Supplements II

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Having put supplements on the correct shelf in part 1, here are five items for strength/power athletes that seem to have scientific merit beyond placebo. They're all safe, as far as anyone can tell so far. You should be invested in training and nutrition and be at least, say, 14 to call youself a serious athlete.

Please note what's absent. While Glucosamine/Chondroitin shows a modest benefit for helping mild to moderate osteoarthritis, it's not particularly used for performance. You don't see HMB, DHA, Yohimbe, Ginseng, NO2, Chromium, and an army of other pretty useless pills and powders here for a reason.

Personally, I usually use whey protein after workouts when I think of it. I've cycled creatine on an inconsistent basis. I would probably use these more consistently and add the items below if I mostly had my act together training and nutrition wise.


Although I train regularly and compete in rec sports, it's just not worth it to me. There are too many other variables that I know could be improved. I have no hopes of getting paid to perform athletically. Even if I did, it would be hard to justify the expense when I regularly eat the kids leftovers for dinner, neglect focused effort toward a specific goal, and often read/blog away anything close to 8 hours of rest.


Nonetheless, here are 5 good supplements if I haven't talked you out of the whole idea by now.

Creatine

According to the the position stand published by the International Journal of Sports Nutrition, creatine monohydrate is the single most effective supplement currently available to athletes in terms of increasing high-intensity exercise and lean body mass (2). Although we have few studies examining the long term (20+ years) effects of taking creatine, we're nearly certain that creatine does not cause muscle cramps, cardiac arrythmia, or any side effects other than increased lean body mass. Lightening your wallet is the only advantage of various forms of creatine (creatine ethylester, micronized creatine, effervescent creatine, etc.) over traditional creatine monohydrate (3).

If you have room, financially or otherwise, to try only one supplement, make it creatine monohydrate. Take it with something sugary sweet after your workout or competition.

Beta Alanine

Although pretty new on the scence, this amino acid (single protein molecule) is showing promise in terms of safety and effectiveness for power athletes. The body combines Beta Alanine with histidine in muscles to make carnosine. Carnosine functions to regulate muscle contraction and buffer pH levels against the build up of lactic acid (4). This, in turn, delays the onset of fatigue during repeated high intensity activity.

Increased power output during interval sprint tests, higher training volumes, and lower ratings of fatigue have been consistantly reported in the literature (5).

Protein Powder

It is well established that you need to get some protein and carbs around workouts (1). Muscles are most sensitive for glycogen and protein synthesis immediately after exercise, and research has shown the benefits of having a mix of carbs and protein (specefically at about a 2 to 1 ratio) immediately after and even before exercise (6).

Regular food comes first and all that, but who really wants to sit down to a big pot roast right before pitching 9 innings in the heat or after pushing yourself to new limits in the gym? Who has the time to make an omelet or chicken sandwich? Unless you want seconds on the same burger you finished 30 minutes ago, get yourself a good whey protein powder. Shake or blend it with some chocolate milk, Carnation instant breakfast, or something less calorie dense if you're primarily interested in fat loss.

The isolated amino acid leucine has been shown to be an important part of what gives muscles the chemical "trigger" to repair and build (7). Extra leucine may be even more beneficial for older athletes since "older" muscles begin to show defects in leucine and insulin signaling (8). One scoop of the average whey protein supplies about 2 grams of leucine. Taking extra leucine may be worthwhile because the maximal effect on muscles is thought to require about 3 to 9 grams of leucine (9).

A quick note here on the Holy Grail of fitness:

The minutia on particular amino acids for muscle building falls by the wayside when total calories are insufficient to support growth and repair, in general. Unless you are extremely overweight or completely untrained, it is nearly impossible to pull off simultaneous fat loss and muscle gain.

Fat loss and muscle gain require different total body hormonal situations, which is why a lot of suggestions for ‘gaining muscle while losing fat’ aren’t very effective. In fact, trying to simultaneously gain muscle and lose fat my be one of the best ways to spin your wheels, making no progress towards either goal. Calories are too high for fat loss and too low to support muscle gains.

Muscle gain is definitely harder to come by than fat loss. So in losing fat, the best you're probably going to do is hold on to what muscle you have. Lose weight slowly. You "tell" your body to maintain it's muscle by hitting the weights and getting plenty of protein as you cut calories.

