MRI not very helpful

MRI shows that there is tearing of the pectoral muscle, but the tendon insertion into the humerus cannot be located. Apparently this is a relatively uncommon injury and an akward anatomical location to visualize under MRI.

Whether the tear is at the muscle-tendon interface versus the tendon-bone interface is important. When the muscle tears away from the tendon, there's nothing to be done surgically. When things scar down things tend to recover to an adequate level. But when the tendon tears away from the bone, surgically reattaching the tendon to the bone will allow for the best long term recovery.

Decisions decisions, surgery or no surgery?

Surgery is a freakin chore. The time and expense of surgery, plus two to four weeks of immobilization to allow for healing and then a very slow process of regaining range of motion and strength.  Caring for children and work is out of the question during that period of immobilization, much less fun.

I really don't care if my chest looks a little uneven or I lose the big bench press. I should function just fine, even with 75% of my "normal" strength level. Right?

On the other hand, if the tendon is tore off the bone and I fail to have that surgically repaired, I'll end up with much less strength. The doctor says that there's really no way to tell without going in surgically, and it's up to me.

Shucks.

Torn Pec

I'm always eager to report various feats of fitness, grit, and awesomeness accomplished by a half dozen or so people training in my basement and around the yard. Well, not today. Today I bring a story of the dis-awesome and plain ugly.

After a few progressively heavier warm up sets the blogger lays on his back under 315 pounds. In many times recently passed, he's benched pressed this plus plenty more. So it's no big deal. But he's taking it seriously. He must, or it's not worth doing.

Never mind - that in the previous month he went on-and-on about the overrated, uninspired exercise that he cared for very little. Neither did he pay heed to the fairly severe muscle soreness lingering in his shoulders and arms from heavy pressing just two days prior. It was Tuesday, lifting day, and he's here, so he may as well give a damn and go hard. It was time to battle or be crushed, yeah, just like he wrote about a few weeks ago.

The core tensed, scapula rigid, lats flared, he un-racks the weight. The first rep feels light, throws it up. The second rep accelerates as well. Descending into the third rep of 5, he feels and hears the sound of a T-shirt being torn apart at a seam. In a fraction of a second the weight crashes down as his right pectoral muscle peels off the insertion into his upper arm bone (humerus).

"Torn pec" he blurts, writhing under the load as his friend regroups, heaves the load off his sternum and back to the stand. 

He stands up.

"It doesn't hurt that bad."

"I am NOT having surgery."

"I feel dizzy."

He sits down. Then stands up, shirt off, poking at his protruding right...it turned from a chest to a boob.

He works until lunch the next day, calls his friend who specializes in shoulders at the Orthopedic Institute of Pennsylvania.

"Come in tomorrow at 9. If the MRI shows a full tear you'll need to have surgery."

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You'll hurt your back (not) doing deadlifts

I did.

It was about two years ago, trying to pull up 405 pounds after four years of not doing a single dead lift. Failing to lock out one clean repetition, I dropped lowered the barbell and immediately assumed the hands on knees shameful hurt back posture. Proceeding directly to the medicine cabinet, I heard a mocking chant of "You'll hurt your back," much like the "You'll shoot your eye out" taunting in the old Christmas Story movie.

These days I pull far more weight for a total of at least 20 reps every Tuesday, and my back is definitely less achy now than it was 2 or 4 years ago. I credit that, in part, to dead lifts.

So what gives? Personally, I planned and now try to allow sporadic form checks, better recovery, and respect for the body's inability to make constant, linear gains. There is most definitely an art to progression once you approach a double body weight dead lift.


But the main point of this is to emphasize the value of the less extreme dead lift variations. I mean, dead lifts don't have to look like this...Or this:

 

Instead, try one of about 10 more sane variations, preferable WITHOUT the singlet:



Dead lifts accomplish what no machine or training device or supplement can: teaching the brain to dial in the correct movement pattern for functional lifting. Picking things up is a part of life, unless you can find a way to hamstring curl your suitcase through the airport or leg press your new TV up to the bed room.

