People have been asking why I haven’t blogged as much recently. I actually average about two blog articles a month which I feel is sufficient as I would rather put more thought into a few blogs instead of just writing filler stuff every day or every week.

To tell you the honest truth, the more I read the more I realize I don’t know – and I have been reading a lot lately. The body is extremely complex, and I often find myself sitting here trying to wrap my head around all the potential ramifications of my training and/or treatments.

These days the profession seems to be striving towards making things as simple as can be. Now, I am all for simplicity and K.I.S.S. when talking to clients and athletes or even when trying to draw up a training program and not getting too bogged down with every little thing. That being said, in the back of my mind (and hopefully yours) I try and consider the fact that things really aren’t that simple. In fact, they are very complicated and sometimes when we distill things down to such simplicity we lose sight of this fact.

There are many systems in the body all working together to create balance or homeostasis. Things like the central nervous system, autonomic nervous system, immune system, metabolic system, digestive system, endocrine system, musculo-skeletal system, cardio-pulmonary system, etc. In previous interviews I have said that, “in a crude way, the nervous system rules the roost”, and I still believe this to be true as when things – muscles, organs, etc – are deinnervated they don’t work. But, we should also keep in mind that all of these systems do have their own time frames to adapt and react to our training or treatment stimuli/stress. Additionally, they all may adapt in a different manner depending on what we are doing. In order to embrace this complexity you need to try and step outside of your box and attempt to oversee the complete person….this can be difficult!

For example, if all you do is focus on the musculo-skeletal aspects of training you may miss out on some key endocrine system or metabolic system changes that you can make in your client (changes that the client may actually need to succeed and progress in their training program). On the flip side, if all you did was focus on the endocrine and hormonal adaptations/ramifications of your training programs you may be destroying your clients musculo-skeletal health or, if you are really doing things foolishly and push to hard and to frequently with loads of metabolic work you may compromise their immune function.

I believe there is a delicate balance with all of these things and being a good coach means trying to sit down and figure out what you are actually attemping to produce with your training stimulus.

As I said, it can get complicated and I don’t have all the answers (or even some of the answers) but I am sitting here trying really hard to figure out how to make all of these pieces work together. Hopefully one day I will have a better grasp of it all and of course, as I dig further down this rabbit hole I will be sure to share some of my ideas along the way in future blog articles (averaging about two a month).

Most everyone that reads this blog knows that I am not a fan of Crossfit. Now, there are some things that I do find intriguing about Crossfit – high levels of fitness/work capacity, the ability to repeat strength challenges with minimal rest, and some of the overall adaptations that these people get when training in this manner – however, when I look at what takes place on some of the youtube videos it makes me cringe:

• Horrible form
• Olympic lifting for high reps
• Extremely intense/stressfull workouts (workout of the day) multiple days a week without any understanding of how to modulate training intensity
• Did I mention horrible form?

Anyway, that being said, if there were a way to train for the Crossfit Games (the sport of fitness) I think that James Fitzgerald of Optimum Performance Training has nailed it down. James won the first ever Crossfit Games and made a lot of the training mistakes that many still make today. The kicker though is that James is also one of the smartest exercise physiology people I know and saw the error of his ways and decided to figure out how to make training, preparing, and planning for a chaotic, ever changing, moving target environment like the Crossfit Games more sensible (without absolutely killing people). Going along with this process James is constantly developing testing methods and protocols as a means of “talent IDing” individuals to determine what qualities give you the potential to excel in the sport of fitness.

Last week James laid out some of his strength and conditioning principles in THIS article in his blog – scroll down below the picture and start reading where it says A Guide To Good Strength and Conditioning Principles.

If you are a frequent reader of this blog you may find a lot of James’ message very congruent with things that I have discussed in the past regarding aerobic work, what he calls the CP Battery (which I have referred to as alactic-aerobic training), and some basic understanding of how to prepare someone for a bigger work capacity and fitness output.

I think you’ll enjoy the article and what it has to offer with regard to the principles and tenets James operates under. I have had the pleasure of sitting and talking shop with James and his assistant strength coach Max El-Hag on several occasions and find their ideas on training to be top notch and very well thought out. If you train Crossfit or you train people for Crossfit I would certainly pay attention to what they are doing or check out some of the certification courses they offer because for that fitness market I don’t really  know if anyone else is doing it better than these guys.

One of the hardest thing as a strength coach, personal trainer, physical therapist, chiropractor, or athletic trainer is controlling what happens when the clients are not at your facility and under your watchful eye.

