Asthma and Swimming: Know the Rules

Asthma is always a hot topic around the pool, whether formally diagnosed or whether used colloquially to describe a swimmer who habitually runs out of breath.  With many athletes taking asthma medications, it’s important to know the rules, even if you aren’t formally tested by regulatory agencies.   Respiratory issues garner even more attention during these winter months as more swimmers are driven indoors full time.  Asthma is also the most common chronic condition among all Olympic athletes, not only swimmers (Fitch 2012).  

For previous discussion here on asthma see An Interdisciplinary Look at Asthma and Swimming and Asthma and Swimmers.  To sum up previous writings, asthma is a multidimensional condition with biomechanical and psychological factors often neglected in favor of a narrow focus on pulmonary and respiratory elements.  Nonetheless, with many swimmers dutifully puffing from their inhalers to control asthma or even using medicine for performance enhancement, it is important to know the rules.   

While some of this may seem abstract to the average age grouper or masters swimmer, thousands of athletes are only one breakthrough performance away from finding themselves in USADA's national testing list (and if you’re fast enough for the officials to care what you’re putting in your body, that’s a good thing).  It behooves coaches and parents to remain abreast of testing requirements for health, performance, and compliance. 

 

In this post we’ll cover the basics of World Anti Doping Agency (WADA) requirements for asthma medications.  For complete information visit WADA or USADA.  Rules governing asthma medications have changed in recent years.  Some may cite politics, while others may point to recent studies indicating asthma medications confer no performance benefits on healthy athletes (Pluim 2011).  If there’s a lesson to be learned it’s that medication rules are a moving target … and you as the athlete are responsible for what you ingest.  Don’t make yourself a news item for the wrong reasons!

WADA’s asthma restrictions are simple yet complex: essentially, all beta-2 antagonists are PROHIBITED except “inhaled salbutamol (maximum 1600 micrograms over 24 hours), inhaled formoterol (maximum delivered dose 54 micrograms over 24 hours) and salmeterol when taken by inhalation in accordance with the manufacturers’ recommended therapeutic regimen.”  As for brand names, salbutamol is commonly known as Albuterol; formoterol better known as Foradil or Perforomist; selmeterol is sold as Serevent.

Despite these restrictions, athletes can apply for a Therapeutic Use Exemption, the core of which is a two-step testing process to demonstrate actual need.  A TEU would allow an athlete to legally use a beta-2 antagonist that’s not one of the three exceptions listed above.  First, an athlete must perform spirometry, or airflow testing.  A “12% or higher increase in FEV1 following the use of an inhaled beta-2 agonist is considered to be the standard diagnostic test for the reversibility of bronchospasm.” 

However, because high level athletes can demonstrate normal flow, yet still have asthma, a bronchial provocation test is available as a second layer to detect the condition.  A positive finding on any of the established bronchial provocation tests would qualify the athlete for the exemption, so long as other administrative requirements are met.  If the athlete has a negative result (no asthma diagnosis) on both tests, they may still submit a medical file for review by the agency. 

To complicate things further, the NCAA has its own rules, as it prohibits asthma medications that are otherwise permitted by WADA, but these medications may be allowed via prescription.  Check with department medical staff if in doubt, as the penalty could be loss of eligibility for a failed test and possibly sanctions for the team. 

Conclusion

Know the rules in this potentially thorny area as winter and indoor training oiten aggravate asthma-like symptoms.  Ensure that swimmers know both the legalities and the health consequences of what they put in their bodies, not only for asthma but for all conditions and performance enhancement.   

References

1. K. D. Fitch. An overview of asthma and airway hyper-responsiveness in Olympic athletes. British Journal of Sports Medicine, 2012; 46 (6): 413
2. Pluim BM, de Hon O, Staal JB, Limpens J, Kuipers H, Overbeek SE, Zwinderman AH, Scholten RJ.  Β2-Agonists  and physical performance: a systematic review and meta-analysis of randomized controlled trials.  Sports Med. 2011 Jan 1;41(1):39-57. doi: 10.2165/11537540-000000000-00000.
3. World Anti Doping Agency: Asthma

By Allan Phillips. Allan and his wife Katherine are heavily involved in the strength and conditioning community, for more information refer to Pike Athletics.

Continue Reading

Friday Interview: Bill Christensen

1. Please introduce yourself to the readers (how you started in the profession, education, credentials, experience, etc.).  

Started in 1989 as Head Age Group Coach of Highline Swim Club in Federal Way, Wa; which through a merger became King Aquatic club.  My first head coaching experience was at Lobo Aquatic for 4 1/2 in Albuquerque, NM.  Then I moved to my current position of Head Coach of North Texas Nadadores where I have been for the past 10 1/2 years.

2. Your team has posted impressive results in the season, what new aspects of training have you added to your team this season?  

Not much has changed this season but more of an accumulation of small things over time.  Our big improvements have been underwater kicking, technique and dryland.  We try to video tape; underwater and with the I pad.  Dryland has improved with a mix of Yoga type of exercises and cross-fit exercises.

 

3. What do you feel you do differently than other coaches?  

Not sure here.  I don't see a lot of coaches on a daily practice basis. I like to hear what other coaches do and apply it in our practices, so I probably don't do things too much different.

4. Which coaches have most influenced your training philosophy?  

Urbanchek and Bob Bowman.  Aerobic training and doing all 4 strokes at all distances is important for development.

5. What are your favorite books on swimming?  

I reference Bill Sweetenham's training book a lot.  I liked Madsen's book on Age group development but can't find it anymore.

6. You've coached a lot of great swimmers. Who are some of the outlier swimmers you've coached in the years and what made them different than other swimmers you've coached?  

