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The 10,000 Hour Rule & Personal Training


In 2005, a research team led by Neil Charness, a psychologist from Florida State University, published the results of a decade long investigation of the practice habits of chess players. The study investigated 400 players from around the World, in an effort to understand why some were better than others. Each player was given a form to fill out that requested a detailed history of the player’s chess instruction. The respondents were asked to re-create a time line of their development as chess players: At what age did they start? What type of training did they receive at each year? How many tournaments did they play? Were they coached? How much? And so on.
Previous studies had shown it takes around ten years, at minimum to become a grand master (As the psychologist K. Anders Ericsson likes to point out, even prodigies like Bobby Fisher managed to fit in ten years of playing before they achieved international recognition: He just started his accumulation earlier than most).
The idea that excellence at performing a complex task requires a critical minimum level of practice surfaces again and again in studies of expertise. In fact, researchers have actually come to an agreement that the magic number appears to be 10,000 hours of practice. This notion has been around since the 1970’s however it was popularized by Malcolm Gladwell in his bestselling novel ‘Outliners’ in 2008. Gladwell pointed to this rule that great accomplishment requires more than natural talent, but instead about being in the right place (in terms of mentors) at the right time to accumulate a massive amount of practice.
The 10,000 hour rule is applicable to any skill whether it is playing a guitar, becoming a great accountant, becoming a top golfer or even a personal trainer.

The personal training qualification consists of a two week course from 9am-5pm on Monday to Friday (for two weeks). Thus totaling 80 hours of practice before they receive their qualification and are legally qualified to train the general public. However the flaw within this course is that students are from varying backgrounds of experience. Some may have trained for over 5 years with a good mentor and have a sound baseline knowledge. Others may have trained for 5 years with a poor mentor (and have a very poor knowledge, contrary to their belief) and some may not have set foot in a gym. Yet they all will have the same qualification at the end of the 14 day period.

Thus some of the students may have as many as 9920 hours left of good practice and feedback left before mastery is achieved.
I myself started training at 15 years old. I have made every mistake under the sun. I have made poor decisions in situations and I have made good decisions in situations. I have competed as a fitness model and had both good and bad experiences also but most importantly I have gained a lot of knowledge from all my experiences. My point being is that the knowledge I have acquired today is from years of practice, contemplation, self reflection, internal/external feedback and reading. If you want to excel within this industry you must live and breathe what you do – simply treating it as a 9-5 job will not get you to the highest level within the industry, nor will it in any industry for that matter!

Let’s take a look at masters within other industries. Bill Gates? He attended one of the first high schools to install a computer and allow students unsupervised access – making him one of the first in his generation to build up thousands of hours of practice on this technology.
Mozart? His father was fanatical about practicing – by the time Mozart was touring Europe as a prodigy, he had practiced more than twice the number of hours than similarly aged contemporaries had acquired.

Take home point… There is no short cut on the road to mastery, embrace the process.

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Mastering Movement

Let’s set things straight from the offset, there is no such thing as the ‘perfect program’. A program can never universally work for every trainee. Specific movements will not suit every individual’s current training ability and thus must be modified so that the exercise is executed corrected and injury is avoided. This modification of the movement is known as a regression to the movement pattern.

There are many ways to regress a movement;
1. Transition from an unstable environment to a stable one
2. Lower the intensity
3. Move the load closer to your center of mass
4. Increase the points of stability
5. Decrease the range of motion/deficit (perhaps further mobility work is needed along the chain to free up movement. For instance thoracic stiffness may limit a trainee’s ability for over head movement).

Coaches must develop a sound awareness of a trainee’s body position in space as it is essential for maintaining proper form. Video analysis is a fantastic way of getting feedback on your movement kinematics and assessing weaknesses along the chain.

“Be prepared to take one step backwards to move two steps forward”, you simply can not have an ego when mastering a movement. Regressing exercises should never be viewed as weakness but as part of the mastery process.


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Breaking Training Plateaus Part 2


In the first installment of ‘Breaking Training Plateaus’ I spoke about monotonous training and lack of recovery (over training) as being the basis for hitting plateaus. Now let’s look a little deeper at how we can break through these plateaus.

1. Track Your Workouts

Progressive overload can be described as the gradual increase of stress placed upon the body during resistance training. Progressive overload is an important part of muscle hypertrophy process – many bodybuilders have successfully based their training ethos on it for a very long time.

In the real World however the problem is that trainee’s fail to accurately log their training data and fail to utilize the principles of progressive overload effectively. How many people track their workouts? By tracking I don’t mean have a workout written up that you follow, I mean the real boring stuff – logging each set, reps completed, load lifted and time under tension. How many of you do this month-by-month, week-by-week and day in day out? Yes you will end up with hundreds if not thousands of pages of data, but that data is extremely useful.

How many people go into the gym and lift the same weight for months on end or even decrease the load because they have potentially forgotten what they lifted the week before? Training log’s are a very simple, yet effective solution.

Log your lifts, progress them and get stronger.

2. Incorporate Overload Mechanisms

The human body is a stress organism, it is designed to adapt to a particular stress response and become more efficient at dealing with it. If a muscle is constantly placed under the same stimuli it has no need to adapt (muscle hypertrophy).

Thus, trainees and body builders are constantly looking for stimuli to induce overload.
There are many protocols used within resistance training to ramp up the intensity of an exercise.

Here is my top 5:

A. Giant sets
B. Tri sets
C. Rest pauses
D. Drop sets
E. Pre/Post exhaust training

3. Sleep Quality Matters!

Since overreaching trainee’s may display objective signs of moderate sleep disturbance and a higher prevalence of infections, trainee’s looking to improve sleep quantity and quality should: identify and target an ideal amount of sleep and form good pre-sleep  habits. Sleep is a necessity as opposed to a luxury when it comes to recovery. Remember the training stimulus means nothing if you can’t recover!

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A Brief Analogy For Gauging Intensity

The best analogy I have heard to date regarding training intensity is by Tom Platz. I can’t find the actual quote but it goes something like this; Training intensity can be viewed as much the same as rev’s of an engine. Where the real magic happens is beyond the red line… most people never go there, most people can not push it that far! Quite often people look to supplements, “advanced nutritional strategies” etc as being the variables that need to be manipulated to break through their training plateau’s. However in reality their lack of progress is due to a variable much closer to home… They simply do not train with enough intensity to stimulate new adaptations!

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If You’re Not Tracking, You’re Slacking (Workouts)

If you’re currently not logging and tracking a weekly training journal here is exactly why you should be!

Progressive overload can be described as the gradual increase of stress placed upon the body during resistance training. Progressive overload is an important part of muscle hypertrophy process – many bodybuilders have successfully based their training ethos on it for a very long time.

In the real World however the problem is that trainee’s fail to accurately log their training data and fail to utilize the principles of progressive overload effectively. How many people track their workouts? By tracking I don’t mean have a workout written up that you follow, I mean the real boring stuff – logging each set, reps completed, load lifted and time under tension. How many of you do this month-by-month, week-by-week and day in day out? Yes you will end up with hundreds if not thousands of pages of data, but that data is extremely useful.

How many people go into the gym and lift the same weight for months on end or even decrease the load because they have potentially forgotten what they lifted the week before? Never mind remembering the total volume performed over the week or course of the meso-cycle. Training log’s are a very simple, yet extremely effective.

Log your lifts, progress them and get stronger.

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What The Squat Are You Doing!

After sharing my blog post ‘3 Reasons Why You Should Fire Your Personal Trainer’ I was inundated with inbox messages asking about coaching the squat and personal trainer’s not correcting poor squatting form. This morning whilst revising some movement material I stumbled across this piece of text by Mike Boyle. It sums up perfectly how personal trainers/strength coaches should approach coaching the squat;

“To examine learning to squat, we must first examine the psychology of lifting weights. There is a macho aspect, particularly with young men, that makes learning exercises very difficult. No one wants to go through the motions with an unloaded bar to groove the motor pattern or develop mobility. Clients want to lift. This presents glaring challenges when teaching the squat. In the words of Gray Cook, what we are often doing is “adding strength to dysfunction”.

In other words if you can not squat properly then do not  squat. Instead address your mobility issues and progress into squatting with an unloaded bar once the you are  mobile enough to execute the movement correctly. It all sounds like common sense yet you don’t have to look too far to see a personal trainer allowing a client to squat incorrectly!

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Breaking Training Plateaus

Plateaus are reached during the process of muscle hypertrophy for

two main reasons;

1. Monotonous training – Training program design, exercise variation, exercise sequence, correct selection of training load and optimal selection of the training load/reps relationship are all key variables involved in muscle hypertrophy. The problem with 90% of trainee’s is that their program is poorly designed in the first place with little consideration being paid to the variables I have previously mentioned.

2. Lack of recovery (Overtraining) – Whilst everyone is aware of the importance of the training stimulus itself, it seems that people often forget to pay equal attention to their recovery strategies. If are not including adequate recovery within your program design, you are not going to progress – it is that simple!

Overtraining is the key to continued progression, however you can not keep overtraining forever. The body will simply stop responding, injuries will creep, your immune system may drop (onset of cold/flu etc.) and your strength may plummet! Not to mention the psychological aspects of overtraining such as burn out, decreased mood or even depression like symptoms etc.

Be prepared to take 1 step back to move two steps forward!
What I am referring to is ‘de-loading’. A ‘de-load week’ is a planned reduction in exercise volume and/or intensity following a period of overtraining. Generally I prefer to incorporate a de-load week after 3-4 weeks of training however de-load frequency is dependent your level of conditioning and the nature of your program design itself. Not every part of your body recovers at the same pace. You can restore energy substrates faster than you can remodel tissue. Muscles repair themselves faster than connective tissues and consideration must also be paid to your central nervous system. With full recovery comes super-compensation, with super-compensation comes greater gains in size, strength and higher levels of conditioning. This is why a lot of power lifters will describe how they hit PRs right after a de-loading phase. De-loading is also applied to the programming of all elite athletes macro-cycles. For example sprinters, swimmers, cyclist’s etc. will all de-load 1 week prior to competition to enable the athlete to ‘peak’ for their event.

For intermediate level trainee’s the best way to implement a de-load week is a volume-reduction approach (Reducing the training load by 30% whilst simultaneously reducing volume during this phase is also an option). Dropping total reps by about 40% every fourth week. Thus, if an intermediate lifter is training for three weeks with 25 reps per exercise — five sets of five reps, say — They would cut back to around 15 reps per exercise in Week 4.

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Core Training Part 2: Where You Are Going Wrong!

Following on from my initial core training blog post last week I said I would write another blog addressing rotational training, here it is…

“During most daily activities, the primary role of the abdominal muscles is to provide isometric support and limit the degree of rotation of the trunk… A large percentage of lower back problems occur because the abdominal muscles are not maintaining tight enough control over the rotation between the pelvic and the spine at the L5-S1 level.”

Sahrmann, S. (2002). In Diagnosis and Treatment of Movement Impairment Syndrones.

The common flaw in core training programming is that coaches, trainee’s and athletes place an emphasis on lumbar rotation. This is potentially injurious and will require us to look at the function of the rotatory core from another angle to understand it. As opposed to viewing training the abdominals as flexors and rotators of the trunk (which they have the capacity to do), they should be viewed as anti-rotators and anti-flexors of the trunk (Sahrmann, 2002). The thoracic spine, not the lumbar spine, should be the site for the greatest amount of rotation of the trunk (Sahrmann, 2002). The overall range of lumbar rotation is calculated to be approximately thirteen degrees. The rotation between each segment from T10 to L5 is two degrees. The greatest rotational range is between L5 and S1, which is five degrees (Sahrmann, 2002).

In a nutshell what Sahrmann is saying, is that rotation of the lumbar spine is more dangerous than beneficial, and rotation of the pelvis and lower extremities to one side while the trunk remains stable or is rotated to the other side is particularly dangerous. Instead we should focus on both internal/external hip mobility and core stabilization as opposed to trying to mobilize the core unit.

Exercises to consider;

Landmine twists (aim to produce the greatest arc with no movement of the core)
TRX inverted rows (begin with palms supinated and finish pronated)
Single arm dumbbell snatch
Single leg squats
Single leg deadlifts
Kettle bell valslide lunges (load the hand opposite to the working leg)

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Core Training Part 1: A Must Read

Firstly I would like to start by saying the primary function of the anterior core is not flexion. The primary function of the anterior core is in fact the prevention of extension. In today’s modern World everyone wants a six pack and naturally you may turn to those who have one to seek advice. However this is much the same as asking Simon Cowell to be your dentist because he has a nice pair of teeth! Poorly designed ‘ab programs’ sold in todays fitness industry focus primarily flexion with little consideration to the actual function of the core unit. They will leave you with a hole in your wallet and a dysfunctional core! You only have to look to leading researcher and educator Stuart McGill who is at the forefront of core training research and education – McGill’s method for causing disk damage in a lab setting is repeated abdominal flexion!

Everyone needs a strong core, exercises such as ab wheel roll-outs, which strengthen your anterior core by resisting extension are the gold standard.
That being said ab wheel roll-outs are an advanced exercise and more often than not, clients do not have a strong enough core to perform them correctly. Thus we will begin with a series of core training phases.

Phase I

• Front Planks

Phase II

• Stability-Ball Roll-Outs
• (The weaker the individual the bigger the ball)

Phase III

• The Ab-Dolly

Phase IV

• The Ab-Wheel

Phase V

• Valslide or Slideboard Roll-Outs

Phase VI

• TRX Roll-Outs

Glute Activation & The Core

Firstly we must examine the most common compensation patterns when someone attempts to train the core. Substituting lumbar extension for hip extension is the main culprit. McGill describes this as ‘gluteal amnesia’ – in other words are the glutes weak because the psoas is tight, or is the psoas tight because the glutes are weak? Either way the solution to the problem will be to strengthen the glutes.
In order to address poor glute function the client needs to be able to set their core and fire their glutes. Potentially depending upon the individual client they may need to reeducate the neuromuscular system (relearn the correct firing pattern). Initially this is best done in the quadruped position to eliminate hamstring contraction.
Mike Boyle (Mike Boyle Strength And Conditioning) suggests that lack of glute activation is the primary source of all lower back pain and in my experience as a coach I would certainly agree. Any client that I have come across in my time as a personal trainer who has suffered from lower back pain has almost always struggled to fire their glutes properly.
Thus I highly recommend performing glute activation pre-core training and not only that but practicing it daily. In our modern day culture where we spend most of the day sitting on our ass it is easy to see why we are so poor at activating our glutes.

Glute activation exercises to consider;

• X-band walks
• Quadruped hip extension
• Prone bridging
• Side lying hip abduction

Take Home Point

Whilst there is a place for a limited amount of flexion within your abdominal training, there is a much bigger picture to consider – core functionality. Be smart with your programming!

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3 Reasons Why You Should Fire Your Personal Trainer

1. Lack Of Preparation

Does your personal trainer ‘smash’ you every session? Ok so they give you a silly amount of training volume (sets/reps) combined with low rest periods and you wake up sore the next day? Surely this means they are a great coach right? Wrong…
Lack of program design is the most common trait of poor trainers. If they haven’t got a workout in front of them that has been pre-programed, the odds are they are making it up as they go along.

2. They Don’t Correct Your Form

A sound understanding of biomechanics is of the upmost importance to any good coach. If you are not moving correctly then you are not getting the most out of your training. Heck you probably are not even recruiting the target muscle properly if your firing sequence/movement pattern is wrong.
If you walk into most commercial gyms you wont have to look too far before you come across a personal trainer who is sat watching their client squat or deadlift with poor form. Most of the time these clients are not even flexible enough to execute these particular exercises through the full range of motion yet the trainer chooses to ignore this. Potentially they don’t care or on the other hand they haven’t a clue how to coach the squat or dead lift correctly in the first place. Continue on this path and you are destined for a chronic or acute injury.

3. Move The Weight From A To B

Total time under tension (TUT) is one of the main variables we must take into consideration when designing a training program. If muscle hypertrophy is your goal you want to place the target muscle under at least 40 seconds of tension per set. Although your personal trainer probably hasn’t told you what TUT is nor have they shown you how to create it. Have you made much progress within the last 6 months? Be honest? Odds are the move it from A to B approach is why you are going nowhere fast.

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Body Transformations… How Can You Fulfil Your Potential?

If you want to make significant improvements in the way you look and feel then there are 3 main areas you need to address;

1. Mind-set
2. Training
3. Nutrition

Training and nutrition are the two variables that everyone is aware of, however if your mind-set is not right you are certainly not going to make the progress that you wish to.
As a coach the main issue I have come across with clients who fail to succeed is that they do not take change seriously. Changing your lifestyle pattern is one of the most difficult yet rewarding things that you can do. The problem being is that people are unwilling to commit to the process. The trainee must be willing to make sacrifices and instead of seeing the process as a chore – they must learn to enjoy it and embrace the process.

Here are 5 simple mind-set interventions which if put into practise will allow you to fulfil your true potential as opposed to falling short.

1. Embrace Self-discipline as Opposed to Motivation

Motivation is unreliable – it comes and goes. Motivation is easy to rely upon as it requires no concentration – it comes to you, you do not need to practise it. Therefore the first thing I want you to do is to disregard relying upon motivation… Instead I want you to practise self-discipline. Self-discipline is the bridge between goals and accomplishments, by exercising self-discipline we will execute the plan to the best of our ability even when motivation is absent.

Without self-discipline we will achieve nothing – with self-discipline we can achieve anything.

2. Have A Plan

Start from the end point and work backwards. What are you trying to achieve and in what time frame? Take the time to map out your training, nutrition, supplementation, rest and down time. Prior to beginning your program everything should have already been written out and revised – you should know exactly what you are doing and how the plan should be executed.

3. Apply Yourself

The most common pitfall when it comes to body transformations is client self-sabotage. Why are you eating unaccounted for calories? Why are you not training at the intensity at which was prescribed? All of these variables are within your control. There is no reason for deviation… The plan is in place for a reason.

4. Consistency & Patience

Results do not happen over night. Depending upon your starting point they may take 2-3 weeks before any slight visual change becomes apparent. Trust in the process and stick to the plan.

5. Self Imposed Limitations & Raising Your Standards

When someone places a limit on what they perceive to be achievable they prevent themselves achieving their true potential. As a coach the single greatest area I see people struggle with is their self-imposed limitations. That person will never evolve unless they raise their expectations of themselves and what they perceive to be achievable. Thus we must raise our standards and look to whom you compare yourself. Don’t look to your peer group when determining what standards are good. Look to people who have achieved the level of success that you aspire to achieve!

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Metabolic Hell

After receiving countless emails asking for a copy of the Metabolic Hell E-book over the last number of months (since releasing the material) I have decided to publish it in a blog post prior to the release of the second E-book… Enjoy!

“Everybody wants a beach body but nobody wants to do any damn conditioning!”

The ‘Metabolic Hell’ E-book contains a series of workouts to spike your metabolic rate, inducing excess post oxygen consumption (EPOC) following your workout – helping you burn fat at a higher rate throughout the day.

What is EPOC and how does it work?

In simple terms EPOC is the ‘oxygen debt’ created following a specific type of workout. This debt can in turn lead to an increased metabolic rate that results in an increased calorific turn over, long after your workout has finished. The rationale for the EPOC effect is that your body requires excess calories calories to restore itself to a state of equilibrium. The good news is that this energy primarily comes from the body targeting our fat stores. In recent years investigations have shown EPOC to be elevated for up to 48 hours in both untrained and trained subjects after resistance training (Abboud et al. 2013).

Rowing Sprint Interval Protocols

Rowing sprint intervals are some of the most challenging HIIT protocols in any trainee’s arsenal. That being said, the adaptations that they induce are more than worth the sweat that will be paid.
Here are my top 3!

Descending Sprints Intervals

• Descending sprint intervals are simply 5 sets of decreasing sprint distances.
• 60 seconds rest between each sprint.
• There is to be no rest taken by the trainee mid sprint.

1. 500
2. 400
3. 300
4. 200
5. 100

Descending Rest Interval Sprints

• Descending rest interval sprints are similar to the descending sprint intervals themselves. In that the distance of the following sprint decreases by 100 meters at a time.
• 90 seconds rest is to be taken following the first sprint.
• However, the rest interval between sprints also decreases by 10 seconds every time.

1. 500
2. 400
3. 300
4. 200
5. 100


• As simple as it gets.
• 10 minutes in total.
• The 30/30 protocol follows a simple system of 30 seconds maximal work, followed by a 30 second recovery interval.
• For advanced trainee’s I would recommend no more than a single 15 minute bout.

Take Home Points
• Competitive athletes in training I would recommend no more than two rowing interval training sessions per week.

• For recreational advanced trainees I would recommend between two and three rowing interval sessions per week.

Metabolic Circuit Protocols

The aim of the metabolic circuit is a simple, to complete as many rounds of the circuit as possible within a specific time frame. As you progress as a trainee the rest periods decrease, so that ultimately there is no rest periods at all and it is a set time of pure work.

• 15 minutes
• 60 seconds rest between rounds
• Four exercises
• Deadlift (bodyweight load on the bar) x 10 repetitions
• Press up x 10 repetitions
• DB clean and press x 10 repetitions
• Mountain climber x 10 repetitions

• 15 minutes
• 30 seconds rest between rounds
• Four exercises
• Deadlift (bodyweight load on the bar) x 10 repetitions
• Burpee x 10 repetitions
• DB clean and press x 10 repetitions
• Mountain climber x 10 repetitions

• 15 minutes
• No rest between rounds
• Four exercises
• Deadlift (bodyweight load on the bar) x 10 repetitions
• Burpee x 10 repetitions
• BB clean and jerk x 10 repetitions
• Mountain climber x 10 repetitions

Take Home Points
• Competitive athletes in training I would recommend no more than two metabolic training sessions per week.

• For recreational advanced trainees I would recommend between two and three metabolic conditioning sessions per week.

Strongman Circuit Protocols

Strong man circuits are becoming increasingly popular amongst trainees as a fat loss protocol. Strong man circuits are a form of functional hypertrophy with the strength that is developed being transferable into daily activities and sporting performance. Strong man circuits are designed to train the anaerobic lactic capacity system and range from 40-120 seconds depending upon the conditioning level of the trainee – which results in the highest levels of growth hormone (GH) output, which in turn stimulates the greatest amount of fat loss.

• 5 rounds
• 120 seconds rest between rounds
• Three exercises
• Deadlift x 6
• Sled push – 40 meters
• Tire flip x 4 repetitions

• 6 rounds
• 120 seconds rest between rounds
• Four exercises
• Deadlift x 6 repetitions
• Sled push x 40 meters
• Tire flip x 6 repetitions

• 8 rounds
• 120 seconds rest between rounds
• Four exercises
• Deadlift x 6
• Sled pull x 40 repetitions
• Tire flip x 8 repetitions

Take Home Points
• Competitive athletes in training I would recommend no more than two strong man sessions per week.

• For recreational advanced trainees I would recommend between two and three strong man sessions per week.

Hill Sprints

For me personally hill sprints are the holy grail of conditioning exercises. I have used hill sprints since I was 18 years old as a highly effective fat loss tool. They were the backbone of my conditioning then as they are today. If they were good enough to be Walter Payton’s secret conditioning weapon then they are good enough for me!


• 10 sprints
• 40-meter distance
• Sprints performed at 85 percent of 100-meter time
• 120 second recovery intervals between sets
• 10 sprints
• 40-meter distance
• Sprints performed at 85 percent of 100-meter time
• 90 second recovery intervals between sets

• 15 sprints
• 50-meter distance
• Sprints performed at 85 percent of 100-meter time
• 60 second recovery intervals between sets

Take Home Points
• Competitive athletes in training I would recommend no more than two hill sprint training sessions per week following this protocol.

• For recreational advanced trainees I would recommend between two and three hill sprint sessions per week following this protocol.

Track Based Protocols

Not all cardio was created equal and thus it is important that you choose a form of cardio that will help you meet your goals in the safest and most time efficient way possible.
Since the mid 1990’s there has been a vast amount of research conducted into sprint intervals (SI) as a fat loss protocol. SI training, otherwise known as high intensity interval training (HIIT) have been shown to improve fat oxidative capacity (Burgomaster et al. 2007), decrease metabolic risk factors (Whyte et al. 2010), increase insulin sensitivity (Richards et al. 2010) improve energy system efficiency (Trapp et al. 2008) and are also recognized as a time efficient fat loss protocol when compared with traditional endurance training (Burgomaster et al. 2007). SI training demands a large amount of energy and places the anaerobic energy system under a significant amount of physiological stress over a short period of time.
The stress response to this bout of exercises results in significantly elevated human growth hormone levels (Stokes et al. 2010) and oxygen consumption (Tomlin and Wenger, 2001) to help restore the metabolic processes to their baseline conditions. This post-exercise oxygen uptake in excess of that required at rest has been termed excess post-exercise oxygen consumption (EPOC). EPOC during the slow recovery period has been associated with the removal of lactate and H+, increased pulmonary and cardiac function, elevated body temperature, catecholamine effects, and glycogen re-synthesis (Tomlin and Wenger, 2001).

