PATRICK WARD'S BLOG

The weather is finally starting to cool down here in Phoenix (at least in the morning), so I decided to go out and do some exercise at the track today (instead of doing my cardio on the spin bike in my bedroom...boring!). Here is what I did:

Dynamic Warm up followed by a short jog

6 laps of tempo runs:
100m of sprints 70-80% intensity (working on form)
100m of walking

Bounding up the stadium stairs
I do skip step bounding because I think that running up the stairs, hitting each step is idiotic. it doesn't replicate any of the joint angles in sprinting and you get a ton of little toe touches on each step. With the skip step bounding, you really get to work on driving off that back leg (hip extension), getting the front hip flexed, and getting a forward trunk lean just as you would during sprinting acceleration. I did 6 reps bounding up and then I always walk down (again, running down just seems weird and nonsensical).

Then I finished with a cooldown jog of 400m.


Anyway, the reason for the title of this entry, was that while I was doing my bounding up the stadium stairs, there was a woman (overweight) walking up and down the stairs for exercise. In fact, she was doing it the entire time I was doing my track work as well. She was working very hard from what I could see, and as I was walking down the stairs, getting my rest after bounding up, she told me "I could never go that fast! But, my goal is really endurance anyway. I just want to get in shape." She then went on to tell me that she started doing this 4 weeks ago. She said the first time out she thought she was going to die. Just making it up the stairs one time had her breathing heavy and her heart rate up. She said that after doing it a few times a week it started to get easier and she started to be able to go a little longer, go a little faster, and do a little more in the amount of time that she was exercising. She said that last week she went on vacation (upstate in AZ somewhere) and she hiked a little bit, but nothing to strenuous. She said the hardest thing for her was to come out here this morning and get started again. She told me that missing a week really sets you back mentally and it is hard to get going and get motivated again, but she forced herself to do it.

The reason I bring this up is because I can't help but think of all the people who never even get started! They never take that first step. They are always waiting for something. Or they are always going to start on "monday" or "next week". The most important thing in achieving any goal is that you get started....NOW! Not tomorrow, not next week, but RIGHT NOW. You have to just get out and do it. Throw yourself into the mix and make it happen! You can't finish if you don't start.

Patrick

Posted by Patrick Ward at 11:52 AM | Permalink | Comments

A lot of trainers (and even some strength and conditioning coaches) seem to shy away from the deadlift.

I understand their allergy, as this CAN be a dangerous lift is the wrong client/athlete is performing it, if the coaching is bad, and if the technique goes out the window.

I have been using the deadlift, and I like to teach it to people (when I feel they are ready) and here are some of the ways I like to use it to make it a little more “fan friendly” and “safe”:

1)Start with a kettle bell between the legs – This is a great version for starting people out with picking things up off the floor. It allows them to get in a solid position with the load between their legs and work on learning the appropriate deadlift pattern. If you don’t have a kettle bell, then place a dumbbell on the floor. With one side of the bell flat on the ground, you will grasp the other side of the bell (fingers grasping under the weight plate) and lift from there.

2)Trap bar deadlift – I am a huge fan of the trap bar as it places people into a more natural posture since the weight is not in front of their body as it would be in a barbell deadlift.

3)Single Leg RDL – Performing this exercise is a really great test in balance and stability. Hold a dumbbell in the opposite arm of the working leg to load yourself and have at it.

4)Barbell Deadlift – I am still a fan of the barbell deadlift, but I think you really have to be specific with what clients/athletes you have perform the lift. You have to be very specific with your technical cuing and you can’t accept any little slips in technique. Once fatigue sets in and things are starting to get hairy, the set is over. I like to use the pick-up and put-down method explained below) to ensure that the individual is always in a good set up position and ready to break the bar from the floor.

Pick-up and Put-down method

The reason I use this technique is because I was always seeing people either:

a)Bouncing the bar of the floor – this is never good, as you are at risk of torquing your back since you have no idea how (or where) that bar will bounce of the ground and you may start to rotate towards once side or the other.

b)Not getting set up enough before breaking the bar from the floor, ending in an awkward or less than desireable pull.

The way the method works, is the person approaches the bar, squats down and gets into a nice tight position. They perform their repetition and then set the bar down and stand up without the bar in hand. They then squat back down, re-grip and perform their next repetition. I like this because it allows them to concentrate and be totally certain they are always getting into a good start position before performing the rep. I even have people start out their single leg deadlifts in the same way. I set up a low step below them and have them lift the dumbbell off the step, set it down and then come back up (unloaded) before repeating the repetition.

