Category — Psychology

I just finished reading the book Allostasis, Homeostasis, and the Costs of Physiological Adaptation edited by Jay Schulkin. The book is fantastic and while it is not written specifically about physical preparation for sport the information contained inside has everything to do with physiological preparation for sport.

Homeostasis and Allostasis

Homestasis is a term most are familiar with and generally the word gets thrown around when we talk about training – “The goal of training is to disrupt homeostasis and force the body to adapt and get stronger.” There is, however, a difference between homeostasis and allostasis and understanding that difference may help us better understand the ramifications of our training program. While the authors who contributed chapters in Schulkin’s book all seem to agree there is a difference between homeostasis and allostasis they do have subtle differences in regard to how those terms are applied and the physiological processes they are applied to. Rather than getting so focused on those subtle differences I think that just grasping the basic concepts would be helpful before I try and put this into the context of physical preparation for sport.

Homeostasis

The concept of homeostasis dates back to Walter Cannon’s work (1935) and for a broader understanding of Cannon’s work I suggest checking out his book, The Wisdom of the Body, as  it is a classic in the field of physiology. Cannon used the term homeostasis to refer to the processes needed to preserve constant conditions within the body which are centered around specific set points and governed by negative feedback loops.

A common example of homeostasis often cited is the thermostat in your home. If you set the air conditioning to 80 degrees in the summertime the thermostat does not kick on until the temperature in your home rises above 80 degrees (the set point), providing negative feedback to the thermostat and requiring it to take action and regulate the temperature back to normal, achieving homeostasis. Of course, if you opened a window in the house the temperature would rise and be constantly above the set point of 80 degrees causing the theromstat to remain on for a significant period of time, as it attempts to maintain the homeostasis, until you finally either close the window or the thermostat breaks down because it has overworked itself.

One of the issues with the homeostasis model in health is that the medical community takes body set points very literally and thus we end up with a large number of medications being prescribed to help people maintain specific numbers considered to be “normal”. This issue was confronted by Sterling and Eyer in 1988 when their research led them to coin the term allostasis. 

Allostasis, Allostatic State, & Allostatic Overload

Schulkin notes three distinguishable features of allostasis (pg. 7):

1. Allostasis – The process by which an organism achieves internal viability through a bodily change of state
2. Allostatic State – Chronic overactivation of regulatory systems and the alterations of body set points
3. Allostatic Overload - The expression of pathophysiology by the chronic overactivation of regulating systems

Noted stress physiologist, Bruce McEwen, goes on to further differentiate between these features of allostasis and homeostasis by making the distinction that homeostasis applies only to a few physiological systems that are essential for life – pH levels, body temperature, and oxygen tension. These systems are so essential to human survival that slight fluctuations for a brief period of time could lead to death.

Thus, allostasis is not so much focused on constancy as homeostasis is, but rather, is able to fluctuate and alter set points in order to meet demands that are placed on the body. Additionally, rather than only being dependent on negative feedback loops, the allostasis model indicates that the body can be predictive and anticipate stress and react based on feed-forward information.

High blood pressure is a good example to use when trying to understand the difference between allostasis and homeostasis and how this has influenced the medical community, as I alluded to earlier. “Normal” blood pressure is often cited as being 120/80. If a patient presents at the doctors office with a blood pressure of 160/90 they are classified as being hypertensive and prescribed medication to try and bring their blood pressure back down to the “normal” 120/80. One of the issues with taking this homeostatic approach to blood pressure is that this individual’s blood pressure set point may have shifted for a reason. Perhaps they live an incredibly stressful life, they sleep only 4 hours a night, and they keep a poor diet. Their blood pressure is simply adjusting its set point in order to try and still be effective and get the job done. Prescribing medication means that you are not acknowledging all of those other important things going on with the individual’s health and well being and attempting to focus on the adaptation (allostatic state) that is rightfully taking place in the presence of these stressors rather than addressing the true problem – life stress, sleep, and diet. Additionally, the medication which is being used to treat their high blood pressure may do so at the consequence of other physiological systems, as there are often side effects and other systems need to adapt to the medication, placing these other systems into an allostatic state. Of course, if this allostatic state of high blood pressure goes on for a considerable period of time the individual may find themself in a state of allostatic overload – potentially life threatening.