The Ecosystem of the Body

The body is like any other ecosystem in nature – it is influenced by and has to adapt to many different forms of change and stress. Like a nice, lush river, if we pollute the water, the fish and vegetation begin to die. Then, everything that relies on the water for hydration, the vegetation and the animals that rely on that vegetation, and the animals that rely on the fish for food are all negatively impacted.

Many things influence the ecosystem of the body:

• Competition
• Training
• Practice
• Therapy
• Travel
• Nutrition
• Hydration
• Lifestyle
• Sleep
• Life stress (financial, social, family, relationships, etc)

In a very general sense we can group these stressors into specific and non-specific categories.

Specific and Non-Specific Stressors

Specific stressors are those that we (as coaches, trainers, therapists, etc) have control over. Things like competition, practice, training, and therapy. We directly apply stress to the individuals body in these situations and hope to see a favorable change.

Non-specific stressors are those that we have much less control over – Things like life stress, sleep, nutrition, relationships, lifestyle, etc.

It goes without saying that the more we can control their non-specific stressors the better results we can get – in either training or therapy. While we may have less control over their non-specific stressors we may still be able to influence them or at the very least educate the athletes/clients about what they should be doing, and the direct impact that what they do outside of the training environment will have on their results. Of course, as they say, “you can lead a horse to water but you cannot make him drink”. Some athletes are just going to be non-compliant.

I tend look at both specific and non-specific stressors as a bank account.

Stress Account

In your bank you have a checking account and a savings account. You cannot withdraw maximally from both accounts without going into the red and ending up broke. In life we have our stress accounts, and similar to our checking and savings accounts, we cannot withdraw maximally from our specific and non-specific stress accounts without going into the red and ending up broken.

The idea is to attempt to balance these two accounts and not hack away at the body’s ability to adapt by negatively impacting its stress resistance.

If you are withdrawing a significant amount from your non-specific stress account then you must alter your specific stress account – less time in practice, decreased volume/intensity, etc. – to reflect this. If you simply attempt to train at a high amount of volume, intensity, and frequency (like you normally would) during this period of compromised stress resistance and adaptation you run the risk of getting a negative result from your training.

If you are doing all the right things with regard to maintaining your non-specific stress account – eating well, hydrating properly, getting restful sleep, have good time management, keep a healthy lifestyle, and have good coping strategies for the other stress in your life – then you can go ahead and withdraw more maximally from your specific account by training harder and/or more frequently because your body has the ability to focus all of its efforts on resisting that specific stress and allowing you to optimally adapt.

Being Honest About How Much You Have In The Bank

What sets some of the best athletes apart from others is their ability to do all the little things right. It isn’t easy trying to manage your stress accounts, and sometimes that non-specific account can plummet. The key is to recognize when this is happening and make the necessary adjustments to training.

I understand that most athletes want to go hard all the time and feel that if they aren’t lying on the floor in a puddle of sweat after the workout, then they got nothing out of it. However, it is more important to find the necessary amount of training you need in order to get the result you want without having to trash the body and constantly beat it down. It is critical to understand the stress accounts, be honest with yourself (and your coach), and understand that training is a long process. Keeping programs flexible to allow for changes when things in life pop up is essential.

I’d love to hear your thoughts on ‘reset’ therapies and window in which we have to affect the baseline pattern (ie how long, and how much, and how much step back do we expect) and expected rate of recovery in the ‘normal’ case. Let’s say for shoulder impingement or shoulder instability.
-Eric

Eric,

Thanks for the great question! For anyone that is not familiar with the term “re-set”, what Eric is referring to is the idea that when we are working with some individuals (mainly those in pain) you are trying to look for some sort of way to “re-set” their brain in order to allow them to progress forward with their rehabilitation and get back to being active and moving pain free.

Let’s start there…

When I think about a “re-set” I think about you, as the clinician or therapist, doing something to the client. This may come in the form of joint mobilizations, massage/soft tissue therapies, dry needling, etc. My friend and colleague Charlie Weingroff wrote a great blog article on manual therapy methods as a “re-set” in his blog – Putting Manual Therapy Into Perspective.

It has always been my thought processes that manual therapy (in my case soft tissue therapy mainly) opens the window. You place your hands on an individual’s skin, interact with their brain, and in some way work to change their perception about what it is they are feeling or experiencing. Basically, in my mind, you are attempting to use touch (which can be very powerful) to modulate the threat response. Once the window is open you have an opportunity to wedge a few pieces of wood under there or maybe a few books and buy yourself sometime to change their perception even more – most likely  with movement or more active therapies. If you simply open the window and then do nothing the window will just close eventually and the person will be back where they were before. This is where chiropractors who just crack their patient’s spine and then send them on their way leave a really bad taste in my mouth. The patient becomes reliant on the manipulation and has to come back frequently because they have not been taught how to build back their own confidence in their body when they window was open.