This method is a little more tiring, since you are standing up in between each rep. For example, instead of getting 6-8 repetitions at a given weight, I may only get 3-4 repetitions. But, I can live with that, knowing that I am really focusing on getting a solid start position and maintaining technique; rather than just worrying about how many reps I can get (regardless of how it looks). I would rather focus on quality over quantity. I typically wont have people doing more than 4-5 reps on the barbell deadlift anyway, so the rep range is right were I like it to be with this method.

Hopefully this gives everyone some ideas next time they go to deadlift (or teach the deadlift).

Patrick

Posted by Patrick Ward at 9:45 AM | Permalink | Comments

I was at the American Massage Therapy Association’s National Convention last Thursday helping out one of my teachers sell his new product.

The Head Rest Support, is a really awesome invention that makes total sense for any massage therapist, physical therapist, chiropractor, or manual therapist who does a lot of soft tissue work on the neck.

Typically, you would have the client lie supine on the table and have to lift their head, support it, and (oftentimes) wrestle with the table to get yourself in a good position to work their neck. Not only can this limit your ability to work certain muscles but; it also places your wrist in a compromised position (especially if you are doing a lot of neck work).

Now with the Head Rest Support, all you do is drop it right into the head rest and have the client lie their head right on it. This leaves their neck area entirely open, so that you are free to work all the muscles and your hands aren’t bound up against the table (and they can rest comfortably on the head rest support as well!). Another benefit is that, with head rests that can tilt forward and back, you can use the Head Rest Support to place the clients neck into a shortened position, to soften up muscles and work on them in a much easier manner.

Click here to see the product demo.

No more fighting with the table or worrying about straining your wrist. All you do is drop this thing right into the head rest hole and get to work.

If you are a person that does a lot of neck work and really want to take it to the next level, this is the tool for you.

I tried it out for the first time with a few clients and they absolutely loved it. Not only did they say that their massage felt more complete, but they also said that they felt totally comfortable and supported when the head rest was tilted back into extension.

I highly recommend checking out this product if you want to get better results with cervical work, and prevent injuries to your hands or wrists.

Patrick

Posted by Patrick Ward at 8:37 PM | Permalink | Comments

This question pops up all the time in our clinic and I think, given the amount of information out there today (books, morning news, internet, family and friends), people are a little bit overwhelmed. I mean, each one of the sources above is telling them to do something different, eat something different, and change what they are doing.

One of the biggest problems with people and their attempt(s) to loose body fat isn’t so much in what they AREN’T eating, as it is in what the ARE eating.

Whenever someone asks me how they should start a diet or which diet to choose, I ask them to first explain to me what they are eating. Usually the fumble and stumble around to give me something that is sort of concrete and makes sense. This just confirms to me that they have no clue what they are taking in.

They best way (in my opinion at least) to begin a diet is to first understand what you are putting into your body. Start an easy 7 day journal and write down everything you eat and drink through out each day. Then, look at it and see if you notice any patterns or any areas that may need more work. For example, it is common for people to come back and say things like:

“Wow, I don’t eat very many greens at all!”

Or

“I really should be drinking more water.”

Or

“I never realized how much (or little) I eat!”

Before you ever get into the fancy stuff, understand what you are currently doing and begin by making small changes. The goal isn’t to change everything overnight. Instead, the goal is to change a little each week in order to adapt to a healthier lifestyle. Just like changing our posture or gaining strength or putting on muscle mass, these things take time and like anything, if you try and rush the process, the end product typically comes out watered down and doesn’t have much “sticking power.”

Today is Tuesday. Begin your journal today and track it until next Monday…and don’t forget to note the buffalo wings you eat while watching football. ;-)

Patrick

Posted by Patrick Ward at 9:59 AM | Permalink | Comments

This email came to me yesterday, and I thought it was interesting.
Doctor's Secrets


enjoy,

Patrick

Posted by Patrick Ward at 5:58 AM | Permalink | Comments

Treatment of tendinopathy: what works, what does not, and what is on the horizon.

Andres BM, Murrell GA. Clin Orthop Relat Res. 2008 Jul;466(7):1539-54. Epub 2008 Apr 30.


Introduction: Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Recent basic science research suggests little or no inflammation is present in these conditions. Thus, traditional treatment modalities aimed at controlling inflammation such as corticosteroid injections and nonsteroidal antiinflammatory medications (NSAIDS) may not be the most effective options.

Methods: We performed a systematic review of the literature to determine the best treatment options for tendinopathy. We evaluated the effectiveness of NSAIDS, corticosteroid injections, exercise-based physical therapy, physical therapy modalities, shock wave therapy, sclerotherapy, nitric oxide patches, surgery, growth factors, and stem cell treatment. NSAIDS and corticosteroids appear to provide pain relief in the short term, but their effectiveness in the long term has not been demonstrated.