Limitations of Selye’s General Adaptation Syndrome

Hans Selye, whom many consider to be the “Father of the Stress Response”, defined stress as a nonspecific response by the body to any demand whether it is pleasurable or non-pleasurable (eustress or distress). Selye broke stress down into three phases – alarm, resistance, and supercompensation:

The Alarm phase takes place when we encounter a stressor, causing the body to break down. The Resistance phase is our bodies attempt to combat this stressor in order to not only restore homeostasis but to actually put our body in a better position to resist that same stressor should it happen again, thus reaching a state of Supercompensation. Of course, if we continually breakdown and do not provide the body ample time or opportunity to resist the stress we are placing on it we reach a state of Exhaustion.

This model was revolutionary at the time as Selye literally discovered the stress response on accident by making some errors in his lab with the way he handled the mice he was studying. However, like most things, the picture is a bit incomplete and many stress physiologists look at adaptation in a different way. This stereotypical, non-specific response to all stressors, pleasurable or non-pleasurable, in no longer considered accurate. Rather, different situations and different stressors can mediate allostasis in different ways depending the response needed and the body’s ability to cope with the stress. Thus, there is a degree of specificity that stress has on the body and the perception that the body has to this stress will help to determine how it reacts.

Physical Preparation and Allostasis

Similar to the discussion regarding General Adaptation Syndrome, it is important to note that stress can have positive or negative outcomes depending on the amount of stress applied to the body and how the body adapts to that stress. While not discussed in the book, the term hormesis comes to mind. Hormesis is a term of biology used to explain how low levels of a toxin can produce a favorable biological adaptation to the cells while high levels of that same toxin would lead to cell death. This concept can apply to training, much like the model of allostasis discussed in the paragraph above, where a little bit of training can produce a favorable adaptation to the body – the appropriate amount allows the body to cope with the stress of the training session – but, if we push too hard and overload the individual they may achieve an allostastic state, where the biological systems become overactive as they attempt to adjust set points in response to the stress. If we then continually apply training stress we end up with a negative result and force the individual into allostatic overload – the toxin, in this case training, when applied at a low level led to favorable adaptations, however once we did too much it ended up becoming toxic and damaging to the system.

An allostatic state, where the body systems become overactive and adjust their set points in response to training stress, may not be such a bad thing. This would probably resemble a brief period of overreaching and, provided we monitor the athlete appropriately and do not push them over the edge, would lead to favorable gains as the increased set points for things like hormonal output, cardiovascular function, and central nervous system firing would result in the athlete getting stronger, faster, bigger, and more fit.

Thinking through this model of allostasis it makes me consider how training influences the three aspects of my Physiological Buffer Zone (which I discussed on the Strength In Motion DVD):

1. Good Movement
2. High Level of Stress Resistance or Stress Tolerance
3. High level of Fitness

All three aspects are governed by the same allostasis model and the amount of training that one can tolerate is highly individual. Some athletes need more focus in one area of the buffer zone than others and collectively, if we can raise each aspect as high as it possibly can be for the individual, we have a chance of developing someone that is highly resilient and able to tolerate a great amount of stress without breaking down. Essentially, their biological set points are higher and their body is able to anticipate stressors that may be applied to it – for example the psychological stress of game day, the physiological stress of the game, the stress of going into preseason where coaches usually run them into the ground, or the stress of travel from one competition to the next – and mount the appropriate stress response without becoming overactive and leading to potential allostatic overload and breakdown.

