the flavanols. The Mars product line is not complete currently, but Acticoa claims to have a powder with a high flavanol content. Normally I would be quite skeptical of a "brand new processing technology that improves the healthiness of a food", but the early research has shown one of these high-tech cocoa powders to effectively lower blood pressure (2). However, I am sure these products are very expensive, for now I am okay with normal organic cocoa powder.

Since right after a hard workout is the best time to get some fast digesting carbohydrates and protein, I like to add sweetened cocoa powder to a shake of fruit, oatmeal, and whey protein. Sweetened cocoa powder (as long as it is not sweetened with high fructose corn syrup) is fine right after a workout (within 45 minutes or so) since a post-workout insulin spike is not a bad thing. Cocoa powder also has a very strong taste; usually a tablespoon of cocoa is enough for a 20 oz smoothie. Like all things, cocoa is best in moderation; flavanols may reduce blood pressure, but eating 20 candy bars will certainly raise it. With that said, next time you need a little bit more flavor in a smoothie, reach for some cocoa powder!


In other news, the Harford County Personal Training website should be up very soon!


References

1. Grassi D., et al. (2008). Blood pressure is reduced and insulin sensitivity increased in glucose-intolerant, hypertensive subjects after 15 days of consuming high-polyphenol dark chocolate. Journal of Nutrition, 138(9): 1671-6.

2. Cienfuegos-Jovellanos E, QuiƱones Mdel M, Muguerza B, Moulay L, Miguel M, & Aleixandre A. (2009). Antihypertensive effect of a polyphenol-rich cocoa powder industrially processed to preserve the original flavonoids of the cocoa beans. Journal of Agricultural and Food Chemistry. 57(14): 6156-62.

3. McCarty, M.F., Barroso-Aranda J., & Contreras, F. Potential complementarity of high-flavnol cocoa powder and spirulina for health protection. Medical Hypothesis, epublished ahead of print.

Saturday, July 18, 2009

Exercise Spotlight - The External Rotation; Maryland Personal Trainer

This week's exercise is the external rotation, depicted in the video below:





Targeted musculature: Teres minor, infraspinatus.




Why:
Increased performance!


How the External Rotation Can Increase Performance

Despite the over-prescription of the external rotation in the physical therapy arena, external rotations are one of the most useful (and overlooked) exercises for healthy people participating in regular resistance training.

The pectoralis major and the latissimus dorsi (yes linking to wikipedia) attach to the humerus in such a way that when they contract, they create a torque of internal rotation around the humerus. In simpler terms, when doing a bench press and the chest contracts to press the bar up, the chest musculature is also "twisting" the humerus.

To prevent the humerus from over rotating, the external rotators must contract in conjunction with the chest and back in order to stabilize the glenohumeral (shoulder) joint. If the pectoralis major's capacity to produce internal rotation during a bench press exceeds the ability of the external rotators to produce a counteracting force, 2 things could happen:
  1. Very rarely, injury could result
  2. Much more commonly, the brain prevents the pecs from overcontracting. This leads to less than optimal performance!
So, in order to prevent this from happening, add some external rotations to your program!

Variations

There are multiple ways to do the external rotation. As depicted in the video above, cables offer an excellent choice. Dumbbells, small weight plates, and bands can also be used. Additionally, as I wrote about in the tempo article, tempo can be added to the external rotation to increase difficulty and in some cases specificity.

Furthermore, changing the amount of shoulder abduction can change which of the external rotators is recruited (1). So, it can be useful to incorporate a variety of shoulder positions, such as the arm against the body and the arm fully abducted. A video of an external rotation with the arm against the body is shown at the top of the page. A video of an external rotation with the shoulder abducted can be found below:




Brief Rant on the History of the External Rotation

The external rotation is a popular physical therapy exercise targeting the infraspinatus and teres minor muscles. In addition to externally rotating the humerus, the teres minor and infraspinatus also depress the head of the humerus. This increases the amount of space below the acromion, theoretically relieving any impingement on the supraspinatus tendon. Since a lot of shoulder pain is simply written off as "supraspinatus tendinitis", external rotations are commonly prescribed to relieve shoulder pain. If you are having trouble visualizing this process, this journal article, has some great pictures on page 4 that show typical a "shoulder impingement".

Occasionally, this is effective, but the fact of the matter is that the glenohumeral joint is extremely complicated and nearly the entirety of the upper body musculature is involved in its stabilization either directly or indirectly (by acting on the scapula or humerus). Additionally, the external rotators end up pulling the head of the humerus forward in the socket when they contract, which can cause pain in and of itself.

In short, if you end up at a physical therapist's office for shoulder pain and they give you a band and tell you all that you need is external rotations, run the other way! As a personal trainer, I have worked with far too many clients who came right from a physical therapy clinic with that exact unfortunate experience.

Conclusion


If your bench press has been stagnant, try adding external rotations to your program. If you already incorporate them, try a variety of angles. If you have not used this exercise regularly in your training, you should notice a difference in your pressing strength within a few weeks!



References

Poliquin, C. (1997). The Poliquin Principles. Dayton Publishers & Writers Group.