Results: We identified inconsistent results with shock wave therapy and physical therapy modalities such as ultrasound, iontophoresis and low-level laser therapy. Current data support the use of eccentric strengthening protocols, sclerotherapy, and nitric oxide patches, but larger, multicenter trials are needed to confirm the early results with these treatments. Preliminary work with growth factors and stem cells is promising, but further study is required in these fields. Surgery remains the last option due to the morbidity and inconsistent outcomes.

Conclusion: The ideal treatment for tendinopathy remains unclear.

Some of my thoughts: The authors of this study set out to review literature on tendinopathy treatments. Tendinopathy is a broad term that pretty much means injury to the tendon, which creates pain. The word tendinopathy often replaces the term tendonitis, as tendonitis by definition is inflammation of a tendon, however research shows that there is often times no inflammation present with this type of overuse injury, causing the name tendonitis to by inaccurate. The fact that inflammation is often not present in this condition is interesting to note, as a typical therapeutic treatment for these injuries involves ice and other means to try and decrease or prevent inflammation (a quality that may not even be present).

Another term in this category is tendonosis, which is a more chronic type of tendinopathy. Tendonosis is characteristic of degenerative changes in the tendon and deals with damage to the tendon on a cellular level, creating micro tearing of the tendon and pain. Tendonosis is typically a condition that arises when someone has “tendonitis” for an extended period of time; hence it being a “chronic” condition.

Tendons can also go through several changes, including a thickening or hardening (calcification) in relation to overuse and trauma, which potentially creates greater amounts of friction between tendon and bone, leading to greater pain and irritation.

This study was basically looking at a variety of treatment options available to those suffering from some sort of tendinopathy, and concluded that the idea treatment remains unclear. One thing that I think is difficult with these types of studies is that they are only looking at treatment to the tendon itself. Part of the problem is that if we want to make someone “healthy”, we need to determine WHY the tendon is damaged. A lot of this comes back to postural evaluations and why things get overused or have to work harder than they potentially need to in order to produce movement (whether it is movement in the gym, on the playing field/court, or activities of daily living).

Personally, I believe that a lot can be changed with regard to tendon problems by addressing soft tissue abnormalities and postural distortions. One thing that this study looked at was “physical therapy modalities”, which was a junk bag term (in this study) that referred to things like strengthening and stretching, eccentric exercise protocol, cold laser treatment, ultrasound, iontophoresis and transverse fiber friction. The authors made the note that different therapists will choose different therapies, so it is difficult to determine what you will get when you attend physical therapy. The issue with this is that some therapists are more skilled than others and can bring a lot more to the table with regard to soft tissue treatments and exercise-based programs. Again, the problem is also that these modalities are only treating the tendon itself. They are not performing soft tissue work to the muscle belly of the muscle, which attaches into that tendon; moreover, they are not dealing with the overall movement and posture of the individual to try and prevent the injury from coming back. Just because you make someone asymptomatic, does not mean they are out of the woods! You need address the other issues which are creating the problem.

I have spoken to several skilled massage therapists who get great results with tendinopathy issues because they look to treat the overall person, instead of boiling them down to a diagnosis; a problem with modern medicine and the way it is taught and practiced today in this country. Oftentimes, in rehab clinics, people are simply defined by their one single injury diagnosis and the concept that they are a whole person gets thrown out the door. Medical insurance companies are partially to blame for this as therapists wont perform a treatment that doesn’t reimburse them as highly as another modality might. As well, therapists typically don’t have enough time to treat a patient as they need to increase the amount of patients have to see in a day in order to make enough money to keep their clinic running. Both of these problems create very watered down and “low-grade” treatment for the patient. The final problem is that therapists are taught different things in schools depending on where they go. Some schools do not put as much of an emphasis on soft tissue work as other schools do (and definitely not as much emphasis on soft tissue work as schools over seas), causing therapists skill levels to be all over the map with regard to their ability to treat these issues. In a massage therapy setting, with a skilled therapist who understands clinical, orthopedic or medical massage, they have more time to work with clients (often times treatments will be 60-90 minutes long) and they are not restricted by medical insurance companies (although some may take insurance, most run cash only practices), so they are free to perform their treatments as they please, allowing them to not only address the tendon, but the muscle affecting that tendon and the overall posture and structure of the person; leading to a more holistic treatment.