The spine is highly resilient when it comes to compressive loading. Almost every movement we make results in some degree of compression, not just loading the spine vertically (as in the squat exercise or carrying jugs of water on our head).

The bad guy is shear force, the tendency of vertebrae to slide forward or backward or rotate on one another. Approximately one zillion muscles in the back, abdominals, and hips are responsible for stabilizing the spine against shear forces. If those muscles are out of sync or plain weak, the passive structures of the spine take a beating.

That's how dead lifts save, yes SAVE, the vertebrae, discs, and ligaments of the spine! More than just stretching and typical training machines, dead lifts demand controlled mobility, hinging the ankles, knees, and hips, while the trunk muscles brace hard to maintain the back in a neutral position. 

Of course the problem is that some of us see how awesome and miserable and rewarding dead lifts truly are. We experience how they make you look and feel and perform like most people simply cannot look and feel and perform. And so we're ever so eager to up the ante on the risk:reward ratio. We're always asking for more reps, more weight, more awesomeness, iron addicted junkie.

If you're one of those, dead lifts will probably hurt your back. How else are you going to know how much you can pull? Even if you're really smart and careful about progression, you'll be wondering why you didn't add 10 more pounds because you really hammered that final work set. 

On the other hand, sitting at a desk, golfing, driving, falling off things, and ninja kicks in the back will also probably hurt your back.

But again, you don't have to dead lift small vehicles to (literally) get off the treadmill of training mediocrity. If you're working out training anyway, why not include something that's effective, requires little space and gear, and translates to more than just burnt calories?

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side effects

Thursday night, planning for the weekends leisure, I'm supposed to be looking up youtube videos on cabinetry or grilling meats or lawn mower maintenance or golf. But I'm studying this tutorial about side flips. 

Most of the day during work on Friday, while helping people restore their physical function, I have side flips on my mind.

After work and errands comes the weekly PlyoFriday workout. I'm late to my own back yard again, rush through it, left less powerful and more fatigued than usual. Two weeks ago I sprained my ankle in a half-hearted effort at one of these. So come hell or high water, today's the day I commit to at least one.

 Yes, my thinking is that ridiculous. And that's about what it takes for a middle aged man to accomplish  tomfoolery.

And...

It's a part of what keeps me ticking.

What has been on your mind - to accomplish physically? It may not have been barrel roll flips. My mom and aunt competed in barrel racing at the Harrisburg's Farm Show Complex this past weekend.

But your something? The physical and mental side effects of that something truly are too numerous to mention. Plus, the side effects justify tomfoolery.

You need something.
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stronger

[My meager hit counters indicate that readers are far more interested in reading about fitness and sports performance than rehab related topics. So okay, here are some training information/motivational type thoughts for the day.]

Quit worrying about the fluff of your training and diet. Focus on getting stronger in a few basic movements. Add in some measure of athleticism (vertical jump, sprint or other run time, discuss, whatever), and there you have a program.

If you do this over a relatively long period of time (for the "extreme" transformation crowd, it's going to be more than 90 days!), you will not be out of shape, especially if you're under the age of 45.

You will not achieve awesomeness (aesthetic or performance) or physical and mental resiliency by doing endless cardio and three sets each of three variations of bicep curls and tricep extensions, or by worrying if the fructose in apples is making you fat. Do you seriously think that people get fat by eating apples? Or strong and ripped by doing the elliptical and abdominal crunches?

On the other hand, all awesomeness could be yours if you'd settle on a handful of big basic weight training movements, forge that coveted love/hate relationship with them, apply yourself to them at regular intervals, and allow rest and healthy living in between.

Entire workouts devoted to body parts, like "shoulders and triceps?" They have to go. A few friends and I have been doing three workouts per week for about, oh, 2 years:

Deadlift day    with some heavy bench and miserable single leg squats thrown in
20 rep squat day    with some heavy chin-ups, rowing, and overhead pressing thrown in
and Plyo Friday    with about 50 minutes of jumps and sprints.