Incorporating SI Training Into Your Program Design
Firstly SI training is for advanced trainees and athletes only. This is not a beginner or novice trainee protocol. If you haven’t sprinted or performed any intense running previously I would advise you to prime your body before incorporating this type of conditioning work within your program design. There are a significantly greater amount of injury risk factors associated with SI when compared with traditional endurance training. Thus my recommendation would be significantly reduce these risk factors by ensuring that you are both mobile and flexible before incorporating SI within your program design. Dynamic mobility movements – such as squat-to-stand or various band traction movements – help to open up our bodies. If we unlock our movement, we can get into better positions, move through a greater range of motion with more control which will ultimately result in greater force production, muscle activation, improved performance and ultimately greater results.

60m Sprint Intervals

• 10 sprints
• 120 seconds recovery intervals between rounds
• Sprints performed at 85 percent of 60-meter sprint speed 

• 10 sprints
• 90 seconds recovery intervals between rounds
• Sprints performed at 85 percent of 60-meter sprint speed 

• 10 sprints
• 60 seconds recovery intervals between rounds
• Sprints performed at 85 percent of 60-meter sprint speed

Take Home Points
• Competitive athletes in training I would recommend no more than two sprints sessions per week following this protocol.

• For recreational advanced trainees I would recommend between two or three sprints sessions per week following this protocol.

100m Sprint Intervals

• 8 sprints
• 120 seconds recovery intervals between sprints
• Sprints performed at 85 percent of 100-meter sprint speed

• 12 sprints
• 120 seconds recovery intervals between sprints
• Sprints performed at 85 percent of 100-meter sprint speed

• 15 sprints
• 120 seconds recovery intervals between sprints
• Sprints performed at 85 percent of 100-meter sprint speed

Take Home Points
• Competitive athletes in training I would recommend no more than two sprint training sessions per week following this protocol.

• For recreational advanced trainees I would recommend between two and three sprint sessions per week following this protocol.

200m Sprint Intervals

• 4 sprints
• 120 seconds recovery intervals between sprints
• Sprints performed at 85 percent of 200-meter sprint speed

• 6 sprints
• 120 seconds recovery intervals between sprints
• Sprints performed at 85 percent of 200-meter sprint speed

• 8 sprints
• 120 seconds recovery intervals between sprints
• Sprints performed at 85 percent of 200-meter sprint speed

Take Home Points
• Competitive athletes in training I would recommend no more than two sprints sessions per week following this protocol.

• For recreational advanced trainees I would recommend between two or three sprints sessions per week following this protocol.

400m Sprint Intervals

• 3 sprints
• 120 seconds recovery intervals between sprints
• Sprints performed at 80 percent of 400-meter sprint speed

• 5 sprints
• 120 seconds recovery intervals between sprints
• Sprints performed at 80 percent of 400-meter sprint speed

• 8 sprints
• 120 seconds recovery intervals between sprints
• Sprints performed at 80 percent of 400-meter sprint speed

Take Home Points
• Competitive athletes in training I would recommend no more than one sprint training session per week following this protocol.

• For recreational advanced trainees I would recommend no more than two sprints sessions per week following this protocol.

Abboud, G., J., Greer, B., K., Campbell, S., C., Panton, L., B. (2013). Effects of Load-Volume on EPOC After Acute Bouts of Resistance Training in Resistance-Trained Men. Journal of Strength & Conditioning Research, (27), 1936-1941.
Burgomaster, K., A., Cermak, N., M., Phillips, S., M., Benton, C., R., Bonen, A. and Gibala, M., J. (2007). Divergent response of metabolite transport proteins in human skeletal muscle after sprint interval training and detraining. The American Journal of Physiology, (292), 1970-1976.
Richards, J., C., Johnson, T., K., Kuzma, J., N. Lonac, M., C., Schwder, M., M., Voyles, W., F. and Bell, C. (2010). Short-term sprint interval training increases insulin sensitivity in healthy adults but does not affect the thermogenic response to β-adrenergic stimulation. The Journal of Physiology, (588), 2961-2972.
Trapp, E., G., Chisholm, D., J., Freund, J. and Boutcher, S., H. (2008). The effects of high-intensity intermittent exercise training on fat loss and fasting insulin levels of young women. International Journal of Obesity, (4), 684-689.
Thomlin, D., L. and Wenger, H., A. (2001). The relationship between aerobic fitness and recovery from high intensity intermittent exercise. Sports Medicine, (1), 1-11.
Stokes, K., A., Nevill, M., E., Hall, G., M. and Lakomy, H., K., A. (2002). The time course of the human growth hormone response to a 6 s and a 30 s ergometer sprint. The Journal of Sports Sciences, (20), 487-494.

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What Is The Best Diet For Long Term Body Composition Change?

For long-term body composition change we need to address our behavior. Behavior modification is key to long-term changes in our clients. How many people have got into great shape over a number of months with a set date/goal in mind? Once this deadline has been met they ‘rebound’, often putting on more body-fat than when they first started dieting. This bodybuilding/fitness competition approach to dieting is for show preparations only and is not suitable for sustained change. As practitioners we need to develop a nutrition regimen that best suits our clients. Our goal is to make this transition into a lifestyle as opposed to a ‘rent a body program’. This means that the plan you develop must be individually tailored to your client’s, lifestyle, work demands and taking into account their motivation levels. Whatever nutrition regimen they can stick with is the best diet for them to follow for long-term adaptations. Consider adding in calorie windows and be flexible with food choices… DO NOT encourage binge eating with ‘cheat days’!

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Fix Your Shin Splints!

What Are Shin Splints?

There is much debate into what shin splints actually is, some say it is small tears and inflammation in the muscles spanning down the tibia bone, or inflammation of the sheath of the bone. Now shin splints is a term applied to general shin pain, but one of the major areas that are assumed to be shin splints are down the inner edge of the tibia. Symptoms down the edge of the tibia is known medically as Medial Tibial Stress Syndrome (MTSS), this is the most common I have come across in the athletes I have treated.

Symptoms of MTSS…

The affected area may be tender and swollen, highlighting the inflammation in this area. You may notice your pain will come on as your start exercise and may ease off as you start to warm up and activity continues. However, you may then notice when you stop or towards the end of exercising the pain returns and may be worse than before. The pain you usually feel will often be described as a dull ache, or throb.

Why Do You Get Shin Splints?

The occurrence of shin splints is described as an overuse injury, which means you may notice it presents after you have recently increased your activity (especially running), or after prolonged, frequent high impact activity, such as road running.

The lower leg and ankle have to absorb a lot of force and if this force is repeated and of high intensity such as running on hard surfaces, some structures are having to absorb these high forces. This may then lead to micro-damage in the structures such as the muscles. If you continue to engage in your activity, the damage to these structures then doesn’t have time to heal and thus you get the reoccurring pain.

If this was the sole cause then everybody who ran would experience shin splints. However, not everybody does. But why?

Altered Biomechanics…

There is usually a domino effect of altered mechanics that will lead to a dysfunction in lower leg movements.

Flat Feet…

One tell-tale sign you may notice is that your feet may flatten during a squat movement or when you run. This alters the pull of your Achilles tendon, alters muscle firing patterns, and also puts pressure on the function of the lower leg. This could be due to weakness of some of the ankle stabilisers such as the inner calf, the muscles surrounding the tibia (Tibialis Anterior and Posterior). This may be combined with a tightness of the outer-lower-leg muscles (Peroneals, Outer Calf). This combination will pull the foot flatter and the weakness will inhibit the
ability to resist and stabilise this.

Caving Knees…

Your knees may also cave in as you squat or run. This will only further contribute to flat feet and thus the pressure on the lower leg. This occurs usually because the outer Hamstring (Biceps Femoris) and Ilio-Tibial Band (ITB – tendinous tissue on the outer thigh) are tight. This will pull the tibia outwards causing the knee to cave in. This dominance of the outer muscles coincides with weaker inner muscles such as the inner Hamstrings (Semitendinosus and Semimembranosus) and the gluteal muscles.

As a general overview these two factors are the most noticeable, and the common things I have experienced. The simple solution to this is to release and stretch the tight, shortened tissues and activate and strengthen the weaker, long tissues. This will rectify the compensatory, altered function of the knee, lower leg and ankle. In turn this will help reduce the stress on the lower leg and therefore reduce the likelihood of shin splints.

How Do I Treat Shin Splints?

Initial Fix/Treatment…

• Reduce your running/high impact exercise – swap for lower impact training such as cycling, or swimming. Refrain from painful activity. This may mean putting a rest day from running in between your normal running days.

• Apply ice to your shins after activity, and on a daily basis to reduce swelling and inflammation.

• Apply compression to the area – compression bandage or stockings whilst exercising and during recovery

• Invest in mouldable inserts for your running trainers.

• Self-Massage – rub along the edge of the shin bone, down the tender areas. This is uncomfortable but helps breakdown scar tissue.

Longer Term Fix/Management…

• Stretch short, overactive tissues:
o Peroneals (Outside of the lower leg down into the outer ankle)
o Outer Calf
o Outer Hamstring

• Activate/Strengthen longer, underactive tissues:
o Inner Calf
o Tibialis Anterior & Posterior
o Inner Hamtsrings
o Gluteals

Example Rehab Programming

Warm Up

1) Shin Stretch – Kneel down flat on your shins, then lean back and attempt to sit on your heels or as close as you can get. Ensure your shins and knees remain flat on the floor throughout. This can be done one leg at a time if you require a stronger stretch.

Perform 3 sets of 30 secs.

2) Wall Calf Stretch – place your hands against a wall, split stance your legs, keep you back foot flat and leg straight, lean your body forwards towards the wall stretching up the calf. The leading foot can be placed at an angle out to the side to target the outer calf.

Perform 3 sets of 30 secs on each leg.

3) Towel Hamstring Stretch – lie on your back, bring your leg up straight, wrap the towel around the lower leg, pull the leg back straight, you can then pull diagonally across the body to stretch the outer hamstring more.

Perform 3 sets of 30 secs on each leg.

4) Active Oblique Stretch – Lie on one side, keep bottom leg straight, bend the top leg to 90 degrees out in front of you. Place your top hand on the back of your head, with the elbow pointing to the ceiling. Grasp the underside of your top thigh with the other hand. Then try touch your top elbow to the floor by rotating body outwards and trying getting your shoulders flat.

Perform 3 sets of 30 secs on both sides.

Activation Exercises

1) Tibialis Anterior Activator – Sit down with legs straight out in front of you. Perform dorsiflexion repetitions (pointing and raising the foot). However, it is important when doing this that you keep your foot rolled outwards so your sole faces inside, and also keep your toes curled in as your raise your foot. This can be resisted with a resistance band.

Do 3 sets of 15-20 each foot.

2) Single Leg Gluteal Bridges – Lie on your back, bend your knees so your feet are flat, then raise one leg off the floor straight, then raise your hips up squeezing your buttocks, but keep your shoulders flat on the floor. Hold at the top for 2secs then lower.

Do 3 sets of 20 each leg.

3) Glute Clams – Lie on your side and place yours knees on a 45 degree angle. Keeping your feet together open your knees out rotating the hip, ensure your torso remains still and you are not twisting it to aid the hip movement.

Do 3 sets of 20 each side.

4) Pigeon Toe Calf Raises – Stand against a wall, rise up onto your toes, but as you do this pull your heels out.

Do 3 sets of 20 (can be done single leg once two foot is too easy).

5) Single Leg Step Up – Stabilise – Curl and Press – In standing keeping the core tight and spine neutral step up with one leg onto a stepper or box until the leg is straight, and bring the opposite thigh parallel to the floor. Ensure that the pelvis remains level and you don’t lean to one side. Your core and pelvis position should remain constant throughout. Once this can be achieved with the leg raise introduce and curl and press then return to the floor and repeat.

Do 3 sets of 12-15 each leg.

6) Heel Walks – In standing, raise the forefoot off the ground so you are stood on your heels, turn your foot outwards so the sole faces inwards and curl the toes in (as in the above exercise).Once in this position walk around in this position. It looks silly but this causes the underactive shin muscles to become reactive during walking which will help with better lower leg function.

Do 3 sets of 20-30 steps.

Guest blog by Ieuan Cranswick MSc Sports Therapy

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Working As A Unit – The Body’s Subsystems

We can sometimes become over-focused upon one area when it comes to any injury, pain, or dysfunction. This is expected because the pain or affected movement is felt or noticed in that area. This then causes us to approach how we manage these complaints with the same specific focus. This is okay for initially managing any trauma but there may be some underlying factors that may contribute to the complaints. The body works as a series of subsystems all working in synergy to allow movement to occur efficiently. It is not just the muscles around a particular joint working independently that causes the movement. The subsystems in place are like chains all connected and working together.

What are these Systems?
There are five main systems described by many professionals. These are the Anterior Oblique Subsystem (AOS), Posterior Oblique Subsystem (POS), Lateral Subsystem (LS), Deep Longitudinal Subsystem (DLS), and the Intrinsic Stabilisation Subsystem (ISS). The function of these systems vary but all help control integrated movements and ensure the body and posture is stabilised throughout.
If there is any downfall, no matter how minor, within one of these subsystems it can have a knock on effect on the efficiency of movements as well as contribute to any postural dysfunctions. By understanding where these systems are, what their functions are, and how they may affect movement and posture, we can prevent/restore/maintain good posture and pain free, efficient movement. Therefore in this article we will discuss these systems and how we can ensure we are including these systems in our daily training.

Anterior Oblique Subsystem…

What Is It?
The AOS according to the National Association of Sports Medicine (NASM) consists of the External Obliques, Abdominal Fascia, and opposite side Adductors.
Additional muscles have been considered part of this subsystem such as the Internal Obliques, and Rectus Abdominis (Brookbush, ).
The job of this subsystem is to stabilise the anterior chain and trunk during movements such as gait. It also helps transfer force between the lower and body, specifically integrating pushing and turning in movements.
This system, put simply, will help reduce any excessive rotation or extension through the trunk, and anterior pelvic tilt or excessive Sacroiliac Joint (SIJ) motion within the Lumbo-Pelvic Hip Complex (LPHC). It does this through eccentric work of the obliques and opposite side adductors control the movements throughout whole body dynamic activities.

What Can Go Wrong?
This system can commonly be either overactive or underactive, which can contribute and present as a dysfunction in certain areas of the body.

Overactivity of AOS
When the AOS appears to be overactive it often presents as a dysfunction in the upper body. Common characteristics of this dysfunction are excessive forward lean during squatting movements displaying an inability to keep shins vertical, scapula winging, excessive internal rotation of the shoulder, and increased kyphosis (rounding) of the thoracic spine. This is often paired with an underactive POS which will be discussed.
If you notice these characteristics and suspect that your obliques, and adductors are working overtime then you can approach this by reducing any core flexion exercises in your program, and release shortened, tight structures associated with the dysfunction such as the pecs, and obviously adductors and obliques. You will also want to increase the activity of the POS which will be discussed later.

Underactivity of AOS
When the AOS is underactive it can contribute to a present as a dysfunction in the LPHC. Commonly you will notice an anterior pelvic tilt, and an excessive curve in the lumbar spine as a result of it being pulled into excessive extension with no resistance or stabilisation from the AOS. This again is often paired with an underactive POS.
You can approach an underactive AOS and the pelvic tilt etc. by loosening the tight structures which are usually the hip flexors and the erector spinae muscles in the lower back. You should also then activate the underactive AOS by including the following into your program.
1. Cable Chop Patterns – to activate the AOS, squeeze glutes, legs stabilise and AOS resists the extension and rotation of the cables as you chop from high to low.
2. Ball Catch-Twist-Throw – sit on a yoga ball, have a partner throw you a medicine ball, catch the ball whilst maintaining stable, twist to one side then twiit back throwing the ball back. Repeat on the other side.
3. Standing Cable Chest Press – this increases the workload for the anterior trunk and legs. Stand with cables behind so you have to resist their pull. Then perform your chest press keeping the trunk stable.
4. Step Up to Press – Step up, raise trailing leg knee to 90° (forcing single leg balance and stability), then press the arms without the trunk folding and becoming unstable.
• Progression 1: drop to one band resisting the rotation pull of the band. Hold band in opposite hand to lead step up leg. Look for a good reach and avoid leaning back and turning out with the band.
• Progression 2: start side on, lead leg nearest step. This starts you in a turned out position forcing AOS to activate to turn the body into the step up, press and stabilise.

Posterior Oblique Subsystem…

What Is It?
This subsystem consists of the Gluteus Maximus, the opposite Latissimus Dorsi, and the Thoraco-Lumbar Fascia. The Gluteus Medius has also been considered as part of the POS by Brookbush Institutes.
The job of the POS is to stabilise the posterior kinetic chain (Lumbar Spine and SIJ). It transfers forces between the lower and upper body, specifically integrates pulling and turning out movements as well as decelerating whole body pronation (turning in or face down), including spine flexion and rotation, hip flexion, adduction and internal rotation.
The anatomy and fibre arrangement runs from the Glute Max transversely across the SIJ into lumbar fascia and into Lat Dorsi. The POS plays a big part in asymmetric movements such as walking with one side decelerating and one side accelerating thus requiring high levels of stabilisation.

What Can Go Wrong?

Underactivity of POS
The POS is almost always underactive and as previously mentioned it is often combine with either an overactive or underactive AOS. This can then contribute to dysfunctions in the upper body or the LPHC as mentioned.
To approach an underactive POS we obviously need to activate the muscles of the system (Glutes and Lat Dorsi). This can be done using the following examples.
1. Glute Bridge Progressions – focusing on a good squeeze of the glutes.
2. Cable Squat to Row – squat holding cable out in front, under tension, as you stand tall, stabilise the trunk and row the bands in. Resist the pull of the band and avoid forward lean or sway.
• Progression 1: progress to single arm row, maintaining stable trunk position minimalizing twist of the trunk.
3. Step Up to Row – This is similar to the AOS step up to press, but the press is substituted with a cable row. But again focus on keeping trunk stable.
• Progression 1: progress to single arm row, maintaining stable trunk position minimalizing twist of the trunk.

Deep Longitudinal Subsystem…

What Is It?
The tissues that make up this system are the Sacrotuberous Ligament in the hip, the Biceps Femoris (one of the hamstrings), Tibialis Anterior, and Peroneals. Other muscles have been suggested as part of this subsystem such as the Erector Spinae, and Piriformis (Brookbush Institute,).
The role of the DLS is to stabilise the Lumbosacral Joint Complex as well as the Medial Arch of the foot. It is important in the control of the lower leg and foot during walking. It helps decelerate the lower leg during the swing phase of walking. It also controls the position of the foot when striking the floor during walking involving lifting the toes and controlling the tilt of the ankle.
It also helps with proprioceptive communication of forces between the foot, knee and hip complex during higher intensity activities. Therefore it helps optimise positioning, balance and alignment of the lower body joints thus preventing injury. However, if this system isn’t functioning optimally this may not be the case.

What Can Go Wrong?
Unlike the POS this system is almost always overactive causing the Biceps Femoris and Erector Spinae to become dominant. This may result in low back pain, or hip pain as well as an alteration in functional movements such as squatting, running or jumping etc. The over-activity of the DLS will also cause the foot to excessively pronate (roll flat) during walking and running gait, this combined with an ineffective ability to dorsiflex (raise the foot) places excessive force on the bones and structures of the foot. It will also contribute to any inward buckling of the knees, thus putting the ankle, knee and hip out of alignment during movement.
To approach this we would need to release the tight structures of the overactive DLS such as the biceps femoris, erectors spinae, peroneals, and often the piriformis. This can be done using foam rolling techniques or active stretching work. You also want to avoid any direct, isolated hamstring exercises as this will further activate the already overactive structures.
To help counteract the over-activity of this subsystem you can add in some POS activation exercises as described above, but basically any leg work (squats, step ups, lunges) with pulling movements (row).

Lateral Subsystem…

What Is It?
This system consists of Gluteus Medius, Adductors, and opposite Quadratus Lumborum. Other muscles are considered to be involved such as the Gluteus Minimus, and Tensor Fascia Latae (Brookbush Institue).
The role of this system is to stabilise the LPHC in the front plane, stabilising in side to side movements, as well as transferring forces between the lower and upper body. It plays a huge part in single-leg movements, ensuring optimal alignment of the hip, pelvis, SIJ, and lumbar spine during both double and single leg stance.

What Can Go Wrong?
You may find that if this system is underactive on one side the opposite side will compensate and become overactive. This can cause dysfunction in the SIJ, and lower leg mechanics. You will notice a drop of the pelvis to the side of under-activity when standing on one leg. The standing thigh will also adduct, as well as some side flexion of the trunk. This means that in single stance exercises such as during phases of running or hopping, the hip, knee and ankle will be out of line and thus excessive, unnecessary forces will be placed on the structures of these joints.
Underactivity of this system often pairs with an underactive POS and overactive DLS.
To approach the LS check the component muscles for tightness and release these. The common shortened muscles are the quadratus lumborum, and adductors. However, in this system the gluteus medius can be underactive, and therefore the approach should be release the QL and adductors but activate the gluteus medius.
You can then include POS exercise as described earlier as well as single leg exercises with shoulder exercises such as:
1. Step up to single leg stabilisation then curl and press (keeping hips level and core engaged, avoiding side bend).
Also include glute medius activation:
2. Clams
3. Side Plank – but avoid dynamic side bending exercises.

Intrinsic Stabilisation Subsystem…

What Is It?
This system consists of the Tranversus Abdominis, Multifidus, Pelvic Floor, Diaphragm, and the Thoracolumbar Fascia. The Brookbush Institute considers the Internal Obliques as part of this system too.
Its role is to increase the pressure in the abdominal cavity, increase rigidity of the spinal segments, optimise SIJ stiffness, and stabilise the LPHC. The pressure created by this system pushes back on the vertebrae reducing any forward translation that may be caused by excessive spine extension or over-activity of the QL, Latissimus Dorsi or Erector Spinae.
The Multifidi provide feedback to the central nervous system allowing continuous movement and postural alteration, this helps with spinal alignment and stiffness during activity.

What Can Go Wrong?
This system is almost always underactive. This may leave us at risk of disc herniation (slipped disc), sprains and strains of the spine, as well as LPHC and SIJ dysfunction. It will also affect posture, and also make the trunk, spine and core less stable during activity. Its ability to withstand sudden position or postural changes, or impacts to the body, this leaves us at risk of injury.
To approach this system the muscles need activating. They are only small muscle groups so there isn’t a huge amount of movement but the following exercises can be introduced to any warm up before training.
1. Draw belly button to the floor in lying position, this can be done by “squeezing the anus” (transversus abdominis activation)
2. Kneeling “superman” exercises – ensure the transversus abdominis is activated throughout.
3. Explosive Moutain Climbers – do these explosively keeping trunk straight and stiff.

Overview of Subsystems and Dysfunctions…
Below is a table of which systems are usually underactive or overactive in certain dysfunctions. Along with the discussion above this may help you approach how to deal with any issues you have and what to include and take out of your training.
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Guest blog by Ieuan Cranswick MSc Sports Therapy

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Injury Part 3: The Importance of Mind-set

In the previous blog we focused on the onset of the injury. The aim of this blog will be to address phase two of the injury process: the rehabilitation phase (Wadey & Evans, 2012). I will discuss what the literature around this phase reports on the psychological impact and identify the key strategies identified in the literature to help athletes during this phase.

The Rehabilitation Phase
As outlined by Wadey and Evans (2012), this phase starts once the individual has had their first physiotherapist or medical practitioner appointment. During this phase injured individuals will experience a whole host of emotions, including frustration and despair, as the try to come to terms with the injury process and the unpredictable nature of injury (Cecil et al., 2009). The literature has highlighted a number of key challenges that individuals will face during this phase including: physical incapacitation; isolation; contractual and financial issues; perceptions of control and autonomy; slowness of progress and setbacks; and the monotony of rehabilitation activities (Bianco et al., 1999, Evans et al., 2000; Kolt, 2000). One of the key factors to help athletes is to come to terms with the injury and accept that fact they are going to be injured. See part 1 for a discussion on acceptance.

Physical Incapacitation and Isolation – The Research
Once the athlete has come to terms with the injury and they start the rehabilitation process, one of the biggest factors that they will face is getting used to the lack of mobility associated with the injury in the early phase of the rehabilitation process (Gould et al., 1997a, Johnston & Carroll, 1998a). This lack of mobility may continue throughout the whole process of the rehabilitation process in some cases. This experience can heighten the individual’s feelings of loss and isolation, and increase frustration and despair (Carson & Polman, 2008). This can be a bitter pill for some athletes to take as now they can’t take part in training or competition with their teammates, they may feel they have lost part of their identity or losing attachment to their teammates because of it (Udry et al., 1997). The may start to feel isolated from the team and start to feel they have lost some of their identity. This can be especially apparent with professional athletes (Bianco et al., 1999; Evans et al., 2000).