Omega 3 Fatty Acids

Likewise, who wants to follow up a bike sprint with a nice big plate of fatty salmon? Although there are many health benefits attributed to omega 3 consumption, few studies have examined the effects on the typical inflammation and soreness induced by intense exercise. "Good fats" are thought to inhibit inflammation and aid healing in various tissues of the body, but do they effect this process in muscles enough to actually make a difference performance-wise?

Omega 3's fall more into the category of "stuff you should probably be taking just for health reasons." But there is preliminary support that their role in recovery from exercise may indirectly benefit performance (8).

Caffeine


If you don't think of caffeine as a sports performance supplement, you definitely should. If you like drastic immediate results, use caffeine as the drug that it is and save it for when it counts.

Caffeine plays several roles in sports performance, including improved logical reasoning, improved reaction time, improved recall and memory, increased time to exhaustion, decreased ratings of percieved exertion, and (surprise) improved physical performance during periods of sleep deprivation (9).


Caffeine has been shown to aid in weight loss by way of increased energy expenditure and increased efficiency in burning fat for feul. There is mounting evidence that caffeine reduces pain and inflammation following intense exercise (10). Yeah, we can add recovery to the Justify Our Habits list.

Some studies have shown that caffiene and energy drinks do not directly effect peak power tests like vertical jump and 1-rep max bench press (11). That's no surprise, given the fact that energy drinks are primarily used for alertness and that extra mental "push" for taking on challenges on the field or in the gym.

Peak power tests in a sports lab are probably not the right measuring stick for the effects of caffeine. Max bench or leg press tests are not exactly grueling events; you just give all you got for 1 rep. I imagine Red Bull does help athletes to concentrate and muster the courage to "go big" far more than it helps them to actually jump higher or further.

Caffeine is the primary active ingredient in energy drinks, but the combination of various other chemicals makes it difficult to draw conclusions. Beta-phenylethylamne HCL, evodiamine, B-vitamins, and taurine are ingredients commonly added to caffeine in energy drinks, but I'd need a case of energy drinks right now if I wanted to discuss the merit of these ingredients.

By far, the performance enhancers that I rely upon most are coffee and diet coke. Use common sense with caffeine and energy drinks. I don't call anxiety, nervousness, irritability, restlessness, headaches, and diarrhea "minor" side effects.

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1 Campbell B, Kreider RB, Ziegenfuss T, Roberts M, Burke D, Landis J, Lopez H, and Antonio J. International Society of Sports Nutrition position statment: protein and exercise. J Int Soc Sports Nutr 4:8, 2007.

2 Buford TW, Kreider RB, Stout JR, Greenwood M, Campbell B, Spano M, Ziegenfuss T, Lopez H, Landis J, and Antonio J. International Society of Sports Nutrition position stand: creatine supplementation and exercise. J Int Soc Sports Nutr 4:6, 2007.

3 Greenwood M, Kreider R, Earnest C, Rassmussen C, and Almada A. Differences in creatine retention among three nutritiional formulations of oral creatine supplements. J Exer Physiol Online 6:37-43, 2003.

4 Harris RC, Hill CA, Kim HJ, Bobbis L, Sale C, Harris DB, and Wise JA. Beta-alanine supplementation for 10-weeks increased muscle carnosine levels. FASEB J 19: A 1125, 2005.

5 Joffman J, Ratamess N, Kang J, Mangine G, Faigenbaum A, and Stout J. Effect of creatine and beta-alanine supplementation on performance and endocrine responses in strength/power athletes. Int J Sport Nutr Exer Metab 16:430-446, 2006.

6 Campbell B, Wilborn C, La Bounty P. Supplements for strength-power athletes. Strength Cond Journal. 32(1): 93-100, 2010.

7 Kerksick CM, Rasmussen CJ, Lancaster SL, Mague B, Smith P, Melton C, et. al. The effects of protein and amno acid supplementation on performance adaptations during ten weeks of resistance training. J Strength Cond Res 20: 643-53, 2006.

8 Spano, M. Functional foods, beverages, and ingredients in athletics. Strength Cond Journal. 32(1): 93-100, 2010.

9 Doherty M and Smith P. Effects of caffeine ingestion on exercise testing: a meta-analysis. Int J Sport Nutr. 14:626-46, 2004.

10 Maridakis V, O'Conor P, Dudley GA, and McCully KK. Caffeine attenuates delayed onset muscle pain and force loss following eccentric exercise. J Pain 8:237-43, 2007.

