The term functional training, once an obscure idea, has become a buzzword in the fitness industry. However, much like the term “core exercise,” its definition often depends on who you ask. Some people equate doing exercises, like bicep curls or squats, while standing on gym balls with functional fitness. Unless you are a circus bear, these types of exercises are not overly functional or well suited to develop purposeful strength.
Functional training is not about fancy gadgets or gimmicks but about a philosophy of training. It is based on strengthening fundamental movement patterns, which have carryover into everyday activity or athletic endeavors.
It is a common myth that machine exercises are safer than free weights. In reality, exercises performed with more freedom of movement better engage the core musculature. This means the intensity of the exercise is determined by the weakest link. When you strengthen the body, beginning with the weakest link, you reduce the risk of injury. To borrow a quote from physical therapist Gray Cook, “Having strong arms or legs without a stable foundation or core is like shooting a cannon from a canoe.” When the foundational movement improves, all other movements that follow are stronger.
Any workout program can be modified to become more functional. Simply replace seated or supported single plane exercise with more full body multi-planar exercises. Here are three simple effective substitutions to make your workout more functional.
• Trade your seated biceps curl for a chin up, pull up or TRX curl.
• Knee extension, hamstring curls and hip abductor/adductor machines are all isolation exercises. Replace with exercises such as squats, dead lifts, lunges and side lunges. These require more neuromuscular activation, are better for your joints, burn more calories and have excellent carryover to your activities of daily living.
• Again, gadgets are not necessary for functional training but some do offer significant benefit. For example, the TRX suspension trainer exemplifies functional training. Almost every exercise performed on it can be multi-planar, multi-joint with high neuromuscular demand.
Some of the best exercises for your body require proper technique to be performed safely. Movements like squats and dead lifts are exceptional foundational movements but often require some instruction to be performed properly and safely. If you wish to learn more about how to make your workout more functional or to reduce injury and improve performance, we would be happy to help.
March is here; the sun is shinning, the temperature is rising, and it's time to get outside and jump-start your heart rate with a run or jog. Running is extremely beneficial to both physical and mental wellbeing. It can impact all bodily systems — from reducing your chances of catching the common cold, to lowering your risk of cancer, to strengthening your muscles and bones and reducing your chance of developing osteoporosis. Running is one of the most effective ways to improve the aerobic conditioning of your lungs and heart. As your cardiovascular health is enhanced, your blood pressure is reduced, the elasticity in your arteries increases, and your resting heart rate is lowered. All of which diminish your chance of heart attack and stroke, and improve circulation throughout your body.
Emotional benefits, though harder to prove with statistics, have been reported by runners time and again. The “runner's high” is a physiologic change in your endorphin levels, which lower the effects of depression and reduce stress. Running can literally be a mood changer as well as a life changer. Those who engage in daily exercise are more likely to make healthier food choices throughout the day. And consistent aerobic exercise, combined with a healthy diet, will result in weight loss and improved self-image, as well as reduced symptoms of depression.
But where do you start? Running is one of the easiest and least expensive hobbies/activities. All you need is a pair of shoes. And then it is just you and the road, wherever you are.
On the other hand, if you are a social person, joining a running group or signing up for local races are great ways to stay motivated and ensure you accomplish your goals. The Vail Recreation District offers a trail running series throughout the summer varying in distances from 3 to 14 miles.
A word of caution: Start slow and listen to your body. Build a running base gradually, one mile to one-half mile at a time. Never increase your total mileage by more than 10 to 15 percent per week. Your pace should be comfortable and you should be able to hold a conversation. As your endurance improves try increasing your speed so that the conversation is interrupted with heavy breathing, pushing your cardiovascular system. Lastly, get proper footwear based on your body-type, arch of foot, and type of running you plan on doing (road versus trail).
Typical running shoes are classified into four main categories: motion control shoes for heavier weight runners with flat arches who have a tendency to over-pronate ; stability shoes for medium to light-weight runners who have the tendency to over-pronate and need stiffness built into the arch of the shoe to help support their natural arch; cushion shoes for the medium to light-weight runner with high arches who stays in a neutral to supinated position as they run; and performance shoes for race day for runners who do not require additional arch support -—these shoes are lightweight and are not made for excessive mileage.
Looking for more information? The Vitality Center at Vail Mountain Lodge & Spa is hosting a running clinic in June (more information to come), including a video running analysis to provide participants with feedback on how to improve running efficiency and prevent overuse injuries.