Three main qualities stand out.  1) willing to work hard during all parts of practice and meets.  2) Self-Driven but stay relaxed and enjoy the experience.  3) willing to do extra work on own.

7. What are the most common mistakes you see in coaching? 

Some coaches believe their program is the only program and are not open to change.

8. How do you coach high school kids to balance their school, sleep, swimming, and social life?

Communicate with the kids.  Talk a lot about balance in life.  If they need to take a club practice off, then so be it.  I just want to talk about it with them before hand.  I have also had some kids where I have just sent them home.  They will push themselves to overworking and get sick.

9. What dry-land techniques do you incorporate in your team? 

Yoga, some basic pilates, and cross-fit type exercises. We try to keep dryalnd interesting and mix into swim practices.

10. What are some of the most surprising things you've tried in coaching? Have they worked?  

Our dryland has improved dramatically over the past few seasons.  Could still get better but much better.  We also like the power towers.  I like the idea of creating just enough resistance to make swimmers adjust technique to swim but not enough resistance to break the stroke down.

11. In swimming, progressions are commonly made (ie underwater dolphin kicking over the past few decades), what do you think will be the next big enhancement?  

Not sure what is next but it will be whatever enhances speed more than endurance.

12. One area on the rise seems to be nutrition, what are your views on supplements in swimming? Do you recommend supplements for any of your athletes? If so, what and why?  

We do not recommend supplements.   We bring in a nutritionist about twice per year to talk about eating and hydrating properly.

13. What are your philosophies on taper? How much and long do you typically rest for boys and girls? Sprinters and Distance swimmer?  

We tend to adopt resting patterns based on distances and strokes swum not gender.  Distance kids do more pace work and middle distance and sprinters do more sprint work.  The type of training doesn't really change just the percentage of yardage.  We do pay attention to individuals and try to adapt to what they like.

14. In your opinion, who are some successful swimmers despite being poorly build for it? Who's good at this who shouldn't be? 

Anyone that appears not to be long and lanky but are good freestyle and backstrokers.  Flyers and Breaststrokers that don't look to have a low center of gravity.  Don't have anyone specifically but those are the general body types that should struggle.

15. What do these people do differently? 

Feel for the water and desire.  Desire to get better can overcome body shape and talent.

16. Who are the most unorthodox or controversial swim coaches? Why? What do you think of them?

Not really interested in naming these type of coaches.  I have learned through the years, coaches get performance with many different styles and beliefs.  Success is always having the best program but having belief in that program.  Coaches that do things differently help point out parts of our program that could get better.  As long as they have the best interests of the kids at heart, then they can continue doing what they do.   Swimmer's performance over time will be the judge of their program.

17. Who are the most impressive, lesser known swim coaches? 

There are too many to list but in general, I admire 1) the coach that produces on a consistent basis in an area that is far from decent competition.  2)  Age Group coaches that continually have kids improve once they get to the Senior program.  They produce happy positive kids that have a solid training and technique base.

18. What is your view on the use of race pace training? 

It is important but not on a set by set basis.  You have to be careful to over-react to race pace training.  There are too many variables that affect daily performance.

19. In your opinion, what is the primary benefit of sets swum at below-race pace? 

Aerobic development, technique improvement, and active recovery.

20. How do you prefer to go about modifying someone's technique (video? drills? equipment?)?  

Video is the best teaching tool.  Then applying specific drills and slow swimming to improve the technique.

21. Do you feel that equipment (boards, fins, paddles, etc) benefits certain types of swimmers or age groups more than others? 

I think fins are the best tool for younger age groupers.  For drill work, they stabilize body position.  Fins also give kids the feel for swimming at a rate closer to true race pace.  It is important to use equipment more as tools than crutches.

22. What projects are you currently working on or should we look from you in the future? 

Hopefully in year or two, I will have another crew of great kids performing at the levels we are at now.

Continue Reading

Rest for Gains

We are well into the holiday season. The holiday season provides opportunities for gains, as many swimmers are out of school and able to train for multiple hours. However, these high volume periods are scattered with periods of rest. These days of rest are dreaded by many coaches, as many feel a day of rest is a day without making gains, but these periods of rest are essential for making gains! In fact, strength is enhanced most during rest. Now this is obvious for swimmers, as swimming is one sport which utilizes rest periods for sporting enhancement. Unfortunately, finding the balance of rest and training is key, but difficult. Too often coaches are one-sided, either providing too much rest or training. Finding a balance of swimming training is difficult, but a modifiable factor worth the hassle! Unfortunately, the ideal balance is much more difficult than stated, as each swimmer handles these stresses differently. To complicate manners more, each swimmer responds to these different stressors differently on a given day, depending on their daily life and sport stressors. This makes it key to control as many modifiable factors as possible. If one can control the controllable, you have done your job. However, constant monitoring and modifying are as essential as yearly planning and programming. Remember, a young man knows the rules, but the old man knows the exceptions. Keep the rules and plan in mind, but don't be afraid to provide more rest, or training or stay on path planned!

By G. John Mullen founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Continue Reading

Pacing 101 for Swimmers: Part III

Earlier this year, Dr. John covered pacing physiology and methods to improve race pacing (Pacing 101 and Pacing 101 Part II).  In sum, even pacing has the strongest support, but competition tactics and stroke specialties in the IMs may warrant deviation.  In this article we’ll expand on this topic reviewing empirical studies on pacing, both in the lab and in the field.  Despite any information here, always consider individual variation, as splits collected from competitions and practice time trials will yield clues for individual swimmers.  Experimenting with different strategies is useful in minor meets.  