11 Astorino T, Rohmann RL, and Firth K. The effect of caffeine ingestion on 1-repetition maximum strength. Eur J Appl Physiol 102:127-32, 2007.

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'Sup With Supplements - I

So you're a serious strength/power athlete looking to wring every drop of benefit from your training. You're seeking safe and legal means to gain the competitive edge, whether it's climbing a cliff, smashing an inside fastball, or dunking a basketball.

The big dis

If it's too good to be true, it is. Most of the items you see one store shelves have only a shred of unbiased scientific legitimacy at most. And none of it is nearly as great as supplement companies would like us to believe. Don't take my word for it; go ahead and do your homework and review the literature.

Supplement companies write in their products as a standard foundational element in any and every fitness effort, when in fact they should only be considered as an afterthought. But of course, treating supplements as...well, supplemental to the diet doesn't sale nearly as many precision engineered proprietary formulas.

Sound bitter? In the 90's I fully bought into the oil smooth, sincere sounding words of Bill Phillips. His revolutionary marketing ways have been totally exposed for what they were; details of the way he had us all thinking that HMB and MetRx (among other things) were magic tickets to awesomeville. And of course he had no self-interest in recommending those items.





Dude didn't get this big by taking "power butter" or any other much less stupid sounding supplement. Or by just doing tricep pressdowns.







Lure of the quick fix

Even still, what power athlete doesn't want bigger, faster, stronger output from the same amount of training input? Supplements get an awful lot of attention, but they never will take the place of the real "secrets" to peak performance. Sound nutrition and intense training require knowledge and loads of plain old fashion, disciplined effort. The details of intelligent nutrition and training are beyond the scope of this writing, but I can assure you that the answer is nothing (legal) you can take in a pill or find at GNC.

So we're going to assume that you have a sound nutrition program that includes the basics. You focus on unprocessed foods, at least most of the time. You take in adequate protein (athletes do require more than the "normal" population) and healthy fats. You take in the right amount of quality carbohydrates, depending on your particular energy needs and current goals. You have some fast digesting carbs and protein within thirty minutes after training and competition.

Do you have all that? The last paragraph is a huge assumption. Until those basic nutrition related factors along with proper training are given careful effort and attention, I rarely recommend supplements (or take them myself). Worrying about the "speck" of supplements is a waste of time and money when you carry a plank in your training and nutrition program.

If your a 120 lb. teen looking to gain some lean muscle, I can't comment on casein versus ionized whey protein while your eating Poptarts for breakfast and doing 12 sets of bicep curls. I don't want to debate minutia about the best rep speed for vertical jump height when you're regularly having wings and nachos for dinner.

What You Pay For...

You get what you pay for, in the truest sense. In fact, viewing this issue from another angle, you start to realize the notion that the benefit of supplements may actually be due to the cost and inconvenience. The big plastic can of powder stuff "works" because you don't want to waste your investment in it. Suddenly you start really delivering the goods on your training, nutrition, and rest/recovery.

So yeah, in the big picture, supplements can work extremely well.

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Part two will include some personal insight and five supplements that I do believe have merit for serious strength/power athletes.

Midstate Man Files Countersuit In Medical Claim

HARRISBURG, PA – Harrisburg authorities have reported an incident involving a man who failed to heed the advice of his mother and physical therapist. He is being held on multiple counts of negligence and willful misconduct.

The man faces punitive damages that include stenosis, nerve root impingement, and other posture-related allegations. He is being held on 800 mg of anti-inflammatory drugs daily. Investigators suspect the mans computer chair and recliner as accomplices.

When contacted by our staff, the mans mother folded her arms and turned her head slowly side to side.

“This circumstance often occurs with repeat offenders,” said Bob Gorinski, physical therapist at First Choice Rehabilitation Specialists. “It takes time for the body to adapt to the demands or lack of demands placed upon it.”

It is suspected that most Americans fail to recognize the cumulative threat of poor posture. Look around you. Scientists have labeled this phenomenon "forward head posture." They believe there may be a correlation between forward head posture and sitting all day with your head forward.

In his defense, the mans lawyer went on the record to state, “he didn’t do anything,” which may be technically correct. He also said that the problem really wasn't his fault, and he intends to seek damages in a countersuit to be filed against gravity. When questioned by authorities, the man rolled his neck in circles and said "ya just need to work it out."

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Spare the Arm II: Mechanics

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This (Part 1) overview of pitching injuries made the claim that focus on the arm may increase the chances of injury when it takes emphasis off the entire athlete. Pitching is a total body effort, and we often need to look beyond the sore shoulder and elbow to get to the root of the issue.