Spring is a great time to add running to your exercise routine. So get outside and celebrate the sunshine and a healthier you. Lindsey Fitch is a physical therapist and a doctor of physical therapy at Vail Integrative Medicine, located at The Vitality Center at Vail Mountain Lodge & Spa. She specializes in running injury prevention and running analysis.
VIMG is hosting a K1, K2 & K3 approved accelerated format seminar on Oct8-10 that will allow attendees to get kinesiotape certified in ONE weekend as opposed to TWO!
Our instructor is Dr. Darren Hancock, one of Kinesiotapes top instructors that has taught kinesiotaping to USA's Olympic Training Centers
You can click on the photos to the right or download the full pdf brochure here.
I’ve been working out with fitness anywhere’s TRX system lately. I had read about it and heard rave reviews from some of my fellow fitness and sports med professionals. The TRX is a portable suspension exercise system that delivers as easy or intense as exercise session as you want. Because the design uses your own body weight, you can modify the exercises from easy to ridiculously hard…all while dialing in your core musculature. I already do metabolic and strength circuits, but was impressed at metabolic demands and intensity of workout that was available with this system. From my first use of this system I could see some good rehab application. Sure enough, they are launching their sports medicine & rehabilitation stream to their system. Click below to see a quick clip about how the TRX works.
I’ll post some of my own workouts in the next few weeks. If you want to try it out, see how you can use it to enhance workout routine, or want to talk about working this into your rehab program, give me a call. All the best. Dr. Mark
The Leadville 100, America's highest 100 mile race is this weekend. Dr. Joel, Dave Blanchard, MPT and Andrew Reiff are all smiles before Andy’s Leadville 100 running race. Good luck Andy and long may you run!!
Own own Adam Plummer gets top spot and a great inside spread in Trail Runner magazine this Summer!
On that note, keep an eye out on our blog, facebook and twitter for our Running Clinic in late August. Our new physical therapist and resident running specialist, Lindsey Fitch will be holding a free seminar at our Eagle office and the Eagle Ranch Fitness Center center and show how we do video analysis of your running gate to identify deficits and faulty biomechanics.
The background and rational for the Functional Movement Screen and associated corrective exercises are excellent. Despite being the only chiropractor there, the functional movement analysis created by physical therapist Gray Cook fits seamlessly into my problem solving approach to injury and dysfunction. In the few days back at the office since the seminar, I have already started looking at patients differently and changing how I address their problems.
The Functional Movement Screen (FMS) and Selective Functional Movement Analysis (SFMA) uses challenging movements that are meant to exaggerate deficits and asymmetry in the body. If the fundamental movement patterns in the body are altered, then any strength, power or sport specific training may be built upon a shaky foundation which at best will prevent optimal performance, and at worst reinforce imbalances leading to greater chance of injury.
We are very pleased to welcome Lindsey Fitch to our team! Lindsey completed her Master and Doctorate Degrees in Physical Therapy from San Francisco State University/University of California, San Francisco. She has worked in the outpatient orthopeadic setting focusing largely on sports injuries. Lindsey has completed specialized training in running analysis and routinely assesses and treats running related imbalances and injuries. Lindsey will be practicing in our Vail and Edwards locations.
Dr. Joel was invited to provide care for Arizona Cardinals and NFL great, Larry Fitzgerald's star-studded pre training camp in Minneapolis.
In conjunction with long time colleague, Dr. Josh Sandell, Dr. Joel assisted pre and post sports medicine treatment for the NFL veterans and rookies for the week. 8-time consecutive pro bowler and training camp coach, Chris Carter had not put on cleats in 5 years until several treatments with Dr. Joel and the group which gave him the 'fountain of youth' to show the NFL rookies a thing or two about creating success in the NFL. Michael Irvin also stated he would have played longer in the NFL with the treatments he received over the week.
Dr. Joel worked with several dozen players from various teams as they prepare for their official training camps in a few weeks. Some of them include Dewayne Bowe (Kansas City Chiefs), Eric Decker (Denver Broncos), Matt Spaeth (Pittsburge Steelers), James Laurinaitis (St. Louis Rams), Golden Tate (Seattle Seahawks), John Carlson (Seattle Seahawks), Domineque Byrd (Arizona Cardinals) to name a few.
