Thursday, December 10, 2015

The Power of Joint Centration

Today I wanted to do a quick tutorial on joint centration, what it is, and why it is so important.  Think of pain or inflammation at a joint.  Have you ever notice painful popping, grinding, or clicking at a joint?  Ever feel like a joint is too loose?

One major bias that circulates is that the cause of your pain or injury is usually a tight muscle.  But that's an over-simplified look at the problem.  Why does the muscle appear tight?  From what evidence I've gathered over years, it's a nervous system thing.  In other words, there is indeed a reason that a muscle is tight, but to say that is the problem is like saying to a blind person their problem is they can't see.  Well...yeah, you've just used words to get nowhere.  When I overhear an athlete or even a medical professional just write something off as a tight muscle, I fear the problem of joint centration is not going to be addressed appropriately.

Let me give you an idea as to why this may be a bigger mystery than you think and why it's important for a practitioner and patient to work together to figure this issue out...
A tight muscle gives incorrect input to the central nervous system (CNS).
Likewise, the CNS can provide an input for a muscle to tighten in response to something else (compensation).
Chronic posture or habits can affect muscle length, which again changes input.
Is it the chicken or the egg?

Joint Centration is a dynamic neuromuscular strategy that leads to optimal joint position allowing for the most mechanical advantage.  Common reasons for poor joint centration are muscle imbalances (which have a variety of causes), structural injury (acute or chronic), and chronic behaviors (such as bad posture).  Furthermore, centration of one joint affects nearby joints, meaning for example that if you do not centrate correctly within your spine (poor posture), you will change your scapular positioning and thus negatively affect the joint centration of your glenohumeral joint (shoulder).

This graphic demonstrates briefly the idea of joint centration.  Keep in mind that this is a dynamic process, even with activities that are considered "static" such as our posture.  To maintain an upright posture, our postural muscles must maintain a low level of firing.  The muscles themselves must not only be strong and endure a full day of activity, but they must be timed properly to allow for consistent joint centration to occur.

When our joints are "seated properly" both statically and dynamically, we allow for maximal use of the surface area, we create the best mechanical advantage for our muscles, and we prevent our passive structures from getting overloaded (examples: the labrums of the hips/shoulders and the menisci of the knees).  This process involves a lot more than just the muscles, it involves the command center (CNS: your brain and spinal cord).  So while we would like to point the finger at a tight muscle, to actually recover from a joint centration problem it is often more helpful to consider muscles that may be too weak (leading to compensation), the function of other joints (leading to compensation), and the actual movement patterns the person uses to accomplish a task (leading to compensation).﻿

The rotator cuff (RC) must work synergistically with the deltoid muscle - as the deltoid elevates the shoulder joint, the rotator cuff has to provide an inferior (downward) glide to the humeral head in order to maintain joint centration. 

Elevation of the shoulder involves more than just the ball and socket joint.  You must properly position the scapula through upward rotation in order to position the socket correctly and fully elevate the shoulder.  If we were to lock down the scapula completely, the average person would only be able to raise the arm 90-120 degrees.  So anything that affects your scapular positioning or mobility (tight trapezius muscles or bad posture anyone?) will affect your shoulder joint centration during overhead movements.

Another look at scapular upward rotation.  Just appreciate how much is involved in a "simple" movement of the shoulder.
UT (upper trap), MT (middle trap), LT (lower trap), SA (serratus anterior), DEL (deltoid). 

Muscular synergy and joint centration are critical aspects to normal function and must be considered in any rehabilitation program.  If performing exercises without proper joint centration, you end up strengthening a muscle in a non-ideal position and pattern, further ingraining compensation into your central nervous system (CNS).  It may indeed reduce pain initially, but it can decrease your joint stability over time which ultimately leads to pain and functional problems down the road.

Some important takeaways regarding joint centration...

#1 - While there is nothing wrong with "treating" muscles that are very tight, normal joint mechanics (if able to achieve), are the ultimate goal.  This is likely to take weeks and months to properly achieve, usually a quick fix or one treatment does not address the complexities of joint centration or re-training muscle synergy.

#2 - Your chronic habits outside of your formal rehabilitation are critical.  Knowing that joint centration in one area affects joint centration in another area, we have to consider our postures and where we hold tension (dealing with our stress in a positive way as opposed to holding it in our bodies).  Complete body posture must be considered.

