The Break Up

Just a cross link, semi-work related, to an essay that speaks of my relationship with professional sports.


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All The Single (and not Single) Ladies...

You avoid "lifting" because you don't like it or just prefer some other form of exercise. Besides, you're trying to lose or maintain weight, not look like the she-male on the cover of Muscle and Fitness.

You don't weight train because you're really not sure what to do. You don't want to hurt something, or worse yet, look dumb at the gym. You feel a little self conscious about your ability to yell and grunt with the guys camping out at the dumbbells.

Okay, fair enough. Too bad. For you, I mean. You're just a girl and probably can't handle it anyway, so never mind.

Oh what's that? Why bother? Okay then, here's why:

1. If you're afraid that weight training will make your legs or anything else too big, may I first suggest that you re-evaluate your ideals. Beauty is in the eye of the beholder, but who really beholds stringy wafes? Maybe it's the modeling "experts" or other women, but it's certainly not men. I've never seen a girl get huge and mannish by adding a few resistance moves per week.

When you're an adult, it's good to look like a fit adult and not worry about how much you weighed at 18. Muscle is the reason for "toned." It turns you into an all day calorie burning furnace and you can actually eat without gaining fat. Using resistance to "tell" your body it needs muscle truly is the only solution to the "skinny fat" look that inevitably occurs if you make good on your commitments to diet hard and do cardio. It has to do with some hormonal adjustments that your body makes during chronic stress and calorie deprivation, but the main point is that it turns into a losing battle where the best scenario is you as the female version of Jarrod (Subway).

If you have trouble keeping unhealthy weight off, don't pull the genetics card unless you've given strength training, moderate cardio, and moderate calorie restriction at least 6 months to a year. Please no warp speed extreme fat loss when what you need is consistant non extreme changes over many days. And if you have successfully managed to stay rail thin, don't tell me it's not miserable. The salads and hunger pangs don't get old? The drawn out cardio isn't a time drain?

What's that? You like long cardio or maybe you run (or would like to try running) competitively? Okay then.

2. While I'm tempted to hit runners with the threat that they must do some strength training or else be injured, the truth probably lies somewhere between "or else" and "just go ahead and listen to your heart; do as much as you want of whatever you love."

As noted here in the Gospel of Not Running, jogging may take more of a toll on the joints than other activities where maximal muscle activation lessens the strain. Did I mention that muscle is functional for opening, carrying, and kicking all kinds of things. Some studies have shown that the addition of a minimal amount of strength training does carry over to a competitive advantage in endurance events.

Walking is low impact, but the next logical step for those with greater fitness aspirations is not jogging. Speed walking is a safe option and scores you lots of points for salsa hip action, but most of you should try intervals of some variety plus a few circuits of total body strength training.

3. Ladies - make your own claim to real strength training! There's plenty to do at home with the most basic gear. At the gym, go at the dumbbells with confidence. Not lycra unitard confident, but the kind of confident that trumps everything: working hard and looking like you know what you're doing.

Real training is not laying on your back to pound out one rep on the bench press in between circuits of flexing in the mirror, talking fantasy football. While I'm aware of at least one study that proved grunting to be slightly beneficial in weightlifting performance (yes, people publish peer-reviewed research on this), I'm pretty sure you can get all the physiological benefits without yelling around like a meat head.

Pilates and yoga and Zoomba are not my thing to speak on. While I'm sure they are good, I'm also sure they are not the all encompassing thing for women's health that they're often promoted to be. Just like the guy who can bench press a house but can hardly walk stairs without being winded, many yoga people suffer the consequences of spinal hypermobility. Many Pilates people could stand to get up on their feet and brace their core hard while they lift something (relatively) heavy from the floor.

The point of this writing is not to offer specific suggestions on a 5-step workout plan, but to help you rethink weight training and possibly consider changing things up a bit...without being too long winded.


Early Advantage

What parent doesn't want to give their child every opportunity to succeed in life? What parent spares their aspiring athlete any competitive edge?

What your child needs, early on, is loading of the muscle-tendon interface that stimulates mechanoreceptors within the cell matrix. This, in turn, causes a response in primary and secondary afferents not directly effected by the mechanical stimulus. Gross motor skills and coordination are developed through structured and unstructured neurological sequencing.

It's like, strengthening the growth plates and stuff.

It's called PLAY. And rest.

"The incidence of overuse injuries and surgery for sports injuries in children are growing within our practice. With a greater emphasis on competition and higher performance on children, the repetitive forces exerted onto developing joints, ligaments, and growth plates frequently exceed their structural tolerance.

