Sunday, April 21, 2024
Shouder Keeps Clicking But No Pain
Sunday, April 14, 2024
Help! My child Is Pigeon Toed
W sitting |
Sunday, April 7, 2024
Tight Or Just Tired?
Who says my hamstrings are tight? |
I always explain that when I put both my hands on their e.g. trapezius muscles that they feel the same, one side is not 'tighter' than the other.
If I get a dollar each time my patients tell me how tight they feel when they come and see me I will have many extra dollars for sure.
A patient ran a very hard 21 km road race recently and complained of 'tightness' in his hamstrings for the past 5 days came to see me in our clinic this week. He said his hamstrings felt very hard, achy and 'tight' of course. They even threaten to cramp when he tried running or doing some strengthening exercises.
However, he can easily put his palms on the floor in a forward bend. (Note: there are other patients whose hamstrings do not feel 'tight' but they can barely get their hands past their knees while bending forward).
He tried stretching but other then feeling a little better for less than a minute the 'tightness' came back quickly. Upon assessment he definitely had some delayed onset of muscle soreness (DOMs). I told him his 'tightness' was actually fatigue from his training and racing.
I suggested resting and focusing on his recovery. Definitely decrease his intensity and mileage. My personal experience after a hard race would be doing any of the 2 aerobic exercses outlined below at reduced intensity and low volume.
These low intensity exercises will increase blood flow to the affected muscles and often reduce pain. Pedaling at low resistance on a stationary bike is ideal as you don't have to worry about traffic (if you ride on the roads). An easy swim or just walking in waist or chest high water works well too. Wearing compression garments will help reduce DOMs as well. These above mentioned strategies do have some support in the research.
After he recovers fully, I suggested testing for strength imbalances and deficits as weaker muscles do tend to fatigue more rapidly. Specific strength training will address that.
In most other cases of patients feeling 'tight', the reason is obvious. If the stay in the same position/ posture for too long, their muscles need a rest or change of position to reduce the lack of blood flow or metabolic stress that is causing the noxious stimuli. Think of the last time when you spent hours in a car, plane or behind your computer, after you move/ stretch, the symptoms of stiffness/ tightness will be alleviated.
Remember this, when you feel stiff and 'tight', it is just a feeling and not necessarily a physical shortening that needs you to structurally change it. Like other things that you feel, you may feel it more sometimes compared to others. Like other forms of sensitivity, those feelings will change if you improve your overall fitness, strength and health.
Reference
Stanton TR, Moseley GL, Wong AYL et al (2017). Feeling Stiffness In The Back: A Protective Perceptual Inference In Chronic Back Pain. Sci Rep. 791): 968. DOI: 10.1038/s41598-017-09429-1
Sunday, March 31, 2024
Even Olympic Athletes Do Not Sleep Well
Thinking of winning even while sleeping |
Whether you are an athlete or not you need to sleep. In theory, athletes need to sleep a lot, since sleep can boost performance, protect against injury and even help recovery. I have written before that a lack of sleep can lead to negative consequences. It can affect your mood, cognitive function and physical performance.
Ever wonder if champion athletes are also champion sleepers? Or they sleep just as badly as average athletes?
A recently published paper studied the sleep habits of more than 1600 Olympic and Paralympic USA athletes in the lead up to the 2021 Tokyo Olympics. The athletes filled up a Pittsburg Sleep Quality Index (PSQI) for that study.
The study compared the typical sleep pattern for male versus female athletes, summer versus winter Olympians and team versus individual sports.
You may be surprised to know that almost 40 percent of athletes were rated as having poor sleep based on their PSQI scores. The scores accounted for how long they typically sleep, how often their sleep is disturbed, how long before they fall asleep and whether sleep medications were taken.
The results were similar to that of Dutch Olympic athletes (41 percent poor sleepers) and Australian Olympic athletes (52 percent poor sleepers).
A goal of the study was to provide what was normal values for athletes training hard compared to the general population on whom the PSQI was first tested. The PSQI has a maximum score of 21, the higher the number indicating a greater number or greater severity of sleep problems. A score of 5 and above classifies you as a poor sleeper. The average among the USA Olympians was 4.3.
25 percent scored above 6 while 10 percent scored above 8 and 5 percent scored above 10. The top scorer was 16 while the lowest got zero (I am definitely envious)!
Reasons for the poor sleep? An early training session at 6 am will definitely affect sleep. Those athletes traveling across time zones to get to training camps/ races/ competitions will also be affected. If your legs or arms are aching from hard training ( I can testify to that), or if your heart/ mind is racing before a competition , you will not sleep well. That's my personal experience too.
The results do not specify what is happening exactly, but they do suggest that a serious athlete typically scores 5 or 6 on the PSQI, so they are classified as a 'poor sleeper'.
This study by Anderson et al (2024) has more subjects compared to previous similar studies which allows the data to be cetegorized into sub categories. Here is what else was reported. Female athletes had poorer sleep quality (4.7 versus 3.9) than men even though they went to bed earlier.
The female athletes were also less likely to report falling asleep straight away after going to bed. They were also more likely to report using sleep medication. A possibility is the variation in sex hormones across the menstrual cycle which may interfere with sleep, although no mechanism was found in this study.
Team sports athletes got up earlier and had poorer sleep than individual sport athletes although this was not what previous studies found.. Perhaps a team mate who got up earlier caused the rest of the team to get up earlier as well?