#3 - Don't get overly fixated on joint damage as the source of your pain.  This may be the case, but just as likely you have a joint centration problem that lead to degeneration or tearing of a passive structure.  This means that your "injury" is the secondary issue, the result of poor joint centration.  Focus your efforts on "repairing" the torn structure and you've just endured a very expensive surgery for no reason.  If you don't fix the poor joint centration, you maintain inflammation and pain.  If you simply try to compensate around the joint centration problem to avoid pain, you create a joint centration problem elsewhere and eventually you'll feel pain there too.

I spend a great deal of time and effort to better understand how to create muscle synergy and good joint centration in my patients.  It is an ongoing learning process and one that I will spend my career improving upon...if it were just a tight muscle problem, I could totally stop learning now!

Thursday, December 3, 2015

Aerobic Development

Aerobic development has taken a hit over the past few years (pun intended) with HIIT training (high-intensity interval training) coming into the spotlight.  There are always caveats to my posts and for this post I want to ensure that people understand that goals and personal history will always be important factors in deciding how to train.  I just want to make a few quick points before we get to the actual aerobic training recommendations.

First, the aerobic and anaerobic systems work together simultaneously to provide our bodies with energy, so it's useless to say one is more important than the other.  In general, your aerobic system will dominate until you start working in which you will progressively dip into anaerobic metabolism for your energy needs.  The other aspect of the aerobic versus anaerobic debate that is nearly useless is the calorie debate (i.e. for a given amount of time, HIIT burns more kcals).  By now I hope that most people realize that the purpose of exercise is not really to burn calories.  The purpose of exercise is to extend the number of quality years to your life and enable you to physically do more while you're alive.  Burning calories is just a side effect.

Second, self-experimentation is the best way to find out what works for you.  It's easy to see a fit person who is ripped and think, "if I just eat how they eat and do the exercise they do I'll look the same."  There's way more to that story, he or she could actually have a pretty crappy diet and a narrow-minded workout regimen and still look good because of genetics.  If something isn't working for you, don't give up and don't beat yourself up, just realize there is a reason and try to figure it out.  
There are many ways that we are not one-size fits all.  So keep that in mind as you read this.  I might give you what I believe to be an excellent principle, but at the end of the day, you've got to test it for yourself to really know.

Third, what works for you today may not work for you tomorrow.  Some principles will stay the same (i.e. make exercise a priority, ensure you do some strength training, ensure you don't let all of your endurance go to crap, eat real food), but other things will change over time (how much recovery you need, how strict you have to be with nutrition, how much sleep you need, etc).  Be aware of changes you might need to make by having a conversation with your body on a regular basis.  Keeping a log/diary is a great way to see what exactly works for you and what doesn't.

Fourth, when it comes to aerobic versus anaerobic, the general guideline I find to be successful time and again is build your anaerobic training on top of a solid aerobic base.

With those points out of the way, what are the general benefits of aerobic exercise?
Moderate aerobic training boosts the immune system.
Aerobic training has been shown to lower blood pressure (expanded capillary network and increased parasympathetic tone of arterioles).
Aerobic exercise has been shown to improve cognitive function (better memory & mood).
Studies show aerobic exercise improves insulin sensitivity.
Aerobic exercise favors a reduction in overall mortality rates and cardiovascular disease.
May be helpful for stress reduction / management
Aerobic exercise increases endurance.

More isn't always better.  How much endurance or aerobic exercise is enough?
That depends on your goals.  If you want performance, you need to know roughly how long (days/hours/minutes) will your competition last?  Train for that.  If you want health, you need to think about what activities you want to be able to do and how you want to feel.  When I cover the MAF method in a moment, you'll see a practical test to gauge if you have maximized your endurance and aerobic capacity.

Why does Sam (me) like endurance training?
I love running & hiking trails in Colorado.  I enjoy being able to explore the outdoors easily.
When I am endurance-trained I have all day energy and I sleep well at night.
When endurance-trained I tend to have my best body composition.
My mood tends to be stable and it's easier for me to both concentrate and relax.
I recover faster from anaerobic workouts/strength sessions.
I notice less aches and pains.

Some of the benefits I notice may appear to be in direct contradiction to reports from others stating that with "chronic cardio" they find they are skinny fat, hungry all the time, tired, and develop overuse injuries.  To that I say execution is a critical component that is often over-looked.  I should also caveat that I train aerobically for health, not for performance.  I have trained for performance at various points in my life and I ran into injury and burn out often (because in my zealous love of running and fitness I was over-training).  More isn't always better, it's just more.