This is essentially the “re-set”. Open the window in some way, keeping in mind that not all therapies will work for all people (therapy is more “read and react” where you do something, see what the effect was, and then go from there), and then try and keep it open with some form of movement therapy to help put the patient/client in control of their own healing. This, I believe, is also where we can see some benefit from the Selective Functional Movement Assessment (SFMA) concept of first trying to work on the dysfunctional-nonpainful and/or functional-nonpainful patterns. A 2010 paper by Boudrea et al., actually discussed the concept of novel movement stimuli and its role in musculoskeletal pain disorders. One of the key points that stood out to me in the paper was that novel movement stimuli could be useful in enhancing neuroplastic changes in the brain as the patient feels that the new movement they are being taught is beneficial. In essence, the patient’s brain makes favorable changes with regard to perception of pain when movement that is new to them is emphasized. With the SFMA, when we exercises in patterns that are non-painful but dysfunctional we are basically choosing movements that don’t cause a threat response from the patient (because they aren’t movements they perceive to be painful) and because the pattern is considered to be “dysfunctional” any movement we choose in that pattern would challenge the patient as “novel stimuli”. Even with the functional-nonpainful patterns, I believe we can make large improvements in the client’s perception of pain because we can exercise in those patterns that are pain free and tell the brain “Hey, I am not that messed up! There are things I can actually do that don’t hurt!”

Just as I emphasized the power of touch above I will also emphasize that movement is just as powerful.

So, to re-cap, open the window, try and keep the window open by choosing appropriate movements, encourage the patient/client to take control of their own healing, and continually find movements that challenge the client’s brain to turn down the threat response. Those are my thoughts on the “re-set”.

How long, how much…Normal Cases?

It is hard to say anything about “normal” cases since each person is individual and each person adapts at their own rate. Additionally, this rate of adaptation is dependent on a number of variables such as their stress levels, which I wrote about in a previous blog article, and their general health. Let’s face it, people are becoming unhealthier and more unfit and not every problem that people have will be solved by some soft tissue work and exercise. People may need nutritional intervention, lifestyle intervention, better sleep, stress management, psychological intervention, etc. You can do all the great therapy you want but if the person is a walking inflammation soup on the inside it is either going to take really long to get the result you want or it is not going to happen at all. If you want really fast results you need to try and control as many variables as possible (which may not always be an option).

Being very general, I like to say that you should see some sort of result after one session and hopefully some more dramatic results after 3 sessions – people should know that you are the guy that can help them after that first session. Sometimes, depending on the individual and how proactive they are with the things I mentioned in the previous paragraph, I can make some really fast changes (like playing 3-days after having a muscle strain or making changes in a pain that someone has had for a very long time only a few sessions) but this is not always the case because people have a lot of things going on in their lives and, again, I can’t control all of those variables. My goal is always to attempt to restore the person back to normal function in the fastest time possible without compromising their health. That being said, there are three people I tend to see:

1. Those that I can help and seem to have the answers for.

2. Those that I can’t completely help but I can help manage their issue better than others might (meaning that they don’t want to take drugs or get a surgery but I can help “keep them out of the red”, so to speak).

3. Those that I can’t help because either I am not the guy for their particular problem, they have some other stuff going on that warrants medical attention, or they need to be in the care of a medical professional to help treat their problem.

So, again, being very general, if I can open the window and pick the right exercises I expect things to happen pretty quickly. I am very hard on myself in terms of how things progress with someone so if I am not seeing the changes that I want in the time that I expect to see them I am immediately thinking about what I am missing or what I need to consider further.

Hope that helps answer your questions!

Reference

Boudreau SA, Farina D, Fall D. The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders. Manual Therapy 2010; 15: 410-414.

Individuality in training is something that gets discussed frequently with some feeling that it is absolutely necessary and others feeling that a general program can pretty much apply to everyone no matter who they are or what their sport is. I tend to believe more in the former than the latter as the way that an athlete responds to an exercise program is highly individual.

Similar to soft tissue therapy, and as I discussed a few weeks ago regarding recovery and the difference between athletes and general population clients, no two people respond the same way to the stressors you place upon them. For example, in the training environment you may have 10 athletes all training on the same program. For three of these athletes the program may be ideal for them to make progress, for another three of them it may be enough of a stimulus/stress to allow them to maintain their current level of fitness, and for the other four of them it might be too much and push them towards a state of overreaching/overtraining and breakdown.