Before we examine competition studies, we’ll begin with one lab study.  Thompson 2003 studied non-elite male breaststrokers who performed a 200m time trial, then three 175m trials 72 hrs later.  The 175m trials included an even paced swim, a fast start, and a fast finish, with each trial spaced 48 hrs apart to ensure no recovery issues.  Each time trial was equally timed but completed in random order.  Most significantly, the even paced trial produced lowest peak blood lactate and ratings of perceived exertion.  Interestingly, turning times exhibited a significant slowing from start to finish comparing the fast start trial to the evenly paced and fast finish trials, perhaps indicating that swimmers are using turns to rest while maintaining velocity in the center of the pool.

Mauger (2012) collected a sample with 264 international competition swims at 400m freestyle by both genders.  Although the sample overlapped suit eras, authors found no impact of suit makeup on race strategy.   Authors found that a “fast start followed by even pacing” and “parabolic pacing” (fast start, slower middle, fast finish) were the most common pacing strategies, but did not study correlations with time/placing.

IM’s are their own unique animals due to variation in stroke specialties.  Saavedra (2012) studied elite 200/400IM performances of both men and women (1,643 total swims) at major competitions (Olympics, US Olympic Trials, Australian Trials, among others) from 2000-2011.  Overall, the men favored a fast start strategy (positive pacing) and women favored fast finish strategies (negative pacing).  Comparing medalists, backstroke pacing was the most significant differentiator in men, with backstroke and free most significant in women.  Looking beyond medalists, breaststroke pacing was the greatest differentiator of performance for men, with freestyle most significant for women.

Robertson (2009) studied top 16 finishers in nine international competitions in all events 100m through 400m events and noted the following findings…

• last lap had the strongest relationship with final time in all 100-m events, except men’s 100-m freestyle where the correlation of lap times was identical in the first and second lap for males
• the winners of the men’s freestyle had a slower first lap than the second placed swimmers, but were differentiated by a smaller drop off (differential between first and second lap time) in the final lap. In contrast, women’s 100-m freestyle winners were faster in both laps.
• In 200-m events, the strongest determinant of finish time was the middle two laps of backstroke and breaststroke, the third lap in freestyle, and the third and fourth laps in butterfly and individual medley.

Summary

There’s little from race results to contradict that even pacing is the most physiologically advantageous method.  Though some results do indicate that fast starts are a common strategy, most field studies do not account for increased velocity via the dive.  Further, it’s not surprising that a fast start is a common strategy in male IM’s with more than 60% of the race consisting of fly (the fastest stroke), underwater dolphin to start backstroke, and a dive start.  This finding may also reflect the reality that many of the recent era's top male IM swimmers have emerged from butterfly and backstroke backgrounds.    

References 

1. Thompson KG, MacLaren DP, Lees A, Atkinson G.  The effect of even, positive and negative pacing on metabolic, kinematic and temporal variables during breaststroke swimming breaststroke swimming.  Eur J Appl Physiol. 2003 Jan;88(4-5):438-43. Epub 2002 Nov 19. 
2. Mauger AR, Neuloh J, Castle PC.  Analysis of pacing strategy selection in elite 400-m freestyle swimming. Med Sci Sports Exerc. 2012 Nov;44(11):2205-12. doi: 10.1249/MSS.0b013e3182604b84. 
3. Saavedra JM, Escalante Y, Garcia-Hermoso A, Arellano R, Navarro F.  A 12-year analysis of pacing strategies in 200- and 400-m individual medley in international swimmingcompetitions.J Strength Cond Res. 2012 Dec;26(12):3289-96. doi: 10.1519/JSC.0b013e318248aed5. 
4. Robertson E, Pyne D, Hopkins W, Anson J. Analysis of lap times in international swimming competitions. J Sports Sci. 2009 Feb 15;27(4):387-95. doi: 10.1080/02640410802641400.

By Allan Phillips. Allan and his wife Katherine are heavily involved in the strength and conditioning community, for more information refer to Pike Athletics.

Continue Reading

Weekly Round-up

1. SIX-BEAT KICKING A DISTANCE RACE
2. Just in time for the holidays: Anti-Inflammatory Foods
3. New Consensus Statement: Overtraining Syndrome
4. Kinesio Taping Does Not Improve Gastrocnemius Muscle Function in Healthy, Active Individuals
5. Exploring Causes of Exercise Associated Muscle Cramps: Part III
6. Ballistics Lunge Activates Muscle to the Same Extent as 34% Lighter Standardlift, Elastic Band & DBs Target Different Muscles. Plus: 10 Arguments for Explosives & Plyometrics
7. Really?: Really? Losing Sleep Reduces Your Tolerance for Pain
8. Lessen Thigh-Area Tightness, Which Can Cause Knee, Hip, Back

 

 

 

Continue Reading

Friday Interview: Daniel Boullosa

1. Please introduce yourself to the readers (how you started in the profession, education, credentials, experience, etc.).
I have competitive experience mainly as sprinter and some experience in soccer and judo. I started to work as coach and consultant for different populations (endurance and team sport athletes, soccer referees, fire-fighters aspirants, etc.) in 2002 after the completion of the Bachelor in Sport and Exercise Sciences. From 2003, I started with my post-graduate formation that finished in 2009 with my PhD in Sport and Exercise Science at University of A Coruña (Spain). During those years I worked on the field and performed research at the same time in Vigo (Spain). Currently, I am working as Lecturer in Exercise Physiology and Sports Training at Catholic University of Brasilia (Brazil) and occasionally as consultant for elite athletes.

