IOL Strength and Conditioning

There is a large collection of measurable variables that, when improved, lead to a longer, healthier life. Most people have not heard of these variables or have read about them only in glossy ads designed to encourage the purchase of supplements, vitamins, miracle foods or weird electromagnetic devices. More magical thinking, more death or a pill thinking tricked out in self-referential gloating about not being hornswoggled by Big Pharma.

Basic medical science is genuinely interested in discovering the causes and cure of disease, suffering, aging and even death. Thousands of people, pure of intent, of keen intellect and purpose, work long hours in labs, in offices, in institutions to unlock the processes of disease and the mechanisms of possible cure. If you don’t believe this, what I say won’t make much sense;  it won’t motivate you to take seriously the work of these scientists, these benefactors of mankind.

Why do I take you back to whether or not you have a basic belief in scientists and the scientific method? Because as a practicing physician for many, many years, I’ve grown accustomed to the fog of beliefs, doubts, skepticism and confusion most people work within in their perception of medical science and physician recommendations. I well understand the problem, but need your essential conviction that real science well done can and does discover things that matter.

This is not as silly as it first seems. If, for example, you believe, as most doctors do, that your cholesterol number is one of the most important things in the world and that behaving in such a way as to drive this number down is “all that matters trumps everything, is the be-all and end-all of heart disease, risk for stroke and the like,” then I cannot be of help. For reasons big and small, all of the basic medical literature has always been clear about this: Cholesterol is just one number among many, and those then are nested together to evaluate your relative risk of vascular disease.

If this notion of multivariate relatedness is too much to swallow, what I say will sound like little more than questioning conventional wisdom “the Holy Grail is Lower Cholesterol” when what I will be trying to do is put this one number in the context of many others that matter as much or more but for which there is no pill to fix, and for this reason you will not have heard as much about these other numbers. The wonderful thing is you have an enormous amount of control over these other important variables, actually much more control than over your total cholesterol number.

With this background in mind, I need to make a few other conceptual points before I get to articles cover the actual things you can fix and why.

Let me introduce you to four ideas:

* First is the idea to be skeptical about what matters. For example, something might change a number related to disease, but not affect or, in some cases, might adversely affect, a more important endpoint like death. Maybe it lowers blood pressure, but happens to increase the chance of death, or lowers blood glucose/sugar but not the diseases or death associated with diabetes. Over the years, many drugs have been withdrawn after discovering just such problems.

An everyday example: Most of the common anti-inflammatory and pain medicines like Advil have been around for decades and work very well for the endpoint of pain. The endpoint of death happens to be increased in those who take these medications, for they are associated with an as much as 40% increased chance of heart attack in regular users. Be careful how you choose your desired endpoint.

Another example: High homocysteine is associated with stroke, heart disease and premature mental decline. Take an array of vitamin Bs and homocysteine goes down, but not the homocysteine-related risk for stroke, heart disease and premature mental decline. Oh, and there is a known risk of colorectal cancer, breast cancer and prostate cancer if you take the B vitamins.

* Second is to note or watch for abuse or misuse of statistics. You will often hear that use of Lipitor and related drugs ‘reduces heart disease by 30%.’ What this actually means is that 1,000 people need to take the drug to prevent heart-related problems in about three people. If 1,000 people do not take the drug and 11-12 of them have heart-related problems, and 1,000 people take the drug and only eight or nine people have heart-related trouble, that ‘reduces heart disease by 30%.’

The perception and the facts don’t add up. A reasonable person thinks “reduction” means if 10 people take the drug, it will save three people’s lives. What it actually means is that 1,000 people risk the side effects and as-yet unknown long-term effects of a drug so that three people might not have a problem. Fine, let’s help those three eating peanuts three times per week has been shown to have about the same statistical impact as Lipitor, yet no one, rightly, has claimed that eating peanuts three times per week reduces heart disease by 30%.

* Third is “number needed to treat” (NNT)—how many people have to take a drug or change a behavior to have a measurable benefit for one person. For example, on the order of one person has to take an antibiotic to be of benefit to one person. This is stretching the case, but is true to the nearest rounded integer. For primary prevention—that is to help a population of otherwise seemingly healthy people—at least 200, that is two hundred, 200 or more people have to take Lipitor to be of benefit to one… I said ONE… person. The others just get the cost and side effects like memory loss.

As you will have noted, NNT and the misuse of statistics are related and reveal each other. By comparison, seven people need to raise their exercise capacity by one MET, a very reasonable thing to do,I will get to this in a later article to help one person avoid the same endpoint, heart attack and so on, as the 200-300 who take Lipitor to help the one person.

* Fourth is “number needed to harm” (NNH). Fine, NNT helps me know my chance of benefit of a proposed therapy like exercise or medication, but what is my risk of harm? Not what the harm might be, but the number of people who take the proposed therapy and wind up having some kind of harm from it. Now this does not tell us whether the harm is a hangnail or death, just the relative risk of harm of any kind. If the NNH is sufficiently high, what the harm is might become less of an issue. If the NNH was two, for example, and the risk was death, I would probably take a pass. But if the NNH was 1,000,000, death might not look like a bad risk if it prevented me from suffering a stroke at age 50 when the NNT was 100.