Physical Incapacitation and Isolation – Strategies
Again, like during the onset of the injury blog, the importance of a good social support network should not be under appreciated. The support from your family, friends and teammates is essential to help you cope with this loss of mobility. However, I myself have experienced injury in the past and sometimes seeing teammates who can train and play no problem can be hard to take. So being around the sporting environment can be a double-edged sword in terms of the impact on you emotionally (Wadey & Evans, 2012). On the one hand, like my example, not being in the sporting environment can be beneficial as it removes you from reminders of what you have lost in being injured. However, not being there you can lose some important support networks or motivation whilst being injured (Bianco, 2001, Carson & Polman, 2008). Therefore, it’s important that your support network (teammates and coaches) should be aware of your need to be away for a bit of time but to still remain supportive away from the sporting environment (Bianco & Eklund, 2001). But it is important to do what works for you (Wadey & Evans, 2012).

Control and Autonomy/Setbacks and Monotony of Rehabilitation – The Research
Motivation is one of the key factors associated with the rehabilitation process (Brewer et al., 2004). An athlete’s ability to stay self-motivated is positively related to adherence to the rehabilitation process (Brewer et al., 2004; Fields et al., 1995). The literature highlights a number of factors that play a role in this including the task involvement, feeling in control and autonomy-supportive environment (Brewer, 2007). These are all impacted, or influenced, depending on the slowness of progress and potential setbacks (Tracy, 2003). Once the rehabilitation programme has begun it is of highest importance that the individual stays self-motivated to keep partaking in their prescribed programme, even when progress is going slower than anticipated. If individuals experience setbacks that may impact their rehabilitation goals or outcome goals, individuals may experience intensified feelings of loss, frustration and impatience to get back performing (Bianco et al., 1999). Equally these emotions can be experienced even if a setback hasn’t taken place (Evans & Hardy, 2002). These can simply be caused by the monotony of completing the rehabilitation programme. One of the keys factors to help alleviate demotivation is variety (Thomee et al., 2007). This has been shown to have significant effects on an athlete’s self-motivation, self-belief, but more importantly adherence to the rehabilitation programme (Molloy et al., 2009).

Control and Autonomy/Setbacks/Monotony of Rehabilitation – Strategies
One of the key interventions which we covered in part one is ensuring that SMARTER goals are set wisely (See part 1). These goals will help ensure that athletes stay adherent and self-motivated throughout the process (Duda et al., 1989; Evans and Hardy, 2002, Levy et al., 2008). However, like I said in part 1 ensure to focus on process and performance goals in particular (Evans & Hardy, 2002). To help keep autonomy and control make sure you are understand the reason behind the goals being set with your physiotherapist etc., this will help ensure that you become more invested and determined to achieve each goal. This can further strengthen the communication and relationship between you and the treatment and rehabilitation providers etc. (Wadey et al., 2011).
Another powerful mental skill to be adopted during the rehabilitation process is imagery (Evans et al., 2006, Law et al., 2006). Imagery has been used in a variety of ways to help throughout the rehabilitation process. In particular research has shown that using imagery aids in the healing process of damaged tissue (Wadey and Evans, 2012). For example, an individual imagining increased circulation of blood to the injured or damaged tissue has been shown to be effective in the healing process. This can be aided in the form of visual images through x-rays and scans of the injured limb. Other ways in which imagery has been effective during the actual rehabilitation stage involve; successful execution of the rehabilitation specific exercise, achieving long and short term goals and remaining mentally tough and resilient throughout (Wadey and Evans, 2012).
One final mental skill that has been researched and shown to be effective during the rehabilitation process is self-talk (Gould et al., 1997). When things are not going the way we plan, it is very easy for individuals to say nasty, doubting and negative words to ourselves. The ability to control that during this phase of the injury process can impact a number of factors including; directing attention during rehabilitation sessions to ensure we are doing the exercises correctly, and to keep one motivated as we pursue our goal attainment with the use of positive affirmations (Wadey et al., 2012). Positive affirmations are little key phrases we say to ourselves to reinforce an action or a feeling. George St Pierre’s affirmation for example, said he went to bed a better fighter than when he woke up. This can be especially pertinent when receiving informational support from practitioners, once again showing the importance of social support throughout the injury process (Wadey et al., 2012). The beauty of this form of mental skill is that it can be used in conjunction with imagery (Smith, 1996).

Guest blog by psychology expert Philip Clarke BSc (Hons), MSc, PhD (Student).

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Kolt, G.S. (2000). Doing sport psychology with injured athletes. In M. Andrews, (Eds.) Doing sport psychology, (pp. 223-236). Champaign, IL: Human Kinetics.
Law, B., Dreidger, M., Hall, C. & Forwell, L. (2006). Imagery use, perceived pain, limb functioning, and satisfaction in athletic injury rehabilitation. New Zealand Journal of Physiotherapy, 34, 10-16.
Levy, A.R., Polman, R.C.J., & Clough, P.J. (2008). Adherence to sport injury rehabilitation programs: an integrated psychosocial approach. Scandinavian Journal of Medicine and Sciences in Sport, 18, 798-809.
Molloy, G.J. Sniehotta, F. & Johnston, M. (2009). Two alternative models of health behaviour and recovery from activity limitations due to acute injury: A prospective study. Psychology and Health, 24, 271-285.
Smith, A.M. (1996). Psychological impact of injury on athletes. Sports Medicine, 9, 352-369.
Thomee, P., Wahrlo, M., Borjesson, R., Thomee, R., Erikisson, B.I., & Karlson, J. (2007). Self-efficacy, symptoms and physical activity in patients with an anterior cruciate ligament injury: A prospective study. Scandanvian Journal of Medicine and Science in Sports, 17, 238-245.
Tracey, J. (2003). The emotional response to the injury and rehabilitation process. Journal of Applied Sport Psychology, 15, 279-293.
Udy, E. (1997). Coping and social support among injured athletes following surgery. Journal of Sport and Exercise Psychology, 19, 17-90.
Wadey, R., & Evans, L. (2012). Working with Injured Athletes: Research and Practise. In S. Hanton and S.D. Mellalieu (Eds.). Professional Practise in Sport Psychology, (107-132). Routledge, Taylor and Francis Group: London and New York.
Wadey, R., Evans, L., Evans, K., Mitchell, I. (2011). Examining the antecedents and mechanisms underlying he perceived benefits following sports injury. Journal of Applied Sport Psychology, 23, 142-158.

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Injury Part 2: The Importance of Mind-set

In the previous blog, I focused heavily on the some of the psychological risk factors associated with injury. I also touched on the importance of acceptance and goal-setting in helping people with coping with an injury. Upon reflection, instead of trying to cram everything into two blogs, I am going to break the injury process further into three phases as advised by Wadey & Evans (2012). These stages will include: 1) the onset of the injury; 2) the injury rehabilitation; 3) and the return to competition. Therefore, I will write three further smaller blogs on each of these phases, discussing the literature, specifically focusing on the cognitions, emotions and behaviours associated and what the literature says about potential strategies for each stage. One thing to make clear is that individuals may not go through each section systematically, as athletes may go back and forth through stages. Although, in extreme cases athletes may not progress through all these phases (i.e. career termination).

Onset Of Injury

As outlined by Wadey and Evans (2012), this phase starts when the individual becomes injured. The literature identifies four key factors that will be discussed which include: emotional turmoil (Gallgher and Gardner, 2007); the individual’s lack of understanding about the injury (Carson and Polman, 2008); the decision of whether to compete when injured (Krane et al., 1997); and inability to do normal day activities (Tracey, 2003).

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Emotional Turmoil – The Research

The emotional turmoil experienced by athletes is very much based on the situations and number of factors associated. Some of the most intense emotions can be experienced in the first few days after an injury. As seen in the table below, there are a number of factors that influence the intensity and duration of the emotional turmoil (See associated factors in table below). These include: the timing of the injury, the amount of physical pain experienced, the injury prognosis; financial concerns associated, potential time away from the sport, misdiagnosis, flashback of the injury, as well as potential personal and situational losses (Bianco et al., 1999; Evans et al., 2011). So in reality if an individual experiences an injury a week before an event that they have planned for months, the psychological back-lash can be more intense than if you just miss a friendly that has little meaning for the individual. Or if this injury now means that you cannot work and means that you and your family are going to be impacted financially, it is not uncommon for this to have major negative implications for individuals.
When all these factors are taken into consideration it is fair to see why individuals experience intense emotions such as anger, frustration and depression (see cognitive/emotions in table below: Grove & Cresswell, 2007; Wadey et al., 2011). These emotions have all been experienced by athletes and individuals in all levels of sport and exercise contexts. In events like the Olympics where athletes have trained for four years to take part in an event that could potentially last as little as 10 seconds in some sports, when your body gets injured, it can be a bitter pill to take. For example that iconic image of Derek Redmond pulling his hamstring during the 1992 Olympic finals when at the 1988 final he also could not compete because of injury. The psychological repercussions can have major implications on us. For example, individuals may isolate themselves from everyone as they find it very difficult to open up about it and as such bottle up their emotions (Wadey et al., 2011b). This can be especially apparent when trying to open up with someone involved in that sport or activity, as they are physically fine. Mankad et al (2009) report that this may be also because athletes don’t want to show signs of weakness or inability to not cope with the situation, that may have negative implications of their place in the team for example (Tracey, 2003).

Emotional Turmoil – Strategies

According to the literature one of the biggest factors to help with the emotional side-effects of injury is social support (Bianco & Eklund, 2001; Brewer & Petipas, 2005). The support network is so important during the whole of the injury process. During this stage, a support-provider can help athletes cope more effectively with these emotions by providing encouragement and empathy where necessary (Bianco et al., 2001) and also they may also help them to rationalise their thoughts (Johnson & Carroll, 2000). Although, for this to happen it is important that the support network is a trusting environment so the individual feels comfortable to open up (Tracey, 2003). Interestingly, individuals who had an effective support network have reported a greater ability to cope effectively when they returned to activity (Wadey et al. 2011b).

Lack Of Understanding – The Research

When an individual experiences injury, there are instantly a number of questions that goes through their mind (Carson & Polman, 2008; Wadey et al., 2011). These include what have I done? What does this mean for my performance? Will I be away for long? How long will the rehabilitation take? These questions can have implications on the emotion turmoil previously discussed.

Lack Of Understanding – Strategies

As well as having an emotional support network, it is evident that athletes want to have informational support (Bianco, 2001; Wadey et al., 2011). This type of support has been shown to be an integral part of successful rehabilitations (Carson and Polman, 2008) However, it important that the information received is from a reliable source, such as people with relevant experience and not just from the internet. Research suggests using credible sources of information such as journal articles or books to further understand the injury (Bianco, 2001). Furthermore, having the support of other athletes who have experienced the same injury can be equally as effective (Bianco, 2001). For example, when UFC fighter Conor McGregor tore his ACL, he took solace from speaking to fellow UFC fighter George St-Pierre who experienced the same injury and recovered successfully. This is evidenced by McGregor’s successful recovery from the injury.

Whether To Compete Or Not – The Research

One of the main questions an athlete will ask themselves is whether or not they keep going or whether they stop for treatment (Collins et al., 2009). This is a big factor, as they may feel a lot of pressure to play due to both external and internal reasons. These may come in the form of being pressured by coaches and team mates to play in an important game. Bianco (1999) interviewed Canadian athletes and reported that individuals reporting taking risks in order to perform, and that they had done so by seeking medical short term solutions (pain killers). We have heard of this on numerous occasions in sport, where athletes play through the pain barrier, but is it always the right choice? The quote below from one of the Alpine ski team members in Bianco’s (1999) study suggests that the answer is sometimes no. Although there is anecdotal evidence of people who have succeeded in these situations, it is more likely that athletes underperform or in some situations worsen the injury (Shaffer & Wiese-Bjornstal, 1999)
“I was ranked top 10 in the world. I was the number one Canadian coming into the Olympics. I tore my ACL (anterior cruciate ligament), and I continued skiing without having it repaired. I wore a brace and went to the Olympics. Two days before the race I fell and destroyed my knee…….and my career” (Bianco et al., 1999, p163)

Whether To Compete Or Not – Strategies

Just like the strategy highlighted in the lack of understanding section, it is important that all information is taken into consideration before this decision is made. However, inevitably, the final decision comes down to the athletes (Wadey & Evans, 2012). Before you do make a decision, weigh up the options and make sure you are well informed.

Inability To Do Normal Day Activities – The Research

The consequences of becoming injured can not only have knock-on effects on the sport itself, but it can have effects on everyday life. In this phase of the injury process, losing the ability to normal day to day activities can add fuel to the fire that is the emotional distress For examples not being able to do activities such as dressing yourself, cooking your own food or playing with your children can cause intense feelings of frustrations and helplessness (Carson and Polman, 2008, Tracey, 2003).

Inability To Do Normal Day Activities – Strategies

Again like for emotional distress, social support is a key aspect for helping to overcome a number of these issues. Tracey (2003) reported that athletes identifying members of their social support network who could help with the everyday demands, proved effective in helping athletes cope with the injury process such as getting appointments, cooking and shopping etc. This support network can come in a number of forms, such as teammates, family, partners or housemates. Furthermore, Wadey et al., (2011b) reported that this type of social support had aconor consequent effect on individuals perception of social support when they returned to play after recovering from the injury.
Part 3 will focus on the injury process and rehabilitation phase of the injury.

Guest blog by psychology expert Philip Clarke BSc (Hons), MSc, PhD (Student).

If you require any further advice please contact Philip via

Email –
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Bianco,T. (2001). Social support and recovery from sport injury: Elite skiers share their experiences. Research Quarterely for Exercise and Sport, 72, 376-388.
Bianco, T., & Eklund, R.C. (2001). Conceptual consideration for social support research in sport and exercise settings: The case of sports injury. Journal of Sport and Exercise Psychology, 23, 85-107
Bianco, T., Malo, S., & Orlick, T. (1999). Sport injury and illness: Elite skiers describe their experience. Research Quarterely for Exercise and Sport, 70, 157-169.
Brewer, B.W., & Petitpas, A.J. (2005). Returning to self: the anxieties of coming back after injury. In M.B. Anderson (Eds.). Sport Psychology in practise (pp.93-108). Champaign, IL: Human Kinetics
Carson, F. & Polman, R.C.J. (2008). ACL injuryrehabilitation: a psychological case-study of a professional rugby union player. Journal of Clinical Sport Psychology, 2, 71-90.
Collins D.J., Moore, P.M., Mitchell, D., & Alpress, F. (2009). Role conflict and confidentiality in multidisciplinary athlete support programmes. British Journal of Sports Medicine, 33, 208-211.
Evans, L., Wadey, R., Hanton, S., & Mitchell, I. (2011). Stressors experienced by injured athletes. Journal of Sport Sciences, 30 (9), 917-927
Gallagher, B.V., & Gardner, F.L. (2007). An examination of the relationship between early maladaptive schemas, coping and emotional response to athletic injury. Journal of Clinical Sport Psychology, 1,47-67.
Grove, J.R., & Cresswell, S.L. (2007). Personality correlates of appraisal, stress and coping during injury rehabilitation. In D Pargman (Eds.). Psychological bases of sports injuries (pp. 267-289). Morganstown, MV: Fitness Information Technology.
Johnson, L.H., & Carroll, D. (2000). Coping, social support and injury: Changes over time and the effects of level of sports involvement. Journal of Sport Rehabilitation, 9, 290-303.
Krane, V., Greenleaf, C.A., & Snow, J. (1997). Reaching for gol and the price of glory: A motivational case study of an elite gymnast. The Sport Psychologist, 11,53-71.
Mankad, A., Gordan, S., & Wallman, K. (2009). Perceptions of emotional climate among injured athletes. Journal of Clinical Sport Psychology, 3, 1-14.
Shaffer, S.M., & Wiese-Bjornstal, D.M. (1999). Psychosocial interventions strategies in sport medicine. In R.Ray and D.M. Weise-Bjornstal (Eds.). Counselling in Sports Medicine, (pp. 41-54). Champaign, IL: Human Kinetics.
Tracey, J. (2003). The emotional response to the injury and rehabilitation process. Journal of Applied Sport Psychology, 15, 279-293.
Wadey, R., & Evans, L. (2012). Working with Injured Athletes: Research and Practise. In S. Hanton and S.D. Mellalieu (Eds.). Professional Practise in Sport Psychology, (107-132). Routledge, Taylor and Francis Group: London and New York.
Wadey, R., Evans, L., Evans, K., Mitchell, I. (2011). Examining the antecedents and mechanisms underlying he perceived benefits following sports injury. Journal of Applied Sport Psychology, 23, 142-158.

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Injury Part 1: The Importance of Mind-set

When athletes or individuals experience injury, people usually think about the physical implications. So, they go and see a doctor or a physiotherapist and they are prescribed a rehabilitation programme, which in some cases can be very lengthy. Although it’s obvious that adhering to the injury rehabilitation process is key for successful recovery from the injury (Taylor & Taylor, 1997), it is not unheard of for athletes not to successfully complete their recommended injury process (Brewer, 1999). This may be caused by a number of reasons, one is that there is a number of psychological side-effects or implications of being injured. An individual’s ability to cope with these side effects can have major repercussions on the physical rehabilitation, quality of life and subsequent return to sport or normality (Ardem et al., 2012). The aim of the current blog will be to provide insight into what the research highlights regarding; psychological risk factors and injury, coping with the injury process and return-to-play.

Psychological Risk Factors
It is clear that the biggest risk factor associated with potential injury can be attributed to physiological processes. However, this shouldn’t mean that we disregard the possibility of potential psychological factors. It has been highlighted by a number of research papers, that psychological factors do in fact influence the number of injuries in sport (e.g. Rogers and Landers, 2005). The most influential of these being, the role that stress plays in the prevalence of injuries. So what is stress? Stress is simply when the physical and psychological demands of a situation exceed an individuals perceived capabilities, where failure to meet the demand has important consequences (McGrath, 1970). This can be caused by a whole host of different environments such as work, family life, financial or even sporting performance. Consequently, there are a number of physical, psychological and behavioural symptoms associated (See table below).

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Anderson and Williams (1988) developed a framework to help explain the role stress plays in the occurrence of injury. They suggest that three aspects have a direct influence on stress and its impact on injury including, history of many stressors (past experience), personality characteristics and coping strategies available. Therefore, people in potentially stressful situations are most vulnerable to experience stress if they have a history of many stressors; personality characteristics that intensify the stress process; and lastly feel like they don’t have the ability to cope with the situation.
These psychological factors then have a major influence on physical and behavioural processes. For example, stress influences our attention, in that we become pre-occupied or focused on the stressful event and possible negative connotations from it (Rogers, Alderman & Landers, 2003, Rogers &Landers, 2005). Therefore, our attention narrows and we miss potential peripheral cues that suggest potential dangers, thus increasing the likelihood of injury. The ability to cope with these stressors is vitally important to help ensure we can focus on what we need to. So in essence we miss things we would usually see when we are not stressed. So, I won’t (in this blog) go into more detail of what the literature says about how to cope effectively with daily stressors (maybe future blogs), but finding a way to cope effectively with life stressors can be a really important factor in reducing your chances of injury. Specifically, this relates to three components; general coping skills (sleep patterns, nutritional behaviour and taking time for oneself), social support systems (having a support network around you), and stress management skills (being able to control your arousal levels and think clearly under pressure). Wills and Filer (2001) identify that having these coping resources available, mean that individuals view situations more positively or less threateningly.

Coping With The Injury Process

As highlighted above in Anderson and Williams (1988) model, it is clear that an individual’s perceived ability to cope with stressors is important. This is especially important when suffering with the injury itself. For many athletes this can mean a prolonged period away from action, a dramatic change to daily routine and a possible limitation to general daily activities. Thus, athletes may experience a variety of emotional responses and stress when being injured. For a lot of athletes, exercise and physical activity is their go-to coping strategy, so when they suddenly can’t partake in this; it can cause even more intense emotions or upheaval (Walker et al., 2007). These emotional responses could come in the form of a number of emotions such as feelings of isolation, irritation, anger, distorted sleeping pattern, lack of motivation, sadness and in some cases, depression (e.g. Carson et al., 2012; Leddy et al., 1994; Walker et al., 2007). These symptoms can have implications not only on the way the individual copes with the current injury, but also the way athletes cope or deal with future injuries (Podlog & Eklund, 2010; Wiese-Bjornstal et al., 1998). Therefore, it is of vital importance that athletes have appropriate and effective coping strategies to ensure that they can successfully complete rehabilitation and return to active involvement, and this is why psychological factors are being increasingly recognized by sports medicine professionals as an important component of the rehabilitation process (Schwab Reese et al., 2012).
In a recent systematic review of the literature Schwab Reese et al. (2012) found support for the use of psychological interventions in effectively reducing post-injury psychological consequences, and improving athletes ability to cope during the rehabilitation process. Based on these findings, goal-setting, imagery and relaxation have been reported as being beneficial throughout the injury process. With that in mind, based on the current literature, the following are a set of strategies that can be helpful during the rehabilitation process. However( as mentioned in the goal-setting blog) there is a science to each of these interventions, as well as an art. Therefore, below I will discuss the science of each of the tips, but the art is applying them effectively to your given situation. This is where the help of somebody trained in mental strength skills use can be helpful. With any mental skills training, you need to picture your brain as a muscle, and like any muscle in the body, without repetitive training it cannot be effective. So put simply, there is no such thing a quick fix.

Effective Rehabilitation

The first important thing, at the early stages of the injury rehabilitation process, is acceptance. This is where individuals are encouraged to accept reality and their emotions, such as; boredom (associated with not being able to take part in your sport or activity), frustration (about rehabilitation setbacks), or even anxiety (about future re-injury; Mahoney & Hanrahan, 2011). This acceptance refers to an individual’s emotional state which allows them to connect more easily with the present moment and to focus on the current task at hand, which in this case, is the rehabilitation process (Gardner & Moore, 2004). Avoidance of these is not beneficial for the individual and can cause future re-injury as you put yourself in potentially dangerous situations.

Goal Setting
Once you have accepted the current situation you can put in place action plans (Goal setting) to help overcome the injury. These include following the rehabilitation programme given to you by the sports medicine professional. Penpraze and Mutrie (1999) found that when specific goal setting was administered as part of a rehabilitation programme (specific rehabilitation goals), athletes not only had a greater understanding of their rehabilitation programme, but also experienced greater adherence to their programmes. This was supported by Evan and Hardy (2002) who reported that goal setting (long and short term/ performance and process) was an effective way of providing task-support during the injury rehabilitation phase. Therefore, it is clear that effective goal setting (See Goal-setting blog for further guidance on goal setting) can be really effective throughout the injury process. However, it is noted that time should not be the main focus of the goal (i.e. being back playing in six weeks), return when your rehabilitation is complete and your feeling strong. Set process and performance goals around your rehabilitation, to ensure you are giving each session 100%.
You can also use this time away from the sport to focus on other aspects of your game/life. Roy Keane said the following when he suffered with a cruciate knee ligament injury, “A bleak period in my professional life had changed me….time spent alone helped me figure myself out”. This time period, allowed him to focus on developing his upper body strength, diet and setting new career goals. Other athletes include Paul O Connell, who was out injured in 2010 for nine months with a groin injury. He adopted a “Personal best approach”, where he vowed to not only come back as good, but to come back better than before. Therefore, by setting his goals he was able to remain focussed throughout his lengthy rehabilitation process.
Part two: will include other mental skills (Imagery & relaxation) and how to approach returning to competition and training.

Guest blog by psychology expert Philip Clarke BSc (Hons), MSc, PhD (Student).

If you require any further advice please contact Philip via

Email –
Twitter –

Anderson, M.B. & Williams, J.M. (1988). A model of stress and athletic injury: Prediction and prevention. Journal of Sport and Exercise Psychology, 10, 294-306.
Ardem, C.L., Taylor, N.F., Feller, J.A., & Webster, K.E. (2012). A systematic review of the psychological factors associated with returning to sport following injury. British Journal of Sports Medicine, 1-8.
Brewer, B.W. (1999). Adherence to sport injury rehabilitation regimens. In S.J. Bull (Ed.), Adherence Issues in Sport and Exercise, (PP.145-168). Chichester, England: Wiley.
Carson, F., & Polman, R. (2012). Experiences of professional rugby union players returning to competition following anterior cruciate ligament reconstruction. Journal of Physical Therapy and Sport, 13, 343-62.
Evans, L., & Hardy, L. (2000). Injury Rehabilitation: A goal setting intervention study. Research Quarteley for Exercise and Sport, 73, 310-319.
Gardner, F., & Moore, Z. (2004). A mindfulness-acceptance-commitment-based approach to athletic performance enhancement: theoretical considerations. Journal of Behavioral Therapy, 35, 707-23.
Leddy, M., Lambert, M., & Ogles, B. (1994). Psychological consequences of athletic injury among high-level competitors. Research Quarteley for Exercise and Sport, 65, 347-54.
Mahoney, J., & Hanrahan, S. (2011). A brief educational intervention using acceptance and commitment therapy: four injured athlete’s experiences. Journal of Clinical Sport Psychology, 5, 252-73.
McGrath, J.E. (1970). A conceptual formulation for research on stress. In J.E. McGrath (Ed.), Social and Psychological Factors in Stress (pp.10-21). New York: Holt, Rinehart and Winston.
Penpraze, P., & Mutrie, N. (1999). Effectiveness of goal setting in an injury rehabilitation programmefor increasing patient understanding and compliance. British Journal of Sports Medicine, 33, 60.
Podlog, L., & Eklund, R. (2010). Returning to competition after a serious injury: the role of self-determination. Journal of Sport Sciences, 28, 819-31.
Rogers, T.J. & Landers, D.M. (2005). Mediating effects of peripheral vision in the life event stress/athletic injury relationship. Journal of Sport and Exercise Psychology, 27, 271-288.
Rogers, T.J., Alderman, B.L., & Landers, D.M. (2003). Effects of life stress and hardiness on peripheral vision in real-life stress situations. Behavioural Medicine , 29, 21-26.
Schwab Reese, L.M., Pittsinger, R., & Yang, J. (2012). Effectiveness of psychological intervention following sport injury. Journal of Sport and Health Science, 1, 71-79.
Taylor, J., &Taylor, S. (1997). Psychological approaches to sports injury rehabilitation. Gaithersburg, MD: Aspen.
Walker, N., Thatcher, J., Lavallee, D. (2007). Psychological responses to injury in competitive sport: a critical review. Journal of the Royal Society for the Promotion of Health, 4, 174-180.
Weise-Bjonstal, D.M., Smith, A.M., Shaffer, S.M., & Morrey, M.A. (1998). An integrated model of response to injury: Psychological and sociological dimensions. Journal of Applied Sport Psychology, 10, 46-49.
Wills, T.A. & Filer, M.F. (2001). Social networks and social support. In Braun, T.A. Revenson, & J.E. Singer (Eds.), Handbook of Health Psychology (pp.209-234). Mahwah, NJ: Erlbaum.