2. You recently published an article on cluster training and post-activation potential (PAP). Could you please describe cluster training, your study, and the results?
Cluster training consists basically of introducing rest pauses between repetitions instead of between sets in resistance and jump exercises. We compared the acute effect on jump performance of a set until failure with a set with the same load but with 30 s pauses between repetitions. The major finding was that the cluster set induced a more rapid jump potentiation when compared to the set until failure probably because of the lesser induced fatigue.

3. Based on the findings, how do you feel post-activation potential (PAP) should be used in elite athlete? Swimmers?
For training, it seems that performing resistance exercises before explosive tasks is good but it is not clear if it is chronically better than the opposite combination. During competitions, PAP is very difficult to apply as the exact competitive schedule is unknown in most cases or simply makes very difficult its application. For swimmers, a recent article of Kilduff et al. suggests that it could be applied for a better swim start but more studies are needed in this area.

4. Do you think PAP applies to all muscle groups?
Yes but It depends on the predominant type of fibers of the muscle group. “Slower” muscles would be better conditioned with low-intensity repetitive muscle actions while “faster” muscles would be more benefited from short high-intensity actions.

5. Who are the most controversial or unorthodox researchers in the field of strength and conditioning?
For me, the most controversial researcher in strength and conditioning was Carmelo Bosco who unfortunately left us some years ago. I was very fortunate to meet him in Barcelona in 2000. His main contribution was the battery tests called "Bosco Test" which include:
sj, cmj and dj. His passionate discussions with his advisor and one of the most important neuromuscular physiologists of all time, Paavo Komi, are legendary.

http://www.boscosystem.com/eng/science-p3d.htm
http://www.boscosystem.com/eng/science-p3e.htm

6. What are the biggest mistakes or myths you see in people attempting PAP?

To perform the jump or sprint exercise immediately after the resistance exercise with no rest pause between them. One interesting thing to take into account in this area is that the greater effectiveness of complex training as commonly performed is still to be elucidated.
 
7. How specific is PAP? Could someone do heavy squats, then see a transference in upper body bike (ergometer)?The current knowledge suggests that PAP response is task and muscle group dependent but some cortical and subcortical influences would be expected with more studies still needed.
 
8. If someone were to perform PAP over time, would they body become accustomed to the training and see diminishing results?Good question. I think that it depends more on the specific adaptations at the right time. Sometimes PAP is not evident because of very little adaptations that interfere on specific performance. In any case, for sure you will need to train with higher loads for looking for PAP if your best RM is higher than before.

9. Who is doing the most interesting research on resistance training in the field? What are they doing?There are lots of excellent researchers in neuromuscular area that are working with a number of different topics. I would say some classic authors like Kraemer, Häkkinen, Newton, Behm and McBride who currently act as supervisors and collaborators of others in very different projects. With respect to younger, I like very much the works of excellent researchers like Prue Cormie and Neale Tillin, but the list of colleagues that publish very good works is very large. Justin Hardee has also recently published a series of very interesting papers on cluster set configuration.

10. What makes your research different from others?
I think that the training background of our participants (firefighter aspirants) that favored the study results as they were trained in both endurance and power, which is not a common characteristic of participants in such kind of studies. From a methodological point of view, we incorporated some important assumptions from a recent previous paper of Chaouachi et al. that helped to understand our results.

11. Which teachers have most influenced your research?
Specifically for this late study, Eliseo Iglesias-Soler, Anis Chaouachi, and Dave Behm who is also co-author of the article.

12. What are your favorite books on resistance training?
Fleck and Kraemer's classic “Designing Resistance Training Programs”, Gonzalez-Badillo and Gorostiaga's “Strength Training Fundamentals” (in Spanish), and Carmelo Bosco's “Muscular Strength” (in Spanish).

13. If I were looking for the greatest results in high jump performance, what program would you prescribe over 8 weeks?
The program would depend on your performance tests and your training background, and -more importantly- It would be adapted to your day-by-day response to training. For me, the most important thing for training is not the program, is the direct supervision and adaptation of that program on an individual basis.
 
14. What research or projects are you currently working on or should we look from you in the future?With respect to sports performance, we are evaluating fatigue-potentiation responses in ultra-endurance athletes and also immunological, neuromuscular, and cardiovascular adaptations to training in different disciplines. In respect to exercise and health, we are starting to work on autonomic adaptations to stress and depression. 

Thanks!

Continue Reading

Hip Pain: Increase in Injury or Diagnosis?

The incidence of hip abnormalities are dramatically increasing in all athletes. In swimmers, the breast kick is the most provocative to the hip joint, as the femoral head excessively rubs the acetabulum in areas of thin cartilage which I've discussed for Swimming World with Hip Pain in Swimmers. In this piece, I briefly discuss the increase in hip injury diagnosis and question if this rise in diagnosis is due an increased rate of injuries or simply from improved imaging techniques. More importantly, are athletic individuals being over diagnosed with hip injuries on diagnostic imaging, similar to the low back and shoulder which show an high rate of structural abnormalities, even in those without symptoms?

A recent study by Register et al. analyzed hip images in asymptomatic individuals and found 73% had abnormalities in their hip, with the majority of these being labral pathologies which accounted for 69% of the injuries.

Unfortunately, this study analyzed hips of active, not athletic individuals, with an average age of 38. However, one could argue a swimmer (specifically breast) would have more wear and tear at the hip compared to someone nearly twice their age. Future studies are necessary to look at the hips of athletes and determine if structural abnormalities are the cause or simply correlated with hip pain. However, it seems structural abnormalities are not always the cause of symptoms (as seen in the shoulders (Radiologic Imaging and the Asymptomatic Athletic Shoulder) and low back (10 Minute Solution: Low Back Pain Part I)), but may simply correlate with symptoms. Keep this in mind in those receiving imaging of the hip and ask, is this a new or old structural defect? 