That's it. An entire program with less than 10 resistance training exercises and about 5 plyo/conditioning activities.

Do you believe that it works?

Cort can deadlift 320 for 5 reps. Ben has squatted 315 for 20 reps. With over a decade of training years on them, I've recently dead lifted 500 pounds for 5 and squatted well above 400 for 20. We all do chin-ups for reps with 45 pounds and more added on. We've managed to not get fat. Lets just say that we've been ready for beach season all fall and winter and spring.

If we are consistent and eat well and recover well, we absolutely progress on most lifts, most of the time. Sure, those are some big "ifs." But progress isn't that much of a question when you narrow your focus, refine your goals, and pour yourself into just a few exercises.

On the other hand it's hard. Single leg squatting well over your body weight for a total of about 30 reps each is damn hard. But it's FAR less painful than "working out" with little real progress to show for it.

And again, the point is not how much we lift. In fact, it's quite the opposite. We're not special. We've made training a priority, just three days per week, and we focus on getting stronger in a handful of movements.

In case you were wondering, yes, we do train biceps. The next installment will include a video which reveals to the world my top secret bicep activation routine.

Until then, focus on strength, getting stronger in a couple hard movements like chin-ups and/or bench press variations, shoulder presses, dips, squats, lunges, whatever you can do regularly. Focus on getting stronger, be patient, and much of the rest will come.

There will be set backs, bumps, and glitches.

But really.

Focus on getting stronger.

stretching the truth

Can you handle the truth about stretching? When we've invested so much of our precious time droning through boring stretches and touting their benefits? And we floss our teeth and wear sun screen and eat yogurt and stretch, not because we particularly like any of these things, but because they're good for us.

Right??

Well the truth is that stretching is limited. It's necessary and good at times. But for relatively healthy individuals, stretching is definitely overrated. 

Stretching neither prevents nor promotes healing of muscle sprains strains.

In fact, I've seen quite a few people try to stretch muscle strains to the point that they interfere with proper healing. So after a muscle strain, back off for a while. For circulation that promotes healing, try some light calisthenic and cardiovascular type activity that involves the strained muscle group but does not reproduce the pain.

A lack of flexibility is NOT the primary reason why you strained your hamstring while trying to stretch that single into a double.You expected your body to sprint full steam on a cold day in March after months of sitting on the couch and jogging?

What prevents muscle strains? Proper training progressions and strength training are the most helpful things you can do to form strong, resilient muscles that don't get torn apart from high force, high speed muscular contractions.

Prepare for weekend warriordome by building up gradually with lunges and squats and dead lift variations and weekly sprinting sessions during the winter. Identify and work on significant asymmetry and form imbalances, which are the enemy of muscles.

Stretching does not reduce muscle soreness. 

It just won't. You can decrease muscle soreness by going easy at first and gradually acclimating to whatever it is you need to do. Or by going like a mad man and making up for it with ibuprofin.

Stretching before activity does not increase performance.

In fact, there's ample evidence that static stretching causes a short-term slackening effect on muscle-tendon units, which translates to decreased peak strength and power. Not exactly what you want for acts of powerful athletic awesomeness.
Instead try regularly strength training and working on muscle and movement imbalance. Before activities and events, go through 5 to 10 minutes of dynamic warm up and simply going easy and breaking a sweat before pushing full steam.

Stretching does not improve strength gain or muscle size. 

Muscles grow larger from the progressive overload of being torn apart, healed, and torn apart again. The best way to do this is through heavy resistance training. Muscles get stronger through both an increase in their size and (even more so) through the brain learning to utilize them more efficiently.

Stretching lengthens muscles only temporarily, and little to no permanent structural adaptations take place. Much of our apparent increase in flexibility is due to increased stretch tolerance; the nervous system learning to put up with the discomfort of a stretch.

Stretching does not improve posture. 