...There has also been less emphasis on recovery and nutrition for our younger population. Whereas we caution our older patients to get plenty of rest and proper protein intake, we assume that our children with their high metabolism and intuitive sense of sleep would naturally eat and rest. Which they would if we adults wouldn’t interfere with their natural cycle of play."

-Thomas Lee, orthopedic doc, makes the case for playing and sleeping.

Sign them up, for sure, but have some limits. And the best thing you could do for their athletic development is turn off the TV when they have to get up at 6 a.m.

At some point, it's right that THE CHILD must answer the question "do you want to get better or have fun?" But unless they have in them the desire to sacrifice a significant portion of their youth to making varsity, now is probably not that time.

Please do your best not to rob kids of this amazing opportunity of being a kid.


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You Can't Fix 'Em All

Sometimes, I just don’t know. Okay?

“If the MRI didn’t show anything, then why is my back so painful?”

Diagnostic testing doesn’t quite add up, orthopedic/mechanical testing is inconclusive, and impairments don’t correlate with the degree of pain and functional limitation.

Sure - think outside of the box. Is this patient struggling with anxiety? Do they want to be off the field? Have they consulted Metzger Wickersham?

Am I missing something, worse yet, something obvious? Is my focus off? My mind is racing, searching the archives in the hopes of churning up some test or piece of evidence. Exactly how long do I sit there in the dust and ashes of clinical prediction rules? Where’s that elusive fact or technique that's the sun to burn away the fog?

What am I going to do with you? Well. ... First....We're gonna...


Patients and PTs like to know what's happening, but how much exactly do we need to know? “Non-specific” low back pain is a term universally recognized in the medical field. If experts investing loads of time and funding into peer-reviewed research aren’t afraid to admit when they’re uncertain, why should the common therapist?

While knowing the exact mechanism or injured tissue (i.e. herniated disc) can help guide treatment, merely knowing rarely guarantees a good or bad outcome. The actual tissue injured in a joint is far less important than knowing what movement(s) can effect lasting improvement. Patients don't like that, but it's the truth.

What if PTs were eager to explain why they're uncertain? What if PTs weren’t afraid of losing 4 units or being “shown up” by another therapist with a different perspective? Far worse things can happen, you know, like the rote application of the same ineffective treatment and the loss of respect for our profession.

There’s a fine line between speaking with confidence and speaking fables. We can all easily come up with fancy medical terms and string them together in a circle. I’ve helped many people to make incredible recovery, but certainly not everybody. I’m getting better at being okay with that.

When will be the day that I'll arrive as a seasoned therapist? Never. I’ll do all that’s in my power to learn and schedule more than 15-minute time slots for patient evaluations. The number of books above our desks and letters behind our names do not earn us infinite wisdom. Or less time to listen.

I won’t always guarantee great outcomes, but I will shoot for truth, to the best of my ability.

P-90 Couch

As a physical therapist and trainer of athletes, I get a lot of questions and comments on the P90X program.

[What's P90X? See beachbody.com/product/fitness]

Let me first say this - P90X is a well-rounded home fitness program. It's simple and effective (depending on your goals). It's relatively easy to apply, though by no means easy on effort. P90X comes with a sound nutrition plan and other information that helps people understand that being fit is more than just exercising.

P90X has caused thousands of people to realize that you don't need a huge gym full of fancy equipment and smoothie bar in order to get a great workout. If your idea of resistance exercise is sitting on a nautilus machine for 3 sets of 10, you're in for a nice big soreprize.

P90X has many rehab/fitness professionals (like me) slapping themselves on the forehead saying, "why didn't I think of that?" But then again, P90X is also good for rehab professionals. Like an ice storm in February. P90X causes people to need rehab.

In my little neck of the woods, I've seen a fair share of shoulder, back, and knee injuries directly attributed to P90X. Despite attempts to make the program (semi-)customizable, P90X still succumbs to the limitations of one-size-fits-all home workout plans.

"Only three months [and doctors appointments and muscle relaxers] to looking great!"

Six, hour-long workouts per week for 3 months is definitely going to cause some physical overtraining and mental burn-out, I don't care how much you vary the activities. The real problem here is the promise and expectation to produce dramatic changes in only 3 months. Try 13 months. Will you still be looking and feeling good then? A less fanatical, yet consistent pace pays off now and in the long run.

