Tennis Elbow and the Radial Nerve

In honor of my favorite tennis grand slam, the French Open (I think it's more athletic then hard court game) I decided to talk a little about tennis. The most common injury you hear talk about is tennis elbow. Funny thing...you can have tennis elbow and never pick up a racket, examples would be plumbers, artists and anyone involved in repetitive elbow extension.

Tennis elbow is the common name for lateral epicondilitis. Pain at the lateral part of your elbow. Essentially what the name defines is an inflammation of the soft tissue that attach on the lateral part of the elbow. The following muscles insert into a common extensor tendon that attaches on the lateral epicondyle: extensor carpi radialis brevis, extensor digitorum, extensor carpi ulnaris, extensor digiti minimi. Brachioradialis and extensor carpi radialis longus are two big culprits, but more on those later.

Your classic case of tennis elbow will respond to rest, stretching, ice and anti-inflammatories. I also like slow eccentrics with a weight to build up that eccentric strength and it has been shown to help heal up any degenerative changes that may be occurring making your itis and osis! That will be a different post though!

If you have done all that and two weeks later you still have the pain, you may have a radial nerve entrapment. The radial nerve passes from the axilla (arm pit) and down the back of the arm. You can have a radial nerve entrapment in the triceps but it is rare. The four main sites that you can commonly get entrapment's are between the brachioradials and brachialis above your elbow crease. Between the brachioradialis and extensor carpi radialis longus below the elbow crease. At the arcade of frohse, the most common spot. The arcade of frohse is a fibrous arch at the top of the supinator muscle. A branch of the radial nerve called the posterior interosseous nerve passes through it. When the supinator muscle, the fourth potential entrapment site, gets tight it can press down on the radial nerve that runs underneath it or compress the posteror interosseous nerve at the arcade of frohse.

To get rid of this and to find the spot of entrapment you must get quality soft tissue work done. I like Active Release Technique. You have to find the point of entrapment and break the adhesion and loosen the muscles to take tension off the radial nerve. You can stretch and stretch till the cows come home, but until the entrapment is released you will be wasting your time and efforts.

A Quick Reference for Multi Vitamins

I get asked the question who makes a great multi vitamin quite a lot. The long answer is one that is pharmaceutical grade and has received the GMP stamp. Pharmaceutical grade is saying that if the FDA finally regulated vitamin production. The manufacturers wouldn't have to change a thing. It's the same quality of production that drugs are put through. GMP stamp says the government ranks it with Good Manufacturing Practices.

If it doesn't have these, your likely paying for ingredients that aren't even in there. If it says there is 500 mg of vitamin C, who knows if there are really that amount in them. Scary thought huh? Scarier is who knows what else is in there?

The short answer to a good multi vitamin is this. Look at the magnesium. It usually has a second word with it. Does it end in -ate? If so, its probably pretty good as this magnesium costs a lot more to add into the formula then the cheaper versions.

So there you go, a long answer and short. I would say do the research on companies your going to purchase from. But, if in a hurry...scan that magnesium. Now you know!

Trigger Points Explained

If you've been around athletics and training for any extended time you have heard the term trigger point at some point. What exactly is a trigger point and are there different kinds?

Trigger points are defined as small palpable nodules in the muscle belly. They usually manifest in postural muscles that are under a lot of repetitive activity. They tend to have a radiating type of pain and don't usually hurt at the site of the trigger point.
This is in opposite of what are called tender points. Tender points are usually at the insertion of the muscle belly (think tendon).
Tender points also do not radiate. Fibromayalgia has characteristically been associated with tender points.

Both trigger and tender points arise when the muscle suffers repetitive activity and oxygen can't get into the muscle as well as it should. So metabolic waste builds up and produces the culprit.

There seems to be two kinds of trigger points, active and passive. Active is when you know your experiencing pain. There is a definite referral pattern, and can even have resultant muscle weakness and decreased range of motion(ROM). The other is passive. In my opinion, the passive is more detrimental to the athlete. Passive trigger points are points that you don't even realize you have, but they are causing dysfunction in the body. They can be shutting down or decreasing strength in other muscles or slowly hindering ROM.

Some examples. Trigger points in the infraspinatous can inhibit the deltoid. TP's in the upper trap can inhibit the lower trap. Tp's in the pec major can inhibit the subscapularis. Trigger points in the peroneal muscles can compromise function of the triceps surae. This is just a tiny number of the inter relationship between muscle groups.

So getting some good quality muscle and movement done by a trained therapist is a must. When you figure out your pattern, a well designed exercise program of movement and self myofascial work can be maintained to keep your body running on full cylinders.