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The Insidious Hamstring

Injury Mechanism in Brief…

Strains or injury to the hamstring are very common in sports involving rapid knee extension or maximal eccentric loading of the hamstring. This involves sports that consist of jumping, kicking and bursts of acceleration and deceleration.

Injury occurs when an athlete exceeds the mechanical limits that the muscle can withstand. The hamstring muscle crosses both the hip and the knee joint and contributes to hip extension and knee flexion. This causes potential problems during the sprint cycles as the hip and knee are driven into extension. Therefore one portion of the muscle is shortening to extend the hip and the other lengthening with knee extension. It is in situations where the muscle is placed under high, rapid tension or overstretched where mechanical limits are exceeded and injuries such as strains occur.

Strains can occur at the mid belly of the muscle group or at the distal or proximal ends. Proximal strains tend to heal slower than mid-portion or distal strains. These strains typically occur with hip hyperflexion and knee extension, placing the hamstring in an overstretched state.

The literature has postulated over possible causes for the common occurrence of hamstring injuries. These include their polyarticular nature, as mentioned, high percentage of fast twitch fibres, limited flexibility, muscle weakness and strength imbalance, disturbed posture and many more (Johangen et al., 1994; Mair et al., 1996; Kujala et al., 1997; Noonan and Garrett, 1999). However, the literature is still to identify any agreeable conclusions as to what factors cause hamstring re-injury. Worrell (1994) proposed that the combination of several abnormalities may increase the likelihood of hamstring strains. These abnormalities were strength, flexibility, warm-up and fatigue. However, there may be more factors to consider and a more global approach to managing these injuries may be needed. Croisier et al. (2004) wrote an article analysing associated factors with hamstring injuries. Understanding such factors could help with the management and prevention of hamstring injury and re-injury.

Associated Factors…

When faced with a hamstring strain it is very easy to dive straight into the injury and manage the acute problem i.e. pain, muscle soreness, rehabilitation etc. This is an approach that does have relief and success for many athletes. However, the rate of re-injury of the hamstrings is one of the highest of all injuries at 34% (Orchard and Seward, 2002) and almost half of hamstring strains in English football are recurrent injuries (48%) (Hawkins et al., 2001). Therefore in order to address the issue of recurrence and prevent any injury or re-injury taking a global approach to the factors involved may help tackle related issues and not simply those directly related to the hamstring and the local injury.

Extrinsic Factors

Warm Up
Fitness Levels
Training Modalities
Intrinsic Factors
Strength Deficits
Joint Dysfunction

Warm Up

The warm up plays a big part in preparing the body for physical activity, one reason for its place in physical activity is the increases in body temperature that occur. This temperature increase appears to facilitate increases in tissue extensibility. In an animal model muscles were innervated causing a rise in muscle temperature. This rise resulted in more stretch before failure and also increases in force production (Safran et al., 1988). The capability of the musculotendinous unit to absorb energy appears to be directly proportional to resting muscle length and muscle temperature (Safran et al., 1988; Taylor et al., 1990). Therefore something to consider is achieving optimal resting muscle length and educating on an adequate warm up to place the muscle in optimal states to cope which the energy and stress demands.


Hamstring injuries tend to occur late in training, competition, or following a fatiguing bout of activity. Fatigue may result in physiological changes within the muscle, altered coordination, concentration and running mechanics. These may increase the risk of injury, through inefficiencies in muscle activation and increased demand on other stabilising muscles (Devlin, 2000). Another animal model found that fatigued muscles had a decreased capability to absorb energy before reaching the injury-stretch point (Mair et al., 1996). Therefore the application this has is highlighting the importance of physical but specific conditioning. If we can manage fatigue, by replicating the demands of an activity in training and making modifications when fatigue occurs, we may be able to provide some protection against injury or re-injury.

Fitness Levels and Training Modalities

Abrupt increases in training volume and intensity offer a predisposition to injury or re-injury. Although training needs to simulate the demands of sporting activity, pre-season or general training needs to be progressed and not favour one training modality. Aerobic and anaerobic systems need to be stressed and trained. Education on physiology and the body systems will help the design and structure of a training schedule that will provide an aerobic base as well as the ability to cope with demands above the anaerobic threshold. In short, trainers must build a base of fitness using suitable modalities, and when utilising anaerobic or lactate threshold training provide sufficient recovery periods.

Intrinsic Factors

Strength Deficits

Deficits in strength and muscle function when observed bilaterally may be a predisposing factor to initial injury and re-injury. Research is inconclusive as to the significance of strength deficits and parameters that determine return to sport. However, some figures in the literature propose that the strength of the affected should be 80-90% of the contralateral leg before returning to sport (Heiser et al., 1983; Clanton and Coupe, 1998).

Crosier et al. (2002) identified athletes with strength deficits in the form of peak torque, bilateral differences and the hamstring/quad ratio. A rehabilitation programme was individually assigned based on strength profile which emphasised eccentric training. They all returned to sport with significantly reduced pain and discomfort and none sustained any clinically diagnosed re-injury.

This highlights the importance of regaining strength in the injured limb before any attempt to return to sport. It also raises the point of seeking accurate measures of strength of both injured and non-injured leg.


Flexibility and its relationship with muscle strains is unclear, it has been found that soccer players with increased hamstring and quad tightness are statistically more at risk of developing a strain in those muscles (Witvrouw et al., 2003). It would seem that if the muscle tendon unit had more compliance the ability to absorb energy and any stress caused by a lengthening muscle would be more effective. Therefore if the muscle-tendon unit is more flexible then the likelihood of any strain injury may be reduced (McHugh et al., 1999).

Therefore flexibility, like strength, should be normalised to match the contralateral leg as closely as possible before returning to sport. However, the mode of stretching should be designed to replicate the movements experience during the athletes’ activity much like the training modalities used. Another consideration would be the aggressiveness of the stretching prior to any competition or training. Overstretching may A) caused muscular damage and B) reduce the cross-bridge availability and thus reduce the force output potential which may be detrimental during power based sports.

Age-Related Factors

Orchard (2001) proposed that age is a risk factor due to degeneration of the lumbar spine. This leads to L5 and S1 nerve impingement and decreased hamstring strength. The quadriceps however do not appear to be affected therefore some muscle imbalances may result. This highlights the importance of taking a more global approach and keeping the spine healthy to reduce the degeneration and risk of injury or re-injury.

Joint Dysfunction

It is unclear whether joint dysfunctions can predict hamstring injuries, however, changes in joint alignment can be associated with muscle weaknesses or elongation. Cibulka et al. (1986) suggested that anterior pelvic tilt and sacroiliac joint dysfunction may elongate the hamstrings. By correcting the dysfunction there was an increase in hamstring peak torque. Although there is no direct link established between joint dysfunctions and hamstring injuries this evidence highlights that athletes’ with hamstring injuries should be assessed for other joint dysfunctions. Rehabilitation should take into account other surrounding joints and structures that may alter the function of the hamstring.

Effects and Treatment of Initial Strain…

The acute injury to the hamstring muscle group will cause structural modifications. If these issues are not treated effectively it can open the door for the future, chronic complaints.

Immediate Actions

The events that occur during this phase of the acute injury need to be reduced. This process is part of healing and plays an important part but the duration of this phase needs to be reduced in order to prevent secondary hypoxic injury (surrounding tissue death). Haematoma, oedema and extravasation of inflammatory cells around the injury site need to be reduced. Following initial injury the commonly used acronym is RICE (Rest, Ice, Compression and Elevation).


I would agree with the above acronym for the initial few days of injury but encourage early utilisation of some progressive, pain-free loading to encourage mechanotransduction (see my article on mechanotransduction). Ensure this loading is not too vigorous or placing too much strain upon the hamstrings.

The initial immobilisation duration will be dependent upon the grade of the strain. This allows the migration of satellite cells and collagen formation which play important roles in the repair and remodelling of the injured muscle tissue. This immobilisation needs to limited as excessive immobility can lead to excessive scar tissue formation affecting the flexibility and function of the repaired muscle leaving it open to future injury. On the other hand too little immobility will simply disrupt the newly laid down collagen hindering the healing process. Therefore this needs to be carefully determined and balanced with early loading to match the degree of injury.


This is highly important for promoting optimal orientation of muscle and newly formed collagen fibres. It also prevents the formation of excessive adhesions. This can be achieved with a well-designed stretching and exercise program consisting of both concentric and eccentric contractions. As well as these beneficial qualities the introduction of early mobility exercises appears to encourage faster recovery of proprioception, although this is lacking demonstration scientifically. This brings back the previously mentioned mechanotransduction, by loading the tissue as early as pain and healing will allow the tissue can be optimally healed and prepared for return to activity.

Soft Tissue and Scar Manipulation

Soft tissue massage and manipulation of soft tissues is a common treatment modality utilise when managing muscular injuries. The idea is that the collagen and scar formation is manipulated to adopt a more functional alignment. This would then, in theory, allow a much fuller range of motion and flexibility. Hopper et al. (2005) demonstrated that utilising a dynamic soft tissue treatment on the hamstrings achieved much greater increases in flexibility than a classic massage treatment and a non-massage control. This highlights that massage techniques can influence beneficial increases in flexibility and movement. If this can be achieved the risk of injury or re-injury will be reduced. The superior, dynamic element shown by Hopper et al. (2005) also fits the factor discussed earlier in training modality about ensuring the warm up and training is functional and replicates performance and competition. So if the massage techniques can also do this by being more dynamic and functional this may also be more beneficial in achieving this injury prevention. The massage in this study only had a duration of 8 mins which is shorter than the majority within the literature. Huang et al. (2010) found that an even shorter bout of massage (10secs and 30secs) to the musculotendinous junction of the hamstrings can also instigate significant, beneficial changes to hamstring flexibility. As flexibility has been identified as a potential contributing factor to hamstring re-injury soft tissue massage may be a method of addressing this factor.

Reducing Psychological Tension

Worry or anxiety above injury or competitive situations may create increased tension upon the hamstring. This tension would be placing more stress than isn’t necessary upon the hamstring which will only put the athlete at a higher risk of re-injury. Therefore as well as physical treatment the athlete may need some psychological interventions to aid relaxation and shift attentional focus. This is often overlooked but the mind set and psychology of the athlete is just as important as the physical treatment. As well as the above areas to consider confidence will be a big issue to tackle. If the player is not 100% confident this will only fuel any anxiety and internal focus on the injury, leaving them open to re-injury. These psychological factors all need to be taken into consideration.


The treatment of recurrent hamstring injuries needs to consider the variety of factors, mentioned above, and take a global approach when managing the injury. Therefore if someone presents with a hamstring injury that is either acute or chronic the initial treatment is to manage any inflammation and symptoms as with any other injury. However, to prevent this common persistent complaint the therapist should take a look at all the contributory factors; assessing training modes, warm up, strength deficits and joint dysfunctions rather than simply targeting the local area. This will, hopefully minimise the risk of future occurrences. By educating the athlete on these potentially contributing factors and coach them on how to address these factors. Things like functional stretching, and ensuring that training modalities replicate their sporting environment.

By educating the athlete on these factors as a whole they can optimise their training, fitness levels and preparation to ensure their hamstrings are in the best state to compete and perform without causing injury or re-injury.

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Self-Soft Tissue Release

What Is Self-Soft Tissue Release?
Soft tissue release is a method or technique used to relieve tight, stiff, or sore areas of the body. Its purpose is to release any restrictions or barriers that may be within the soft tissue of the affected limb or body part (Barnes, 1991). The method involves applying pressure to the sore area with a tool such as a foam roller, the motion of rolling creates friction between the roller and the soft tissues. It also provides a sweeping pressure which stretches the tissues.
It can be used manually by therapists, however it is becoming readily self-applied within both recreational exercise, athletic, and rehabilitation environments. It is regularly used within a warm up to prepare us for subsequent activity, or post-workout to prevent any muscle soreness. It is also used by many simply to maintain flexibility and quality of life, or to recover from injury or pain complaints.
This method can be applied using many tools. Common examples of these tools are as follows:
• Own Hands,
• Foam Roller,
• Cricket/Hockey/Lacrosse Ball,
• Barbell
There are many things that can be used to apply this technique once you know the principles behind how it works and how it should be applied.

Why Do We Self Massage?
With regular activity, injury and inflammation stress, or postural stress our body forms unwanted bonds between tissues. These bonds or adhesions stop the tissues moving freely over each other or functioning as an individual unit. Fascia can also become dehydrated and lose elasticity and become bound to the injured or damaged area of the muscle tissue which can also form adhesions. As a result of the adhesions fibrous deposits can form within muscle bellies etc. The accumulation of the above can cause pain, affect range of movement, alter the skeletal alignment, and may alter the angle of force generated by muscles, as well as joint mechanics (Boehme, & Boehme, 1991; Barnes, 1997; Curran et al., 2008; Swann & Graner, 2002).
Many people use of self-soft tissue release, such as foam rolling, as a form of recovery from an intense bout of exercise or sport. Many individuals, both recreational and elite exercisers, experience exercise-induced muscle damage (EIMD) which is characterised by soreness, swelling, temporary muscle damage, decrease in muscular strength and range of motion (Cheung, et al., 2003; Torres, et al., 2012). This is what appears to cause the delayed onset of muscle soreness (DOMS) after exercise bouts. It can also affect neuromuscular performance, which alters muscle firing and recruitment patterns (Cheung et. al, 2003). EIMD and DOMS can be seriously debilitating to athletic performance or general training ability as it alters our muscle function and joint mechanics through all of the above (Rowlands et al., 2001). The usual aim of self-tissue release is to reduce this soreness etc. of EIMD and DOMS resulting from these exercise bouts so they can engage in subsequent bouts of exercise with minimal effects on performance.
Many athletes will use foam rolling or soft tissue release pre-exercise or activity with the aim of enhancing performance by ensuring the soft tissues are in the best shape they can be to exercise. This potential for performance improvement may be due to some of the factors mentioned above such as decreasing any soreness, and improving the ROM of the tissues. In turn this may improve force output or firing patterns.
Others may simply use the method to maintain a good quality of life and prevent aches, pains and injury by maintaining a comfortable ROM in their soft tissue by reducing restrictions and shortened muscles.

How Does It Work?
The specific proposed benefits of self-tissue release that may influence why we apply these methods are as follows.
Proposed Benefits of Self-Soft Tissue Release:
1. Help correct muscle imbalances
2. Increase the range of movement around a joint
3. Decrease muscle soreness
4. Decrease increased muscle tone/spasm
5. Increase flexibility of bodily tissues
6. Maintain normal muscle length
(Shah & Bhalara, 2012)
The basic principle behind the method is the stretching, and relaxing of the restricted tissues. During this method the elastic components, fascia, and muscular crosslinks are stretched or relaxed. Pressure created by soft tissue release increases arterial blood flow or vasodilation to the restricted site. Also reported are increases in nitrogen oxide, and restoration of soft tissue. All of these may have beneficial effects such as the above mentioned (Okamoto et al., 2013)

Does it actually work? What is the evidence?

Can Foam Rolling Help Recovery?
As mentioned previously people experience EIMD and DOMS from intense bouts of exercise. Soft-tissue release techniques such as foam rolling are readily being applied after sessions as a recovery tool to reduce the symptoms of DOMS. One of these symptoms is that the damaged muscle is sore to touch and the pressure-pain threshold is decreased. Some evidence has shown that foam rolling can actually increase this threshold and reduce the muscle soreness ratings. These results were seen with both short duration rolling (1 min bout on each area) and long duration (20 min whole body) done immediately, 24 hours post-exercise, and 48 hours post-exercise (MacDonald et al., 2014; Pearcey et al., 2015). This highlights that both short and long bouts of foam rolling have the potential to reduce the soreness of DOMS, which may then increase the ability to train again in subsequent sessions.
As the aim of recovery foam rolling is to be ready to train or perform again in following sessions the method needs to restore performance attributes. There is evidence that sprint speeds, jump power, agility speed, and dynamic strength-endurance is increased compared to non-foam rolling after intense exercise (Pearcey et al., 2015).
The physiological effect of foam rolling appears to have more effect on the non-contractile tissues such as tendons and connective tissue. This suggestion was proposed due to an observed decrease in muscle twitch force when externally stimulated, however there was an increase in the ability to voluntarily activate muscle fibres. This may suggest that by improving stimulation of the connective tissue via foam rolling increases feedback to the central nervous system, thus increasing its ability to recruit and activate muscle fibres. This improved ability to recruit muscle fibres and activate muscles may explain any improvements in power output restoration (MacDonald et al., 2014).
In the latter study the greatest difference in voluntary muscle activation levels was at 48 hours post exercise which interestingly was when muscle soreness was at a peak for non-foam rolling. The foam rolling group soreness peaked at 24 hours and interestingly, there appeared to be more muscle damage caused by foam rolling. This may suggest that the early peak in soreness with foam rolling, possibly due to rolling induced further muscle damage allows quicker recovery of activation allowing the individual to train more effectively and sooner.
Foam rolling improved passive ROM of the quadriceps and hamstrings, and the dynamic ROM of the hamstrings. This will have benefits when performing later exercise as it will allow the individual to achieve greater ranges, optimising muscle function. Improvements in ROM have been attributed to the reduced soreness as noted above, as well as decreased inflammation, and reduction in adhesions within the muscle tissue (Barnes, 1997; Curran, et al., 2008).
The above evidence suggests that foam rolling may actually be a beneficial method for decreasing pain, increasing ROM, reducing performance decrements, increasing the ability to recruit and activate muscle fibres. This will aid the recovery from intense exercise and ability to engage in subsequent training sessions with a more productivity therefore highlighting the huge benefits of foam rolling.

Can Foam Rolling Help Improve Performance?
Warm ups usually involve some form of dynamic stretching, or low level cardio and modern warm ups are no stranger to the addition of foam rolling, aiming to ensure performance is optimal. There is evidence that including foam rolling into our warm ups can improve strength, power, speed, agility, and sub-maximal exercise performances. These improvements were attributed to the potential for enhanced muscle fibre recruitment as discussed above (Peacock et al., 2014). These results were observed with a very short duration of 30s bouts on six areas of the body. This highlights that short bouts of foam rolling pre-performance or exercise could help improve our output whether it be strength, power, speed, or endurance.
However, this study combined dynamic warm ups with foam rolling and despite the obvious additional benefit of foam rolling it is unclear whether the effect of foam rolling will be as effective alone.
Unlike previously discussed studies there was no improvement in ROM noted, but this may be because the protocol of foam rolling was a whole body application for a short duration. If the foam rolling focus on specific areas and targeted tight areas specifically this may have helped produce some improvement in ROM. Some people suggest that increases in ROM may have hindered effects on performance output. Therefore some may be reluctant to use methods to improve ROM pre-exercise or performance not to risk any negative effects. However, studies do provide evidence that foam rolling appears to significantly improve knee ROM using 5 second and 10 second bouts (Sullivan et al., 2013), and 2 minute bouts (MacDonald et al., 2013). This ROM improvement is achieved without any reduction in force output or muscle activation. The negative correlation between the ROM and muscle force observed with non-foam rolling was reduced with their 2 minute bouts of foam rolling (MacDonald et al., 2013).
The evidence from these studies suggest that using self-tissue release, i.e. foam rolling, can actually help improve performance factors, increases ROM, and the thought that by increasing ROM reduces the performance factors may actually be unlikely. Therefore if we want to ensure we can perform to our best foam rolling and soft-tissue release may be a quick and effective way of achieving this, as the studies used very short bouts.

So What Can I Do?
Now there are hundreds of exercises and techniques people apply to relieve their aching muscles and joints but in this article I will give you five examples that I consistently apply to my warm up and recovery. They target 5 areas I personally find get very tight and restricted.
I use a whole host of different tools to apply my techniques but as long as you understand what you are trying to actually achieve and how this works. The tools I include are the standard foam roller, barbell, cricket ball, and kettlebell. The exercise I use are as follows:

Chest ReleaseThoracic Spine Release
There are two tools you can use for this exercise, one is your standard foam roller or you can make shift what we call a “peanut”. I use this method before and after any overhead training days.
Using the foam roller, lie it horizontally and place it roughly near the rib level of the spine. With your legs straight and flat on the floor start by arching over the roller taking your arms straight above the head. You want to aim to try get your hands to the floor eventually, but don’t allow your hips to lift off the floor. You may hear of feel some cracking with this movement, but as long as it is not significantly painful this is normally and may feel relieving. This can be done 5-10 times or until you feel an improvement in range of movement or feel looser through your spine.
You can then move onto using your peanut, which is basically two tennis balls taped together so it looks peanut shaped. You can then place this in a similar spot to where the foam roller was so the balls of the peanut are either side of the spine and work your way up toward the neck. The way you can work into this is firstly by simply slowly rolling down over the peanut, and back up until you feel the muscles either side of the spine start to loosen and soften.
You can also lock into the muscle by lying on the peanut as above, then slowly performing a crunch movement to stretch these muscles for 10 reps, then reposition the peanut and go again.

Quad Release
This is a very simple exercise but can be very effective. I always start with a foam roller and lie face down with my target quad on it. Then placed as much pressure, using bodyweight, as you can stand. Then slowly roll up and down the quad creating a wave of pressure, you can also rotate your leg in and out to create a pressure wave across the quad.
Once you have loosen and warm up the muscle you can then stay in the same position, and lock the tissue in by finding a tight spot and put as much weight as you can onto this spot with the roller. Then slowly bend your knee, bringing your heel towards your buttocks. DO this slowly so your quad stretches from the “locked” point. You can do 2-3 at this point and then reposition the roller to a different spot and repeat. If you struggle to get enough pressure using a roller you can substitute it for a barbell, or even a cricket/hockey ball for a more direct pressure.

Hamstring Release
As with most of the above I start with rolling down and up the hamstring using my foam roller by sitting with the roller under my thigh on the muscle. I try focus one leg at a time rather than both so I can get more pressure on it.
I will then move on to placing a barbell in a rack, and then lift my target leg over it and resting the hamstring on the bar. I will use the other leg to stand on for stability. I will then drop down pushing the hamstring into the barbell at a restricted point in the muscle. Once locked in I will then slowly straighten my leg stretching the hamstring from the locked point, do 2-3 then reposition the leg.

Hip Flexor Release
For this exercise I use a kettlebell and a cricket ball. For this you will need to lie on a bench, bend your hip and knee so your foot is flat on the bench. We are targeting your high hip flexor (Psoas), to find this area it is generally approx. an inch up from your “hip bone” and an inch or so in just off the side of your “abs”. You can check you are in the right spot by pressing your fingers into the area and straightening and bending your leg and you will feel the muscle working. Once you are confident you have found it, bend your hip and knee again to bring your foot flat, and then place the ball in the area. Apply pressure onto the ball and muscle by using a kettlebell on top of the ball. Once you have put the pressure on and locked in straighten your leg slowly, and if you can lower it down off the bench to get a further stretch, release the pressure return and repeat. Do this a few times or until you feel looser and improvement in hip flexor movement.

Take Home Message
There are many tools, and exercises that can be used to achieve the results of self-tissue release. However, as long as you have a brief understanding of what it is, how it works, and how it may benefit us you can use it to your advantage without having to fork out for a therapist to apply it for you.
You can be creative with exercises as long as you understand the anatomy of tissues you are targeting. The above are only a few examples that I use myself and find work for me, there is no guarantee that they will work for you. The evidence for foam rolling and self-tissue release methods is very limited at present so it is not a guaranteed method, but the evidence does look promising.
Should anyone want a personal and specific stretching and mobility program please do not hesitate to contact me. This is something I can offer online with support throughout.