The Allostatic Model and Pain

As I read through the book I couldn’t help but think about the topic of pain when referencing this allostatic model. Pain is an output from the brain, a perception, based on all of the information coming in from the environment. When an individual suffers from chronic pain sometimes signals can get crossed and the person gets stuck in this state of protection where the brain is extremely hypervigilant and protective of the painful region. Thus, this individual finds themself first in an allostatic state where the system is hyperactive and set points – in this case perceptions of pain – are altered in order to initially protect the area from further potential damage. If this continues for a lengthy period of time the individual may then find themself in a state of allostatic overload where there is chronic overactivation of bodily systems that lead to a pathological state of chronic pain characterized by changes in the nervous system (central sensitization), changes in movement and motor programs, psychological changes (depression), and changes in behavior (fear avoidance).

The Allostatic Model and Hands on Therapies

Another place where it is interesting to consider this model is in various hands on or touch therapies (IE, massage and manual therapy). Touch may be one potential way in which we can help to influence the allostatic state and sort of “pull the person back” in an effort to preventing them from reaching a state of allostatic overload. Massage, when used appropriately, may help some cope with stress-related symptoms by decreasing anxiety and enhancing psychological well-being. Additionally, during periods of intense training or frequent competition (IE, the in season period) massage may be help to increase an athlete’s stress resistance and ability to cope with stressors when used at the right time during the week. This approach is essential during a long season to help maintain the health of the athlete and prevent them from breaking down and not being able to perform at their best during game time.

Conclusion

The allostasis model underpins everything that we do as strength coaches. Understanding this model can help us see the bigger picture when it comes to the training programs that we write and how different individuals may adapt to those programs. By understanding the unique ability of each athlete to adapt to the stress we place upon them we can begin to increase the athlete’s physiological buffer zone by increasing their biological set points and enhancing their bodies ability to be predictive and anticipate potential stressors.

Patrick
patrick@optimumsportsperformance.com

High amounts of stress over prolonged periods of time can wreak havoc on our bodies.  Besides the commonly talked about issues that come with a high stress life – increased blood pressure, heart attacks, depression, etc – stress can affect both sexes on a hormonal level as well.  For female athletes, intense physical and psychological stress may be a catalyst in the development of the female athlete triad.

Female Athlete Triad

The female athlete triad is a three-part, interrelated pattern of dysfunction that can evolve when the athlete is under high amounts of physical and/or psychological stress, causing a change in eating patterns, menstruation, and finally bone mineral density.

It is important to note that this pattern can happen to any physically active woman who faces physical stress, it doesn’t exclusively apply to an athlete. I would even suspect, and consider, the fact that this pattern could happen in a woman who is not physical active at all but rather faces high amounts of psychological and emotional stress, forcing any one of these three catalysts to begin the process.

Physical and Psychological Stress

As strength coaches and trainers (and even women or female athletes who train themselves) it is important to be aware of the athlete’s stress level and its impact on their training and sports program. Female athletes, especially in the high school and collegiate settings, typically face a high amount of psychological/emotional stress.  This comes not only in the form of course work and exams but can also be tied to social stress – making new friends, being away from home (for the collegiate athlete), relationship stress, body image stress, etc.

The last example, body image stress, can kick off the female athlete triad as extreme changes to diet and nutritional intake commonly follow a negative self image.  When nutritional intake is poor, energy imbalance may create a platform for amenorrhea (cessation of normal menstruation).  As well, high amounts of stress can alter hormones which can also have negative implications on normal menstruation.  A decrease in nutrients, such as vitamin D and calcium, and alterations in hormones, especially estrogen, can eventually create a loss of bone mineral density.

This example clearly shows the interrelatedness of the female athlete triad and if we had started the example with more of a physical stressor (intense training, competition, and eventual overtraining) the same type of interrelated connection would easily be seen.

According to Powers and Howley (Exercise Physiology: Theory and Application to Fitness and Performance, pg. 467) 4% of all female athletes will meet the criteria of the triad and 26% will have two of the components in the triad.  Additionally, 3% of nonathletic women (ages 13-29) display all three aspects of the triad.  Given the prevalence of this issue, we should first evaluate some of the potential signs of the female athlete triad.