It is better to go into a competition 10% under-trained than 1% over-trained.

Can you believe it?  When you arrive to competition slightly under-trained, you're in a position to go above and beyond what you normally do.  You just have to realize you can mentally go harder in competition than in training.  However, if you are 1% over-trained, you do not have more to give in competition than you did in your training.  You've already begun your downward spiral in performance.  I believe this may ring the wrong bell with some people because it doesn't fit what most of us are told as athletes.  Most coaches will tell you that you have to run faster in training than you do in racing.  The fact is, many competitive running athletes (endurance) are actually over-trained.  And the worst part is, they see their low performances and just train harder.  It is difficult to be a highly-motivated athlete and not become over-trained.  I remember being a scholarship athlete and feeling the pressure to train harder than my body was actually capable of recovering.  And I did, I got the flu several times at the end of my cross country season (missed regionals in the year I had my best performances) and had chronic sinus infections every year of college from chronic suppression of my immune system.

Effective Training: You break down the body (RED) when you exercise and with recovery you compensate (YELLOW).  If you were to rest for too long of a period without a stressor, the YELLOW line would return to baseline or lower.  If you didn't work hard at all in training, you would not see the RED line dip much and therefore the body would not compensate with any meaningful changes.  This process does imply several things (such as you are relatively healthy and able to heal).

Over-training: This is one breakdown stimulus (workout) after another without proper recovery.

Your risk of overtraining involves many other factors aside from your workouts.
  • Life Style:
    • Inadequate sleep, irregular routine by day
    • Use of alcohol and nicotine
    • Excess of caffeine
    • Over stimulating company
    • Nutritional deficiencies (lack of vitamins)
    • Rush and hurry
    • Frequent necessity to adjust body-weight
    • Taking on more stresses when already at capacity
  • Environment:
    • Over burdening with family duties
    • Tensions within family (parents, husband, wife)
    • Difficulties in personal relationships
    • Dissatisfaction with career, studies, school
    • Conflict of attitudes to sport (family, superiors)
    • Excess of stimuli (TV, cinema)
  • Health Upsets:
    • Feverish colds, stomach or intestinal upsets
    • Chronic illnesses
    • After effect of infectious illness
How do I work aerobically and build endurance without over-training?
The first lesson that people should know before committing to training their aerobic system is should rarely feel hard.  Not all exercise is difficult by default.  In fact, you should be very choosy with how you expend your energy.  Higher-level athletes do not train hard daily though it may seem that way when they describe their hardest week of training in the whole year.  But it's not reality, they don't do that all the time and they have a ton of recovery built around all of those training sessions.  There are world-class marathoners, guys who run around 5-min/mile for 26.2 miles, who do their easy runs at 9- or 10-min/mile paces.  The average person would run with them and say it was too slow.  What are they doing?  They make their easy days easy so their hard days can be hard.

If you're new to aerobic training, or its just been awhile, consider doing what many professionals do and train by heart rate.  While perceived exertion is a reasonable way to train, it must be understood that heart rate does not always correlate to perceived exertion.  For example, when I've worn my HR monitor on easy runs, I was surprised to find that I had to walk up almost every hill in order to stay in my aerobic heart rate.  While my body felt completely fine to jog the hill my cardiovascular system was telling me it wasn't quite so easy.  Anyone training without an accurate HR monitor could easily over-train and assume that because the pace feels easy, it is also easy on the body.  If you knew my history as a marathoner, this might surprise you.  Historically I am an excellent pacer.  I have run marathons where the second-half of the race was 30 seconds faster than the first half...without using my watch to pace me.  If the question is how can I train sustainably, get healthier and more fit without over-training, then heart-rate training is the way to go.

Don't assume your effort.  Buy or borrow a HR monitor and see what your body is telling you about your aerobic capacity. If you normally run a 7-min mile but aerobically (at your max aerobic HR) you're running a 9-min mile, you aren't actually maximizing your aerobic base.  Maximizing your aerobic capacity by training at your max aerobic HR is relatively easy and will pay huge dividends when you increase the intensity of your workouts later.

There are several formulas out there to try.  Feel free to test a few methods to see what works for you.  If you have the opportunity to be tested in a laboratory this will be more accurate than any formula.  That said, my favorite formula that I have used over the years is the Maffetone Method or "180-formula."