Guest blog by Ieuan Cranswick MSc Sports Therapy

If you require any further advice please contact Ieuan via

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Barnes, J. (1991). Pediatric Myofascial Release. Physical Therapy Forum – MFR Techniques.

Barnes, M. (1997). The basic science of myofascial release: morphological change in connective tissue. Journal of Bodywork and Movement Therapies, 1(4), 231–238.

Boehme, R. and Boehme, J. (1991) Myofascial release and its application to neuro-developmental treatment, pg. 5-8, 11-16, 80. Boehme Workshops, Milwaukee.

Cheung, K., Hume, P. and Maxwell, L. (2003). Delayed onset muscle soreness: treatment strategies and performance factors. Sports Medicine, 33(2),145–164.

Curran, P., Fiore, R., and Crisco J. A comparison of the pressure exerted on soft tissue by 2 myofascial rollers. Journal of Sport Rehabilitation, 17(4), 432–442.

MacDonald, G., Penney, M., Mullaley, M. Cuconato, A., Drake, C., Behm, D. Button, D. (2013). An acute bout of self-myofascial release increases range of motion without a subsequent decrease in muscle activation or force. Journal of Strength and Conditioning Research, 27 (3), 812-821.

MacDonald, G., Button, D., Drinkwater, E. and Behm, D. (2014). Foam rolling as a recovery tool after an intense bout of physical activity. Medicine and Science in Sports and Exercise, 46 (1), 131-142.
Okamoto, T., Masuhara, M. and Ikuta, K. (2013) Acute effects of self-myofascial release using a foam roller on arterial function. Journal of Strength and Conditioning Research, 28 (1), 69-73.

Peacock, C., Krein, D., Silver, T., Sanders, G. and Von Carlowitz, K. (2014). An acute bout of self-myofascial release in the form of foam rolling improves performance testing. International Journal of Exercise Science, 7 (3), 202-211.

Pearcey, G., Bardbury-Squires, D., Kawamoto, J., Drinkwater, E., Behm, D. and Button, D. (2015). Foam rolling for delayed-onset muscle soreness and recovery of dynamic performance measures. Journal of Athletic Training, 50 (1).

Rowlands, A., Eston, R. and Tilzey, C. (2001). Effect of stride length manipulation on symptoms of exercise-induced muscle damage and repeated bout effect. Journal of Sports Sciences, 19 (5), 333-340.

Shah, S. and Bhalara, A. (2012). Myofascial release. International Journal of Health Sciences and Research, 2 (2), 69-77.

Sullivan, K., Silvey, D., Button, D. and Behm, D. (2013). Roller-massager application to the hamstrings increases sit-and-reach range of motion within five to ten seconds without performance impairments. The International Journal of Sports Physical Therapy, 8 (3), 228-236.

Swann, E. and Graner, S. (2002) Uses of manual-therapy techniques in pain management. Athletic Therapy Today, 7, 14–17.

Torres, R., Ribeiro, F., Alberto Duarte, J. and Cabri J. (2012). Evidence of the physiotherapeutic interventions used currently after exercise induced muscle damage: systematic review and meta-analysis. Physical Therapy in Sport, 13(2), 101–114.

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Effective Goal Setting

Goals are something that we set in our daily lives, whether it is something you want to achieve in your career, attaining your dream body or making the first team in your given sport. Goal-setting is one of the most effective skills you can learn, yet it is one skill that so many do incorrectly. So many people set goals that are not thought out or planned and evidently setting themselves up to fail. The aim of this blog will be to provide insight into: what goals are, why they are effective, the biggest mistakes people make and finally, how to put a structure in place to achieve your goals, using the most up to date research and principles on goal-setting from sport, exercise and business environments.
What are goals and why do they work?
A goal is defined as an aim or object we are trying to obtain (Locke & Latham, 1985). Sounds simple, yes, but achieving that goal or object is where the problems may arise. In most athletes or exercisers this goal is usually achieving a level of proficiency in their skill (e.g. scoring 70% of their free throws in basketball season), achieving a specific aesthetic look (e.g. stage body) or achieving a specific health objective (e.g. reducing levels of cholesterol) within a certain time frame.
The three types of goals you can set vary in their level of specificity based on what you are trying to achieve, and the level of difficulty required in completing the task (Weinberg, 2013).

• Outcome goal focusses simply on the outcome of an event, winning or losing for example, more so, these goals are usually long term in nature.

• Performances goals are where individuals set goals for their level of actual performance in relation to the standard of excellence.

• Process goals usually focus on the technique an individual wants to achieve (e.g. getting the bar down to your chest on a chest press), performing a certain skill (e.g. the pendulum motion of a golf swing), or carrying out a specific strategy (e.g. fitness model preparing for getting on stage).

Although all three goals are beneficial for enhancing performance, the biggest mistake people make is that they focus all their attention on the outcome goal, which is usually something that is outside of their control. It is important that your attention is focussed on things that are within your control. This means that you become accountable for whether you achieve this goal or not. This is why performance and process goals are so important, as they are very much within the control of the goal-setter (Weinberg, 2013). Research also shows that those individuals, who set process and performance goals, rather than outcome goals, experienced less anxiety, had greater confidence, improved concentration, and improved overall satisfaction and enhanced performance (Kingston & Hardy, 1997; Pierce & Burton, 1998). So in essence, ensuring your goals are within your control is very important, and should be incorporated into your goal setting plan alongside outcome goals. Furthermore, you should set these goals in both competition and practice to ensure you achieve your objectives.
It is clear from a number of studies that effective goal-setting is a powerful tool for enhancing overall performance, with extreme emphasis on the effective aspect of this (e.g. Burton et al., 2010). So why is it, that effective goal-setting enhances performance? Locke et al. (1981) provides four potential mechanisms to explain why this occurs:
• Directing attention
• Mobilising effort
• Enhancing persistence
• Developing new learning strategies
So why are these four mechanisms important? Well, each of these factors play not only a key role on performance, but also on a number of psychological factors previously mentioned such as motivation, anxiety, confidence and satisfaction.

The “How” of goal setting
One thing before we discuss the aspects associated with setting these goals effectively: there are two distinct factors that need to be taken into consideration when setting goals effectively. One reflects understanding the “science”, which is about understanding the literature and models associated with goals setting. The second reflects the “art” of goal setting. This is probably the most difficult part to get right, but is what makes goal setting the powerful tool mentioned. The reason this part is more difficult is this is where the individual and the situation are taken into consideration during the process. The individual’s personality traits and the situational constraints both need to be taken into account with the following goal setting tips. Therefore, the tips presented need to be viewed within this context (Weinberg, 2010).

Specific Measurable Achievable Realistic Time-Bound Exciting Recorded

Smarter Principle
The first principle of effective goal setting is using the “SMARTER” model. You have probably seen this model before online, but with alterations to each stages meaning. The figure above is probably the most citied and is something that I always have at the forefront of my mind, or on the top of my sheet when setting goals. So let’s look a little bit deeper about what each part is and why it’s important:

• Specific-
Bad Goal: I want to improve my free throw percentage (basketball)
Good Goal: I want to achieve my free throws from 50% to 60%
Many times people identify that they “want to do their best”, which can help motivationally (Weinberg, 2013). However, goal-setting is more effective when you make your goal as specific as you possibly can. As you can see in the goal above, the difference between the bad goal and good is small in wording, but huge in terms of the focus.

• Measurable
Bad Goal: I want to be a better athlete than last year
Good Goal: I want to improve my passing distributions by 5% overall this year
This goal is something that is easily measurable. If you can’t measure progress or measure what you want to improve, how can you see if you have made progression? Therefore you need to ensure that you can actually measure your progress
• Achievable or attainable
Bad Goal: I want to be able to lift as much in a bench press as Luke Haslett
Good Goal: I want to be able to increase my 1RM in bench press by 5% in the next month
You need to ensure that goals are both challenging and realistic; this is another factor for setting effective goals (Weinberg, 2010, 2013). This is where the “art” of goal setting really comes into play. If goals are too challenging or not attainable then you might lose motivation and experience increased feelings of anxiety and stress. Whereas, setting goals too easy means you might not progress as it’s too easy. So, people need to assess where their current capabilities are and push those limits and goal set accordingly. Weinberg (2013) recommends that no more than a 5% increase above current performance should be aimed for. So the art is finding the balance between setting yourself up to lose with goals that are too difficult, and allowing for an easy ride with goals that are too easy.

• Realistic
Bad Goal: I want to Qualify for the PGA tour
Good Goal: I want to lower my golf handicap by 3 strokes
“If you set a goal, your subconscious will attract the things that support that goal. If you don’t set a goal you’ll drift. If you make your goals too hard, you’ll destroy yourself; if you make them too easy you’re going to underperform” (Roger Black – Olympic Silver Medallist)

• Time-bound
Bad Goal: Fit into my jeans
Good Goal: Fit into my jeans by June 1st
The next aspect of the model refers to placing a time-line on the when they want to achieve their goals. This will help provide a goal attainment attitude instead of saying “I will start Monday”. However, many people set goals that are maybe 6-8 months away from now, meaning it can be very difficult to remain focused for that long a period. So it is important to make both short and long term goals (Weinberg et al., 2001, 2002; Weinberg, 2013). If you imagine a staircase, with long term goals being at the top, and each short term goal as being a step up towards the top of the staircase (Weinberg & Gould, 2011). This means that you always have an upcoming goal to work towards, that is inevitably (is planned well), taking you closer to your long term objective.

• Exciting
Bad Goal: I want to lose 20 pounds
Good Goal: When I lose 20 pounds I can buy a new dress
With that in mind, your goals need to be exciting. If planned effectively this will help you get up for that early morning training session, or work that bit harder when you feel you have nothing left. This can be achieved by coming up with different and interesting ways of achieving your goals. This may be byhaving the goal of fitting in a dress or clothes that you want to wear for a party, wedding etc.

• Recorded
Bad Goal: Saying it in your head
Good Goal: Putting it on your kitchen fridge

The final aspect of the model refers to something that can have huge implications on the chances of achieving yours goals (Burton et al. 2008; Gould 2010; Weinberg, 2002). This is the “ink it, don’t think it” approach. By recording the goal, you make a commitment to yourself that this is something you want to achieve. This is why it’s very easy to say it in your head, but putting it down on paper is a completely different thing. You get to check; is this actually attainable? Is it realistic? Once you have made that commitment, put it in places that can be easily seen, this will reinforce that goal every time you see it. Put it in your gym bag, put in on your bathroom mirror or your kitchen fridge. Therefore, the most important people in your life can help give you encouragement and feedback on your goals.
“The two most important parts of setting goals are that you write them down and that you put them someplace you can see the, every day. I usually recommend the bathroom mirror or refrigerator door, two places I know you will always look. When I was 16 years old, training for my first Olympic games, my coach wrote all my goal times down on the top of the kickboard I was using every day in practise. I couldn’t escape the, but my result after executing the plan, was that I made the Olympic team”- Dr Gary Hall Jnr- Three Olympic teams as a swimmer, 10 world record.

Develop goal achievement strategies
Locke (1968) first identified that one key factor associated with goal attainment/effectiveness is developing specific plans to achieve the goal. This is usually an aspect that individuals and coaches neglect (Weinberg, 2013). So for example, if you want to achieve an increase of 5% in your 1RM max squats, what are is the process? Are you going to focus on; lifting more weight with smaller reps? Increasing the reps you’re able to do on the weight you’re currently doing? Or changing your technique? This will allow you to find what works best for you, so you use this to help with achieving future goals.
This type of mind-set will allow you to think about and be aware of possible barriers you may experience when trying to achieve your goals. These barriers can come in the form of internal barriers (confidence, lack of ability, etc.) or external barriers (lack of time to train properly) as (Weinberg et al., 2000). By evaluating these barriers, you can put action plans in place to overcome them.
Burton et al. (2010) reported that athletes, coaches and exercisers are not very systematic when developing strategies to help overcome goal barriers. Therefore it’s essential to have these strategies in place to guide you to your objective so you don’t fall at the first hurdle (Locke & Lathan, 2002).

Monitor and evaluate goals
Lastly, the initial goal-setting should be a starter place not the end. This is another big mistake individuals make when setting goals. You should monitor and re-evaluate your goals periodically based on current performances, and then based on the original goal; the goal should be made easier or more difficult accordingly. This will allow you to keep the goals realistic but also challenging at the same time.

Burton, D., Pickering, M., Weinberg, R., Yukelson, D., & Weigand, D. (2010). The competitive goal effectiveness paradox revisited: Examining the goal practices of prospective Olympic athletes. Journal of Applied Sport Psychology, 22, 72-86.
Gould, D. (2010). Goal setting for peak performance. In Williams, J. (Ed). Applied Sport Psychology: Personal growth to peak performance. 6th ed. Mountain View: Mayfield, 2010, 201-220.
Kingston, K., & Hardy, L. (1997). Effects of different types of goals as processes that support performance. The Sport Psychologist, 11, 277-293.
Locke, E.A. (1968). Toward a theory of task motivation incentives. Organizational Behaviour and Human Performance, 3, 157-189.
Locke, E. A. & Latham, G.P. (1985). The application of goal setting to sports. Journal of Sport Psychology, 7 (3), 205-222
Locke, E. A. & Latham, G.P. (2002). Building a practicality useful theory of goal setting and task motivation: a 35 year old odyssey. American Psychologist, 57, 705-717.
Locke, E.A., Shaw, K.N., Saari, L.M., & Latham, G.P. (1981). Goal setting and task performance. Psychological Bulletin, 90, 125-152.
Pierce, B.E., & Burton, D. (1998). Scoring a perfect 10: Investigating the impact of goal setting styles on a goal-setting program for female gymnasts. The Sport Psychologist, 12, 95-103
Weinberg, R.S. (2013). Goal setting in sport and exercise: research and practical applications. Revista da Educação Fisica, 24 (2), 171-179.
Weinberg, R. S. (2010). Goal setting for coaches: a primer. Journal of Sport Psychology in Action, 1, 57-65
Weinberg, R.S., Burton, D., Yukelson, D., & Weigand, D. (2000). Percieved goal setting practises of Olympic athletes: An exploratory investigation. The Sport Psychologist, 4,, 280-296.
Weinberg, R. S., Butt, J., & Knight, B. (2001). High school coaches perceptions of the process of goal setting. The Sport Psychologist, 15, 20-47
Weinberg, R. S., Butt, J., Knight, B. & Perritt, N. (2002). Collegiate coaches’ perceptions of their goal setting practise: a qualitative investigation. Journal of Applied Sport Psychology, 13, 374-399.

Guest blog by Psychology Expert Philip Clarke BSc, Msc

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Painful Squats?

Lumbo-Pelvic-Hip (LPH) Dysfunction
The LPH complex is an area where a whole can of worms can be opened up, there are “cross-roads” of muscles around that area and a whole host of conditions/injuries that can occur. Without opening this can of worms and discussing each and every injury possibility I want to discuss pain and dysfunction in a general sense that may be experienced during squatting movements or exercises that require deep hip flexion.
I myself have experienced this and got my therapist head on and broke down the squat movement and the LPH complex. Many of my friends and clients have expressed a similar discomfort but simply got on with it. What I then noticed with these people is that their squatting form was hugely compromised due to restrictions and pain. It also then translated into other activities such as lunges, step ups, or simply climbing stairs.
Common Symptoms. . .
• Nipping pain in the upper, front thigh
• Pain in the outer or font knee
• A feeling of tightness and congestion in this front thigh/hip area
• Pain in the lower back
Signs of Dysfunction and Compromise. . .
• Knees may bow in
• There is an excessive forward lean of the upper body
• Arching lower back
• Shift of weight on to one leg
What Could Be Happening? . . .
There is no one factor that will be responsible for a dysfunction, or pain. You should not rule out any pathology or condition so if the problem doesn’t subside with an attempt to self-treat then visit a medical professional. I have found both in myself, and others that there are some common factors present in individuals with squatting pain or activity related pain in the LPH complex. These factors are:
• Joint Dysfunctions
• Shortened, Overactive Muscles
• Lengthened, Underactive Muscles
Joint Dysfunctions. . .
Certain areas of the LPH complex commonly alter in terms of positioning. This then creates compensations and has effects on our movements. One of these effects is the ‘nagging’ or impingement like pain in the hip. Areas I have found to be dysfunctional in those (and myself) with this hip discomfort are as follows:

• An anterior or superior translation of the femoral within its socket. . .
After hunting around and doing some reading I discovered another theory surrounding this phenomenon. I found a model of explanation by Shirley Sahrmann, she proposed some familiar muscle imbalances to be contributors to this anterior translation.
Tightness in the posterior capsule combined with a weakness in the gutes prevents the femoral head from gliding backwards during our squat, it may also force the head forward. Along with this there is a proposal that the hip flexor (psoas major) is actually weak and unable to stabilise the hip into its socket. This allows this anterior translation to occur and thus creating the ‘nipping’ during a squat as the head of the femur cant glide backwards as we flex the hip, instead it remains forward causing some impingement.
• Anterior rotation of the sacroiliac joint (SIJ). . .
This is a very common alteration in a lot of athletes and gym trainers. A lot of people tend to be front dominant in their musculature. A lot of people mention tight hip flexors when it comes to forward tilting of the SIJ and the pelvis. Now above we mentioned that psoas may be weak if the head of the femur is translating forwards. The psoas is a hip flexor but in my opinion the rectus femoris (one of the quadriceps, and hip flexors) is the main culprit for anterior pelvic tilt. This muscle attaches to the inferior spine of the ilium and therefore if it is tight it will pull this forward. The psoas could still be weak and actually part of the reason the rectus femoris is tight as it may be working overtime to make up for the psoas weakness. If the glutes are also weak, as mentioned above, they will be unable to rectify any anterior tilt of the pelvis.
If the femoral head translates forwards as well as an anterior tilt of the SIJ and pelvis. This will close the space within the hip joint itself and therefore increase the likelihood of impingement and discomfort when moving through ranges of motion at the hip. During a squat you already close the angle between femur and pelvis so if there is an excessive amount of forward tilt even before we start squatting this will cause obvious problems.
Shortened, Overactive Tissues. . .
There are many muscles that could be involved in problems at the hip but for the purpose of this article I will discuss the major muscles I have found to be major contributors to hip pain during squatting.
• Rectus Femoris (part of the Quadriceps)
• Adductors (or groin muscles)
• TFL (outside of the hip, causing tightness in the Iliotibial band or ITB)
• Erector Spinae (lower back muscles)
• Piriformis (deep muscle in the buttock region)
• Hip Capsule
So when experiencing some form of hip pain assess these areas, if shortened they may feel tender to touch. One step to attempting to rectify your hip position and ultimately your pain would be to release these tight tissues. There are many ways to approach this, stretching, foam rolling and self-release, or deep tissue massage. These will be covered in the treatment section of this article.
Lengthened, Underactive Tissue. . .
• Gluteus Maximus (big glute muscle)
• Gluteus Medius (smaller glute muscle)
• Rectus Abdominis (“Abs” or “6-pack”)
• Transversus Abdominis (internal core muscle)
• External Obliques (muscles around the side of the core)
If these muscles are weak they are unable to aid the stability and proper control, and movement of the hip and therefore these compensatory patterns of movement and altered joint positioning occur. To attend to this issue, we do what we would normally do with a weak muscle, we train it to strengthen it and activate it. How we do this will be covered in the treatment section of this article.
Treating Yourself. . .
Addressing Joint Dysfunctions. . .
When it comes to adjusting this alteration in joint position and mechanics we need to physically manipulate this joint. This is usually done manually by a therapist however, there are many ways in which you can apply similar mobilisations yourself using resistance bands.
1. Addressing Anterior Translation of the Femoral Head
The issue is that the head of the femur is stuck in a forward position and doesn’t glide as it should in the socket which causes the discomfort we feel during movements of the hip. Good ways of addressing this situation are as follows:
• Kneeling Banded Mobilisation – attach a band at kneeling hip height behind you. Place your affected leg through the band and place it high up into the groin region so it covers the hip joint. Kneel on all fours. You should adjust you distance from the band to alter the tension, you want to feel the band pulling the hip joint back. Once you have a good tension you can rock back and forth sitting onto your heels and back. You can also rotate you hip in and out from this position by twisting your leg so you lower leg moves side to side. The direction of pull can be altered in order to pull the head in different directions and mobilise the hip in various directions. You can perform 30 or so reps with band at one angle and then change angle and do another 30. Do a couple of sets at each angle of pull and also the rotations.
• Standing Split Squat Banded Mobilisation – stand through a band attached behind you at hip height wrap around the affected leg. Then perform a split squat, leading with your good leg. Adjust your position to alter the tension on the band, tension should be enough to pull the hip joint back as you dip into the split squat. Do 15-20 for 3 sets.
• Banded Step Ups – attach the band behind you again and place your leg through it wrap up into the groin around the head of the femur. You then want to step up with the banded leg and perform your step up. Choose the tension wisely as you don’t want it pulling you off the step/bench, but you want enough to pull back on the hip joint. Ensure you get full extension on the step up and if you want to engage the core too try not to touch down with the trailing leg and raise it up so thigh is parallel to the floor before stepping back down. Do 10-15 step ups.
• Lying Wall Squat With Rotation – Lie on your back with your feet flat against the wall and hips and knees bent as though in the bottom squat position. From here you can allow your knees to fall out stretching the inside of the hip and the adductors (groin). Extra pressure can be applied by the hands for more stretch on this. You can also then cross one foot over the other knee, as though cross the leg. Once crossed you can press down on the crossed-leg knee pushing it towards the wall. This can be pressed and held or can be oscillated in and out stretching the capsule.
To make the banded exercises affective you should have enough tension so you can feel the band pulling the head of the femur feeling it glide slightly as you move.

2. Addressing Anterior Pelvic Tilt
This is a common problem and is a fairly simple fix if you put in the time and work. It comes down to primarily two things. Tight anterior (front) musculature pulling the top of the pelvis forwards, and underactive posterior (back) musculature not pulling the top of the pelvis backwards. This imbalance then has the overall forward tilt of the pelvis. This in turn then alters the position of the hip joint as discussed above. So based on this the way to approach this is simple. Lengthen the tight tissues, and activate the underactive tissues.
• Foot Up Hip Flexor Stretch – This is similar to the Bulgarian Split Squat. Place the laces of your shoe on a bench and lunge the opposite foot forward. Then drop your hips towards the floor, keeping the foot in contact with the bench. You are wanting to feel a stretch right up the quad and into the hip flexor, this can be further stretched by raising the arms straight above the head and keeping the torso upright as you drop down. You eventually are aiming to be able to get the trailing knee to the ground, getting the raised foot against the buttocks, whilst keeping the torso upright so knee, hips and shoulders are all inline. This should be held for 30secs once a stretch is found or can be gently oscillated in and out of stretch 20-30 times.
• Lying Quad Stretch – lie face down with legs straight out. Then grasp one foot behind you by bending the knee, pull the foot into your buttocks. Aim to keep the pelvis, hips and core flat on the ground. If you struggle to grab your foot without raising the hips or arching the back you can use a band or towel and use this to pull your foot close to your buttocks without compromising position of the hips etc. Hold this stretch for 30 secs and repeat 3 times.
• Single Alternate Leg Wall Push – lie on your back next to a door frame. Bring the foot closest to the door frame up so it is flat against the frame, you want to have the knee as bent as you almost like this side is a deep squat position. Have the other leg out straight. Then you want to push hard down on the frame with the foot flat so the glutes are firing. Hold this for 20 secs or so, relax then repeat 5-10 times. Then you can swap sides so other foot is pushing down. This causes the glutes to maximally fire aiming to pull the pelvis back and into a better position, rectifying any anterior tilt.
• Single Leg Bridges – lie on your back with the feet flat and knees bent. Then raise one foot off the floor completely straightening and outstretching the leg. Then push through the flat foot, firing the glutes, and raise the hips off the floor until your knee, hip and shoulder is flat and in a diagonal line. Hold at the top for a second or two, keeping the core engaged, then lower under control then repeat. Do 3 sets of 15-20 reps.
You should also learn to adjust your own posture to help rectify any stuck hips or tilted pelvis.
• Stand up tall
• Squeeze and contract the glutes hard
• Flex the abs and engage the core and transversus abdominis so you stomach is pulled in and ribs pulled towards the pelvis slightly.
• Once all contracted you can ease off slightly as walking around in a fully flexed state is not comfortable, so ease off to about 50%.