Think this way when you worry about flying versus driving.

Now with these ideas in mind, you can both police my claims and be a better consumer of pharmaceutical and other medical advice.

Let me summarize those three points.

1. NNT: number needed to treat
2. NNH: number needed to harm
3. Abuse/misuse of statistics
4. Meaningful clinical endpoints—am I dead or not—and not “some number went down” that may or may not matter when treated.

Mike Nichols, MD

As you finish reading, click on over to the doc’s site and listen to the video lectures. Then subscribe to the updates (right sidebar subscription box) so you’ll get an email notice of his new articles. Each one leaves me pondering, considering changes I need to make, and they’ll do that to you, too. Especially those cardiovascular lecture video clips. Wow! I heard them once, but need to go back for a second round. ~ Laree

Perry Nickelston, DC, FMS, SFMA

If you’re not stretching your fascia, you’re not really stretching.

How would you like to…

•    Increase coordination?
•    Reduce muscle tension?
•    Increase Range of motion?
•    Prevent injuries?
•    Improve posture?
•    Develop body awareness?
•    Heal from chronic pain?

The good news is…..YOU CAN!

If you exercise regularly, you are considered an athlete, and as such, you must follow certain guidelines to enhance performance and prevent injury. One of the most important missing components for many athletes is regular stretching, but not just any type of stretching—not the type you are probably used to seeing or are perhaps even doing. Most athletes who stretch usually do so ineffectively, performing the same old-style stretching exercises most coaches have used and fitness magazines have promoted for decades.

These programs often consist of holding the familiar boring positions to stretch the groin, hamstrings, hip flexors and low back at the same intensity and for the same duration, day in and day out, regardless of the sport or activities the athlete will engage in during that day. These athletes are likely to be worse than they would have been if they hadn’t stretched at all! Why? When stretched for too long, muscles will inherently tighten up as a self-protective mechanism. They are protecting themselves from potential tearing and injury. Unless you learn how to bypass this protective mechanism, your body will never allow an increase in flexibility.

So what then is the secret? FASCIA.

Fascia is the most overlooked system in the human body when it comes to rehabilitation, pre-habilitation, and the recovery phase of athletics or injury. Fascia is the missing element to unleashing our athletic and healing potential.

The traditional medical system treats every system other than the fascial system when an athlete gets injured or when treating chronic pain. Although there are several forms of work that specifically address fascia, most people are unaware of the different types of fascial work that can be done to facilitate healing, optimize performance and provide the answers to many questions when it comes to dealing with chronic pain.

What is Fascia?

Fascia is a specialized connective tissue system that plays a critical role in the support of the body. Fascia is a very dense tissue that envelops every muscle, bone, nerve, artery and vein, as well as all of our internal organs. It’s an intricate, 3-D web supporting the organs and joints from head to toe, as it acts as a shock absorber to the body.

The fascial system is actually one structure that exists from head to toe without interruption. When there is tightening or restriction in one place, we can feel pain and dysfunction in another seemingly unrelated location.

Most people stretch a painful area and experience little lasting results while neglecting to stretch the actual site of dysfunction. Always stretching and never improving! Sound familiar? The secret is learning the most effective system of fascial stretching.

How do you stretch fascia?

A.    Myofascial release with foam rolling
B.    Active Isolated Stretching (AIS) with ropes and bands
C.    Dynamic movement prep

Foam rolling is a technique of self-myofascial release using body movements rolling on a compressed foam tube. It is a type of deep tissue massage during which we can stretch all the fascial lines. Athletes will notice a significant and profound improvement in tissue elasticity—how the muscles move—in just a few sessions. Foam rolling is one of the easiest and most effective ways to stretch.

Active Isolated Stretching (AIS) uses the principle of multiple repetitions holding stretches for no longer than two second with assistance from ropes or bands. It works muscles, joints, ligaments and soft tissue. There is no need for a partner, thus making it easy to actively stretch difficult-to-reach muscles. Just a few sessions of AIS is equal to weeks of old-school stretch-and-hold programs. Technique is of key importance; taking a class or lessons is highly recommended.

Dynamic Prep teaches our muscles how to move and hold the new length of stretched muscle, preventing the body from getting stiff and returning to a pre-stretch tightness. Athletics and fitness is all about proper movement, and dynamic prep ensures that the body has optimal healing and restorative power before, during and after workouts.

Let’s take a closer look at active isolated stretching.

Created by Aaron Mattes, AIS is based on the principle of Reciprocal Inhibition, which states when you contract one muscle, an opposing muscle will relax. When this occurs, we have an opportunity for a more effective stretch of the relaxed muscle.