Physical therapists that have the appropriate amount of time to treat patients and do not allow themselves to be restricted by insurance billing have a greater opportunity to help treat patients with tendinopathy than their colleagues who may be working in a facility that sees several patients an hour and doesn’t take the time to address the whole person.

Patrick

Posted by Patrick Ward at 2:00 PM | Permalink | Comments

“How many times a week can I do ABS?”

“What is the best core exercise?”

“Should I do high reps on crunches or low reps with heavy weight?”

I have been seeing a lot of questions about “core” training lately, so I figured I would write a little bit about how I approach/think about it currently.

First, we have to remember that the “core” is a lot more than just the rectus abdominus; and for that reason, it encompasses a lot more than just doing some crunches. In fact, it is this short sighted view of core training that often gets people in trouble, as they think they are doing the best they can in order to protect their back/spine.

In reality, the core consists of the lumbo-pelvic hip complex (so everything attaching to the hip), the lumbar spine, thoracic spine and the abdominals. So basically the muscles of the trunk and pelvis. These muscles are responsible for transferring force from our lower body to our upper body, and to stabilize us as we transfer force to our extremities. From here, it is very easy to see that those who are doing crunches as their only means of core training are missing the bigger picture!

So the question now becomes “How do I train my core?”

The answer to that is pretty loaded, as everyone is individual and everyone has different abilities and needs. What I can tell you is that there are some people who are going to need to start with remedial work down on the ground; such as, planks, bird dogs, kneeling chop and lift patterns, rev. crunches, etc; and some people that can go right into performing more of their core work standing up, such as, med. ball throws, standing chop and lift patterns and exercises which integrate the entire body (IE, Squat and DB press, 1-leg squat to cable row, etc.).

“What about Squats and Deadlifts? Those are all you need for core training!”

This is a common question from some and a common mantra for most. Do squats, deadlifts, cleans and other various multi-joint/“big-bang” exercises train your core? Yes, absolutely they do! BUT (and this is a big but), if you don’t have things working properly from the get go, and if you have compensation patterns, things aren’t going to be working properly! The result is usually injury and a trip to physical therapy where you do…CORE WORK!! But, you are doing the remedial stuff, where you probably should have started in the first place.

What about the remedial exercises? This is a funny one. I have tested people that have done pretty well on basic core exercises (planks, bridges and the like) but when they go to do something on their feet, it doesn’t seem to translate. Something gets lost and the movement breaks down. In her book “Diagnosis and Treatment of Movement Impairment Syndromes”, Shirly Sahrmann states:

“Also, some individuals have normal strength of both the internal and external oblique muscles and yet have poor control when these muscles have to work in a coordinated pattern to prevent rotation of the pelvis. The question of task specificity is applicable to all exercises. Does an exercise performed in one plane (e.g., sagittal plane) or under one set of circumstances (e.g., lying supine) participate appropriately in a different circumstance (i.e. performing diagonal movements or performing exercises while standing erect).”

So now…”How do I train my core?”

Again, this is going to come back to your assessment and determination of where your flaws are. If you are very good at core exercises on the floor, in a very controlled and isolated environment, then you should probably be challenging yourself with exercises which ask you to take that isolated stability and begin to use it in a real situation. I like medicine ball throws and exercises which incorporate the entire body into a coordinated task such as squat and dumbbell press or 1-leg squat and cable row or split squat and cable row. Of course, the squat, deadlift and clean are always great choices for exercise in my book as long as you learn appropriate technique and you earn the right to do those movements (meaning you clean up any poor movement or posture problems before trying to develop maximum strength in these exercises).

A short story/lesson on “earning the right” to perform those lifts, which actually applies to our discussion on core training…

I knew an Olympic weightlifting coach who was very selfish. He wanted nothing more than to have a junior national champion; and not for the athlete’s sake, but for his own, so he could walk around and say, “I have a junior national champion that I train!” One day a young 15 year old kid started training with him. The kid was very skinny and wiry but had a tremendous amount of speed. Since the Olympic lifts where his first introduction to weight training and he didn’t have much in the way of strength (and very little in core strength. More on that in a second.), he quickly learned great technique and relied on his amazing speed to get under the bar. He could clean pretty much anything because he was so fast at getting under it and his technique was good enough that he could get into the position properly. The question was always, “Is this kid going to be able to squat out of the bottom once he gets under this weight”, and then “would he be able to fix the weight overhead (in the snatch) or jerk the weight overhead (in the jerk).” It was the last part there that was his Achilles Heel so to speak. He had absolutely no stability! He would put a weight overhead in the jerk and he would be shaking all over the place and about to totally crumble. He would squat out of the hole after getting under the bar in the clean and his back would be rounding and he could not stabilize the load to save his life, which made the following portion of the lift, the jerk, that much more scarier! I watched as the coach would have the kid take singles in training all night long, the entire time thinking to myself “god, I would be having that kid do lots of basic core training and stability training and practicing the technique in the competitive lifts with much lighter weight.” Honestly, if he did that he would probably be a really competitive lifter today because he would have (a) laid a great base level of fitness and stability and (b) learned to have exceptional technique to go along with his strong foundational core strength and blazing speed. However, his coach had a different plan! “If I just keep pushing the weight on this kid, no matter what it looks like, I will have my junior national champion.” Unfortunately, in the second meet this athlete ever competed in, he walked out for his second snatch, pulled the bar from the floor and in the process of trying to fix the weight overhead (and it was always a process because he had zero stability), he blew out his elbow and never competed again.