3. Other Areas to Strengthen. . .
The following areas will help maintain good hip and pelvis as well as help stabilise the complex of joints and tissues.
• Superman – kneel on all fours and level your spine so it is flat, then attempt to pull your navel towards your spine without moving your spine or over-contracting your abdominals. To do this you should pretend you are trying to cut off your flow of urine midflow or clenching your rear passage. This is the best way to cue the Transversu Abdominis (deep core muscle) to activate. Once you can master contracting this muscle and keep core flat, then raise one arm straight out in front of you. As you do this raise the opposite leg straight out behind you, then lower them both and repeat with the other arm and leg. If you feel any movement in your spine or abs, or you feel your Transversus Abdominis turn off then stop reset and start again. Do 15-20 reps each side for 2-3 sets.
• Half Plank Progressing to Full Planks – the plank is often done wrong to reduce the difficulty of the exercise. The shoulders, hips and knees should be all in line with no sag of the stomach or arch in the lower back. If you struggle to do this without lower back arch, or a sag in the hips or stomach start with a half plank with the knees on the floor. Hold the plank for 30-40 secs for 3 sets.
• Straight Leg Reverse Crunch – Lie on your back and grasp some stable object behind your so your shoulders and arms are fixed still. Then squeeze your abs pulling your legs towards your chest, keep legs as straight as possible to avoid excessive firing of the hip flexors, you are only aiming to lift the hips off the floor so don’t need to fully bring legs into the chest. Also avoid any excessive folding of the pelvis. Perform 3 sets of 15-20 reps.
• Glute Medius Clams – lie on your side and bend the knees to 45° with one foot on top of the other. Then open the knees apart as far as you can without twisting your body or separating the feet. There may not be a huge movement you are looking to feel the outside of the glutes activating here. Do 20-30 reps on each side.
• Active Oblique Activation – lie on one side keeping the bottom leg straight and in line with the shoulders and neck. Bend the top leg to 90° out in front of you. Grasp the underside of your this thigh with your bottom hand. Place your top hand on the back of your head, with the elbow pointing to the ceiling. Then try touch your top elbow to the floor by rotating the core inwards, hold briefly at this point then rotate the core outwards, opening the body out and try get your back and arm flat on the floor, keeping you hand on your head. Again hold at this end point. Perform this for 15 or so reps. Check this link for a demo.

4. Foam Rolling and Self-Release
I could write a whole article on this area alone with the vast range of exercises available. However, I thought I would share a little gem of simplicity that can be used when trying foam rolling or self-release exercises. If you find an area that is tight or shortened you can pick up your foam roller, barbell or hockey ball etc. (something solid to apply pressure to the muscle tissue) and do the generic sit on it and roll. This may give you some relief but there is so much more you can do.
• Contract-relax – place the body area on the roller, hunt around until you find a sore, painful, tight spot. Once you find this spot hold as much weight over it as you can, holding it still on the roller. Then contract the muscle, in a static contraction and hold it for 5-10 secs, when you relax try put more weight onto the area via the roller. Do this until you notice an improvement in pain.
• “Lock and Load” – this is a concept I decided to term lock and load. If you find a muscle that is short or tight, you can place a “lock” on the muscle near the tight area. This can be done by placing the roller or cricket ball etc. across the muscle belly or near the tendon (depending where the tightness is felt in the muscle). Once the lock is in place you can “load” and move the muscle into stretch through full range as far as you can. As you do this keep pressure on the muscle locking it in. then you can release the lock and return to start. You can then repeat on same area until improvement occurs or find another tight area.
There isn’t any really right or wrong way to do this. Simply find an area that is tight and go at it using these methods as well as your generic sitting and rolling on a foam roller. For example if my quad feels tight just above the knee I will lie face down and place this thigh on a roller. The roller will sit at the end of the muscle at the top of the knee near where it starts to meet the tendon. Once there I will lock it in putting my weight through it. I will then move my heel towards my buttocks so my quad stretches. This pulls the fibres from the “lock” stretching the tight area.
Take Home Message. . .
If you are suffering with a nagging hip pain during your squats, or even just a noticeable anterior pelvic tilt (which could lead to hip pain) try addressing the above issues using the exercises above.
Basically all you need to consider is to lengthen and stretch the shortened tissues (listed above), and strengthen the weaker, lengthened tissues (listed above). By addressing these common characteristics you may help alter any alteration in joint and pelvis position, as well as create more space for the hip joint to glide during your squats.
You should always gain medical advice for any long lasting hip complaint that is not relieved with exercise or with time. The above is not an alternative for seeking advice from a medical professional it is merely what I have found to be successful for myself and some of my clients.

Guest blog by Ieuan Cranswick MSc Sports Therapy

If you require any further advice please contact Ieuan via

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Blood Flow Restriction Training ie. ‘Occlusion Training’

Traditionally increases in strength and muscle mass are expected when the muscles are subjected to loads of moderate to high intensity that correspond to values at least of 70% of 1-RM (Campos et al., 2002; McDonangh and Davies, 1984). However there has been a significant amount of research conducted into strength training combined with blood flow restriction (BFR) as a method of improving the levels of muscle adaptation (Abe et al. 2006; Neto et al. 2014). Studies have shown that low-intensity (approximately 20–50% of 1-RM) resistance training combined with BFR also leads to significant elevations in muscle strength and muscle fiber cross-sectional area (Abe et al. 2006; Shinohara et al. 1998; Takarada et al. 2000; Takarada et al. 2002; Mardame et al. 2008; Yasuda et al. 2010) Loenneke et al. (2011) conducted a review which looked at the potential safety issues of this type of training and concluded that it offered no greater risk than traditional exercise.
BFR has been applied to several different types of exercise (e.g. knee extension, leg press, bench press, flexion, cycling, walking) and most have observed a significant increase in muscle hypertrophy (Abe et al. 2006; Madarame et al. 2008; Yasuda et al. 2010). Interestingly, aerobic exercises do not typically lead to increased muscle hypertrophy or strength, however Abe et al. (2006) observed both when BFR was applied to both a slow walk (Abe et al. 2006) and cycling (Abe et al. 2010) when BFR was applied.
Published studies hypothesize that BFR induces muscle hypertrophy through a variety of mechanisms. Proposed mechanisms include increased fiber type recruitment, metabolic accumulation, stimulation of muscle protein synthesis, and cell swelling, although it is likely that many of the aforementioned mechanisms work together, further research is required. For a review please refer to Loenneke et al. (2010).

Cuff Pressure

Throughout the literature a variety of devices have been used to restrict blood flow including elastic knee wraps (Loenneke et al. 2010; 2011), nylon pneumatic cuffs (Cook et al. 2007; Mannini et al. 2011), elastic belts with a pneumatic bag inside (Fahs et al. 2011; Rosscow et al. 2011) or a traditional nylon blood pressue cuff (Lorrentino et al. 2008). Often, training studies begin at an overall low pressure and progress to high pressures throughout the training programs. In a meta-analysis by Lorenneke et al. (2012) cuff pressures over- lap, but differed at where the initial training pressures began (140 vs. 160 mmHg) and where the final training pressures ended (160–240 mmHg). This overlap may have led to the non-significant finding, however it may also indicate that the absolute pressure needed for muscular adaptation is much less than commonly thought, especially when using a wider cuff to induce blood flow restriction (Crenshaw et al. 1988). In support of this, evidence suggests that higher restrictive cuff pressures (200 mmHg) are no more effective at increasing intramuscular metabolites than moderate pressures (*150 mmHg or 130% systolic BP) when using a wide (18.5 cm) cuff (Suga et al. 2010).

Cuff Width

Another important factor that we must take into consideration is the cuff width used to restrict blood flow, which is not reported in much of the current literature. Cuff width is such an important variable to account for since wider cuffs transmit pressure through soft tissue differently than narrower cuffs (Crenshaw et al. 1998) which may impact changes in muscle hypertrophy (Kacin and Strazar, 2011). In a study performed by Kacin and Strazar, (2011) they found that the application of a wider cuff (13cm) during knee extension exercise had a deleterious impact on muscle hypertrophy at the site at which the wider cuff was applied. The authors hypothesized that this may have occurred due to the high restrictive pressure (230mmHg) used coupled with the wide cuff, which likely resulted in high levels of compression and sheer stress under the cuff. Thus, the purposes of low load BFR exercise applying 200mmHGF using a 5cm wide cuff will likely produce a different stimulus than 200mmHG applied using a 13.5cm wide cuff.

Real World Application

Elastic belts with pneumatic bags inside etc. are not practical nor is the equipment readily available to every day trainee’s. Thus a pair of elastic knee wraps as used by Loenneke et al. (2010; 2011) will suffice. Placement of the knee wraps is very important to ensure the beneficial effects of the protocol are not compromised. Wraps must be placed as high as possible on the limbs being trained. For the upper arms, they should be wrapped as high on the biceps as you can get. For the thighs, they should be wrapped just beneath the gluteal fold. If the wraps are placed too low, optimal venous occlusion will not be achieved. On a scale of 1-10, pressure should be about a 7 – the wraps should be safely secured to the limb, but not causing excessive discomfort at rest. Use a set of knee wraps equating to a width of 5cm, which from an application point of view will mean wrapping the folds as closely over one another as possible.

In terms of integrating BFR into your training I would advise you to incorporate it at the end of a session (as a finisher) following traditional moderate to heavy load traditional hypertrophy protocols (I know a number of other coaches apply the technique in the same way). Select a load of 20-30% 1-RM for a given exercise and aim for > 20-25 repetitions on the fist set. My advice would be to keep rest intervals low (30 seconds) to pool more blood in the working muscle and increase the metabolic stress. Generally I would decrease my target repetitions by 5 reps over each of the 4 sets so that by the final set I am struggling to perform 10 repetitions as the ‘pump’ feels like the muscle is about to explode. For instance yesterday I applied BFR training to my arm workout and I could barley lift my arms at the end of the session. Please note it is important to keep the working muscle restricted for the duration of the sets. In a study by Lorenneke et al. 2010 they found that untying the elastric wraps between sets significantly reduces metabolic stress which in turn will have a negative effect on the potential growth stimulus.


Abe, T., Kearns, C. F. and Sato, Y. (2006). Muscle size and strength are increased following walk training with restricted venous blood flow from the leg muscle, Kaatsu-walk training. Journal of Applied Physiology, 100, 1460-1466.
Abe, T., Fujita, S., Nakajima, T., Sakamaki, M., Ozaki, H., Ogasawara, R., Sugaya, M., Kurano, M., Yasuda, T., Sato, Y., Ohshima, H., Mukai, C. and Ishii, N. (2010). Effects of low-intensity cycle training with restricted leg blood flow on thigh muscle volume and VO2max in young men. J sports Sci Med ,9, 452–458.
Cook, S. B., Clark, B.C. and Ploutz-Snyder, L.L. (2007). Effects of exercise load and blood-Xow restriction on skeletal muscle function. Med Sci Sports Exerc, 10,1708–1713.
Crenshaw, A. G., Hargens, A.R., Gershuni, D.H., Rydevik, B. (1988). Wide tourniquet cuVs more eVective at lower inXation pressures. Acta Orthop Scand, 4, 447–451.
Fahs, C.A., Rossow, L.M., Seo, D. I., Loenneke, J. P., Sherk, V. D., Kim, E., Bem- ben, D. A., Bemben, M. G. (2011). EVect of diVerent types of resistance exercise on arterial compliance and calf blood Xow. Eur J Appl Physiol. doi:10.1007/s00421-011-1927-y
Kacin, A., Strazar, K. (2011). Frequent low-load ischemic resistance exer- cise to failure enhances muscle oxygen delivery and endurance capacity. Scand J Med Sci Sports. doi:10.1111/j.1600-0838. 2010.01260.x
Loenneke, J. P., Kearney, M. L., Thrower, A. D., Collins, S. ns Pujol, T. J. (2010). The acute response of practical occlusion in the knee extensors. J Strength Cond Res, 10, 2831–2834.
Loenneke, J. P., Balapur, A., Thrower, A. D., Barnes, J. T., Pujol, T. J. (2011). The perceptual responses to occluded exercise. Int J Sports Med, 3,181–184.
Madarame, H., Neya, M., Ochi, E., Nakazato, K., Sato, Y. Ishii, N. (2008). Cross-transfer effects of resistance training with blood flow restriction. Medicine in Sports & Exercise, 2, 258-263.
Manini, T. M., Vincent, K.R., Leeuwenburgh, C.L., Lees, H.A., Kavazis, A. N., Borst, S. E., Clark, B. C. (2011). Myogenic and proteolytic mRNA expression following blood Xow restricted exercise. Acta Physiol (Oxf), 2, 255–263.
Neto, G. R., Santos, H. H., Junior, A. T. A., Araujo, J. P., Aniceto, R. R. and Sousa, M. S. C. (2014). Effects of high-intensity blood flow restriction exercise on muscle fatigue. Journal of Human Kinetics, 41, 163-172.
Shinohara, M., Kouzaki, M., Yoshihisa, T. and Fukunaga, T. (1998). Efficacy of tourniquet ischemia for strength training with low resistance. Eur J Appl Physiol Occup Physiol, 77, 189–191.
Takarada, Y., Takazawa, H., Sato, Y., Takebayashi, S., Tanaka, Y. and Ishii, N. (2000). Effects of resistance exercise combined with moderate vascular occlusion on muscular function in humans. J Appl Physiol, 88: 2097–2106.

Yasuda, T., Fujita, S., Ogasawara, R., Sato, Y. and Abe, T. (2010). Effects of low-intensity bench press training with restricted arm muscle blood flow on chest muscle hypertrophy: a pilot study. Clin Physiol Funct Imaging, 5, 338–343.

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Improving Recovery Post Training

The rationale for training itself is to place the body under stress followed by periods of rest/recovery to stimulate adaptations. These adaptations occur during the recovery phase yet many trainees pay little to no attention on how they can improve their recovery rate. In simple terms recovery may be described as the time it takes for the fatigue caused by training or competition to disperse.

Within the literature there are three types of recovery that are referred to as;

1. Immediate recovery; Refers to the recovery that is allowed during performance, between muscular contractions i.e. a certain amount of recovery between muscular contractions.
2. Short-term recovery; Refers to the recovery that is allowed between sets of intervals or between multiple sets of resistance-training exercises.
3. Training recovery; refers to the period of adaptation between training sessions or competition bouts.


Within the literature our understanding of what actually constitutes as fatigue is unclear. Reduced performance across a range of measurements post training/competition is commonly referred to as a state of fatigue. However, the understanding of whether or not fatigue is central origin (central nervous system) or of peripheral origin (compromised muscle performance) related is unclear. The underlying mechanisms are far from understood due to the complexity of the topic.

However this post will address the strategies that have been proven to increase recovery rate as opposed to discussing the mechanisms outlined above.

Measuring Recovery

1. Performance measures
2. Electrolyte replacement and rehydration
3. Glycogen re-synthesis
4. Biomarkers
5. Heart rate variability
6. Self perception of delayed onset muscle soreness (DOMS)

To the ‘average-Joe’ considering all of these measurement tools is unrealistic as the equipment is not readily available. Measurement tools such as biomarkers of muscle damage are slightly more “scientific”, as are HRV measurements. However, the extent to which these are accurate measurement tools for assessing overall fatigue is open to debate. Performance can be utilized as a tool to measure fatigue by measuring how long performance took to return to normal levels post training/competition. The exact speed at which performance returns is affected by any super-compensation that might occur in response to the training bout.

How Can We Improve Recovery Post Training/Competition?

Electrolyte Replacement – For a person undertaking regular exercise, any fluid deficit that is incurred during one exercise session can potentially compromise the next exercise session if adequate fluid replacement does not occur (Shirreffs et al. 2004). Rehydration after exercise can only be achieved if the electrolytes lost in sweat, as well as the lost water are replaced (Maughan & Shirreffs, 1997). However, the amount of electrolytes lost in sweat is highly variable between individuals and although the optimal drink may be achieved by matching drink electrolyte intake with sweat electrolyte loss, this is virtually impossible in sport settings (Maughan & Shirrefs, 1997). The importance of ensuring euhydration before exercise and the potential benefits of temporary hyperhydration with sodium salts or glycerol solutions are also important issues (Shirreffs et al. 2004). Post-exercise restoration of fluid balance after sweat-induced dehydration avoids the detrimental effects of a body water deficit on physiological function and subsequent exercise performance. For effective restoration of fluid balance, the consumption of a volume of fluid in excess of the sweat loss and replacement of electrolyte, particularly sodium, losses are essential (Shirreffs et al. 2004).

Glycogen Resynthesis – The pattern of muscle glycogen synthesis following glycogen-depleting exercise occurs in two phases. Initially, there is a period of rapid synthesis of muscle glycogen that does not require the presence of insulin and lasts about 30–60 minutes (Jentjens & Jeukendrup, 2003). This rapid phase of muscle glycogen synthesis is characterized by an exercise-induced translocation of glucose transporter carrier protein-4 to the cell surface, leading to an increased permeability of the muscle membrane to glucose (Jentjens & Jeukendrup, 2003). Following this rapid phase of glycogen synthesis, muscle glycogen synthesis occurs at a much slower rate. This second phase can last for several hours. The highest muscle glycogen synthesis rates have been reported when large amounts of carbohydrate (1.0–1.85 g/kg/h) are consumed immediately post-exercise and at 60 minute intervals thereafter, for up to 5 hours post-exercise. When carbohydrate ingestion is delayed by several hours, this may lead to ∼50% lower rates of muscle glycogen synthesis. The addition of certain amino acids and/ or proteins to a carbohydrate supplement can increase muscle glycogen synthesis rates, most probably because of an enhanced insulin response (Jentjens & Jeukendrup, 2003).

Delayed Onset Muscle Soreness (DOMS)

DOMS describes muscle pain and tenderness that typically develops several hours post exercise and consist of predominantly eccentric muscle actions, especially if the exercise is unfamiliar (Zainuddin et al. 2005). DOMS is often used as a marker for measuring fatigue however it is not always associated with a decrease in performance. Depending upon the severity of the DOMS and the discomfort the individual experiences performance decrements will vary (up to and beyond 72 hours). Some prophylactic or therapeutic modalities may be effective only for alleviating DOMS, whereas others may enhance recovery of muscle function without affecting DOMS (Zainuddin et al. 2005). Although there are a number of other practices that may be used to improve recovery such as electrotherapy, I will outline the methods that are both economical and readily available to the public in this post. The following practices have been found to be useful in alleviating DOMS.

Foam Rolling – To combat the adverse effects of DOMS, a 20-minute bout of foam rolling on a high-density roller immediately post-exercise and every 24 hours thereafter may reduce the likelihood of muscle tenderness and decrements in multi- jointed dynamic movements (Pearcey et al. 2015). Just three 20-minute bouts (60 minutes total) of foam rolling can substantially enhance recovery after DOMS and alleviate muscle tenderness. This form of self-induced massage could benefit athletes seeking a recovery modality that is relatively affordable, easy to perform, and time efficient and that enhances muscular recovery (Pearcey et al. 2015).

Massage Therapy – In a study conducted by Zainuddin et al. (2005) they investigated the effects of massage on DOMS, muscle soreness, swelling, and recovery of muscle function. They employed an arm-to-arm comparison model with 2 independent variables (control and massage) and 6 dependent variables (maximal isometric and isokinetic voluntary strength, range of motion, upper arm circumference, plasma creatine kinase activity, and muscle soreness). A 2-way repeated-measures analysis of variance and paired t tests were used to examine differences in changes of the dependent variable over time (before, immediately and 30 minutes after exercise, and 1, 2, 3, 4, 7, 10, and 14 days postexercise) between control and massage conditions. Ten healthy subjects (5 men and 5 women) with no history of upper arm injury and no experience in resistance training took where selected as subjects. Subjects performed 10 sets of 6 maximal isokinetic (90°·s−1) eccentric actions of the elbow flexors with each arm on a dynamometer, separated by 2 weeks. One arm received 10 minutes of massage 3 hours after eccentric exercise; the contralateral arm received no treatment. Delayed-onset muscle soreness was significantly less for the massage condition for peak soreness in extending the elbow joint and palpating the brachioradialis muscle (P < .05). Soreness while flexing the elbow joint (P = .07) and palpating the brachialis muscle (P = .06) was also less with massage. Massage treatment had significant effects on plasma creatine kinase activity, with a significantly lower peak value at 4 days postexercise (P < .05), and upper arm circumference, with a significantly smaller increase than the control at 3 and 4 days postexercise (P < .05). However, no significant effects of massage on recovery of muscle strength and ROM were evident. The study findings concluding that massage was effective in alleviating DOMS by approximately 30% and reducing swelling, but it had no effects on muscle function. Performance Reductions

Performance reductions are widely regarded as the gold-standard measurement tool for assessing acute fatigue as they apply to both overtraining and overreaching. Compression garments, cooling and water immersion are all effective tools for enhancing recovery of strength and power based measures. However, the effect that they may have upon athletic performance based recovery is much less clear and more research is needed.


Zainuddin, Z., Newton, M., Sacco, P. and Nosaka, K. (1997). Effects of massage on delayed-onset muscle soreness, swelling and recovery of muscle function. Journal of Sports Sciences, 15, 174-180.

Maughan, R. J., Shirreffs, S. M. (2004). Recovery from prolonged exercise: Restoration of water and electrolyte balance. Journal of Sports Sciences, 22, 297-303.

Shirreffs, S. M., Armstrong, L. E., Cheuvont, S. N. (2004). Fluid and electrolyte needs for preparation and recovery from training and competition. Journal of Sports Sciences, 15, 57-63.

Pearcey, G. E. P., Squires, D. J. B., Kawamoto, J. E., Drinkwater, E. J., Behm, D. G. and Duane, C. B. (2015). Foam rolling for delayed onset muscle soreness and recovery of dynamic performance measures. Journal of Athletic Training, 1.

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The Shoulder Complex Part 4: Rotator Cuff Injuries

As was mentioned in my previous article on the shoulder complex, this joint relies heavily upon muscular stability and control to aid its large range of movement. Therefore, when an injury to the rotator cuff (RC) occurs it can be significantly debilitating.
What is a Strain?
A strain is basically damage caused to muscle or tendon tissue. This is not to be confused with a sprain which is damage to ligament tissue. Now I often hear people saying “it’s only a strain, it’s not like you have torn it”. However, a strain is classified, typically, into three grades; grade I, grade II, and grade III.
• Grade I consists of minimal micro-damage and can often be played on with and will cause mild discomfort, and very minimal strength loss.
• Grade II has a greater proportion of fibres damaged, cause more severe pain and tenderness, a noticeable drop in strength, as well as swelling and potential bruising.
• Grade III strains consist of a full rupture, or the majority of fibres will have been torn/damaged. In these grade III strains there is often an audible or felt tear/pop, severe pain at time of injury, severe swelling, discolouration, loss of function, and sometimes a clear deformity in the muscle belly.
It is these grade III strains that most people know as a muscle tear, however, technically any strain has caused some tear/damage to the muscle. Identifying the grade can be inferred through a physical exam and confirmed via imaging techniques such as MRI. Full grade III rupture are rare as a result of acute trauma, it is often a result of accumulative damage. Also, full tears often pull fragments of bone with them (known as an avulsion), this is due to the muscle-tendon structure being stronger than the bony attachment.
How do RC Strains occur?
As mentioned in a previous article the RC is a huge stabiliser of the humeral head and therefore during most, if not all, shoulder movements these muscles are working to stabilise the joint. Injury to these muscles tend to occur as a result of overstretching, excessive forceful contraction, or excessive eccentric loading as the limb is decelerating. Injury can also result from a direct fall onto an outstretched arm which will force the humeral head upwards compressing the tendons of the RC muscles. A fall on to the top of the shoulder can also result in RC injury through the traction of the humerus causing the supraspinatus tendon to stretch, resulting in strain.