To make life easier for patients, contributors and me, I have merged our articles, patient resource and news blogs into one. I hope you find the compiled information more convenient. All the best - Mark
If you have been at the Eagle Ranch Fitness Center, you may have seen me doing these odd looking exercises and wondered what the heck is he doing? I certainly do seem to be breathing hard to just get off the floor a few times.
The Turkish get up (TGU) is an old school, whole body strong man exercise. You know what I am talking about - Big guys with handlebar mustaches wearing leopard print unitards and bending steel with their teeth. You may not have such fashion or fitness goals. That's ok. The Turkish get up also builds core strength and when used in a circuit with short rest periods between exercises, can be part of a great fat and weight loss program.
One of my friends once remarked " I have no idea what muscles its working, but it definitely kicks my butt". The truth is, it works all of your muscles to some extent. Have a look at the exercise below:
shoulders, lats and chest to hold and stabilize the weight above you.
abdominals to bring yourself to a seated position.
triceps and arms to hold your body as you swing your leg through.
legs as you go from lunge to standing.
core activation throughout the exercise.
There are a few variations of this exercise typically having to do with balance and how you move your leg behind you. It is most safely done with kettle-bells and dumb-bells. Start with lower weights get the form, rhythm and balance down. As always, it is good to talk to the resident trainer or therapist to help guide you your first time around.
Mark Pitcher DC, MSc
chiropractor, exercise physiologist
Dr. Pitcher works in the Vail, Edwards and Eagle offices. To make an appointment call, 926-4600. If you have questions for Dr. Pitcher, you can email him at drpitcher@vailhealth.com
This might seem like an odd rallying call in this day and age. After all, it seems like there is healthy and nutritious food available in every grocery store. However, if you've ever read a book by Michael Pollan, watched "Fresh", "Food, Inc.", or seen Jaime Oliver's Food Revolution on tv, you may be wondering if your food is really healthy beneath the surface. Over the years there have been product recalls ranging from spinach to frozen meat and peanut butter that have shaken our trust in the large agribusiness and food processing companies. Why are we so scared of our food? And what can we do to ensure that we don't have to be?
My grandmother used to tell me that food didn’t have flavor any more. I was 10, and I thought that my grandmother was just old and experiencing what happens when you get old. As I grew up I saw an explosion of processed foods, convenience foods and fast foods that seemed to be huge steps forward until I was out in an organic garden. I plucked a ripe tomato and bit into it; all of the sudden I understood what my grandmother had meant all those years ago. My grandmother was raised on a farm in Mississippi over 90 years ago where they grew a few cash crops to support the family’s finances along with their own vegetables and raised their own livestock. This was a prototypical small family farm that helped provide for the family and the wider community. As the world changed and industrialization started to become the norm these very small farms faded quickly. After World War Two industrialization spread like wildfire, making many farms impossible to sustain.
We live in a world that surrounds us with cheap food. My grandmother spent a full 25% of her income on food. The average modern family only spends 10%. Subsidies of commodity crops and the extensive use of chemical fertilizers, pesticides and herbicides allow us to grow a lot of cheap calories. Add convenience foods full of empty calories and fat to this equation, and you can see how our food culture has changed.
Thankfully we are experiencing a renaissance of food that has more flavor, nutrition and vitality than anything we have seen in decades. As people found organic foods and demanded more, the industry listened and organic products flourished. Even more importantly, we now understand that even organic food has high costs and risks associated with long distance shipping.As a result, we are seeing a resurgence in gardening, community gardens, farmers markets, farm stands and community supported agriculture.
The relocalization of our food system is a vibrant movement that can change the food landscape all over our state and the country. The challenge in the high country is that we have such a short growing season, ranging from 39 days in Summit County to 59 days in western Eagle county and Routt county. Colorado Mountain Communities are blessed to have growing regions on the Front Range and Western Slope that can feed us through their much longer growing season.
Community Supported Agriculture (CSA) is a way to connect you and your family to a local farm. In a CSA program people become members of the farm and purchase a full season of vegetables that are grown for you on the farm. This direct relationship allows you to know who is growing your food and dramatically reduces the miles your food travels to get to you. Unlike grocery store produce, your farmer grows food for you that is allowed to fully ripen in the field so that you can eat food that is full of flavor, nutrition and healthy for you. CSA’s will normally deliver your produce to your town once a week throughout the growing season. Even in the high country it’s easy to eat farm fresh produce.
