The VMO

The VMO is short for vastus medialis oblique.  It is the tear drop muscle on the inside portion of your leg.  It has major implications in knee health.  It is one of those muscles that seem to get amnesia whenever there is trauma around the joint.  So if you have ever had a knee injury, chances are it's not as strong as you need it now to be.  It has direct involvement in patellar femoral pain.  

Research is finding new things about this interesting muscle.  Recently they have discovered that the VMO has actually three motor innervation's while the other quadricep muscles, vastus intermedius, lateralis and rectus femoris only have one.  There is good reason to believe that there is fascial connections to the actual patellar tendon an also into the adductor magnus.  So you can see this muscle has influence in a lot of places!

So how to train it?  I think the best way to train such an intricate muscle is to be varied.  The VMO has been show to be around 52% type 1 muscle fibers.  So it must also be trained for endurance, not just pure strength.  For this I like a time under tension approach.  One of my favorites is to pull a sled backwards in a low crouch position.  Try pulling a heavy sled backwards for 60 seconds.  You will feel your VMO's if you have never felt them before!  

Terminal Knee Extensions or TKE's as they are known in the rehab world is another simple exercise.  It involves something as simply as placing a theraband around something secure and then around your knee.  Face in the direction of where the band is secured to.  Bend the knee slightly under tension and contract your quad so that your leg straightens.  I like this more for activation the strengthening.  So if you have just had knee trauma this is one of the better ones to start with.  

Step ups on a slight decline is another great exercise.  On a medium to low box ( 8 to 12 inches) that is slightly declined.  Place your foot facing going down the step.  With an erect posture dip and straighten the leg.

Single leg activities that require balance checks such as a single leg dumbell deadlift will challenge the proprioception and stability of the VMO.  

Finally any full squat will develop the strength qualities of the VMO.  Check any Olympic lifters VMO and they are highly developed.  Snatch Grip Deadlifts off a podium of 2-4 inches is my favorite all around exercise and will develop the VMO as well.  

So hope this helps you with exercise selection when thinking about targeting the VMO.  Remember that variety is the key to a well developed functional muscle.  

Managing the Nervous System

As a strength and conditioning coach your always monitoring volume and intensity.  Overtraining is always a big concern.  I've always liked the three weeks on followed by a back off week for an older athlete, and five weeks on followed by a back off week for a younger athlete or for an athlete just getting back into the swing of training after a long break.  But, what you also must concern yourself with is outside stress.  Are the athletes sleeping well?  Is the food good or are they scraping by on fast food and skipping meals?  Family issues?  Long flights or car rides?  

This past week training in Whistler, BC, I've seen the new bobsled track take it's toll.  There has been a lot of nervous energy being on a new track.  A new track that is the fastest track in the world.  As a result it's been draining on the Central Nervous System (CNS).   The athletes just don't have the spring in the sprints or the pop in the Olympic lifts.  Anything with big motor unit recruitment is feeling sluggish.  

One thing you can use to measure recovery pretty easily is a hand dynometer if you own one, or more cheaply a simple grip tool, like a captains of crush.    Grip strength has been shown to have a correlation with recovery.  Use it everyday, the days it feels harder, your probably still not fully recovered.  On days you feel super strong, it may be an indicator for Max Effort work.  

So make the appropriate  adjustments.  The best piece of advice I ever received about training is this, "One workout will never make you, but one workout can indeed break you."  Realize that your not just juggling volume and intensity.  Your managing stress.  Stress, recover, repeat.  So take into account all stress, not just in the weight room, and it will help keep you on track for bigger gains, better performance, and keep you out of pain.  

Wheres the Glamour

Lots of people get the idea that because you compete for a country like the United States, that you lift and train in the finest facilities in  the world no matter where you are.  This week the U.S. National bobsled  team and I are in Whistler, BC.  Were here for two weeks training and getting ready for the track that will be site of the 2010 Olympic games.  Scene here is a pretty typical scenario.  The weights we travel with set up in a hotel garage.  It's about 30 degrees Fahrenheit.  There is ice on the floor in some spaces.  This is TJ Burns getting ready to finish his last set of squats.  It's not always glamorous, it's not always comfortable, it can be cold and dark, but this is where champions are made.  

Random Thoughts

1.  The enteric nervous system could be the next big playground for athletic performance.  To much information is being learned about the "2nd brain."  

2.  The VMO has three innervation's, so the muscle should probably be worked in three different ways.  

3.  Menisci are the most important internal knee structure.  Cruciates can be repaired and replaced.  To date the only thing they do with menisci is remove them.  I heard an orthopedist say you lose your season with a cruciate, eventually you lose your career with a meniscus tear.  

4.   People still think high blood cholesterol cause heart disease.  This has never been proven.   Listen carefully to any of the drug commercials such as Lipitor.  They never actually claim cholesterol caused heart disease, because if they did, a false claim, they would get into some big trouble.  They imply it, very clever.

5.  When a muscle is strained it is usually a fast twitch muscle such as a hamstring with type 2b fibers.  Most rehab protocols focus on the  slow twitch aspect, type 1 and 2a fibers.   Match the right rehab with the correct fiber type and healing will happen a lot quicker.  