Signs of the Female Athlete Triad (Morgenthal AP [PDF])

• Fatigue
• Anemia
• Depression
• Abnormal or cessation of menstruation
• Stress fracture
• Decreased ability to concentrate
• Cold intolerance
• Hypothermia
• Cold and discolored hands and feet
• Enlargement of the parotid glands
• Sore throat
• Erosion of dental enamel from frequent vomiting
• Abdominal pain and bloating
• Constipation
• Dry skin
• Face and extremity edema
• Lightheadedness
• Bradycardia
• Chest pain

What to do

Now that we have identified what the problem is (the components of the triad) and how it can be initiated (high amounts of physical/psychological stress) we can lay out a game plan with practical information for addressing the problem.

First, it is important to emphasize that due to the intense psychological component of eating disorders, coaches, trainers, and nutritionists should seek out help from a qualified psychologist who works with these individuals to ensure they get the appropriate information and are well attended to on that front.

From the training side of things, picking up on some of the warnings signs of the female athlete triad is the first step to ensuring that you address the situation promptly.  In fact, having good communication and rapport with your athlete(s) will hopefully allow you to pick up on a potential problem before it even gets this far.  Once you have identified a potential risk, it can be helpful to have or consult with a qualified psychologist on the safest and most appropriate way of addressing the issue with the athlete.  Sometimes, very direct questions will be met with a lot of denial and resistance.  You want to ensure that you handle the situation with care and respect for what the athlete is going through.

Work with a qualified sports nutritionist who can talk to the athletes and teach them about the importance of healthy eating and answer any questions they may potentially have about diets, weight loss, and certain strategies for decreasing body fat. We all know there is so much information out there and a lot of it is not only poor but potentially dangerous.  Additionally, in the high school setting, a meeting with parents may be arranged, as they are the ones typically seeing the athlete on a more frequent basis than you do. You can present this information as well as some of the potential red flags of the female athlete triad so that the parents are well-informed and know what to look for.

Finally, analyzing the training and competition schedules as well as how these schedules work in conjunction with the school schedule can be a proactive approach on the coach’s part.  Knowing when mid-terms and exams are, from a strength coach standpoint, will allow you to plan training accordingly, and back off the intensity/volume/frequency a little bit as the athletes at this time are facing high amounts of psychological stress and usually sleeping less, as they are increasing their time studying, both of which will lead to a decreased ability to recover from the training stress.  Furthermore, manipulating the training program around periods of frequent competition (as well as paying special attention to year round training in three sport athletes) can be helpful in preventing overtraining and ensuring that the athletes have appropriate time to recover both physically and psychologically from the demands of game day.

The female athlete triad is a very serious issue and should be dealt with appropriately.  Have good communication with your athletes and recognize when there is problem. These are key steps to ensuring the the issue is addressed before it develops into something far more serious.  Having a well-planned training program and educating the athletes on appropriate nutritional strategies can be helpful in preventing the female athlete triad and assisting the athlete in establishing healthy habits that they can carry with them through life beyond their sport.

Patrick
patrick@optimumsportsperformance.com

Over the last few articles we have talked about stress, quantifying stress, and Heart Rate Variability (HRV).  In the HRV article I hinted at massage and the potential effect is can have on HRV and helping the athlete/client get into a more parasympathetic state.  While science continues to exam what is happening under the skin when soft tissue therapy is being applied, one thing is for certain, people tend to feel better after getting some bodywork.  Athletes report less delayed onset of muscle soreness (DOMS) and tend to feel more relaxed and rested following massage therapy.

As I stated in previous articles, as coaches we have become very good at applying the stress.  We can take the athlete out and run them, make them lift heavy, throw medicine balls, do circuits, do intervals, etc., however, we often overlook the restorative aspect in our training programs.  No program is a good program if you cannot recover from it.  One of the ways that I have found soft tissue therapy to be of extreme value is its use in restoration and recovery.  It is one way in which we can help the athlete relax and calm down following intense bouts of work and stress (training, competition, etc).