Who is likely to Experience a RC Strain?
This type of injury is likely to occur in the following populations of people:
• Athletes in overhead racket sports; tennis, badminton, and squash players etc.
This may occur during a forceful cocking of the racket, or during the deceleration at the follow through phase. It may also be simply down to repetitive overhead swinging.
• Athletes involved in throwing sports; cricket, baseball, and American football QB etc.
This occurrence is much like the racket athlete, during a cocking phase of throwing, deceleration, or repeated throwing phases.
• Weight lifters
This could occur anywhere in weight lifting. However, I would expect the risk to be on lowering a weight as the muscle will be under excessive eccentric load. It may also occur during forceful, power movements where the muscle is forced to contract heavily in a short space of time.
• Anyone who repetitively uses their shoulder overhead.
This could simply come down to repetitive overhead movements, causing fatigue, wear and tear, and accumulative damage.
Signs and Symptoms of a RC Strain
• Pain at the front and/or side of the shoulder,
• A clear point of tenderness over the muscle/tendon
• Decreased ROM in shoulder movements such as rotation and overhead
• Some loss of strength depending on the grade, noticeable in rotation movements
• Pain may radiate down to the midpoint of the upper arm
• Will be painful to sleep on affected side
How should a RC strain be treated?…
1. Initially inflammation needs to be controlled, and excessive tissue death reduced.
The extent of tissue damage needs to be reduced to prevent further complications.
2. The loss of motion needs to be addressed.
Without full range of motion optimal strength and function will not be able to be exercised or restored.
3. Scapula, and shoulder control needs to be retrained.
If proper control of the shoulder complex is not retrained then it may result in dysfunction, muscular compensation and further shoulder problems, such as impingement (see my shoulder complex article).
4. Strength needs to be restored in the weak areas.
Once near-normal range of movement and control is restored the weakened muscles need to be strengthened to ensure that re-injury does not occur.
5. Explosive power, and neuromuscular (mind-muscle) function needs to be restored.
This needs to be addressed so the injured area is retrained to respond to unstable and spontaneous situations and also to ensure a safe return to these environments such as sport.
6. Sport/Activity related skills need to be retrained.
To ensure that a safe return is made the basic skill and movement patterns need to be retrained. This will be specific to the sport/activity of the individual.
1. Reducing Inflammation
This can be achieved by refraining from activities that caused further pain, or swelling. To reduce the swelling, inflammation, and pain cold therapy can be applied to the area for 15-20mins every 2 hours. This should be especially done in the first 72 hours after injury. The cold therapy can be applied throughout rehab to control any pain or swelling that may occur after any activity.
2. Restoring Range of Motion and Flexibility
To achieve this gentle stretching should be introduce as well as non-resisted movements of the shoulder. This will help optimise the scar tissue formation into a more functional arrangement, and optimise muscle length. Examples of stretches/exercises are as follows:
• Side Lying Rotator Cuff Stretch
• Towel Stretch
• Broom Handle Rotations
• Work through all shoulder movements; flexion and extension, horizontal flexion and extension, scaption, abduction and adduction (all shoulder be unweighted aiming simply for as much movement as possible, aids such as broom handles, bands, yoga balls, or the wall can be used)

3. Restoring Control
This is important to regain proper control of the scapulae during shoulder movements to allow full, unrestricted shoulder function. Exercises focus on training smooth, stable, and controlled scapula motion. Examples of these exercises are as follows:
• Fixed Arm Retraction/Protraction
• Plank Trunk Rotations
• Scapula Wall Clocks

4. Increasing Muscle Strength
It is important to strengthen the weakened muscles to ensure the injured tissue is strong enough to perform its role within the shoulder. As discussed in my shoulder complex blog, the RC is responsible for humeral stabilisation as well as rotation of the humerus. There are a whole host of strength exercises and to identify these for all areas that need working would be hugely time consuming for me and the reader. Therefore I will briefly discuss the areas to include and provide examples specifically for the RC.
The areas that need to be focused on, other than the RC, will depend upon where there is an imbalance or weakness that may or may not have contributed to the initial injury. Commonly shoulder dysfunctions result from overactive anterior (front) musculature and underactive posterior (back) musculature. In my experience my clients need to strengthen their scapula retractors such as the rhomboids (see my shoulder complex blog). Good exercises for these are as follows:
• Seated Row – emphasise initiating the movement by squeezing the scapula together before pulling the elbows in.
• Straight Arm Pull Downs – focus on switching the pectorals off and feeling the latissimus dorsi and back muscles activating.
The main focus of strengthening is getting the injured RC back to normal strength. Exercise examples are as follows:
• Banded Internal/External Rotations (start with elbows in at side, progress to upper arms at 90°, from band to Db)
• Banded Pullbacks (progress to weight lying straight reverse flyes)
• Banded Scaption (progress to Db)
• Dumbbell Side Raise-to-Rotation-to Press

In terms of weight, sets and reps, initially you want to start light (progress from band, to light Db). Start with higher rep ranges to build a base of strength endurance, then lower the reps and up the weight to further develop strength. Do not progress until at least 20 reps can be performed pain free for all sets.

5. Restoring Power and Neuromuscular Function
In daily activities our bodies, and shoulders, have to respond to, and remain stable in, events such as falling, and catching objects, raising or lowering ourselves from and to a chair. If you are an athletes or exerciser there are more scenarios where your shoulder needs to be able to respond to spontaneous and explosive events such as throwing, tackling, catching etc. Therefore, this needs to be included to ensure our mind-muscle connection is functioning properly, then our body can recognise these events and react appropriately. These exercises will consist of balance and co-ordination movements, and stretch shortening (plyometric) exercises. Examples are as follows:
• Full Arm Planks > Progressing on to Yoga Ball > Ball Press Ups
• Overhead Wall-Ball Throws > Progressing to Single Arm Wall-Ball Throws
• Stepper On-Off Press Ups > Progressing Clap Push Ups

6. Sport Specific Exercises
This is obviously dependant up the sport you play. You will have to be confident in all skill areas of your sport before returning.
For Ball and Racket Sports:
• Progress drills covering, passing, catching, kicking, tackling, evasion
For Weight Lifters:
• Relearn technique for your lifts, ensure full range, then progress weight gradually.
Maintenance and Re-injury Prevention…
Once you have relieved your symptoms, and you have rehabilitated the injury to a near normal state, your job isn’t done. The injury happened for a reason, so we need to keep our body in a state that is optimal to prevent the injury occurring again.
We have discussed the specific rehabilitation for the RC injury, but there are other areas that you should consider after your rehab to prevent reoccurrence. Certain factors may alter our positioning during activities, or the way our muscles have to work in order to do their job. These often small alterations can lead to extra stress upon tissues and structures which in turn can leave us prone to injury or failure of these structures.
Some of the following areas to consider have been discussed in my ‘Shoulder Complex’ blog series which can be found on my website. By including these areas, post-rehab, in your warm up or training regime it will help maintain a good, functional range of motion and allow the muscles and tissues to do their job optimally minimising unnecessary stresses.
Areas to Address…
• Tight Pectorals – these will pull the shoulder into internal rotation and translate them forward into a rounded, hunched posture. This will put stress up the RC and other structures.
• Tight Upper Trapezius – this will raise the shoulder excessively again putting stress on the RC structures and also reducing the space within the shoulder.
• Reduced Thoracic Mobility – if the vertebrae of the thoracic spine is limited in mobility any overhead movement of the arms is restricted. The thoracic spine is unable to extend enough to get the arms directly above the head, this means other areas have to work harder to achieve this range of movement. These areas may be the muscles of the shoulder such as RC pulling the shoulder into position or the lower back may extend excessively, causing problems in this area.
Various stretches can be found for these areas, but I swear by the use of other aids such as foam rollers, hockey/lacrosse balls, barbells any solid object you can apply pressure to these areas with. Basically, you can ‘iron out’ these areas by rolling them, you can play with applying sustained pressure over a tender area until it subsides, apply pressure and move the body part through a range of movement. All these techniques, and more, will help maintain flexibility and mobility which will only help keep injuries at bay.

Guest blog by Ieuan Cranswick MSc Sports Therapy

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The Shoulder Complex Part 3: The Rehabilitation Process

This week I am delighted to release another fantastic piece of material written by Ieuan Cranswick MSc Sports Therapy. For all of you that have been following the series of blog posts regarding the shoulder complex you will be very excited to hear about the content that Ieuan has planned to release via the Physique Consultant blog over the forth coming months. Later this week I will give you a little more insight however for now he is part 3 of the series… Enjoy!

Rehabilitating Yourself for Shoulder Impingement…

The primary concern for both the therapist and athlete/client when it comes to approaching shoulder impingement is the initial pain and discomfort that the athlete/client experiences. This often prevents them achieving the movements they require in their training etc. If they can’t achieve a good range of movement without pain they won’t be able to strengthen their shoulder in a full range.

This article will offer a general approach to treating shoulder impingement. It is based upon my successful experience in working with many athletes who have this complaint. It is in no way an exclusive list of exercises and the only way to approach this condition.

Manual “Hands-On” Treatment…

Many manual, and hands-on techniques can be applied to help reduce any muscular tension and mobilise the joint into a more optimal position with the aim of relieving any symptoms of pain. You can visit a therapist and receive massage, muscle energy techniques, and mobilisation techniques which will help significantly in relieving pain and discomfort through reducing tension in tight and overactive areas as well as freeing the joint capsule and creating more space in the “sub-acromial” space.

Some people are reluctant to visit a therapist due to cost etc. so visits to the clinic may not be an option. Therefore I offered these self-treatment options to these individuals, and it is that self-treatment option that is the focus of this article.

Much like any exercise program all the aspects of rehabilitation (mobilisations, stretches, strength, and functional exercises) should take a progressive path not to further irritate the structures within the shoulder. Without going through a full rehabilitation program breakdown I will discuss some of the successful exercises I have used in the past. The people I see often have had this complaint for a prolonged period of time or it is a recurring complaint. Therefore they are often able to achieve a reasonable range of movement but it may be uncomfortable. For those who have significant ROM losses you will want to adjust the level of the following to suit their condition or seek further advice or more remedial exercises.

Self-Mobilisations, Stretching, and Joint Play…

As discussed in the previous article the humeral head and whole shoulder complex can translate forwards and rise, which encroaches into the sub-acromial space. Therefore to help relieve this encroachment, compression and ultimately the pain and discomfort we can help physically mobilise this joint into a more optimal position.

The aim is to try to free the humeral head in its socket so it increases that space under the acromion. Manually this would be done by the therapist passively applying a force to the humerus causing it to move into a more optimal position. However, there are also ways of doing this by yourself which I have found to be very relieving for my clients. As we identified in part 2 of this article this alteration in shoulder position, and impingement can stem from tissues becoming over-active and shortened.

Weight Plate Chest Release
Lie on your back on a bench and place a kettlebell or weight on your affected side pectoral muscle. Take a deep breath then press the weight into the muscle as much as discomfort will allow, then raise the arm diagonally above the head whilst maintain the pressure on the weight. You will feel the muscle stretching from the point of pressure. As you lower the arm again release the pressure on the muscle. You can alter the position of the weight to find areas of the pec that are tight. Do this until you notice some improvement in pec range of movement or a feeling of improved flexibility through the muscle.

Upper Trapezius Stretch
Stand on a towel and grasp it at your side with your “bad” hand. Your arm should be hanging at a resting length, then lean away from the towel with your upper torso and tilt your head to the same side (so your ear drops towards the shoulder). You should feel the towel pulling your arm down as you lean away, this causes the upper trap to be stretched. Hold this position for 20-30 seconds and repeat 2-3 times.

Banded Distractions
Once less pain is experienced this is a good addition. Attach a heavy duty band/rope/towel to a stable object/frame at just above shoulder height. Grasp the band etc. with your “bad” hand, turn your palm upwards, then walk your body backwards and shift your weight backwards so the band pulls the arm “out of its socket”.

From this position your can drop your chest towards the floor and rotate the body to loosen the joint capsule. Find areas that feel restricted and work into these. You can also then rotate the shoulder in and out keeping the arm straight. This has a stretching and loosening effect on the capsule as well as distracting the joint and freeing it up.

Banded Chest/ Shoulder Opener
This helps open the chest musculature and front of the shoulders. Attach a band/towel etc. to a stable object or frame just above shoulder height. Grasp the band etc. with your “bad” hand then turn your whole body away from the band so your chest is opened right up. Again hunt around looking for uncomfortable tight areas then work into these by holding the position or oscillating in and out of this area. To incorporate the neck muscles into this you can turn you head away too. Play around with the height to achieve various stretches throughout the chest and front of the shoulders.

Lying Shoulder Drop
Lie on your back and raise your arms straight out in front of you vertically. From this position we are wanting the humerus to drop to the back of the socket. This will help free the space and improve our pain free range, especially flexion (raising the arms out to the front). To allow this drop of the shoulder, keep the arms straight and try relax the upper body, you should feel the space between the back of the shoulder and the floor reduce. Ideally you are wanting to feel your shoulder hit the floor on relaxation.

To aid this you can grab a weight or simply a bag of objects to help force the humerus back. Once you have mastered the relaxation and you feel the shoulder drop back, you can then start to rotate the humerus outwards by turning your thumb away from your body. Ensure as you do this the shoulder remains relaxed back into the floor and doesn’t rise. If it does rise up, stop and relax again.

Strengthening/Activation Exercises…

Banded Scaption
Grasp a band/towel with each hand at each end. Hold this straight out in front of you with straight arms, then pull the arms apart and turn your thumbs out creating tension in the band/towel. Find a band/towel suitable that allows you to pull your arms out at a 45° angle. From here raise your arms above your head keeping the tension and angle maintained then lower all the way back down again maintaining the tension, angle and thumbs out.

Turning the thumbs out externally rotates the humerus which is the better position for achieving optimal joint space. By pulling the arms out as well as this external rotation engages the rear rotator cuff muscles which are usually weak in impingement. By incorporating this engagement with overhead movement it retrains the muscles to work together in this overhead motion. As we mentioned previously it is usually the fact that the rotator cuff muscles are firing enough to stabilise the humerus in these movements. So by doing this move we are forcing the rotator cuff to activate whilst moving the arms overhead.

Banded Protraction/Retraction
Start with protraction and attach a band behind you (or can use cable machines) at shoulder height. Grasp the band/handle out in front of you with a straight arm. Then you are aiming to push the band forward by thrusting your whole shoulder forwards and feeling your scapula slide around your ribs as you do this. Ensure you keep your arm straight and initiate the movement form the shoulder not bending the elbow (as this becomes a chest press which is what we don’t want). Do 2-3 sets of 20-30 reps on each arm.

Retraction is in the same set up only you now face the band/cables and grasp the handle. Then, again keeping the arms straight, pull the band/cables back. You are looking to move the whole shoulder and feel the scapulae squeeze together. Do 2-3 sets of 20-30 reps.

Banded Shoulder Rotations
For external rotation, and to work the infraspinatus and teres minor, attach a band at head height and face the band. Then grasp it with your hand, place your upper arm out to the side so it is parallel with the floor (at 90°) with the forearm vertical. Then pull the band backwards as far as is comfortable then relax back to the start position, ensure you keep the upper arm parallel with the floor throughout.

To work internal rotation, and the subscapularis, simply turn around with your back to the band. Then rotate the arm forwards pulling the band forwards. Again ensure you keep the upper arm parallel with the floor. Do 2-3 sets of 15-20 reps of both external and internal rotations.

Banded Squat to Row
For this you will need a light band, attach this at chest height in front of you. Grasp the band and walk back so there is moderate tension on the band when rowing your arms in. Ensure you can achieve a full range row, so elbows can be drawn all the way back. Once you find your starting position place the arms out straight in front, drop into a squat (engage core as you would any normal squat), rise out of the squat and as you reach the top row the band in. The band will want to pull your body forward but the idea is that you stabilise your body position whilst you row so you do not track forwards as you row the band in. Perform 2-3 sets of 15-20.

Once you can perform the squat to row with good stability and control. Set the band up as above but place a stepper in front of you. This time perform a step up bringing your trailing leg up so your thigh is parallel with the floor and you are balanced on one leg. As you get to the top of the step up, stabilise your body and then row the band in. Again as you row maintain the stability and minimise “wobble” or forward translation. To progress this further perform the row with one hand (the opposite hand to the standing leg). Perform 2-3 sets of 12-15 on each leg/arm.

The lower body and row exercises integrate the whole body, and activates the posterior system of the body which will help rectify any forward translation of posture. It also uses our target muscles in a whole body movement which is essential when wanting to achieve postural stability in everyday activities as we are never isolating one muscle group when performing our daily activities.

Further Strengthening Advice
In regards to any general strength work you are doing it should be pain free. If it is causing that nagging, nipping pain stop doing those exercises until your symptoms are relieved. Include the above into your current program, and even when your pain and symptoms have subsided use them as a warm up.

To really strengthen the shoulders as a unit work on all movements of the shoulder as you when strengthening any other muscles. Start progressing the weights lifted as pain allows. Put simply, short of providing a full rehabilitation program, work front and side raises, external/internal protraction/retraction, and overhead presses. When training these movements with weights however, don’t slip into the past habit of tightening the upper traps and chest to help you lift a heavy weight. Conscious think about the tension in these areas, and if you notice a rise in the traps or over-activation of the chest stop, relax and start again or drop the weight.

The above exercises are not a full rehabilitation approach, nor are they the “gold standard” for treating impingement, they are simply some exercises I have found to be successful with both myself and clients. Ensure you seek medical advice if symptoms continue without improvement.

Guest blog by Ieuan Cranswick MSc Sports Therapy

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The Shoulder Complex Part 2: Common Dysfunctions

The focus for this article is impingement syndrome in particular and what common dysfunctions and factors contribute to the development of impingement within the shoulder complex. The reason for this focus is because over recent months I have assessed and treated several clients who all present with symptoms of impingement and appears to be a common complaint within the sporting and recreational fitness world.
As mentioned briefly in part 1 impingement syndrome is not a diagnosis in itself it is more a result of some alteration in function, strength or stability of the shoulder complex or in many cases a combination of these factors. This may be through an acute injury or usually a more chronic occurrence.

What is Impingement Syndrome?
This complaint involves the area under the acromion process of the scapula, known as the sub-acromial space, see image below. This space is where the tendon of the supraspinatus muscle passes and also where a fluid filled sac, known as the sub-acromial bursa, sits and acts as a sort of shock absorber or lubricator. In brief impingement syndrome is when this space is reduced and encroached upon and the tissues within that space are compressed. Impingement has been categorised into primary and secondary impingement.
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Primary Impingement
Primary impingement is a direct encroachment on the sub-acromial space, and this is usually a result of a structural deformity of the acromion itself, it may be genetically more hooked or can grow bone spurs which directly compress the structures underneath. These spurs can be a result of conditions such as osteoarthritis. Detection of primary impingement requires scans of the affected area and often requires surgical intervention to reduce the bone spurs and free up the space under the acromion. This type of impingement is usually observed in the older athlete or client, although not exclusive to this population.
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Secondary Impingement
This is the type of impingement that you are more likely to see in your athletes. It stems from postural and movement related causes. In many cases, much like the ones I have seen, there is a whole combination of factors related to the cause of impingement. These factors include an instability in the shoulder due to ligament laxity, or muscular weakness. An alteration in movement patterns can also result in impingement, which again can be down to muscular weakness or imbalance. This can be treated by targeting the weakness/imbalance and rectifying any compensatory movements.
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Common Symptoms of Impingement
• A “painful arc” – pain within the middle portion of the movement when moving the arm out to the side or up in front.
• Nipping sensation that can send pain from top of the shoulder to the elbow.
• Dull ache in the shoulder, and point tenderness around the front and/or side of the acromion process.
• Pain exacerbated by overhead movements, weakness in overhead lifting movements.
• Pain on side lying on affected side.

Below I discuss the common factors I have encountered in the cases of impingement that I have experienced. This is not an exclusive list, only the common factors associated with impingement that I have seen.

Muscle Weaknesses

Rotator Cuff
One of these factors is a weakness in the rotator cuff, i.e. the supraspinatus, infraspinatus, teres minor and subscapularis. These muscles, as described in part 1, have the primary role of rotating the humerus externally and internally respectively. However, they also play a big role in the stabilisation of the humeral head, they pull it down and depress it into the socket. Therefore if these muscles are weak this ability is diminished and therefore during arm movements the humeral head rides up and compresses the supraspinatus tendon against the arch between the acromion and coracoid process (coracoacromial arch). The symptoms of this compression tend to be replicated with overhead movements. During these arm movements of the shoulder complex there is a force couple between the deltoid and the rotator cuff. As the arm moves the deltoids pulls vertically upwards on the humerus, and the rotator cuff muscles pull horizontally towards the midline of the body. If the rotator cuff is weak and this horizontal pull doesn’t keep the humeral head pulled in then the upward rise occurs and the compression and pain occurs.
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Serratus Anterior
As described in part 1, this muscle aids protraction and rotation of the scapula. It also plays an important role in holding the scapula in against the ribcage. If this muscle is weak or not functioning correctly then the scapula position will be altered and thus its movements will be hindered. The scapula and GH joint work together to allow full range of motion. If the scapula is not able to rotate effectively and is not pulled in to the ribs it is likely to tilt away from them, this is likely to cause the whole shoulder unit to move forward or rise to compensate for the lack of scapula rotation. This may then contribute to the reduction in the sub-acromial space and result in the compression and impingement of the structures within it.
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A weakness in the rhomboids have a similar effect as above. This muscle is responsible for pulling the scapula back (retraction) and holding the scapula onto the rib cage. If these are weak the scapula will translate forwards and tilt away from the ribs as above, and again the shoulder unit will translate forwards. This will result in compression of the sub-acromial structures for the same reason as discussed above.
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Mid and Lower Trapezius
A weakness of this portion of the trapezius is quite common. This muscle holds the shoulder blades back and down, this stabilises the scapula and controls rotation. If this portion is weak then this control of rotation and stabilisation is lacking and therefore any over-activity of the upper trapezius, discussed next, will lift and elevate the scapula excessively affecting its rotation and thus overall shoulder motion. This dysfunctional movement may cause translation of the humeral head as previously mentioned and thus contributing to any impingement.

Overactive Shortened Muscles

Upper Trapezius
It is common for the upper trapezius to become overactive and become shortened. As this portion of the muscle acts to, rotate, lift and elevate the scapula it will cause the scapula to rise into excessive elevation and affect the ability of the scapula to rotate. This again affects the motion and position of the scapula so when the arm is raised the sub-acromial space is further reduced due to this elevation. Also the GH joint position and movement may be altered to achieve its ROM with the limited/altered scapula movement, i.e. the humeral head may rise to help achieve overhead ranges. This occurrence of over-activation of the upper trapezius tends to occur in combination with a weakness of the other scapula rotator muscles such as the serratus anterior.
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Levator Scapulae
Similarly to the above, the levator scapulae becomes overactive as it has to work harder in compensation for a weakness of other scapula stabilising muscles. When this muscle becomes shortened it excessively lifts the scapula, and has the same effect as above in the upper trapezius.
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Many of my clients with impingement symptoms present with very over-active, tight pectorals (both major and minor). A tightness and shortened state of the pectoralis major pulls the head of the humerus forwards in its socket. If the pectoralis minor is also tight, which it usually is, this will pull the scapula forwards into protraction which again moves the whole shoulder unit forwards. This forward translation of the humerus and shoulder complex reduces that sub-acromial space and the head will compress the structures within this space.
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Altered Kinematics (Movement) and Posture

Scapula Dyskinesis
This term scapula dyskinesis sometimes gets thrown at people almost in a diagnostic sense, much like impingement. However it is not a diagnosis in itself. Scapula dyskinesis basically means a dysfunction in the movement of the scapula. This could take many forms, anything that strays from normal scapula movement could be termed scapula dyskinesis.

Common characteristics that I have seen with my clients have been excessive protraction and tilt of the scapula, this results in the scapula “sticking out” or “winging” and reduces the movement of the scapula around the ribcage. This could arise through some of the above factors such as weak rhomboids, serratus anterior, and mid-lower trapezius.

I have also seen excessive elevation which reduces the ability of the scapula to rotate optimally, this could arise from a combination of weak scapula stabilisers and an overactivation of the upper trapezius, and levator scapulae.
The movement of the scapula in some cases is judders and lacks control which stems from a combination of imbalances and fatigues of the mentioned muscles. Scapula dyskinesis often comes down to alterations in muscular control, strength or endurance. These altered movements of the scapula then alter the movement of the whole shoulder complex as previously mentioned. There are compensations, both muscular and mechanical, that occur to achieve different ranges of motion. For example the position of the humeral head in the GH joint may alter with poor scapula mechanics in order to achieve full abduction or flexion.

Upper Cross Syndrome
This concerns a common position that someone with shoulder problems may adopt. It often consists of a forward head position, rounding of the neck and upper back and also the altered position of the scapula that have been included above. These positions including anterior tilt (winging), elevation and protraction.
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The altered mechanics and posture in the shoulder complex such as scapula dyskinesis and upper crossed syndrome alters the axis of shoulder movement in the GH joint this can then cause the humeral head to encroach on the sub-acromial space and compress the structures within leading to impingement.

Take Home Message as a Therapist

As a therapist we should not use impingement as scape goat. We should dig deeper and assess the whole shoulder complex. Be that therapist that is annoyingly pedantic and looks at areas that people wouldn’t think to look at. Don’t leave any stone unturned when it comes to impingement. In the long run it will help your client with a truly successful rehabilitation. Look for those weaknesses, altered mechanics, lack of control, and over-active structures and design your rehabilitation to alter these factors. These are the real diagnoses not simply “you are experiencing impingement” and prescribe the generic shoulder rotation exercises.

Do ensure that serious pathologies are cleared as a priority, such as a long thoracic nerve pathology which affects the control and position of the scapula. Clear all neurological symptoms by testing athletes’ sensations and looking for any significant motor weakness, numbness, tingling, or complete loss of muscle tone.

Part 3 of this article will discuss potential approaches to treating shoulder impingement.

Guest blog by Ieuan Cranswick MSc Sports Therapy

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The Shoulder Complex Part 1: Functional Anatomy

Earlier this week there was a large volume of interactions on a post (via my Facebook page) regarding rotator cuff injuries and the rehabilitation process. It soon became apparent that a large number of people who follow my page had previously suffered from or are currently suffering from a shoulder injury of some degree. Thus, I have decided to ask a college and friend of mine Ieuan Cranswick MSc (Sports Therapy) to write a series of blog posts over the forth-coming months on injuries and the rehabilitation processes.

I am absolutely delighted to have Ieuan on board a guest blogger. I encourage you to follow him and make the most of the ‘golden nuggets’ of information he posts for FREE via his social media channels (please refer to the links at the bottom of this page).