In AIS, we hold the stretch for a maximum of two seconds to prevent the stretch reflex from occurring. This reflex occurs when a muscle is stretched for too long and too hard—the nervous system actually tightens up that muscle in anticipation of an injury. In reality, the muscle becomes tighter, not more flexible.

We do 10 two-second repetitions per movement.

What are the top benefits to AIS stretching?

•    Promotes muscle and tendon growth by increasing nutrition and oxygenation to the tissues
•    Helps eliminate metabolic waste from cells by stimulating and pumping the lymphatic drainage system
•    Increases muscle health and elasticity so you burn more body fat and become symmetrical
•    Breaks down fascial gluing between the muscles. (See website for more info on fascia)
•    Breaks down fibrotic scar tissue adhesions and reduces inflammation.
•    Realigns collagen fiber matrix in muscle and fascia, the building blocks of soft tissue
•    Reduces muscle spasm and functional tightness
•    Reduces the risk of muscle strains and tearing
•    Increases recovery and regeneration between workouts so you can train longer and more frequently while reducing the risk of overtraining
•    Increases peak performance and response time for movement, prolonging your athletic career.

I recommend rope stretching prior to every workout session as part of the warm-up. It takes just five minutes and can make you feel incredible. It takes a little practice, but just like everything in life, the more you stick with it, the better you will get. To learn more, purchase the book Active Isolated Stretching by Aaron Mattes.

Every one of my clients learns the rope technique. The change in hip movement and function can be astounding.

Check out my videos on YouTube to see more stretches,channel name njlaserdoctor.

Perry Nickelston, DC, FMS, SFMA
www.stopchasingpain.com

Many of us use non-steroidal anti-inflammatory drugs, NSAIDs, regularly; some of us use them daily, and some use them prior to workouts on training days. Do they work? If so, how? Are these a good idea in terms of long-term health?

Here I’m talking about over-the-counter products like aspirin, ibuprofen (Advil, Motrin) and naproxen such as Aleve. Because they’re OTC, most of us assume they’re completely safe; heck, better than safe—your doctor may even have recommended a daily half-dose of aspirin to help stave off heart disease. But safe? That’s definitely not accurate, probably less that you might guess.

Pain Killers and Training

When we train, we purposely damage muscle tissue, the plan being for the amazing human body to repair itself stronger than it was before the workouts. This process actually works; the cells send a message to the CNS to start the healing process, and so it does.

However, when we take an NSAID for pain relief, the incoming chemistry destroys the prostaglandins, which are the chemical messengers between the damaged cells and the brain. This slows down the healing process, preventing the body’s best repair work. These cheap over-the-counter drugs literally hold back our training progress.

If occasional pain warrants, that’s one thing. But what about those who take the medications regularly, even preemptively? Does this sound like a good idea to you? That answer would have to be no.

Side Effects

What about dangerous side effects? Are these real; are they common?

• The prostaglandins that send the repair message also maintain the stomach lining, and when they’re destroyed by the NSAID drugs, this can damage the stomach lining and cause gastrointestinal bleeding.
• Regular use of both aspirin and Tylenol-like products are associated with increased risk of kidney failure—kidney failure, as in stuck in dialysis a few days a week, heading for a wait on the organ transplant list.
• Acetaminophen is the most common cause of liver failure here in the US.
• Aspirin thins the blood. This can be really bad if you’re bleeding and can’t get it to stop. In fact, pre-surgery instructions include specific directions to discontinue aspirin use a few days before surgery. By the way, fish oil is also included in the “discontinue” category for the same reason.
• Back to the doctoring with low-dose aspirin to protect against heart attacks—he or she told you to take an 81mg aspirin daily, and you’ve been doing it ever since. Unfortunately, the recommendation is no longer in vogue, but you may not have been back to that physician, or perhaps the doc forgot to bring it up again. It turns out the follow-up studies did not confirm the original work, and aspirin is now out of favor as a daily therapeutic protector. In fact, high-dose NSAIDs may even elevate the risk of heart attack. According to Doctor Mike Nichols, NSAIDs increase the chance of heart attacks more than 15% if there’s cardiovascular disease, and since most people who have CV disease don’t know it, this is meaningful.

And of course, all the general-population side effects change, sometimes drastically, when these pain killers are combined with other OTC or prescription drugs, or if taken by people with existing problems such as coronary heart disease or kidney or liver problems.

When most people read the above list of serious medical issues,  human nature kicks in real fast, and we think, “That won’t happen to me.” Fair enough, maybe it won’t. But what about the less-serious cellular chemistry conversion that’s happening every single time? Sure, taking a pain killer for occasional pain isn’t a big deal, but is down-graded tissue repair something you want happening in your system regularly? Probably not. Those of you taking an Aleve before or after your workouts to stave off a mild case of DOMS would be far better served by a mouthful of branch-chain amino acids to help the system rebuild.

Dumping a half-dozen aspirin and chewing them for quick relief may be the hardcore musclebuilder way, but we’re in this gig for long-term health, too, and that picture of macho man is no longer working.