Benching tip for Shoulder Pain

Benching, or Monday workout for most people, is that favorite exercise of a lot of people. So if your going to do it, do it right! Dave Tate has some great set up tips over at T-Nation. So I won't waste your time and repeat what he's saying. But I will give you this tip, when your experiencing pain in the front of the shoulder when your pressing, your subscapularis needs some love and attention.

Your Subscapularis is part of the rotator cuff. It's job is to hold the humerus posterior and inferior while your pressing. If its weak your humerus goes superior and anterior. This can let some soft tissue structures to get pinched ( impingement).

There are a few reasons the subscapularis can get weak. It can be inhibited from an over developed pec major. They are in an antagonistic relationship. It can be tight (tight = weak) from the infraspinatous (another rotator cuff mm) being weak. This will allow the scapula to shift with abduction of the humerus.

So get some soft tissue work done on the subscapularis, spend some extra remedial work on the external rotators of the rotator cuff, and do some direct stretching of your subscapularis. Picture is shown above. Make sure your scapula is pinned against the table or floor.

USAIN BOLT 150 METRES WORLD BEST AT MANCHESTER

WOW!!!!!!!!!

Michigan Victory Games

This past Friday I had the privilege to give a health and fitness presentation to a bunch of students that a friend teaches through Grand Valley State University. It was a lot of fun to try to bring important basics to a diverse group and get the kids interested in easy to follow steps to live a long healthy life.

A few of the students were competing for a group called the Grand Rapids Eagles. They are a team that travels around and competes in the Michigan Victory Games. Well, it just so happened that that night, Michigan State University was holding the championships. Since a few of his kids were competing in powerlifting, we thought it would be cool to go watch them. There are a myriad of events, from swimming to javelin, wheelchair obstacle course to discus, ping pong and of course powerlifting.

Now all the kids have a mental or physical impairment and watching them compete in a strict powerlifting (bench press) was amazing. Pause at the bottom, no shaking at the top, a clean rack call, or it doesn't get the white light. It was inspiring to watch kids struggle and win with the just the bar. One girl stood out, in this video above she puts up 235 lbs. As you can see the legs get strapped down, as many kids don't have great function or control.

Squat Analysis

Believe it or not, this is the first time I've ever seen myself squat. I have been training pretty serious since I was 14, so thats a long time. If you have never analyzed yourself doing an exercise, try it. It's an amazing learning tool.

I had gotten away from back squatting for numerous reasons. But lately I've been considering adding it back in. So this was the first back squat session in a long time. It's surprising how easily the groove is lost.

As you can see I don't come close to hitting parallel depth. Thats ok, for now. I can see I need a lot, I stress, A LOT, of hip mobility work. You can see exactly where they stop moving and I stop getting depth. Probably the main reason I have been experiencing low back discomfort in the morning. To get any lower would either require lumbar flexion ( no good) with the sacral tuck, something I don't let my athletes do. Long term ligament problems are waiting if that persists. I can see some need for ankle mobility as well.

Any thoughts? Do you see anything that I may need to address on my road back to squatting?

VO2 Max Testing

Last week I got to witness a VO2 max testing at one of the numerous Health in Motion PT clinics. It was pretty cool. Danielle Musto's ( pro mountain bike racer extraordinaire) little sister, Tony was the victim! Tony is a pretty outstanding endurance athlete in her own right. She just completed her first year at Grand Valley State University, where she achieved All-American on the swim team. She also is a sponsored rider for Team Priority Health and will be competing all over the country this summer.

If you never have witnessed one of these tests, they're pretty grueling. Your basically tested on a few things on the way to pushing yourself to the limits of your physical capacity. For many of us, that's to the point where you feel like your going to pass out. Not the most fun thing to do on a Wednesday afternoon, but pretty fun to watch someone else go through it!

Tony wasn't allowed to eat anything since the night before, as one of the things tested is how well her body burns fat and glucose. So now your not only pushed to the limit, but your body is someone depleted to begin with.

One of the cool things that gets tested along the way is your anaerobic threshold. This is essentially the heart rate your at when your body starts using carbs instead of fat for a fuel source. This point is kinda like the efficiency of your engine. This is a great place to stay when your putting in miles to build up that aerobic base. Stay below aerobic threshold and you can probably go for hours on end. It's usually a lot slower then what your used to going.

Another point that gets tested is your Anaerobic threshold, this point is where your body quits using oxygen to burn glucose. So this is the point where your body can't get rid of the lactate and it starts to build until you can't accomplish work any more.That's why this point is also called the Lactate Threshold. Essentially this is the point where your legs start to give out and the vision starts to narrow. Stay here and you won't be racing very long! This point is how much of your engine your using.

Finally the last point that gets tested is the VO2 Max. This point is the maximum amount of oxygen your body can use. It's measured in milliliters used in one minute per kilogram of bodyweight. This is essentially how big your engine is.