    The Shoulder Complex

The shoulder complex is a highly mobile joint expressing a large range of movements. To achieve this large range of motion (ROM) there is limited stability provided by the inert structures within the complex. This meaning that there is a high responsibility on the muscles of the shoulder to provide stability to support the large ROM. This large responsibility on the muscles means that any imbalance in muscle function and strength may cause problems with overall stability, and function.
This article will look specifically at the imbalances, alterations and factors that may lead to impingement syndromes in the shoulder. This stems from the large amount of cases of impingement I have seen over recent months. It will be split over 3 parts, describing the functional anatomy of the shoulder complex, the common contributors and causes of impingement, and finally some possible treatment considerations.

Functional Anatomy…

Skeletal Structures
As most people will know the shoulder joint is described as a ball and socket joint. This being true the shoulder as a functional unit doesn’t stop there. It is best to view the shoulder as a complex unit. This unit comprising of the “ball and socket joint” or glenohumeral (GH) joint and the shoulder girdle. The shoulder girdle is comprised of the shoulder blade (scapula) and the collar bone (clavicle).
The only direct attachment from the shoulder to the axial skeleton is via the clavicle attaching to the breast bone (sternum). This joint is known as the sternoclavicular joint (SC).
The GH joint is where the head of the upper arm bone (humerus) or the “ball” meets the scapula and specifically the “socket” known as the glenoid fossa. This joint is very shallow so to allow for the great ROM.
There are many bony landmarks on the scapula but so not to complicate this article we will discuss the main aspects. There is a joint where a prominence of the scapula (acromion) meets the clavicle, this is known as the acromioclavicular joint (AC).
See figure 1 for the overview of the skeletal structure of the shoulder complex.
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    Figure 1 – Skeletal Structure of the Shoulder Complex

As mentioned the bones do not provide significant stability to the shoulder due to the shallow joint surface of the GH joint. Therefore the support for the shoulder has to come from elsewhere.

Ligamentous Structures
When the shoulder complex is static there is support provided by the capsule surrounding the shoulder joint, the ligaments, and the cartilage lining around the rim of the glenoid fossa (glenoid labrum).
There are 3 main ligaments of the GH joints; the top (superior), middle, and bottom (inferior) glenohumeral ligaments. Surrounding these ligaments there is then the capsular ligament or capsule. Inside the joint itself, under all these ligaments, is the labrum. This increase the congruence of the joint creating a deeper “socket” for the humeral head. See figure 2 and figure 3 showing the ligament structures of the shoulder. These structures do provide some element of stability, primarily when the shoulder is static. In order to maintain the large ROM of the shoulder these structures must be relatively lax to allow this movement of the shoulder.

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    Figure 2 – Ligaments of the Shoulder Complex
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    Figure 3 – Labrum of Glenohumeral Joint

The low contribution of the skeletal and ligamentous structures means that the majority of the stability of the shoulder complex comes from the active structures i.e. the muscles.

Muscular Structures
The muscles of the shoulder complex provide the majority of the stability for the shoulder especially during dynamic movements. The muscles of the shoulder all serve their own function during specific movements of the shoulder but all work as unit to provide stability and control proper mechanics during these movements.

• Raising arm out to the side (Abduction)
• Raising arm out to the front (Flexion)
• Raising arm backwards (Extension)

Pectoralis Major
• Bringing arm across the body (Horizontal Flexion)
• Contributes to flexion
• Turns arm and shoulder inwards (Internal Rotation)

Latissimus Dorsi
• Raising arm backwards (Extension)
• Bringing arm in to the side (Adduction)
• Draw arm horizontally backwards (Horizontal Extension)

• Pulls shoulder blades back (Retraction)
• Lower part pulls shoulder blades down (Depression)
• Upper part lifts Shoulder blades up (Elevation)
• Rotation of the scapula

Teres Major
• Turns arm and shoulder inwards (Internal Rotation)
• Bringing arm in to the side (Adduction)
• Stabilises humeral head

• Pull shoulder blades back (Retraction)
• Generally hold the shoulder blades onto the rib cage

    Rotator Cuff Muscles Actions

• Raising arm to the side for first 15 degrees (Abduction)
• Stabilises and pulls the humeral head into the socket.

• Turns arm and shoulder outwards (External Rotation)
• Stabilises and pulls humeral head down in the socket (Depression of Humeral Head)

Teres Minor
• Turns arm and shoulder outwards (External Rotation)
• Stabilises and pulls humeral head down in the socket (Depression of Humeral Head)

• Turns arm and shoulder inwards (Internal Rotation)
• Stabilises and pulls humeral head down and forward when arm is raised

    Other Muscles Actions

Serratus Anterior
• Pulls scapula forwards around the ribcage (Protraction)
• Helps with scapula rotation
• Helps keeps scapula pulled into the rib cage

Pectoralis Minor
• Pulls scapula forward around the ribcage (Protraction)
• Pulls scapula downwards (Depresses Scapula)
• Rotates Scapula Downwards

Levator Scapulae
• Lifts the scapula (Elevates Scapula)

Pectoralis Major
• Bringing arm across the body (Horizontal Flexion)
• Contributes to flexion
• Turns arm and shoulder inwards (Internal Rotation)

The extensive list of muscles above may look overwhelming. These muscles all work as a unit to ensure efficient movement of the shoulder. Various movements are possible around the GH joint, and the scapula as described below, you can use Table 1 for reference to muscle involvement.

Movements of the Shoulder Complex
The GH joint movements include flexion-extension (raising arm up in front and pull arm back), abduction-adduction (raising arm out to the side and back in), internal-external rotation (turn shoulder inwards and outwards), and horizontal flexion-extension (taking arm horizontally across the body and pulling it back).

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    Figure 4 – Glenohumeral Movements

The scapula movements include, protraction-retraction (forward and backward tilt around the ribcage), elevation-depression (uplift and downward pull), and upward-downward rotation.

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    Figure 5 – Scapula Movements

The co-ordination of both GH and scapula movements needs to be precise to allow unrestricted and efficient movement of the shoulder complex. For example as the arm is abducted the scapula rotates upwards in a 2:1 fashion after the first 30° of abduction. The same applies for flexion of the shoulder after the first 60° of flexion. If the scapula is restricted then the whole shoulder movement will be restricted. This shows the importance of examining the shoulder as a whole unit or complex rather than narrowing on the GH joint itself.

This has been a very brief and simplified description of the shoulder complex anatomy. This will be followed up by discussing and explaining the common dysfunctions that occur and lead to problems in the shoulder, in particular a chronic condition known as impingement syndrome. Although this term is very common it is not a diagnosis it a term given to the symptoms and experiences of the patient. The cause of this is often down to other irregularities such as a dysfunction in movement or weakness in certain muscle groups.
The Shoulder Complex Part 2: Common Dysfunctions will follow tomorrow.

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Sprinting For Fat Loss

Sprinting For Fat Loss

Not all cardio was created equal and thus it is important that you choose a form of cardio that will help you meet your goals in the safest and most time efficient way possible.
Since the mid 1990’s there has been a vast amount of research conducted into sprint intervals (SI) as a fat loss protocol. SI training, otherwise known as high intensity interval training (HIIT) have been shown to improve fat oxidative capacity (Burgomaster et al. 2007), decrease metabolic risk factors (Whyte et al. 2010), increase insulin sensitivity (Richards et al. 2010) improve energy system efficiency (Trapp et al. 2008) and are also recognized as a time efficient fat loss protocol when compared with traditional endurance training (Burgomaster et al. 2007). SI training demands a large amount of energy and places the anaerobic energy system under a significant amount of physiological stress over a short period of time.
The stress response to this bout of exercises results in significantly elevated human growth hormone levels (Stokes et al. 2010) and oxygen consumption (Tomlin and Wenger, 2001) to help restore the metabolic processes to their baseline conditions. This post-exercise oxygen uptake in excess of that required at rest has been termed excess post-exercise oxygen consumption (EPOC). EPOC during the slow recovery period has been associated with the removal of lactate and H+, increased pulmonary and cardiac function, elevated body temperature, catecholamine effects, and glycogen re-synthesis (Tomlin and Wenger, 2001).

Incorporating SI Training Into Your Program Design

Firstly SI training is for advanced trainees and athletes only. This is not a beginner or novice trainee protocol. If you haven’t sprinted or performed any intense running previously I would advise you to prime your body before incorporating this type of conditioning work within your program design. There are a significantly greater amount of injury risk factors associated with SI when compared with traditional endurance training. Thus my recommendation would be significantly reduce these risk factors by ensuring that you are both mobile and flexible before incorporating SI within your program design. Dynamic mobility movements – such as squat-to-stand or various band traction movements – help to open up our bodies. If we unlock our movement, we can get into better positions, move through a greater range of motion with more control which will ultimately result in greater force production, muscle activation, improved performance and ultimately greater results.

Beginner Protocol

• 40 meter sprint intervals x 10 @ 85 percent of 100-meter time
• 2-minute recovery interval between sets.

Moderate Protocol

• 40 meter sprint intervals x 10 @ 85 percent of 100-meter time
• 90 seconds recovery interval between sets.

Advanced Protocol

• 60 meter sprint intervals x 10 @ 85 percent of 100-meter time
• 60 seconds recovery interval between sets.

Take Home Points

• When it comes to designing your cardio regimen just as resistance training must be periodized so to must SI training.
• Keep your program design basic. There is no need to over-complicate things.
• Competitive athletes in training I would recommend no more than two SI training sessions per week.
• For recreational advanced trainees I would recommend between two and three SI sessions per week.


Burgomaster, K., A., Cermak, N., M., Phillips, S., M., Benton, C., R., Bonen, A. and Gibala, M., J. (2007). Divergent response of metabolite transport proteins in human skeletal muscle after sprint interval training and detraining. The American Journal of Physiology, (292), 1970-1976.

Richards, J., C., Johnson, T., K., Kuzma, J., N. Lonac, M., C., Schwder, M., M., Voyles, W., F. and Bell, C. (2010). Short-term sprint interval training increases insulin sensitivity in healthy adults but does not affect the thermogenic response to β-adrenergic stimulation. The Journal of Physiology, (588), 2961-2972.

Trapp, E., G., Chisholm, D., J., Freund, J. and Boutcher, S., H. (2008). The effects of high-intensity intermittent exercise training on fat loss and fasting insulin levels of young women. International Journal of Obesity, (4), 684-689.
Thomlin, D., L. and Wenger, H., A. (2001). The relationship between aerobic fitness and recovery from high intensity intermittent exercise. Sports Medicine, (1), 1-11.

Stokes, K., A., Nevill, M., E., Hall, G., M. and Lakomy, H., K., A. (2002). The time course of the human growth hormone response to a 6 s and a 30 s ergometer sprint. The Journal of Sports Sciences, (20), 487-494.

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It is very common amongst trainee’s to compare their individual progression to that of a friend or someone they aspire to look like. In reality this is entirely pointless, it is not a level playing field (enhanced/natural aside). There are huge individual variances in genetic potential from person to person. For example – An individual who has been gifted with good genetics may add muscle at twice the rate of a person with poor genetics. The gifted individual may indeed spend less time in the gym, train with poor form and rarely stick to their diet… Yet they look a lot more impressive than their counterpart. As frustrating as this may be it is the painful truth… Genetics matter.

What we can do is focus on manipulating the variables that we can actually control and in turn make the most of our genetic potential.
Is my training programmed correctly?
Have I stuck to my diet?
Has my training been intense enough?

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Core Training…What Has Gone Wrong?

The ‘core’ itself may be broken down into two separate units (inner and outer). The inner unit refers to the internal synergy between the deep core muscles. The inner unit is composed of the transversus abdominis, the posterior fibres of the obliquus internus abdominis, the diaphragm, the pelvic floor muscles, the multifidus and lumbar portions of the longissimus and oliocostalis. When these deep core muscles contract they provide the segmental stabilization of the spine. The outer unit (phastic muscles) generates movement, controls range of motion, provides stability and is made up of the obliquus externus, obliquus internus, erector spinae, latissimus doris, glutegus muscles, quadratus lumborum, adductors and hamstrings.
When the units function synergistically they generate greater muscular power, improve movement and stabilize the spine.

The inner and outer units can be further broken down into four systems. These systems consist of the deep longditudinal system, the posterior oblique system, the anterior oblique system and the lateral system (functional training requires both the inner and outer ‘core units’ to function synergistically, resulting in joint and body stability, economy of movement, enhanced power and decreased susceptibility to injury). However this synergy between the systems is far from what is seen when examining the firing sequence within many trainees today. As a result of the conventional fixation on the crunch/sit-up style abdominal exercise, a culture of postural distortion is readily observable. In every gym you will see multiple trainees with a forward transposed neck, sunken chest (and of course compensatory over-developed pecs), distended over-developed abdominal wall, posteriorly-tilted pelvis (accompanied with a ‘fanny pack’ of lower back tension). Today’s culture have forgotten the importance of maintaining this natural homeostasis between muscles. Muscle tension creates changes within your musclo-skeletal alignment. In this case, the over-emphasis of outer unit abdominal work pulls the chest downward, the neck forward, shortens the hip flexors which all collectively leads to a collapsed posture (which in turn may lead to decreased range of movement, joint instability and ineffective breathing patterns) so prominent within todays culture.

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The Environment, Stress and Digestive Health

The World we live in largely influences the landscape of our gastrointestinal tract, including the health of the beneficial bacteria that reside within the intestine (DeLongis et al. 1988). Gut microbiome help keep bowel movements regular, balances immune system function and protects against a variety of infections and diseases (Holmes et al. 2011). The more we learn about the gut the greater the connection becomes between the health of good bacteria, blood pressure, cholesterol levels, risk of diabetes and psychiatric disease (Sekirov et al. 2010). It seems that gut flora play a major role in determining body composition and predisposition to a variety of chronic diseases (Huang et al. 2014; Koplin et al. 2008; Tsai and Coyle, 2009).

There are many variables we must taken into consideration when discussing the factors that influence gut health, even birth practices must be accounted for. The human fetus lives in a germ-free intrauterine environment and enters the outside world containing microorganisms from several sources, resulting in gut colonization (Weng and Walker, 2014). Cesarean section (C-section) births can prove problematic and can lead to impaired gut function. During vaginal delivery, newborn babies are inoculated with beneficial bacteria from the birth canal (Barford et al. 2011; Dominguez-Bellow et al. 2011) this process kick starts the development of microbiota – which is key to shaping the immune system and regulating digestive function (Barford et al. 2011; Dominguez-Bellow et al. 2011). During a cesarean section this bacterial initiation process is by passed which dramatically increases the potential for health problems in later life. Unless these children receive probiotic supplementation upon delivery they do not receive a dose of healthy flora (Bezirtzoglou and Stavropoulou, 2011). The implications are serious and include asthma (Huang et al. 2014) and food sensitivity (Koplin et al. 2008).

Stress is an illness that affects everyone chronically. However it is often overlooked as a major influencing factor in gastrointestinal function. Chronic stress leads to an imbalance within the nervous system (Djordjevic et al. 2010). Allow me to explain… There is an enormous amount of nervous tissue between your esophagus and rectum. This system is known as the entric nervous system (ENS). The ENS is commonly known as ‘the second brain’ as it receives input from the brain itself however it is capable of overriding signals and operating entirely on its own. The ENS receives signals from the autonomic nervous system (ANS) which is responsible for our unconscious actions i.e. breathing and heart rate. The ANS may be subdivided into two branches known as the sympathetic nervous system (fight or flight branch) and the parasympathetic nervous system (rest and digest branch). Digestion is more efficient when we are less stressed and the parasympathetic nervous system is the more dominant of the two. Under stressful circumstances the balance between the two nervous system’s shifts and the sympathetic nervous system becomes more dominant which may lead to impaired gut function. The ENS receives input from your gut microbiota, your immune system and the CNS, along with food, supplementation and stress. This is why stress management is so crucial to not only performance but to health more importantly.

Another factor that we must account for is chemical exposure. It is impossible to avoid all chemical exposure – from the very air we breathe to the processed food we consume, it is all loaded with chemicals. A multitude of chemicals are toxic to the lining of the gastrointestinal system and gut flora. Many of them are endocrine disruptors – substances that alter hormonal signaling and give rise to infertility, metabolic dysfunction, fat loss resistance and a host of other complaints. Measures can be put in place to reduce the degree to which we are exposed to chemicals however eliminating all chemical exposure is not realistic.


DeLongis, A., Folkman, S. and Lazarus, R. S. (1988). The impact of daily stress on health and mood: Psychological and social resources as mediators. The Journal of Personality and Social Psychology, (3), 486-495.

Holmes, E., Li, J. V., Athanasiou, T., Ashrafian, H. and Nicholson, J. K. (2011). Understanding the role of gut microbiome-host metabolic signal disruption in health and disease. Trends in Microbiology, (19), 349-359.

Tsai, F. and Coyle, W. J. (2009). The microbiome and obesity: Is obesity linked to our gut flora? Gut Gastroenterology Reports, (11), 307-313.

Sekirov, I., Russell, S. L., Caetano, L., Antunes, M. and Finlay, B. B. (2010). Gut microbiota in health and disease. Physiological Reviews Published, (90), 859-904.

Nelun, B., Magnusson, K., Lexner, M. O., Blomgvist, S., Dahlen, G. and Twetman, S. (2011). Oral microflora in infants delivered vaginally and by caesarean section. The International Journal of Paediatric Dentistry, (6), 401-406.

Dominguez-Bello, M. G., Blaser, M. J., Ley, R. E. and Knight, R. (2011). Development of the human gastrointestinal microbiota and insights from high-throughput sequencing. Gastroenterology, (140), 1713-1719.

Koplin, J., Allen, K., Gurrin, L., Osborne, N., Tang, M. L. and Dharmage, S. (2008). Is caesarean delivery associated with sensitization to food allergens and IgE-mediated food allergy: a systematic review. Paediatric Allergy and Immunology, (8), 682-687.

Huang, L., Chen, Q., Zhao, Y., Wang, W, Fang, F and Bao, Y. (2014). Is elective cesarean section associated with higher risk of asthma? A meta-analysis. The Journal of Asthma, (27), 1-10.

Djirdjevic, J., Djordjevic, A., Adzic, M. and Radojcjc, M. B. (2010). Chronic social isolation compromises the activity of both glutathione peroxidase and catalase in hippocampus of male wistar rats. Cellular Molecular Neurbiology. (5), 693-700.

Berzirtzoglou, E. and Stavropoulou, E. (2011). Immunology and probiotic impact of the newborn and young children intestinal microflora. Anaerobe, (6), 369-374.

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Tempo – Training Tips

Your muscles do not know what load they are being placed under whilst lifting. Total time under tension (Tempo) should be your primary focus.

Here is a great reference table outlining the specific time under tension and training intensity required for specific strength qualities.

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There is no switch between strength and muscle hypertrophy once you hit 8 reps, cast aside rep counting and focus on total set duration. If your goal is to build a maximum amount of muscle ask yourself whether or not the muscle has enough time under tension and intensity to elicit sufficient lactic acid? Aim for 20-45 seconds time under tension if maximal muscle hypertrophy (size/shape) is your goal…

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Travelling & Dietary Adherence

“You must be shapeless, formless, like water. When you pour water in a cup, it becomes the cup. When you pour water in a bottle, it becomes the bottle. When you pour water in a teapot, it becomes the teapot. Water can drip and it can crash. Become like water my friend.” – Bruce Lee.

Adapting to environmental change is something that we must to do on a daily basis. Change is inevitable and thus we must be able to adapt to the situation in the most efficient way possible.
I am a huge believer in systems. Having a system(s) in place enables us to make the most of our time, to stick to our plan and to keep moving forward. However what happens when that system fails you? Which in reality is inevitable at some point in time… Thus we need a plan B and potentially a plan C, D etc. for when they all fail too? What if we could develop a plan B that was so flexible it covered all problems that could potentially arise within a system?

Now whilst I personally believe in having a nutrition plan (a system) that is set in stone for myself and my clientele (utilizing optimal food choices for performance: fat type ratios, carb sources, fiber and a range of protein sources). There are indeed circumstances when I have ‘plan B’. Travelling always presents problems when it comes to adhering to a ‘rigid’ nutritional regimen, especially if it involves trans Atlantic flights etc. It can in fact make the journey itself quite stressful and unpleasant. Most people either simply do not eat, or go completely off the bandwagon making poor food choices i.e. binge eat and this in itself may create even more stress! So what is the solution? If It Fit’s Your Macro’s (IIFYM)… (shock, horror – yes for someone who was so against it in the first place, I now see the value in using it as a system). IIFYM is a nutrition system that I personally use whilst travelling. Now that is not to say I will simply eat highly processed foods as long as I keep within my macronutrient ratios… No! What it does mean is that if I need 40g of protein (for the sake of argument) I will try and source the best possible protein that I have available to me, whether it is chicken, beef, eggs etc. it doesn’t matter as consuming the best of what I have available to me is simply more advantageous than throwing caution to the window and going to McDonalds!

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Sleep Quality Matters

This morning whilst doing some reading between clients I stumbled across an interesting article by Chris Beardsley in the November 2013 issue of Strength & Conditioning Research. The article discusses the importance of sleep in athletes and adverse effects poor sleep quality can have upon health and athletic performance.

The first study up is Sleep Disorders and the Development of Insulin Resistance and Obesity. In this important review, the reviewers begin by observing that the pressures of modern society and the structure in which many people now live their lives (e.g. shift workers and long office hours) have led to progressively decreased sleep duration over a period of several decades. The reviewers note that researchers performing observational studies have found a correlation between people who have shorter durations of sleep and the incidence of type II diabetes. Additionally, they observe that prospective studies that have followed diabetes-free individuals with various sleep durations over time have found that short sleep duration is a significant risk factor for developing type II diabetes. Moreover, in studies of mild sleep-deprivation, researchers have found that glucose homeostasis is impaired as a result of short sleep time. Finally, the reviewers observe that a reduction in sleep duration leads to increased appetite and is therefore a risk factor for obesity, while sleep deprivation itself leads to an increase in preference for foods rich in carbohydrates and fat. The reviewers concluded that short sleep duration appear to be associated with impaired glucose tolerance, which may perhaps lead to the development of type II diabetes and that certain sleep disorders, such as obstructive sleep apnea, may put individuals at an increased risk of type II diabetes.
The second study is Evidence of Disturbed Sleep and Increased Illness in Overreached Endurance Athletes. In this study, the researchers wanted to find out whether changes in sleep parameters were evident between a group of triathletes with functional overreaching in comparison with a control group. The researchers found that 9 of the 18 subjects in the intervention group displayed a reduction in performance after the overload period, which was then followed by an increase in performance post-taper. On the basis of this analysis, these 9 subjects were considered to be functionally overreaching. Therefore, the researchers presented the results for these 9 athletes and rejected the data from the other 9 subjects, who did not reduce in performance. The researchers found that actual sleep time, sleep efficiency and immobile time all progressively decreased in the functionally overreaching group during the overload period in comparison to baseline and the proportion of subjects who experienced symptoms of infection was higher in the functionally overreaching group (67% of total infection cases). The researchers therefore concluded that functionally overreaching athletes display objective signs of moderate sleep disturbance and a higher prevalence of infections. They therefore recommend that athletes at risk of overreaching or who are already diagnosed as having become overreached should be encouraged to increase their sleep quality and quantity.
In the third study, which was also a review article, Sleep, Recovery, and Athletic Performance: A Brief Review and Recommendations, the reviewer made five recommendations for athletes so that they can optimize recovery from training and competition by improving sleep quantity and quality. The recommendations were: identifying and targeting the ideal amount of sleep, forming a good sleep routine and habits, napping, ensuring that muscle soreness and pain do not impact on sleep, and reducing anxiety and worry prior to bed-time.
Based on these reviews, we can pull out a number of key recommendations for both the general population and for athletes, as follows:

For the general population
Since short sleep duration appear to be associated with impaired glucose tolerance, which may perhaps lead to the development of type II diabetes, individuals are recommended to avoid succumbing to the temptation to do more at the expense of getting their necessary hours asleep each night.

For athletes in hard training
Since functionally overreaching athletes display objective signs of moderate sleep disturbance and a higher prevalence of infections, athletes at risk of overreaching should increase their sleep quality and quantity.

For athletes looking to improve sleep quality and quantity
Athletes looking to improve sleep quantity and quality should: identify and target the ideal amount of sleep, form a good sleep routine and habits, take naps, ensure that muscle soreness and pain do not impact on sleep, and try to reduce anxiety and worry prior to bed-time.


Sleep Disorders and the Development of Insulin Resistance and Obesity, by Mesarwi, Polak, Jun and Polotsky, in Endocrinology and Metabolism Clinics of North America, 2013.

Sleep, Recovery, and Athletic Performance: A Brief Reviewand Recommendations,by Bird,in Strength and Conditioning Journal, 2013.

Evidence of Disturbed Sleep and Increased Illness in Overreached Endurance Athletes, by Hausswirth, Louis, Aubry, Bonnet, Duffield
and Le Meur, in Medicine & Science in Sports & Exercise, Publish Ahead of Print.

Sleep Disorders and the Development of Insulin Resistance and Obesity, by Mesarwi, Polak, Jun and Polotsky, in Endocrinology and Metabolism Clinics of North America, 2013.