The first strike against pitchers is having optimistic expectations with the traditional "do it like it's been done" of preparation. Overlooking mechanics and accepting advice on mechanics are two more related paths to an injured arm.

2. Ignore mechanics

The less common error is to just go pitch without giving much thought to mechanics. Since higher level pitchers are usually coached ad nauseum, "mechanical neglect" occurs more often in younger athletes. Athletes who think bench pressing 350 or some other training secret is the answer to a mediocre fastball should also give more attention to mechanics.

It's rare that a 14-year old intuitively generates high force with the legs and efficiently transfers it to the arm. At this level, coaches and parents describe vague notions of mechanics, often referring to the shoulder, elbow, or "the core." Again, little attention is given to numerous details down the kinetic chain.

Greater velocity comes from applying more force to the ball over a greater range of motion. But no amount of weight training or conditioning will bring about the skilled coordination that allows an athlete to safely achieve that end result. In fact, the combination of great foundational power with relatively low skill (in any sport) is a great recipe for injury.

Big bench; probably not hitting 90 mph.

See It

High speed video is needed to capture everything that happens so quickly during pitch delivery. Instructors should understand normative values(1) and be able identify outliers that may lead to injury or suboptimal arm speed.

For example, anterior shoulder pain often comes from late "opening" of the trunk toward home plate during delivery. Opening late may come from decreased rotation and extension range of motion in the spine or hips. Insufficient loading of the back leg can also cause mistiming of hip and trunk rotation.

A detailed analysis of angles and forces at each joint is beyond the scope of this review, but suffice to say that there's a lot you can miss without the aid of a camera and sound mechanical instruction.

If It Ain't Broke?

Knowing what's happening mechanically is one thing, but when do you actually try to change a pitchers mechanics?

Do you change mechanics in order to achieve greater throwing velocity? Sometimes. How much force can the athlete generate? How is his flexibility? If he can't vertical jump 20 inches or achieve near 90 degrees of hip flexion during a straight leg raise, for example, then mechanics may not be the main issue. Put the glove down for a while and hit the gym.

Do we fix him?

Mechanical "tweaks" are often good and even essential when there's pain. An athlete with medial elbow pain who shows well below 90 degrees of shoulder abduction during the late cocking phase should probably try some torso tilt with a higher arm slot (so long as there are no ROM limitations in the trunk or legs). Careful though, because more shoulder abduction tends to spare the elbow but increases strain on the shoulder (2).

3. Accepting Advice

The down side of instruction.

Do not blindly accept everything from the local baseball "expert" (including me). Not all advice from baseball instructors, trainers, and physical therapists is good advice. When did your instructor or trainer change from the dumb jock stereotype to a well read critical thinker? Just like making it to the pros does not make one a great teacher, the nuances of pitching are not required material for medical license exams.

A few common pieces of plain bad advice include:

"Stay tall then fall."
"Always throw down the mound."
"Keep the elbow up."
"First throw strikes."

[If you want a young pitcher to aim the ball with horrible short-arm mechanics instead of gradually learning from the feedback of cutting it loose in a total body effort, tell him to "settle down and throw strikes."]

Throwing Downhill

Official looking poster, but the guy along the bottom has serious mechanical issues.

Approaching Why

Mechanical faults in pitchers are usually more than just bad habit. Why are the shoulders opening too soon? Why does the front knee collapse when trying to increase stride length? Is your coach or instructor able to assess and correct the impairments that cause poor movement patterns? When the athlete is lacking in range of motion or the strength is takes to produce, stabilize, and control appropriate forces, pitching lessons are not the answer.

In summary, pitchers should not put all their eggs in one basket. Mechanics only go so far without correct training, and training only goes so far without attention to applying correct mechanics.

Instructors should avoid being too rigid with athletes of any age. They should know how to assess and correct potential problems, but appreciate that pitching is an art. There is great value in one athlete's natural rhythm, and it's good to remember the limits of what the literature says should be happening.

Whatever the case, do you get the feeling that it's ideal when sports medicine guys and hardcore baseball guys (coaches, instructors, etc.) team up (3)?

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1) Matsuo T, Fleisig GS, Zheng N, Andrews JR. Simulated influence of shoulder abduction and lateral trunk tilt on peak elbow varus torque for college baseball pitchers. Journal of Applied Biomechanics 22:93-102, 2006.