Some athletes will require more recovery between intense periods of training/competition than others, making it important to understand your athletes and how they respond to these situations so that you can adjust training accordingly.  Using some form of soft tissue therapy/bodywork is one method that can be helpful in bringing the athlete back to a parasympathetic state.  A number of papers have looked at changes in HRV following a few different types of massage techniques – trigger point therapy, rolfing, joint manipulation, and thai massage.  In all instances, massage helped to increase HRV, indicating a move towards a parasympathetic state.

While the changes in HRV, enhanced parasypathetic state, and overall psychological well-being are impressive, many of these studies are not conducted in conjunction with exercise.  However, one study conducted by Arroyo-Morales et al, looked at the effects of 40min. of myofascial release work compared to placebo (sham ultrasound) following three 30-second Wingate tests (high intensity exercise).  Interestingly enough, those in the massage/myofascial release group actually had better recovery in HRV and blood pressure compared to the placebo group.  Those in the massage group recovered their HRV and blood pressure back to baseline/pre-exercise levels.

Practical Application

As noted above, knowing your athletes and when they need a “recovery day” is important for enhancing their development and avoiding overtraining.  One thing that I have noticed in athletes that are in a more sympathetic or under-recovered state is that their skin is a little more tight/taught when I try and move it, compress it, or roll it.  Additionally, there are other changes in the skin and muscle that may be interpreted as an increased sympathetic state:

• Goosebumps when skin rolling techniques or pressure is applied

 

• Inability to relax when pressure is applied (often times going into an upper chest breathing pattern or being very guarded)

 

• Some have suggested that being ticklish is a sign of an overly sympathetic state (especially if it happens on one side of the body and not the other)

 

• Extreme soreness or tenderness with light pressure

From a practical standpoint, when athletes are in this sort of sympathetic state, it is necessary to be patient with your soft tissue therapy and be aware of how the athlete is responding to the treatment.  Being to aggressive in times like this or trying to ”work deep” to quickly (not patiently waiting for their body to make the changes that allow you to work into deeper layers) may lead to a less than desirable result, as it is important to keep in mind that soft tissue therapy can also be thought of as a stress that ones needs to recover from.

Trying to get the athlete to relax and get comfortable is an important goal to have in these times, as these circumstances differ slightly from doing soft tissue therapy for a specific injury or painful movement pattern.  I often think of it as successful if I can get the athlete to nod-off a little bit on the table and get “sleepy”.  Because the parasympathetic nervous system is thought of as the “rest and digest” portion of our autonomic nervous system, eliciting a more rest-full/sleepy state is a good goal to have.  My colleague, physiotherapist Willem Kramer, has stated before that “a little bit of pain can be a gateway into the parasypathetic nervous system”.  What Willem means by this is a little bit of the good pain – you know, the “it hurts so good” stuff – can help to fatigue the athlete or make them a little bit tired (sort of like what happens when you sit in the sun all day and get sleepy).  Willem states that a goal is to try and get the athlete to fall asleep on your table, as he interprets this as helping push them into a parasypathetic state and increasing healing (Willem, is talking about more “treatment” based soft tissue/manual therapy here, where you are dealing with a specific injury).

Acknowledging the recovery aspect of your training program and being aware of your athlete’s physical and mental state is an important part of a well-rounded training program.  Massage therapy is one type of modality that can be used to help improve recovery and increase heart rate variability.

Patrick
patrick@optimumsportsperformance.com

Stress plays an important part in what we do as strength coaches/trainers, as well as in other areas such as physical therapy, chiropractic, and even massage therapy.

Basically, we apply a stressful stimulus to our athletes/clients - either in the form of a training intervention or in the form of a therapeutic modality (soft tissue therapy, manipulation, stretch, etc) and we ask their bodies to respond.  When stress resistance is low, the response is not favorable as the athlete cannot recover properly and their body will not respond the way it needs to.  When stress resistance is high, we can push the envelope a bit more and train at a higher level, knowing that the individual is able to sustain this level of stress, recover from it, and come back for more.

With a sound training and recovery program we can help to enhance stress resistance.  Obviously this is also dependant on what else the athlete has going on in their lives, as this too can play a factor in how they respond to the stresses of training and treatment. 