It seems that most people pay no mind to the fitness test and guidelines they give you before beginning the program. Some exercises (tricep kickbacks) are nearly a complete waste of time and others (upright rows) are just plain bad for human anatomy. A DVD can't say if you're hyperextending your back while doing planks, if your shoes are right for your foot type, or if your single leg squats look anything like what's being performed on screen.


Muscle confusion is not an advanced technique. In short, the concept of muscle confusion is to constantly change exercises, sets, reps and other training variables so that you never go through the same workout twice. It helps prevent overtraining and getting stale. But it also prevents peak performance and efficiency.

Do you imagine that this “confusion” (not adapting to any one thing) is most effective for sports performance, where the name of many games is power applied to a specific skill set? If you have come to knowledge of key components related to your sport, why in the world would you often want to "confuse" your muscles?

Sure, your muscles will be sore when you put them through something new. But continual muscle soreness is not a good indicator of effective progress toward sport-specific goals. If you want an "advanced training technique" for athletes, try a sport-specific total body exercise, performed with great intensity, and then do it again, even more next time.

I would highly recommend P90X for anyone who has good body awareness, has already attained a certain level of fitness, and their primary goal is to become and stay lean. It's an excellent alternative for those who are bored with their current routine or tired of the gym scene.

Just remember - doing anything is not always better than doing nothing.

"Get absolutely no shoulder pain in just 90 days of P90Couch !!!"

The Gospel of NOT Running

I just don't get it. Why do so many equate "getting in shape" with jogging? Plodding along for 30 to 60 minutes...thump thump thump, three or more days per week?

Many come into the clinic, having sustained injuries from their most well intentioned health and fitness efforts. They begin jogging or attempt to increase their mileage when a nagging pain pops up. They push through it because no pain no gain, and they gain a significant injury.

I can see this as a problem if you like running. If that's your chosen sport or the one thing that you really enjoy, then yes, you should be disappointed when you can't do what you love. And you should make time and energy to incorporate corrective range of motion and strengthening exercises to get you back on track.

But this article is not for you. This one is dedicated to all those of you who think jogging is a safe way to correct the problem of being overweight; to those who think it's the most effective tool for getting in shape; to those who think it's a great way to increase athletecism...BUT HATE TO JOG...

Have I got news for you!

First, you are sorely mistaken. Second - you don't HAVE to jog. In fact, I would often advise you against it.

With distance running, the body will automatically seek the greatest "running economy" which necessarily translates into the least amount of muscle effort to maintain a given pace. Less muscle effort means lots of plodding along, pounding on the joints, sometimes hours at a time. Anything above "ideal" body weight magnifies ground reaction forces at least ten-fold, which is good for keeping PTs and orthopedic surgeons in business.

Or let's say you're feeling and seeing the effects of getting a little older, sitting at a computer or in the car all the time. Maybe your joints are tight and other areas not so tight. When you take a body with weak muscles and poor range of motion and apply extended periods of repetitive pounding over a small range of motion (as occurs with jogging), the new heights of pain you achieve is definitely not gain.

Distance running can actually be a detriment to peak performance. Which do you imagine correlates well with a 90 mph fastball - an explosive vertical leap or a high aerobic capacity? Has any young prospect ever jogged his or her way to 10 or 20 pounds of lean muscle gain? More evidence is beginning to show that concurrent endurance training mutes the bodies best adaptive response to strength and power training.

Train smart. If you don't believe that excellent fitness can come without jogging, I can convince/show you otherwise. I may have you do specefic stretching and resistance exercise, intervals on a bike and maximal sprints if your sport involves sprinting.

Condition your body to jog if you WANT to jog. But you don't have to.



I need a place to share thoughts on PT, fitness, and sports performance; a place to compile my more professionally oriented ramblings. I have some thoughts, as you may know. And now I've actually committed to some projects that will be a good fit here.

Why now? First and foremost - having this will focus my efforts a little, and that's good for me (in turn good for patients/clients too). It's good to be researching and engaging developments in the field. It's good to refer patients and professional contacts without worrying about them getting blasted with comments and pictures of the kids jumping off furniture.

Not that they won't fit in here sometimes. Not that I won't hope that some friends, just plain friends, will join me in the personal pursuit of trying to gain and keep whatever fitness you can.

I enjoy writing for fun and still fear being pinned down to anything beyond my regular work. I'm just to the point where I can take a stab at this. The family situation is more stable, so I can commit to say, one writing a week.

We'll see what happens. Maybe I'll help someone. Maybe someone will help me. I'm pretty sure that will happen.

Thanks for checking in.