References:

1. Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of Abnormal Hip Findings in Asymptomatic Participants: A Prospective, Blinded Study. Am J Sports Med. 2012 Oct 25. [Epub ahead of print]

By G. John Mullen founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Continue Reading

December Swimming Science Research Review

The December edition of the Swimming Science Research Review was published on Saturday December 15th (remember if you sign-up for the December edition, you'll receive an exclusive paper on dry-land for swimmers!). Below are the articles reviewed in this edition. Most notably was an outstanding study on the effects of pre-exercise non-steroidal anti-inflammatory drugs (NSAIDs) on the intestinal lining of the gut. 

In this study, Van Wijck found taking NSAIDs the night and morning before endurance exercise resulted in intestinal wall damage more than exercise alone. This suggests this practice should not be followed, despite it's common use on swim decks. However, this study did require athletes to consume this medication on an empty stomach, potentially not providing a protective lining to the gut upon consumption. Nonetheless, it seems NSAIDs prior to exercise is not necessary and likely causes intestinal gut damage, especially since it seems inflammation is necessary for improvement (Inflammation in Sports).

Another key area reviewed were those addressing myofascia. Myofascia is described as a layer of fibrous tissue which surrounds muscle and is typically discussed in rehabilitation circles, but little is known about its composition or response to manual therapy, especially in painful patients. However, it seems myofascial trigger points (MTrP) correlate with pain in multiple joints (Muñoz-Muñoz 2012; Shah 2012). Moreover, manual myofascial techniques  may result in improved immune system response (Fernández-Pérez 2012). However, trigger point release therapy for 60-seconds around the hip yielded no improvements in muscle torque in those with patello-femoral knee pain (Roach 2012). This brings up three different possibilities: 

1. Trigger point pressure release therapy is not effective for improving the myofascial trigger point.
2. The MTrP only correlates, but does not cause the pain.
3. The application of the trigger point pressure release therapy method was not correct (possibly too short of a session, maybe to the wrong muscles). 

Future studies on myofascial are required, as many rehabilitation specialist utilize these techniques with favorable results.

$10/month

December 2012 
Unexpected Hip Abnormalities in Asymptomatic Adults
Laser Treatment for Knee Pain
Effects of Shoulder Mobility Deficits on Shoulder Biomechanics
Inflammation in Ultra-Endurance Exercise
Inflammation, Endurance Exercise, and the recovery response
Analysis of Elite Flip Turn Kinematics
Hip Muscle Activation during Common Rehab Exercises
Myofascial Trigger Points in Patellofemoral Pain Syndrome
Trigger Points in the Hip for those with Knee Pain
Can bad posture induced by backpacks be fixed with education?
Training for Aerobic Capacity and Hypertrophy Simultaneously
Night Time Calf Cramps
Accuracy of Physical Shoulder Tests
Comparison of Shoulder Tests
Trigger Points and Sleep Quality for those with Neck Pain
Improving Scapular Positioning with Rehab Exercises
Transverse Abdominus Activation and Drawing-In
Effects of Myofascial Techniques on the Immune System
Searching for Trigger Points
Taking Ibuprofen prior to training: Potentially Dangerous
Assessing performance of a squad based on competition
Genetic factors influencing odds of tendon injuries
Movement Perception ability and Lower Back Pain 

$10/month

References:

1. Muñoz-Muñoz S, Muñoz-García MT, Alburquerque-Sendín F, Arroyo-Morales M, Fernández-de-Las-Peñas C.Myofascial trigger points, pain, disability, and sleep quality in individuals with mechanical neck pain.J Manipulative Physiol Ther. 2012 Oct;35(8):608-13. doi: 10.1016/j.jmpt.2012.09.003.
2. Fernández-Pérez AM, Peralta-Ramírez MI, Pilat A, Moreno-Lorenzo C, Villaverde-Gutiérrez C, Arroyo-Morales M. Can Myofascial Techniques Modify Immunological Parameters? J Altern Complement Med. 2012 Nov 23. [Epub ahead of print]
3. Ahah JP, Phillips TM, Danoff JV, Gerber LH. An in vivo microanalytical technique for measuring the local biochemical milieu of human skeletal muscle. J Appl Physiol. 2005 Nov;99(5):1977-84. Epub 2005 Jul 21.
4. Roach S, Sorenson E, Headley B, San Juan JG. The prevalence of myofascial trigger points in the hip in patellofemoral pain patients. Arch Phys Med Rehabil. 2012 Nov 2. doi:pii: S0003-9993(12)01079-9. 
5. VAN Wijck K, Lenaerts K, VAN Bijnen AA, Boonen B, VAN Loon LJ, Dejong CH, Buurman WA. Aggravation of exercise-induced intestinal injury by Ibuprofen in athletes. Med Sci Sports Exerc. 2012 Dec;44(12):2257-62. doi: 10.1249/MSS.0b013e318265dd3d.

Continue Reading

Neural Fatigue and Swimming

Several months ago, Dr. Mullen touched on a rarely discussed, but very critical topic: neural fatigue.

“The devil, or forgotten Little Nicky, for optimal race results is neural fatigue. This forgotten and unknown variable rises higher in events with high force production. Make sure the nervous system has achieved proper time to recover. If the nervous system does not recover it will not have adequate time to react and will fail...no good! It is estimated the neural system takes seven to ten times the length of the muscular system to recover.” (See Perfect Swimming Warm Down)

What is neural fatigue? Quite simply neurons get tired. It’s still not entirely clear how or why this happens, but we do know that fatigue is more than the muscular and cardiovascular systems. Some theorize neural fatigue is an evolved biological mechanism to prevent us from causing serious damage to our bodies, which is one application of Dr. Noakes' Central Governor Hypothesis.  One way to address neural fatigue is via proper warm down, as described in the earlier post. Indeed some theorize that easy, over distance training is that much like a slow warm down, as easy swims can balance the nervous system and provide ongoing neural recovery.