To learn more about Community Supported Agriculture and how you can eat better this year call 970-328-1200 or 970-846-6233
We were at the Red Kettle Golf Tournament, June 15, supporting the Salvation Army. We were offering complementary consultations to Red Kettle participants, as well as pre-game sports massage and facilitated stretching. Learn more about the Red Kettle here:http://www.salvationarmyvail.org/volopps.asp
This is a great interview with Dr. Stuart McGill about how his laboratory research propelled him (Albeit reluctantly at first) into clinical evaluation of patients. He talks about his approach and addresses many rehab myths surrounding lower back pain. Its a long, but extremely interesting interview. Click here and have a listen and you'll see why I am a big fan of Dr. McGill's no nonsense scientific approach to evaluating and treating low back pain.
If you have picked up a health, fitness or training magazine recently, you can not avoid reading about the importance of “core stability”. Core stability is touted as paramount to maintaining a healthy back, however the idea of what “core” actually means, what muscles are involved and what exercises are best vary greatly depending on who you talk to. When you think of the core, the abdominal muscles inevitably come to mind. But that is only part of the picture.
Many of today’s popular ideas of spinal stability originate from research out of the Australian physical therapy group back in the 1990s. The research showed that the transverse abdominis (TA), a deep abdominal wall muscle and the multifidus, a series of spinal muscles, thickest across the lowest part of the lumbar spine, had unique behavior when injured. The transverse abdominis was shown to have a feed forward ability, meaning it turned on before other muscles did during a task that required stability.1,2. Further it was shown to have altered activity when there was a lower back injury, sometimes turning on late or not at all.The multifidus was shown to decrease in size and have increased fat content after injury local to the site of injury. 3This deficit did not recover spontaneously, even if the pain went away and it was found specific exercise was needed to rehabilitate the area.4 Therapists began to use very focused rehabilitative exercises to activate the multifidus and deep abdominal musculature.
The research became popularized, spilling over beyond physical therapy and other health disciplines to personal training and popular fitness culture. The rehabilitative concepts, while useful for addressing specific muscular deficits, grew beyond its scope shaping personal training and core conditioning programs. This may have led to an overemphasis of the deep musculature.
Researchers such as world renowned biomechanist Stuart McGill found that exercises used to activate many abdominal exercises particularly those that repetitively flex and extend the back, offer unhealthy loading of the spine and only work very specific muscles. Further he argues that emphasis on deep musculature can actually destabilize the spine (More on this next time). McGill’’s live and biomechanical modeling also showed that there are not necessarily muscles that were more important than others. All the muscles in the trunk are important at different times, with different loads, under different circustances.5 Movements in the body are almost never a result of one specific muscle, but a result of coordination of many muscles, or muscle systems. Muscles that are further away from the center of rotation (the spine) offer better mechanical advantage than deeper muscles. McGill’s approach is to take a broader stroke, training the movement, not an individual muscle. He developed exercises to address the trunk musculature more comprehensively, focusing on exercises that create adequate muscular challenge across a number of muscle systems while putting the least compressive load on the back.
All patients are different and what is appropriate for one person may not be appropriate for another. But generally McGill’s basic spine sparing core exercises can be used across many patient populations. Clinically I typically pull from more than one school of thought. If there problems with joint mechanics or muscle adhesions, they are addressed with manipulative and soft tissue techniques. I may also look to identify overt muscular deficits such as multifidus or transverse abdominis issues. If present, muscular deficits are addressed and some basic motor control exercises are taught. However, I will usually progress quickly to include a broader and more balanced approach using various spine sparing exercises based on McGill’s research and concepts.
In our next newsletter, we will continue exploring spinal stability
References:
1.Cresswell, A.G, Thorstensson A. (1994) “Changes in intraabdominal pressure, trunk muscle activation and force during isokinetic lifting and lower. Eur J Appl Physio Occup Physiol. 68: 315-21
2.Hodges, P. W., Richardson C. A. (1997) “Feedforward contraction of transversus abdominis is not influenced by the direction of arm movement.” Experimental Brain Research 114 (2): 362-370
3.Hides, J.A., Stokes, M.J. et al. (1994) “Evidence of lumbar multifidus wasting ipsilatreal to symptoms in patients with acute/subacute low back pain.” Spine 19(2) 165-72
4.Hides, J.A. , Richardson, C.A. et al. (1996) “Multifidus recovery is not automatic after resolution of acute, first episode low back pain.” Spine 21(23): 2763-9
5.McGill 2. M, (2004) “Linking latest knowledge of injury mechanisms and spine function in the prevention of spine disorders.” J. Electromyogr Kinesiol 14(1):43-7
At the clinic, we've used Graston Technique for muscle and tendon injuries, but the recent research suggests that it may be useful for increasing the recovery time from ligament injuries as well. It is generally accepted that ligaments repair through repetitive scar formation rather than true regeneration. This can lead to mechanical weakness in the ligament and may be one reason that re-injury is so common in patients with previous ligament injury.