The 180 Formula
To find your maximum aerobic training heart rate,
  1. Subtract your age from 180.
  2. Modify this number by selecting among the following categories that best matches your fitness and health profile:
Now to blow your mind.  When just starting out, there is no need to train above this heart rate to improve your aerobic development/base.  Training at that heart rate without going over will help you fully maximize your aerobic capacity.  Training above that HR will exponentially take you into anaerobic metabolism, so you aren't building your aerobic base anymore.  Once a month run, do a 10-minute or so warm up, then run 3 miles on a flat track at your max aerobic heart rate (that you calculated above) and record your mile splits.  If you don't have a track you can use a treadmill but you need a place where traffic won't interrupt you and hills won't be a factor.  Average your mile splits to determine your average mile time.  Each month you should see your average mile time quicken for the same HR.  Eventually you will see your progress stagnate and that is your cue to begin adding faster running and speedwork to your routine (if you desire to get faster).
Some people find it takes 6 months or more for their purely aerobic work to manifest all its benefits.  If you'd like to read about endurance athletes who have used this method after having issues with over-training, just google "Mark Allen training methods" and read what you find.  He won Kona six times, arguably the best ironman ever, by using a 3-step mesocycle in which he maxed out each component before moving onto the next level.  He first trained aerobic endurance, then strength, then speed.  Many athletes today only pay lip-service to the aerobic endurance aspect of training because they're in too big a hurry to get to the sexy workouts.

Science has proven that sedentary behaviors shorten life span and this is even taking into account someone who is "active" and exercises vigorously for 1-hr a day.  Sitting all day is bad for you.  This is an interesting concept that I've taken to the performance world...what I mean is the average American doesn't have an aerobic base due to sedentary lifestyle factors.  Some of these same people are trying to do HIIT workouts on top of nearly no exercise foundation.  The risk of injury, burnout, and over-training will be much higher and the benefits lower than what they could achieve if they took a longer road.  Not many people want to take the longer road.

Because your aerobic base is essentially your level of cardiovascular function (mitochondria, fat-burning ability, capillary network, aerobic enzymes, etc), having a high cardiovascular function tends to have a healing and recovery effect on the body (compare to an extreme example of diabetes, which inhibits blood flow/cardiovascular function, wounds heal much slower if at all).  When heart rate training is done correctly, you should feel more energized after the workout, as though you could do it again.  I know this is counterintuitive to many short-cut exercise regimens today.  10-minutes to this, 20-minutes to that.  But if you have the patience to build a solid aerobic base, your platform will physically and biochemically support the harder training to come.

Tuesday, December 1, 2015

Crash Course on Running Shoes

Welcome to Running Shoe - 101.

Why you need to know this....




So what is my current practicing paradigm?


Now for what you need to know about shoes.









Without your spine compensating, you would fall forward.
All heels mis-align the spine to some degree.
Toe spring, like an elevated heel, is NOT natural.
Specifically, toe spring leads to toe deformities.





while some versions are more flexible.
They also make a few shoes that are maximalist cushioned which
do not fit the criterion for a minimalist shoe.
Are there conditions when a stiffer shoe is desirable?  Probably.
(could be helpful on very sharp-rocky terrain)


This Vivobarefoot brand shoe displays excellent flexibility throughout the entire shoe,
to include rotating through the shoe (torsional flexibility).
Transition slowly and your foot strength will improve dramatically.


The shoe on the left allows your foot to function naturally.

What are the unintended consequences of modern conventional running shoes?



So how do I change doc?





I'll finish this post with pictures of some of my shoes.


These are healthy features of running shoes.


It's leather attached to a thin rubber sole.




So much for the HOKA theory.


Thin 3-mm tread

Good longitudinal flexibility

My Vivobarefoot - ideal for road running.


Good tread for roads.

It doesn't get more flexible than this.

I wish I could do this with all of my shoes.



THIS IS A RUNNING SHOE believe it or not.



Again got mine WIDE

Trail tread

A thicker tread somewhat decreases the flexibility of the shoe.
Still highly flexible compared to most shoes.



Still reasonably flexible despite the midsole material/thickness.



Still nice and flexible though.

Luna Mono sandals.  

I got them thicker for some protection on very rocky terrain

The sole.



Namaste for today!