Two studies from Beaven et al. (2008), highlighted this sort of individuality to training stresses.

Individual differences to the same training program

The first thing this group of researcher did was establish the testosterone and cortisol ratios in response to four different strength training protocols in 23 elite rugby athletes (only 15 completed all four protocols).

The four training protocols were as follows:

• 4×10 @ 70% of 1RM; RI = 2min
• 3×5 @ 85% of 1RM; RI = 3min
• 5×15 @ 55% of 1RM; RI = 1min
• 3×5 @ 40% of 1RM (performed with max speed); RI = 3min

The athletes in the program performed each one of the training protocols once during the study, in a random order, separated by at least 2-days. The same four exercises were used on all of the training days – bench, squat, leg press, and seated row.

What was interesting about the results was that when the athletes were looked at as one homogenous group testosterone did not change as a result of any of the training protocols and cortisol showed a significant decline; however, when the athletes were looked at as individuals there was an individual hormonal response to each of the training protocols. This is important information as it helps us better understand that each athlete will respond to a training program in a different fashion and what we find to be optimal for one athlete may not be great for another.

Applying specific training protocols

After this initial study the same research group, now knowing that every athlete had a different response to each training protocol, decided to take it a bit deeper and see what the result would be if the athletes were asked to perform a block of training using the protocol that provided them the greatest testosterone response versus a block of training that produced their minimum testosterone response.

This study was carried out on 16 amateur rugby players. The athletes first performed an examination phase of training where their testosterone was measured following training during each of the four protocols:

• 4×10 @ 70% of 1RM; RI = 2min
• 3×5 @ 85% of 1RM; RI = 3min
• 5×15 @ 55% of 1RM; RI = 1min
• 3×5 @ 40% of 1RM (performed with max speed); RI = 3min

The exercises used during each of the workouts were bench press, squat, leg press, and cable row. The athletes performed each of the above workout protocols twice during the examination phase, in a random order, with at least two days separating each workout.

Upon completion of the examination period the workouts, when averaged over the two repeated sessions, the protocols which produced the maximum and minimum testosterone where selected for each individual athlete.

The subjects were split into two groups. One group performed a three week block of training where they completed the protocol which elicited their maximum testosterone twice per week while the other group performed a three week block of training where they completed the protocol which elicited their minimum testosterone twice per week. After this block of training there was a five day unloading period followed by another three week block where the subjects in each group switched – those performing their maximum testosterone protocol twice per week were now asked to perform their minimum testosterone protocol twice per week and vice versa.

Following the examination period twelve of the sixteen athletes showed significant consistency in their response to the protocol which produced their maximum and minimum testosterone. The other four athletes showed inconsistent results in their stimulation of maximum and minimum testosterone during the examination period.

When performing their maximum testosterone protocols (which were different for each athlete), regardless of which group they were in and the order in which their three week blocks were set up, twelve of the sixteen athletes saw a significant increase in their strength and bodyweight. When performing their minimum testosterone protocols, again regardless of the group they were in, twelve of the sixteen subjects saw significant losses of 1RM strength and body weight.

Interestingly, the four athletes (two in each group) who did not see consistent results during the experimental training blocks (sometimes showing no change and other times showing increases in strength and bodyweight regardless of the protocol used) were also the athletes who showed inconsistent results two their maximum and minimum testosterone protocols in the experimental phase of the study.

Final thoughts

Each individual has a different response to the various treatment or training stressors we impose upon them. As a strength coach it is essential that we understand this and strive to develop training programs that are specific to the individual to produce the greatest training effect. As these studies highlight, one training protocol (with variations in training volume, intensity, and rep ranges) may be optimal for eliciting the maximum results from one athlete while the same training protocol may elicit negative results from another.

Strive for individuality as best you can. The human body is not a protocol. Training, like soft tissue therapy, is not black and white. It is not cookie cutter. Each individual presents with a different level of training, fitness, stress resistance, and recovery capabilities, thus each requires a different dose of training to see improvements.

References

Beaven CM, et al. Salivary testosterone and cortisol responses in professional rugby players after four resistance exercise protocols. J Strength Cond Res 2008; 22(2): 427-432.

Beaven CM, et al. Significant strength gains observed in rugby players after specific resistance exercise protocols based on individual salivary testosterone responses. Journal of Strength Cond Res 2008; 22(2): 419-425.