Unfortuntely, stress resistance is not infinite.  We can’t increase our resistance to stress forever.  Rather, stress resistance tends to modulate depending on what we have going on.

• Your girl friend breaks up with you and you may be feeling depressed, which brings you down and lowers your stress resistance.  Alternatively, perhaps breaking up with your girlfriend is a huge relief and a large amount of stress has now been lifted off your shoulders….stress resistance goes up!!

 

• You start working another shift at work and your stress resistance may decrease because you are now cutting into some of your recovery time and adding more hours in an environment that can be taxing (both physically and psychologically).

 

• You get sick for a few days and stress resistance is impaired.

As coaches and therapists it is important to understand stress and take into account all the factors of your athletes/clients lives.  If you push an athlete with low stress resistance to hard, you may run into a rather large set back in training.

A favorite book of mine was written by stress researcher and Standford professor, Dr. Robert Sapolsky.  Why Zebras Don’t Get Ulcers does an excellent job of explaining stress and its affects on the body in a rather easy (and often times humorus)  manner.  I can’t recommend this book enough.

Additionally, National Geographic did a great piece on stress featuring Dr. Sapolsky called Stress: Portrait of a Killer.  Below, posted in six parts (about an hour), is the entire episode. 

I hope you enjoy them!

Patrick
patrick@optimumsportsperformance.com

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One of the greatest things you can do to become better in your profession (whether it is strength and conditioning, sports coach, personal trainer, physical therapist, etc) is to seek out those whom have more knowledge than you and learn from them.

For as long as I have been working in the health industry, I have always tried to find people to “talk shop with”. I strive to get better every day and by communicating with those that have more experience than me and who are great at what they do is one way in which I have enhanced my knowledge in this field.

This past Saturday was one of those incredible opportunities. This Saturday was the Trevor Brown High School/AZTECH training group running clinic. It was a full day (7am-2pm) of workshops and exhibitions.

Coach Bill Strachan, the director of the AZTECH training group has been training runners for more years than I have been alive. He has worked with some of the best of the best in terms of athletes and coaches in the running and track and field industry. Obviously the man is a tremendous resource and I have had tremendous opportunities over the past 2 years working with him personally and the runners of the AZTECH team. I am truly grateful for these opportunities as they make me better at what I do.

This weekend was no different! I helped out with the event by doing some speaking and question and answer sessions for parents and coaches. However, the real treat for me was the 2 hours I spent outside on the track with Coach Bill videotaping runners and then critiquing their form and technique. We would have the individual run about 50 meters and video tape them from the front, the back and the side. As the person was running, Coach Bill was running the video and he and I would make comments about things we were seeing (or weren’t seeing). It was an amazing opportunity to learn from someone who has really perfected his skills in watching people run. I would comment on and pick up a lot of things, but Coach Bill was a juggernaut. Nothing would get by him and oftentimes he would see something, comment on it and then follow up the comment with “but why is that happening?” Then, he would look longer, have the person run the 50m again, look harder and all of a sudden he would say, “I got it.” Once the person was done getting video taped and we had made our comments, we would talk to the person about what we were seeing and why it was happening. After that, Coach Bill would make some recommendations on how to begin to fix the problem and then have them run the 50m again. It was awesome to see him make corrections and give his technical cues. I learned a ton.

If you are in the industry of strength and conditioning, personal training, physical therapy or sports coaching, I urge you to seek out people like Coach Bill. People who can help make you better at what you do.

I think one of the reasons I love the Olympics so much isn’t just because of the incredible athleticism, but because of the incredible coaching behind the athleticism. Unlike American sports (baseball, basketball, football), where the coach is fired after a season or two if the team doesn’t do well or were strength coaches may take a more short sighted view of sports preparation (IE, we have 12-16 weeks to get ready for this season). Olympic coaches are there for 4 years with the athlete. The are there for the long haul and they understand what the long term goal is. To be able to take an athlete and visualize those 4 years of training leading up to the Olympic games is truly amazing and a real gift.

Patrick