2) Whitley, R. Baseball throwing mechanics as they relate to power and performance. Journal of Sports Science and Medicine (6) 1-20, 2007.

3) Gorinski, RW. Plug for gowags training center. If you didn't get the hint already 2010.



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PT v. Chiropractic

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"Can't you just crack it back in?"

What's the difference between PT and chiro?

That's like asking one Pennsylvanian the difference between PA and all of the West Coast. There are plenty of similarities, for sure. I've read much about various chiropractic philosophy. I've even visited a local chiro just to experience what goes on there. But I haven't been trained in the way.

I do know that all physical therapists are not the same, and can only assume it’s no different with chiros. Surely some are better than others. Here's my typical answer that attempts to appeal to common-sense perspective.

What's the story?

Do you know what elite orthopedists and researchers label most cases of spine pain? They call it "nonspecific." No joke! While stubborn back and neck pain remains a mystery to most everyday people, clinicians are armed with X-rays, MRIs, clinical tests, and pertinent medical history information. With all this, the top dogs of medicine readily acknowledge that we often can't be certain of exactly what’s causing the pain.

Pain that improves (or worsens) with different movements, activities, or positions is often mechanical in origin (i.e. from moving parts of the musculoskeletal system as opposed to an infection, kidney stone, etc.). Most cases of mechanical pain are treatable, or at least manageable, without resorting to surgery.



The first question then, is not "what exactly is causing the pain," but "what, if anything benefits the pain?" Medications, lotions, nutritional supplements, and ultrasound do not get to the root of a mechanical joint problem. Diagnostic imaging and a label (sciatica, stenosis, etc.) rarely tells you if the problem will respond to treatment, much less the best treatment.

While other general labels like subluxation and muscle strain may feed your hunger for a label, they often lack reliability and do nothing to help you get dressed and drive to work without feeling miserable.


Subluxed Jelly Donut





Just Fix It?

In the end, only you can really help yourself. If modalities like massage or electric stimulation have failed to provide lasting relief, they are not getting to the root of the problem. Traction/decompression and spine manipulations are often beneficial. But why should you remain better from these if you do nothing to function differently outside the clinical setting? What happens once you get up off the treatment table?

There's at least a few things you should always be doing:

1. Specific stretches or other corrective exercise to reinforce the PT or chiropractic manipulation/mobilization.
2. Identify and practice new movement patterns.
3. Strengthen the legs and core muscles in a safe and functional manner.
4. Train your body in ways that improve on weak areas without irritating the problem.

Who's this about, anyway?

Is the primary goal to help you manage your health or to wow you with mad cracking skills? Manipulations have merit, but they should not be given to everyone with pain in order to deliver it to the few who really need it. What if you can drastically improve your chances of staying better? If it’s possible that you can treat the problem yourself with some coaching and guidance, would you not like to fully explore that option?

Risk?

It only makes sense that forceful manipulations do carry some risk, especially in the neck area. If a manipulation is needed to restore movement or alignment, it's also likely that manipulating with the wrong technique or direction can cause harm.

YIPES. THIS is not a representation of all cervical manipulations, much less all chiropractors. But still - YIPES.

I don't know the entire story behind this forceful neck cranking. But I imagine that the last thing this sedentary young lady needs is someone whaling to "fix" the already loose segments of her upper cervical vertebrae.

It takes a little more time to build forces in a gradual manner. But along the way, you may learn that you didn’t need forceful cracking. Just because something cracks does not mean it was "out" to begin with. Test that theory on your knuckles.

That's All Good, But My Back...?

All health care clinicians are called to humbly acknowledge the limits of their services, to foster patient independence and ownership of their health, and to explain the rationale behind treatments. Any clinician that attends to these concerns is probably a good one. In my practice, I’ve had the privilege of helping many, but certainly not everyone. Some people respond better to fruit smoothies and a hot shower than they do to chiro or PT.

With an active role in treatment, you're absolutely more likely to stay better without needing to be "fixed" three times per week for the rest of your life. At the very least, you learn something about your body and the limits of conservative care.


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Psychic Therapist Predicts Diagnoses

Step right up. Hear from a real live physical therapist who can see the future!

[Initiate wavy dream transition sequence.]

Oh yes. Yes, there it is. I see you there, my friend. You're on the sofa. I'm getting a strong sense that your muscles are not strained. You have some typical aches and pains, but nothing major to speak of right now.