Let me be careful here, because I truly believe that specific stretches that reverse the mechanical forces that we regularly place on our bodies are quite valuable. But more than anything, posture is a result of complete neural programming. You could say it's a lifestyle thing.

Stretching and strength training and exercise in general will all effect posture, but not nearly as much as whatever it is you do for hours at a time over days and weeks and months. Duration is king when it comes to posture, that's why the only real fix is to be ever mindful of how you carry yourself. It's a matter of adopting the correct posture until neural reprogramming is established. It will take time.

That being stated, every single person who sits for a spell (and that means you!) should be doing thoracic extension, hip flexor stretches, and cervical retraction. But it's all for naught if you collapse back into a heap in front of the computer.


Don't hate on stretching too much though.

Physical therapists make a living by getting people to stretch and performe corrective strengthening exercise. I regularly implement hands-on mobilizations and manipulations that help loosen tight tissue and establish new movement patterns. By tight tissue, I'm referring to joint capsules and ligaments and scar tissue that's may be interfering with proper joint mechanics or directly putting strain on neural structures.

There are certainly some stretches that specific athletes should be doing at specific times. For example, most (but not all) pitchers, volleyball players, and other overhead athletes should be doing some version of shoulder internal rotation and horizontal adduction (cross body) stretches to counteract the bazillion repetitions of external rotation and abduction strain they place upon their shoulder joint complex.  

So stretch what you need to and when you need to. But don't feel too guilty if you have to skip it before exercise. My dentist says you should floss your teeth every day though.

The fastest way to get in shape

...is not Crossfit or Zoomba or that 4 Minute Miracle exercise device as seen in SkyMall. The fastest way to get in shape is not even dead lifts or miserable single leg squats.

Some of the above may be important components of a well rounded, long-term training program. But the one thing that will get you in shape the quickest is undoubtedly hill sprints. 

Yes there's gold in them thar hills. If you sprint the hill, you will be able to do just about anything.

Why are hill sprints so valuable?

Hill sprints are simple. All you need are shoes. And a hill. If your local topography offers no hills, you should seriously consider relocating. Hill Sprints know that's just how awesome they are.

Hill sprints are relatively safe. The graded surface allows you to pour out total body effort with only a fraction of the pounding to your joints (less loading cycles and impact than standard jogging, plyometric training, etc). At the same time that Hill Sprints are coddling your joints, they are mocking and laughing at what you look like pushing full throttle but actually moving at a snails pace.

Hill sprints are super efficient. You run hard (or walk fast or jog, depending on your fitness level and abilities) up a hill, stroll down, and repeat. Try doing that 5 or 10 times and see how well your "I don't have time to get in shape" holds up. Hill Sprints have a zero tolerance policy toward lame excuses.

Drawbacks?

As awesome as hill sprints are, pushing too hard, too soon at anything runs the risk of problems.

Achilles tendon problems, though unlikely, may be exposed due to the biomechanical shift of running uphill. If you're not used to the acceleration of sprinting, you will benefit greatly from rolling starts of light jogging that progresses to faster jogging before breaking to (your) top speed.

Hill sprints will absolutely tax your cardiopulmonary system to the max. Seriously, Hill Sprints are no respecter of hearts, and you don't want to be found in the gutter. Maybe your "sprint" interval looks more like a speed walk or an uphill jog, and you build from there.

There have been times when full throttle hill sprints have left me dizzy and numb for 15 or 20 minutes, though this may also have something to do with my inability to go easy when I've neglected the hill for a while. And my tendency to drink coffee on an empty stomach before workouts. 

So go find a moderate hill (we're not talking ski slope grade) somewhere between 50 and 80 yards. Or thereabout. Make due with what you have close to home. Warm up a while, then go to battle. Lean into the hill when it's most miserable.

One other drawback is that hill sprints are difficult. Hill Sprints know that there's no such thing as quick and easy. The rule is that no matter how fit you are, the Hill always wins. If the hill didn't kick your ass, you're not doing your sprint interval hard enough.

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