Many swimmers train their easy days too hard and thus detract from optimal velocity on their harder days. Trying to squeeze a few seconds faster per 100 on an easy day adds only a negligible benefit for conditioning, but may chip away at the body’s neural readiness for the next hard workout. Alternatively, even if someone can habitually “dig deep” and attain optimal velocities on harder days, short term performance comes at the price of increased neural fatigue. As Gandevia (1996) writes,

“[D]during sustained maximal voluntary contractions, voluntary activation becomes less than optimal so that force can be increased by stimulation of the motor cortex or the motor nerve. Complex changes in excitability of the motor cortex also occur with fatigue, but can be dissociated from the impairment of voluntary activation. We argue that inadequate neural drive effectively 'upstream' of the motor cortex must be one site involved in the genesis of central fatigue.”

Likewise, greater fitness may actually increase one’s susceptibility to neural fatigue, which may partially explain why many athletes suffer setbacks during critical times in the season. When you’re not in peak form, the body is limited by both coordination and fitness. Coordination limits performance when the brain forgets how to optimally use muscles. Think of returning to pool after a layoff…it’s hard to make your muscles sore when your hand repeatedly slides through the water like pure air. Likewise, an undeveloped cardiovascular system limits your ability to work at a high percentage of maximum effort for an extended period. In contrast, peak fitness brings a perfect storm for neural fatigue. Finely tuned coordination and a strong catch and pull mean high recruitment of motor units; cardiovascular fitness means you can operate for an extended duration.

Consider a 2009 study by Ahtiainen comparing strength athletes with non-athletes in a knee extensor test to fatigue. Perhaps counter-intuitively, only the strength athletes demonstrated reduced muscle activation at the end of the experiment. Authors reasoned that “experienced strength athletes were capable to activate their muscles to a greater extent than their non-strength-trained counterparts indicated by neural fatigue during the exercise. Greater motor unit activation in strength athletes than in nonathletes may be due to training-induced neural adaptation, which manifested during fatiguing exercise.”

Additionally, males may also have more fatigue susceptibility than females (Hakkinen 1996). Perhaps due to greater percentage of muscle mass than females, males have greater propensity for neural fatigue and may require recovery (Should Female Swimmers Train Differently than Males).

Summary
The challenge with neural fatigue is how to measure it directly.  Subjective measures like mood, muscle soreness, appetite, and range of motion can sometimes correlate with neural fatigue but once you notice changes you’re probably too late!  Autonomic nervous system readiness can also be measured, but it simply measures the resting state. It doesn’t tell us HOW to address neural fatigue. Here are a few simple ways to address neural fatigue:     

1. Warm down: (I know, sometimes hard to do with school/work shortly after practice, along with getting thrown out of your lane by the next group beginning practice).
2. Recovery days easier: Remember, the nervous system requires longer recovery than the musculoskeletal and cardiovascular systems (to the extent we can isolate these systems as independent).
3. Management of work to rest ratios: Some such as Dr. Rushall advocate ultra-short training, with short sprints and short rests. The total workload may be similar in 30 x 25 at goal pace set with 15 seconds rest compared to 7 x 100, but shorter workbouts are theorized as less impactful on neural fatigue, which is ongoing and not isolated to one workout. Work and rest lengths are especially important on dry-land where “metabolic conditioning circuits” and high rep/high intensity lifts add little to someone already swimming 10, 15, or 20+ hours per week already.

Without advanced measuring tools, neural fatigue is highly conceptual for coaches and athletes. Nonetheless, know that the nervous system plays a role in fatigue and affects the body in ways not obvious on the surface.

References

1. Gandevia SC, Allen GM, Butler JE, Taylor JL.  Supraspinal factors in human muscle fatigue: evidence for suboptimal output from the motor cortex.  J Physiol. 1996 Jan 15;490 ( Pt 2):529-36.
2. Ahtiainen JP, Häkkinen K.  Strength athletes are capable to produce greater muscle activation and neural fatigue during high-intensity resistance exercise than nonathletes.  J Strength Cond Res. 2009 Jul;23(4):1129-34. doi: 10.1519/JSC.0b013e3181aa1b72.
3. Häkkinen K.  Neuromuscular fatigue in males and females during strenuous heavy resistance loading.  Electromyogr Clin Neurophysiol. 1994 Jun;34(4):205-14.

By Allan Phillips. Allan and his wife Katherine are heavily involved in the strength and conditioning community, for more information refer to Pike Athletics.

Continue Reading

Weekly Round-up

1. Wasted Effort or Useful Technique – What's The Truth About Scapular Repositioning and Muscle Activation
2. The Lessons and Experiences of a Strength and Conditioning Professional’s 30+ Year Career
3. Can Laser Therapy be used to Treat Meniscal Injuries?
4. Massage and Acute Injuries – Part 1: The Healing Process
5. The IGF-1 Promoting, Myostatin Reducing, Muscle Building Effects of PGC-1 α-4: What It Does and Why Doing Cardio Before Weights Appears to Promote It's Expression
6. The Strength of Evidence Podcast – Episode 3 (Olympic vs Power Lifting)
7. Should Baseball Players Bench? 
8. Best Squat Depth for Glute Activation
9. Science of Performance: Neuromuscular Shoulder Warm-up
10. Are NSAIDs Beneficial Before Training?
11. Excess Vitamin C Impairs Hypertrophy
12. Hydration Status: Are you drinking enough … water!