I see you rising up off the sofa. Now you're signing your name and address on a piece of paper - it's a roster! You're outside enjoying the fresh spring air as you stretch. You're going easy at first, jogging a little, laughing with the guys, doing big arm circles and other random things you did back in the day.

Wait. What's this? Good news - I see that you hit a shot to right center field. It's a close game and you're going to stretch an easy double into a triple. You're rounding second in an all out sprint. Oh. Oh no.

You turned back. I see you standing on second base, right hand grabbing your butt, left hand motioning toward the bench. I hear it. The word designated runner comes to mind.

I see you back on the sofa.

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Mark my words. The time is near when this prophecy will come to pass.

I just hope it's not me.

Every sports medicine/rehab guy gets asked what to do about strained muscles at least four times per year. Hamstrings groan, hip flexors scream, and achilles tendons rupture. With each new season comes a new wave of folks hobbling around because they didn't read up at wellduh.com.

Oh imagine that: you got hurt running as hard as you can. When was the last time you did anything as hard as you can? Did you shovel snow or vacuum or grill burgers with 100% all out physical effort? But now your tendons and muscles that have sat around most of the year or maybe did some bench pressing and (submaximal) cardio at the gym are magically supposed to hold up to extreme demands.

Aw, don't feel bad. A few of my best friends who are doctors and therapists and former pro ballplayers have recently fulfilled this prediction. One friend who (distance) runs competitively suffered a pretty severe strain when sprinting in flag football. And yes, this big mouth therapist has suffered with it too.

What can you do other than just stay on the couch? Before we get into treatment for strained muscles, lets talk about the best treatment strategy around: not straining them in the first place.

Stretching before activity does not prevent strained muscles (1). Neither does massage, E-stim, IcyHot, or anything that the guy at GNC tries to sell you (2). Warming up properly does help a little. The older you are and the more strains you've experienced in the past, the more likely your chances of fullfilling (something like) my vision of the future (3).

The ONLY thing that has been proven to prevent muscle strain is functional eccentric strength training(4). Sure, you do need to stretch your back, ankles, and hips against the tightness that develops from hours and hours...and hours of sitting. But you need more than stretching and jogging before the game.

I don't think we need hard data to support the idea that if you plan to run hard, you need to prepare your body to run hard. That means weight training and a gradual build up of form running with interval sprints. You don't need to sprint until you puke. A light warm up then 5 to 10 sprints is quicker, less boring, and pays far bigger dividends than going for a random jog.

Yes sprint. I don't want to hear about how old you are. You have to be smart about it. But if you want to keep living well after twenty, you're too old not to run hard.

Six to eight weeks of the right strength training and progressive sprinting, each done once every five days or so, is a realistic timetable if you want to escape from the wiles of the couch and survive church league softball.

And think of the implications of proving my psychic skills wrong. Think of being able to actually changing the future.

1. Anderson K, Strickland SM, Warrn R. Hip and groin injuries in athletes. Am J Sports Med 2001; 29:521-23.

2. Orchard, JW. Instrinsic and extrinsic risk factors for muscle strains in Australian football. Am J Sports Med. 2001;29:300-03.

3. Heiderscheit, BC, Sherry, MA, Silder, A, Chumanov, ES, and Thelen, DG. Hamstring strain injuries: Recomendations for diagnosis, rehabilitation, and injury prevention. J Orthopedic Sports Phys Ther. 2009;40:67-79.

4. Brooks JH, Fuller CW, Demp SP, Reddin DB. Incidence, risk, and prevention of hamstring injuries in professional rugby. Am J Sports Med. 2006; 34:1297-306.

To Our Wealth and Hellness

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A free range, grass fed, all certified natural organ...toast: to our loss of perspective and ever creative solutions to problems real and imagined.

When we visit my parents, mom goes out of her way to buy at least two different kinds of milk. Skim for the parents, whole for the under two crowd, and often 2% thrown in for good measure. It occurred to me that this may be slightly belligerant.

I know about special diets and imposition; how even noble ambition toward health and fitness can take on an unhealthy life of its own. My late teens and early twenties were invested in pushing the limits of imposing, annoying, Debbie-downer discipline. I would be a huge, ripped, strong, (and good looking) baseball star at Slippery Rock.

Not.

The vice associated with health and wellness is the opposite of gluttony, but it may as well be the same. What do the quantities or content of foods matter, so long as an appetite, a particular appetite, promotes a whole lot of imposition and loss of perspective and, above all, extra self-concern?