A study published this summer in the Journal of Orthopaedic & Sports Physical Therapy (1) examined instrument assisted cross friction massage (Graston) in an experimentally induced ligament injury in rats.
Four weeks after the injury, the treated ligaments were 43.1% stronger and 39.7%
Stiffer, able to absorb 57.1% more energy before they failed than the non-treated ligaments.
Twelve weeks after injury the differences between treated and untreated ligaments were minimal in terms of strength; however the treated ligaments were 15.4% stiffer.
Although an animal study, this study does support the theoretical basis of using early cross friction massage to speed repair after ligament injury. Although the differences in strength even out over time, lasting increases in stiffness could confer additional protection to the joint itself.
New Study from Dr. Stuart McGill’s Biomechanics Laboratory at the University of Waterloo
As many of our patients know, we favor research based exercise and rehabilitation at our clinics. For many types of low back pain, spinal stabilization exercises are very commonly used. For patients with back trouble, the back’s load bearing capacity is often diminished so that many commonly prescribed exercises can excessively load the back and are usually inappropriate.
One of the exercise protocols we use for improving spinal stability while minimizing excessive loading is based upon research out of Dr. Stuart McGill’s laboratory at the University of Waterloo in Canada. I have had the opportunity to study with Dr. McGill and am always impressed by his ability to explain extremely complex physiology and biomechanics with clarity. The quality and sheer volume of his research has allowed him to construct an evidence based approach to lumbar spine rehabilitation.
Dr. McGill’s publishes exceptional papers more often than some people change underwear. But we found the recent article published this year in the Archives of Physical Rehabilitation titled “Exercises for spine stabilization: Motion/motor patterns, stability progressions, and clinical technique” especially relevant for patients and clinicians.
The article investigates three well researched and commonly used spine sparing exercises that are used in our clinics for spinal stabilization. Three exercises and their progressions were studied: (1) curl-up (2) side bridge, and (3) bird-dog (the “Big 3”). With these exercise, they studied muscle activation, 3D spinal mechanics and the effect of theclinician offering corrective input during exercise.
While I rarely see anybody doing the neutral crunch at the gym I do occasionally see the side bridge and bird dog. However when performed, they are usually done too fast and without the control, neutral spine posture, or attention to muscle co-contraction that is talked about in McGill’s methodology.
One of the co-contraction techniques widely used is an‘abdominal brace” where the patient contacts the abdominal muscles like they are bracing for a abdominal muscles like they are bracing for apunch. Not pushing the belly out or sucking the belly in. Dr. Mcgill’s research showed that raising the elbows off the floor during the neutral curl up increased rectus abdominis activity. Co-contraction with an abdominal brace during the neutral curl up increased the internal and external oblique to 30% of maximal voluntary contraction.
The studies involving the side plank exercise showed clear progression in muscle activation from ½ bridge to full bridge (with legs straight) with the most muscular challenge moving from side bridge to plank resulting in muscle challenge of 50% of maximal voluntary contraction in the rectus, abdominis internal and external obliques.
The bird dog progression was from the all fours position to just arm, then just leg and then both arm and leg, using abdominal bracing and then abducting the arm slightly. The study again showed a clear progression of muscle activation through the progression of the exercises.
When evaluating clinical guidance, factors such as addressing patient asymmetries and applying fascial raking (using firm fingers pressure on the abdominal musculature to add feedback and better activation) were assessed. The fascial raking resulted in increased oblique muscle activation and decreased rectus abdominis activation, therefore improving the neutral spine posture. It was also especially useful in decreasing the amount of twisting (or uncoupling) of the torso during the plank to side bridge.
Although we currently use employ feedback on abdominal bracing and clinical corrections for asymmetry during the exercises, strive for neutral posture and promote abdominal bracing, we have not used the abdominal fascial raking to any large extent. Given the findings of this study, I think patients should expect to start seeing our practitioners digging their fingers in some abdominal musculature during stability exercises.
Mark Pitcher DC, Msc
chiropractor, exercise physiologist
For additional information read Dr. McGill’s Books:
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