Continue Reading

Friday Interview: Kristof De Mey

1. Please introduce yourself to the readers (how you started in the profession,

education, credentials, experience, etc.).
Kristof De Mey, I´m a physical and manual therapist in Ghent, Belgium, working in the Department of Rehabilitation Sciences and Physiotherapy of the Ghent University. I have a background in sports rehab and athletic training. My research contain the rehabilitation and prevention of shoulder injuries in overhead athletes in general, and the muscle recruitment during exercise training for athletes with impingement symptoms in particular.

2. You recently published an article on the role of conscious control of the scapular in overhead athletes, could you please explain the significance of your results?
We investigated the effect of conscious scapular orientation during four exercises which showed low upper trapezius activation compared to the amplitude levels of the middle and lower parts of that muscle. We found that actively setting the scapula into a more neutral position before starting the exercise significantly increased the activation levels during the prone extension and side-lying external rotation exercise, while during the side-lying forward flexion and prone horizontal abduction with external rotation this was not the case. We also demonstrated that in none of the exercises, the muscle ratio´s, which were previously found to be low, were not altered.

3. Do you think these results would transfer to painful subjects?
From a scientific point of view, we cannot state this. However, we suppose they would, however depending on the levels of pain by the subjects. In patients with high pain levels, we might find different results. Future research on this topic is needed before making any conclusions on this topic.

4. In those with pain, it is theorized motor control is impaired, do you think this conscious control improves motor control?
Well, this is an interesting point. The question is how conscious control of muscle activation can influence the movement of the scapula during functional activities. In fact, I intuitively suggest that corrective movement exercises are more relevant compared to a muscle-oriented approach, which can only serve as a basis within a functional progression of exercises.

5. What are the most important muscles in preventing shoulder injuries in overhead athletes?
The rotator cuff and the scapular stabilizers (middle and lower trapezius and serratus anterior).

6. Is this the same for rehabilitation?
Yes.

7. Do you feel the high volume of shoulder rotations in swimmers requires a different approach to rehabilitation or injury prevention?
I think it would. Correction of swimming technique (thoracic rotation and scapular plane arm elevation) are more important than conscious muscle control during muscle strength training exercises, although both can be of complementary value.

8. What makes your research different from others?
I focused on the muscle recruitment during exercises and on the effect of exercises on this parameter. Previous research showed exercise training can help to treat patients with impingement, but few investigated whether these benefits are caused by alterations in the scapular muscle recruitment.

9. Who is doing the most interesting research on shoulder injury prevention/rehabilation in the field? What are they doing?
My promoter Prof Ann Cools, she is constantly looking for new links between scientific evidence and clinical implications to the field. Of course the work of Dr. Ben Kibler and his team is well known because they made clear that the scapula plays a major role in shoulder treatment and prevention. Finally, there are people who do not focus on the shoulder but rather on how to implement the existing knowledge into practice (referring to the work of Prof. Meeuwisse and Dr. Finch).

10. Which teachers have most influenced your research?
Again the same people as mentioned above.

11. What are your favorite books on the role of shoulder rehabilitation/prevention?
Diagnosis and treatment of movement impairment syndromes by Sahrmann.

Complete shoulder and upper extremity conditioning by Evan Osar.

A book in Dutch called “Exercise therapy in those with shoulder injury” by Ann Cools

12. If I were looking for the most comprehensive shoulder injury prevention program, what program would you give me over 6 weeks?
One which is individualized. There are so many exercises and different approaches in this field, that a standardized program is difficult to describe. In a recent study in the American Journal of Sports Medicine, we investigated a 6-week exercise program consisting only four exercises in a group of overhead athletes with impingement symptoms who did not yet stopped training. We found that it could be helpful for those, however, a program tailored to individual needs, would probably increase the effectiveness and long term benefit.

13. What are the most common mistakes you see in those training shoulder musculature?
Training too much in a position of abduction with external rotation, without any additional value. Many exercises can be done in a more safer position, not increasing the risk for impingement of the rotator cuff tendons beneath the acromion.

14. What mistakes still exist in professional athletes and rehabilitation clinics?
They fix too much on a certain approach. I think the future belongs to those working with people from different disciplines, integrating the existing knowledge on this topic.

15. What research or projects are you currently working on or should we look from you in the future?
We are working on the effect of a fascial therapy approach compared to a more conventional approach (as is outlined in our recently published study) for correction of scapular dyskinesis.

Thanks Kristof!

If you're looking for an Injury Prevention program with a systematic, time-efficient approach with the ability to individualize your own program, buy the Swimmer's Shoulder System today!

Continue Reading

Should I Lift Before or After I Swim?

When to lift in correlation to swimming is a frequent question I receive. No matter the skill level, athletes always ask, "should I lift before or after I swim"? I typically responded with a Devil's advocate position, asking "is lifting beneficial for swimming?"

This catches many people off guard, as I commonly write about the benefits of dry-land. However, if you search the literature, they is not much support for resistance training in the sport of swimming, despite the common use of it in elite programs (read more about dry-land and swimmers in an older Bret Contreras post). As you see, resistance training yields a mixed review in the literature. However, I do feel resistance training is beneficial for swimmers, if the following goals are kept in mind:

Main goals of my programs are

1. Keep swimmers healthy! 
2. Improve motor control! 
3. Improve weak points! 
4. Maximize power production!
5. Don't make the swimmer sore!