It’s no leap to claim that any diet (and exercise) plan can run the risk of consuming us. I think one of todays biggest tempters toward loss of healthy, yes, "holistic" balance has to be the organics. Have you read the rationale or considered the costs of seeing that all way through?

I try to be understanding of those who swear by it. You can't argue with anecdotal testimony, and certainly special circumstances do exist. But by definition, everyone doesn't have said special circumstances.

I use to be in the know on this. In order to sift through the junk science and billions of claims by people who stand to profit from selling organics, you really do need to know the basics of biochemistry. I mean, serious reading. Organic chemistry. Anatomy and physiology of the digestive system. The American Journal of Clinical Nutrition. The International Journal of Sports Nutrition. The center for science in the public interest. This is what a nerd looks forward to on slow weekends in college.

And now I don't have time for that. I mean, you will sometimes catch me reading this site that I absolutely love. But I'm supposed to know the latest and greatest of how to remodel collagen and re-align scoliosis and effectively increase the explosive strength of high school athletes. After thinking critically over literature in my own field, I'm just not into pouring over the variables that influence the oxidative processes of various types of triglycerides.

So the bottom line with organics is 1) I don't claim to be an expert on this, and 2) I'm just not buying it. While there’s certainly value in the checks and balances that allow us to reach environmental and food quality middle ground, an ounce of science only stretches so far. And there does seem to be more review articles like this.

Can organics really abolish all (or even any) of the maladies of the earth and her people? Is it likely, even probable, that things would be worse without all those darn highly efficient, high yielding farming techniques? Remember, Americas poorest and least educated cohort suffers not from malnourishment but from obesity.

When our bodies are frail from a lack of getting outside and actually moving, and years of coffee for breakfast, are organic potatoe chips really the answer there? Is organic soy nard the solution for vegetarians who feel constant fatigue and anemia and blood sugar swings? Are traces of pesticides the cause of all the stress and lack of sleep associated with our economic competitiveness and all nighters with the Wii (or blogging)? It's possible, but I doubt it.

Even if there were some benefit, are the costs justified? The "well off" have slightly better nutrition with which to fuel their polo matches and family conflicts while everybody else starves. Try asking an old time farmer or the 3rd world about minutia regarding food they don't have. They are freaking starving, and would probably choose this "unnatural" fertilizer over cow dung and bugs in their food, anyway.

Take care of your body and the environment we all share – yes. Maybe for you that means organic food and no meat. Fine, there are a lot worse things to do with your life. But please have equal grace toward my position. Don't go reversing the moral compass on me - you who consider sex and relationships to be a matter of preference while suddenly our choice of food is handed down from some universal moral standard. Yeah, you're right, let's not go there.

And for everyone, in your effort to maintain a clean running, pain-free, long lasting machine of a body, do give some attention to where you're going.

Whatever the case, I'll keep trying to put some effort into eating fresh produce and non-processed foods - organic or otherwise. I'll continue with less effort debating the marginal-at-best benefits of organics, because I can't afford it (in time). I literally can't afford to continue with my small part to help the third world and feed organic blueberries to my family of 6.

And whatever milk mom has on hand when we visit will do just fine.

Spare The Arm - I

As far as I know, I'll be doing a presentation on throwing injuries this fall at the American College of Sports Medicine (Mid Atlantic) conference. I'll also be looking to educate the baseball and medical communities on addressing pitchers in a truly comprehensive way; hopefully letting them understand what we're trying to accomplish at GoWags.

Below is the first of a series of writings on pitching.

Every child who is physically large or shows some baseball skill tries their hand at pitching. Many kids (hopefully) play for fun, but when it comes to pitchers advancing to higher levels of play, it's nearly impossible to perform exceptionally and stay healthy. Chronically sore arms are no fun. Careers end early and talent is wasted.

Imagine focusing relatively less on the arm in order to spare the arm. What if the rest of the entire athlete is significantly underrated as a cause of injured shoulders and elbows? Despite plenty of information and advances in sports medicine, I believe that huge gaps still exist between "prehab", rehab, and actual performance on the field.

A typical example is a 15-year old who commonly experiences mild to moderate medial elbow pain that significantly worsens at about one month into the spring season. He rests for a week, possibly takes some anti inflammatory meds, and feels better. He returns to the field and immediately reaggravates the problem.