6.  For a blanket statement.  If you get your neck extensors stronger, all your upper body lifts will go up.  

Digestion

Interesting fact, the human digestive tract has roughly the same number of neurons as the spinal column.  The brain uses neurotransmitters to tell your heart to beat, lungs to breath, stomach to digest.  They have huge influence on how you concentrate, mood, sleep patterns, and weight.  There will be adverse symptoms when they are out of balance.  So what exactly does this mean for an athlete or even the average weekend warrior? 

 First lets take a look at a few more interesting facts.  Someone with a lot of subtle food allergies will produce much more cortisol when they eat something that slightly irritates them.  Now were talking subtle food allergies here, not the kind that sends someone to the hospital, often times you won't even know you have them.  But what will happen is that it will inflame the person and irritate the gut.   66% of all neurotransmitters are made in the intestinal gut lining.   That number jumps to 95% for  serotonin.   Depression and inhibited immune system are a few things associated with low serotonin levels.  So someone with a leaky gut syndrome will definitely have there neurotransmitter production compromised.  Someone with depression caused by lack of serotonin may in fact be suffering from leaky gut syndrome.   So there is a huge price to play for unhealthy digestive tract. 

 I'm still learning a lot of what it takes to deal with this type of situation.  One way you can go about restoring intestinal health though is through the use of probiotics.  I'm currently playing with a few different brands and will let you know what I think and results I have seen.  But realize there is much more going on in the digestive tract then just food digestion!

Another Great Exercise

Sticking with the hip extension theme that has been woven throughout the last few blogs, here is another exercise to add to your repertoire. This is the classic Cook Hip lift, but adding a plate for a little bit more external load. This is a great glute/hamstring exercise.  Concentrate on pushing through the heel as you press the hips off the floor.  Have fun!

Triple Extention

Triple extention is often talked about in weightlifting because of its carryover to sports. Simply stated it's the ankle, knee, hip, all firing. This has great carry over to strength and speed gains and one reason the olympic lifts are so popular among coaches and athletes. This video is of Bill Schuffenhaur 2x Olympic games bobsledder for the United States. Billy is doing a Split Snatch and is a good example of triple extention in action. This week we are training in St. Moritz, Switzerland. It's the only completely natural track in the world and one of the fastest reaching speeds of 145 km/h. But even then it often comes down to a hundredth of a second over a few runs. That is why athletes like this one train for hours every day year in and year out, to get a hundredth better.

Congratulations

Congratulations to Train out Pain athletes Shauna Rohbock and Valerie Flemming for winning Gold at World cup race in Koonigsee, Germany this past Saturday. They are part of the US Womens National bobsled team. They are the silver medal winners of the 2006 Olympic Games in Turino, Italy.

Importance of the Talus

The talus is a free floating bone in the ankle joint. It lies inbetween the medial and lateral maleolus. Basically it sits in the middle of your ankle joint. It comes in contact with your calcaneus (heel) and navicular (inside by your arch) bones. It has no muscle attachments hence the term free floating. Because of its lack of muscular attachments it often times can be slightly off. This can lead to movement impairment.  Every patient that comes into my office (Train Out Pain Chiropractic in Grand Rapids)  gets there ankles checked biomechanically.  That is how important I think it is!

Clean movemnt of the ankle joint is critical not only to health of the foot but of the knee. If you lose mobility in the ankle your knee becomes more unstable, thus setting it up for possible injury. When the talus becomes stuck inversion/eversion won't happen as cleanly as well. Without the eversion between the talus and calcaneus, pronation won't happen as well as it should, which following the chain up leads to Glute Max inhibition.

Also with the talus stuck dorsiflexion won't happen as well. This can lead to your plantarflexors of the calf working much to hard. When muscles work harder then they should this leads to pontential injuries in the form of strains or tears.

One way to ensure good ankle mobility is to do a few drills. Place your foot 3 inches from a wall. Keeping your heel on the ground bend your knee until it touches the wall. Keep moving your foot back until your knee can't touch the wall while the heel stays on the ground. Do this for 15-20 reps at that spot. Next, keep the ankle and foot locked perpendicular to the wall. With your other leg do leg swings back and forth across your body. This puts a rotational force into the ankle joint. Again shoot for 15-20 leg swings.

Another Vitamin D Win

I read and copied this off the modern forager blog...if I can get as much information on Vitamin D to the public it will be a victory!

What Does Vitamin D Have To Do With Your Back Pain?

There are a number of reasons for why vitamin D deficiency can cause chronic pain.
1. Vitamin D deficiency causes a reduction in calcium absorption.
2. Production of parathyroid hormone is increased to maintain blood calcium levels
3. Parathyroid hormone results in increased urinary excretion of phosphorus, which leads to hypophosphatemia.
4. Insufficient calcium phosphate results in deposition of unmineralized collagen matrix on the endosteum (inside) and periosteum (outside) of bones.
5. When the collagen matrix hydrates and swells, it compresses the sensory-innervated periosteum, resulting in pain.