May I boldly suggest that all the sub patterns were confounded by a huge variety of sports in this study. A runner is not equal to a tennis player or swimmer. Competition timings will play a part as well since most marathons are held in the early mornings compared to the later starts in some other sports. Especially those held in the late evenings.
Defintely sleep is a great untapped frontier. Since 40 percent of Olympic athletes are poor sleepers, imagine one's advantage if you can improve or even master sleep.
Is good sleep "nice to have" rather than "need to have" for achieving sporting excellence? Or you may even argue that sleep may not be that important if all these Olympians are not sleeping well and are good enough still to compete at those lofty levels.
Personally I do think sleep is important for sporting performance as well as keeping you sane during the day.
On a side note, I will add that the cost to mental health is significant too, especially for the general population. Sleep problems may increase risk for developing certain mental illnesses like depression and anxiety disorders, as well as result from them. In this age of poor mental health among the young, are they getting enough sleep to begin with?
If you're an athlete, take your sleep habits seriously, but remember that if you still have problems, you are in Olympic level company.
Reference
Anderson T, Galan-Lopez N, Taylor L et al (2024).Sleep Quality In Team USA Olympic And Paralympic Athletes. Int J Sp Physiol Perform. 19(4): 383-392. DOI: 10.1123/ijspp.2023-0317
Sunday, March 24, 2024
Just One Set Of Exercises Can Make You Stronger
Leg extension exercise |
This concept of non-responders were first described in studies done in the 1980s and 1990s. These studies explored the role of genetics in exercise response.
When a bunch of people were given the same training program, their genes can explain about half the variance in how their fitness improves. Some people did not get fitter at all even after months of training. Note that later studies took the non-responders from a study and had them train harder or a higher volumes, they did get fitter. The studies above focused on aerobic exercise, but this study (Lixandrao et al, 2024) was on strength training.
The authors had a total of 85 subjects (41 men, 44 women) above the age of 60 and not currently doing any strength training (Lixandrao et al, 2024). The study was designed to see if adding extra sets would turn the non-responder into responders. The subjects were assigned to different strengthening routines with each leg. That eliminates variations that can cloud results of strength training studies.
Note that older adults are usually less responsive to size and strength stimulus of strength training, making non-response more likely.
The exercse program consisted of 2 workouts a week for 10 weeks, Each set consisted between 10-15 reps of single leg knee extension with the weight selected to reach failure in each set. Each subject did 1 set per workout with one leg and 4 sets per workout with the other leg.
Muscle size of the subjects was measured by MRI. As expected, there were many non-responders who did the 1 set routine. 60 percent of the subjects did not gain more than 3.3 percent in the cross section of their quadriceps (this is the minimum threshold for a statisically significant improvement).
The proportion of non-responders for those who did 4 sets decreased to 19 percent. Yes, you read this correctly, those who responded to only 1 set of training had bigger responses than those who did 4 sets!
Conclusion: Doing more sets lead to greater muscle gain, even among those who do not seem to repond initially.
Note that doing 4 sets of exercises did not produce bigger strength gains than 1 set, which was both surprising and unfair. Previous studies have also shown this in experienced lifters. Doing 5 sets was better than 3 sets, which in turn was better than 1 set for muscle size. However all 3 options were basically the same for muscle strength.
Stength is a function of muscle size and the (complex) signaling process between brain and muscle. Both do not always go hand in hand.
Among those who responded to 1 set of exercise, only 51 percent got significantly bigger muscle size results from 4 sets. 15 percent actually did worse doing 4 sets. Note that the 1 set and 4 set parts of this study were taking place simultaneously in the same person but different legs. This may suggest that while 4 sets are better than 1 for some people, they really are worse for others.
Take away from this study (Lixandrao et al, 2024)? You can get away with a minimum of 1 set of strength training if your main goal is to get stronger. However, if your main goal is to gain or maintain muscle mass, you will benefit from more sets.
Note that the more interesting take away is this rule is not always true for everyone. Definitely a little annoying if you ask me. My suggestion? If what you have been doing is not working, even if it is suggested by the latest research, you need to try changing it.
Reference
Lixandrao ME, Bamman M, Vechin FC et al (2024). Higher Resistance Training Volume Offsets Muscle Hypertropjy Nonresponsiveness In Older Individuals. L Appl Physiol. 136(2): 421-429. DOI: 10.1152/japplphysiol.00670.2023
Sunday, March 17, 2024
Knees Out Or Knees In When You Squat?
Out (left) versus in (right) |
Sunday, March 10, 2024
The Most Efficient Way to Run (According To Science)
It's a long review paper, key findings in the pictures attached. Let me highlight some of the important points. The paper does lend some support for increasing your cadence or step rate to improve running economy as this increases leg stiffness and reduces vertical oscillation. When you watch some runners run, you can see that they tend to 'bounce' up and down while running, that is vertical oscillation.
Initial Contact |
Mid stance |
During Mid Stance phase, decreased trunk flexion and reduced vertical oscillation may be associated with improved running economy. Increased vertical and leg stiffness may also be associated with lower energy cost.
Toe off |
At the Toe Off phase, if trunk flexion and ankle plantarflexion are reduced, running economy may be improved.
Those metioned above are just he key findings which I have summarised. However, there are many more details and applications in the paper itself. You can read the free paper here.
I have previously written before on running cadence and running form if you wish to read further.
Reference
Van Hooren B, Jukic I, Cox M et al (2024). The Relationship Betwen Running Biomechanics And Runnng Economy : A Systematic Review And Meta-Analysis Of Observational Studies. Sports Med. DOI: 10.1007/s40279-024-01997-3
Summary |