Our athlete then winds up in the hands of a PT or trainer. Early on we do some anti-inflammatory modalities and careful loading of muscular and ligamentous structures that support the elbow and shoulder. We address shoulder ROM and scapular dynamics, culminating in the Throwers Ten routine.

Six or eight weeks after the injury, the athlete is then instructed to follow a throwing schedule that gradually increases the repetition and intensity of the very same sequence that injured him in the first place.

Treating the arm (and scapula, if we're lucky) is worthwhile to some extent. But when our athlete returns to pitching, will a stronger rotator cuff and improved glenohumeral internal rotation keep him from reinjury? Sometimes, but often not.

What else can be done to comprehensively address the athlete in order to spare the arm? Plenty. Keeping consistent with baseball form, we have 9 innings to a sore arm:

1. Have optimistic expectations.

If a young athlete has "a good arm," put him on the mound as much as the rules will allow and generally don't give it too much thought. Older, more advanced athletes, should simply follow the traditional protocol for pitchers.

The overhead throwing motion is a highly skilled total body movement which requires flexibility, strength, synchronicity, and neuromuscular control. Imagine if this repeated, maximal effort, ballistic, asymmetrical activity is inherently dangerous? What if we finally have to admit that pitching is just plain and simple not good for you?

During acceleration, the shoulder internally rotates over 7250 degrees per second - the fastest motion in all of sports. The anterior translation forces and distraction forces at the shoulder are tremendous. Tensile forces at the medial elbow (during the late cocking phase) and at the lateral elbow (during deceleration) can mangle supportive tendons, ligaments, and even nervous tissue.

A brief look at some of the data will allow two easy conclusions: (1) pitchers face a rough road because there are many ways to fall, and (2) the traditional methods for training and rehabilitation are not cutting it.

[Chart common shoulder and elbow lesions and common trunk and lower extremity movement impairments].

Almost 60% of pitchers suffer a shoulder injury each year, and at the major league level account for almost 70% of time on the disabled list (1).

Almost 90% of high level pitchers have (at least) partial thickness tears of the rotator cuff (2).

All high level pitchers develop some degree of labral tearing or fraying (3).

Pitchers develop shoulder instability and humeral torsion (an actual twisting of the bone). We're still not certain if this leads to more pathology or if this has a protective effect on the elbow and shoulder complex (4).

Pitchers exhibit scapular position changes and dyskinesis including increased upward rotation, protraction, and anterior tilt. Again it is unclear if these are protective adaptations or are predisposing factors to injury (5).

I know this is a lot of talk about the shouler for an essay about focusing less on the shoulder. But the point is that pitchers can and will develop changes to the shoulder complex. That leads us to ask what, if anything, we can do to prevent these adaptive changes from going over the threshold of symptomatic pathology?

Until we decide to do away with pitching altogether, we should seriously think about (rethink) our expectations and revise our approach to training and rehabilitating the arm of pitchers.

The next 4 entries in this series will address the 8 other interrelated "innings" to a sore arm.

Part II
2. Take lessons and accept everything they teach you.
3. Don't take lessons and overlook mechanics altogether.

Part III
4. Strength Train like a pitcher.
5. Condition Like a pitcher.

Part IV
6. ROM: warming up focus on the shoulder.
7. ROM: never static stretch.

Part V
8. Do these exercises that are a waste of time, at best.
9 Planning errors: pre season, pitch counts, fatigue, and curve balls.

Part I References:

1. Ouelette, H, Labis J, Bredella M, Palmer WE, Sheah K, Torriani M. Spectrum of shoulder injuries in the baseball pitcher. Skeletal Radiol. 2007;10:3.

2. Mazoue, CG, Andrews JR. Repair of rotator cuff tears in professional baseball players. Am J Sports Med. 2006;34:182-89.

3. Burkhart, SS, Morgan, CD, Kibler WB. The disabled throwing shoulder: spectrum of pathology: evaluation adn treatment of SLAP lesions in throwers. Arthroscopy. 2003;19:531-539.

4. Whitley, AR, Ginn, KA, Nicholson, LL, and Adams, RD. Sports participation and humeral torsion. J Orthopedic and Sports Phys Ther. 2009;39:4.

5. Thigpen, CA, Gill, T, Schneider RE, DiStefano MJ, Reinold MM, and Seitz AL. Adaptations in 3D scapula position of professional baseball pitchers over one season. Presented at the 2009 Sports Physical Therapy Section Meeting.