Unfortunately, these goals and criteria are commonly broken on many swim teams. If you are interested in more of my dry-land views, sign-up for the Swimming Science Research Review and you'll receive a complimentary, one of a kind, dry-land training paper which I presented to a few Pacific Swimming Coaches a few months ago. This document contains information about the benefits and risks of resistance training, as well as providing an outline from age-group to elite swimmers. Sign-up today!

Now back to the question I commonly receive, should I lift before or after I swim?

In a recent Friday Interview: Dr. Tommy Lundberg, he responded with the following answer:

"If aerobic exercise (AE) is performed before resistance exercise (RE), it may be important to include a rest period between sessions, so that the muscle can perform high forces, especially if increased strength is desired. In our case, the endurance exercise bout, completed 6 hours before RE, did not affect subsequent strength or power performance. Hence, at onset of RE, the muscle was fully recovered from a functional perspective. If AE and RE are combined into one single session instead, it may be more effective to do the other way around, i.e. RE before AE. It should be noted however, that increased muscle size and strength can be achieved by a range of different loading protocols."

This was only one intriguing answer during the interview, if you haven't read it, read the interview. However, I must disagree with the answer. Personally, I agree completely with Dr. Lundberg, if you can, lift at a time other than before or after practice. However, if you do have to lift before or after swimming, I highly encourage lifting after practice. This suggestion is based on the view of altering motor control, and perhaps improving muscle mass (a typical prerequisite to strength gains). If you lift before swimming, and even if you follow the above goals (don't make the swimmers sore), lifting even the smallest volume will result in fatigue. This fatigue can impair performance and motor control, an essential component of swimming success. This fatigue will likely impair workout, alter motor control, and prevent optimal gains.

If you are already a reader of the Swimming Science Research Review, then you're familiar with the implications of blood flow resistance training. Now, before I suggest restricting blood flow during dry-land, it seems hypertrophy is stimulated by stress. If you perform dry-land after swimming, then your body is likely more stressed (physically, nutritionally  etc.) than before workout, and potentially resulting in greater gains in hypertrophy (without having to add blood-flow resistance!). One can argue hypertrophy could impair swimming speed (by increases drag), but typically strength gains coincide with hypertrophy and as we've noted (anecdotal evidence alert), athletes have been seemingly increasing in size over the past few decades. This is a potential mechanism for performing dry-land after swimming, but a nice potential benefit! 

Summary

Although no research consistently suggests resistance training directly improves swimming, if certain goals are kept in mind it is likely a mode to benefit swimming performance. Also, if you do decide to lift, swimming prior to resistance training is likely most beneficial to allow maximal performance at swim practice and potentially stress the body more at dry-land to yield greater results

By G. John Mullen founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Continue Reading

Resolution of Pain is Not the End Game!

In any sport, injuries come and they go. This is the nature of placing high levels of stress on your body. Swimming places the most stress on the shoulders and low back, both frequent sites of pain in swimmers. If you search swim decks, you'll find a plethora of swimmers with a long history of low back or shoulder injuries. Most of the time, these symptoms are in remission and all is perceived as fine. However, resolution of pain is not the end game! In fact, after any injury (no matter the severity) current research is demonstrating a residual effect of muscle coordination. Unlike popular belief, this dysfunctional muscle timing during the injury does not resolve once pain is resolved. Also, the literature suggests previous injury is universally recognized as one of the most predictive factors of future injury.

This phenomenon has been demonstrated most recently in a study by Butler (2012) in the low back, but as rehabilitation specialist, I can assure you this occurs at all joints. Just think of the last time you hurt yourself, for example if you stubbed your toe on the way to get a drink at night (read about the importance of hydration on cognitive-motor skills). When you stub your toe, you likely scream a few obscenities (this may also improve the pain), then you hobble around the house like Frankenstein until the pain resolves. This hobbling is altering your normal motor control to mitigate the pain in your toe. Now, if this pain resolves and you return to normal walking in a few minutes, then the amount of time spent altering this motor control is minimal, a little harm is done. However, most injuries don't last a few days, as they frequently last days, weeks, years, or even decades. This extended alteration in motor control is damaging and likely causing the results in Butler's study when she compared a few movements in those in remission of low back pain compared to those without low back pain. In fact, the low back pain remission group had higher muscle activation during the activity. However, the posterior fibers of the external oblique had decreased activation. This altered motor programming leads to some muscles being over active and some being under active. Moreover, this leads to stroke compensations which are repeated thousands of times every day, even if not perceptible to the naked eye; all of which leads to risk of reinjury or at least can impair performance if the swimmer is subconsciously using excess tension to maintain normal biomechanics. For a full resolution of an injury, improvement in symptoms, imbalances (muscle length and strength), and motor control (muscle timing) are key! Unless you improve all these facets, your injury is likely to return. In swimming, if you have a history of shoulder injury, you're at a higher risk of reoccurrence, unless the proper precautions and rehabilitation is received. Make sure you seek and demand full improvement of the injury, not simply resolution of pain, as this is far from the end game!

Summary
Do not be content with the resolution of pain. Seek further improvement of the injury and improve the underlying issues of muscle length, strength, and timing. For the shoulder, consider purchasing the Swimmer’s Shoulder System.

Reference:

1. Butler HL, Hubley-Kozey CL, Kozey JW. Changes in electromyographic activity of trunk muscles within the sub-acute phase for individuals deemed recovered from a low back injury. J Electromyogr Kinesiol. 2012 Nov 28. doi:pii: S1050-6411(12)00195-2. 10.1016/j.jelekin.2012.10.012. [Epub ahead of print]

By G. John Mullen founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Continue Reading