Now…Do squats, deadlifts, cleans and snatches build a strong core? YES! Are they the only thing that you need to do? NO. Are they the best starting point for most people? Absolutely not!

In a perfect world, I like to start people with the basics as we learn technique in our main lifts. Once they have mastered the basics, those exercises are integrated into the warm up just as a way to make sure everything is “fine tuned” before we move to the core exercises on our feet which we described and then the heavier loading in the main lifts.

Disclaimer: These are just some of the ideas/opinions I currently hold with regard to the topic of core training. The reason I highlighted the word some is because I am only talking about one aspect of core training (stability) and haven’t talked about the muscles of the pelvis (IE, hip mobility/flexibility) and the muscles of the thoracic spine. That isn’t to say that I may change my mind down the road as I continue to read, learn and develop what I do. In all honestly, these ideas I have shared today are a far cry from what I believed/did a few years ago. The most important thing is to continue to read and develop your ideas so that you can better serve those you work with.

Patrick

Posted by Patrick Ward at 9:45 PM | Permalink | Comments

Impressive anaerobic adaptations in elite karate athletes due to few intensive intermittent sessions added to regular karate training.

Ravier G, Dugué B, Grappe F, Rouillon JD. Scand J Med Sci Sports 2008 Aug 5.

Purpose: The aim of this study was to investigate the effects of adding a high-intensity intermittent session twice a week during a 7-week karate training (KT) on markers of aerobic and anaerobic metabolisms in elite class karate athletes.

Methods: Two groups were studied: a KT group (n=8, age 20.1+/-0.9 years, 70.0+/-8.8 kg) that followed traditional KT, and a group that followed combined traditional karate and a high-intensity intermittent training (HIT group, n=9, age 24.4+/-3.1 years, 67.0+/-7.8 kg). The subjects undertook a supramaximal exercise and a maximal oxygen uptake test before and after the training. Blood lactate, pH and plasma ammonia were determined at rest, immediately at the end of the supramaximal exercise and during the recovery period at 2, 4, 6, 8, 10 and 15 min.

Results: After the training period, no changes occurred in the KT group. However, in the HIT group, the time to exhaustion, MAOD and in the maximal oxygen uptake test were significantly improved by 23.6%, 10.3% and 4.6%, respectively. A clear-cut discrepancy was observed in the time course of lactate and pH in the supramaximal test after the training in the HIT group. We observed a significantly higher peak for lactate and a lower extreme value for pH with a shorter delay of appearance. At the end of the test, the lactate concentration increased significantly (+53.7%) and pH declined significantly, when compared with the values obtained after the same test before the training period. Ammonia was not influenced.

Conclusions: The addition of high-intensity intermittent sessions twice per week during the period of KT induced beneficial physiological adaptations in athletes, allowing improvement in the duration of intense physical exercise before a state of fatigue is reached.

Some thoughts:

Really nothing-new here that we don’t already know or that I haven’t already talked about in past entries. I thought that it would be nice to throw this up in the blog since there are so many people these days that train in MMA or other types of “combat sports”. They always seem to be coming onto the forum and asking how they should train, what they should be doing, or IF they should be training at all! Obviously, doing the whole long slow endurance thing that boxers used to do is now a thing of the past. It would be a waste of time to throw on the old running suit and head out for a 5 or 6 mile run 3x’s a week, as we now know that this type of training can deter from out anaerobic endurance and power (not good if we want to avoid getting kicked in the head!). Besides, interval work has been shown to concomitantly increase both anaerobic and aerobic abilities at the same time. Even with as little frequency as twice a week, as used in this study, the beneficial properties were evident.

Hope this gives you some ideas when you head to the gym after your Brazilian Jiu-Jitsu session!

Patrick

Posted by Patrick Ward at 5:45 PM | Permalink | Comments