So VO2 max is how big an engine you have, anaerobic threshold is how much of the engine you can use, and aerobic threshold is how efficient your engine burns. There are a lot of different methods that can be used to improve all three.

What I found most interesting is that there is a zone in between aerobic and anaerobic threshold. Where if you stay there, neither gets improved, but for most people this is exactly where they train. Aerobic training seems to easy, and anaerobic seems to hard. So it's definitely worth knowing where your at, so when you go out for a run or a ride, your improving with your efforts, just not going through the motions.

I won't say what Tony's VO2 score was, but it was impressive. Good luck this year!

The Diaphragm and Neck/back Dysfunction Part 2

So in part one of this blog post we discussed the anatomy and function of the diaphragm, how it functions and hopefully you now have a good understanding of how it functions. So now we have the ability to see the big picture so to speak. So now we'll discuss some problems that arise.

First a simple evaluation. Watch yourself or someone you know breathe. Does your clavicle rise with each breath? Does your abdomen protrude with each breath. The first is dysfunctional. The second is something you want, and if you don't see it, your a chest breather. More on this later.

So if we have these two dysfunctions your setting yourself up for neck and low back problems. If you don't have the proper abdominal breathing, your intra abdominal pressure will not be as effective. This is needed to tense the thoraco lumbar fascia. This is part of your bodies natural "weightlifting belt." So when this isn't tensed and you go to lift, your unstable and more likely to hurt your lumbar spine.

When the clavicle is raising with each breath, your a chest breather, expanding up and not out. Your probably only using a 1/3 of your lung capacity, but also overusing your scalenes. This is an accessory breathing muscle that lies on the side of the neck underneath and slightly in front of the trap.

When this gets dysfunctional your body is forced to have a more kyphotic posture then what it healthy in the thoracic spine. So you can get your upper ribs and thoracic spine mobilized all you want, but until proper breathing is learned, it will continue to come back and you will continue to have trigger points through the upper trap area.

So besides consciously thinking about breathing a simple exercise you can do is lie on the floor on your belly. Put your forearm underneath your head and get into a comfortable position. Slowly take a deep breath and feel your belly press into the floor. Slowly exhale. Repeat for five minutes. Not only will this teach new breathing patterns, but it will gently mobilize the thoracic spine. Enjoy!

Yoseph Johnson and Ultimate Athletes Concept

This past weekend I had the pleasure to visit strength coach Yoseph Johnson and his company Ultimate Athlete Concept. They are based out of Muskegan, MI. It was quite the trip. It is always cool to get to pick someones brain and gain a few nuggets of knowledge that you can apply to your athletes. It gives you things to think about and to either prioritize, reprioritize or even eliminate when it comes to writing your training programs. Yoseph works closely with Michael Yessis, and has translated much of the Russian literature that is now available.

It was really cool to be able to spend an afternoon, watching him take a few athletes through different workouts, all the while explaining the rationale on why this exercise is being done, and why it's being done at this time. He worked out, what he calls a few low level athletes, kids just starting, a mid level, and one elite level athlete, a D1 football player.

Check out Ultimate Athlete Concepts if your interested in getting some of the Russian Literature and looking to expand your knowledge on training. If your an athlete in the West Michigan area, he would be a great help in trying to improve your athletic abilities.

The Diaphragm and Neck/back Dysfunction Part 1

How many can honestly say they understand the diaphragm? If someone were to ask you to picture the diaphragm as you take a deep breath in, what do you picture?

Have you ever payed attention to your breath?

Lets get some anatomy clear so your picture gets a little less fuzzy. The diaphragm is a dome shaped muscle that separates the thoracic cavity from the abdominal cavity. There are essentially three parts, costal, sternal and crural. The costal portion attaches to the lower 6 ribs, sternal portion to the back of the xiphoid process and the crural part to the upper bodies of L1, L2 and L3, anterior longitudinal ligament and IV discs. The crural part attach by a right and left crus.
The three parts converge to form what is called the central tendon. This tendon has no bony attachments. There are also fascial connections to the psoas major and quadratus lumborum.

So that's the anatomy, now how about picturing the function. 70-80% of inspiration is performed by the diaphragm. As you breath in, the diaphragm contracts, which lowers and flattens its dome. Now remember, the diaphragm is between the thoracic and abdominal cavity. So as it lowers, the thoracic cavity gets bigger and the abdominal cavity gets compressed. This compression builds up and resists the diaphragm coming lower. So now you have intra abdominal pressure. This pressure expands the lower ribs laterally. Now because the intra abdominal pressure stabilizes the diaphragm, if it continues to contract the costal part of the diaphragm elevates the middle and lower ribs. (ribs 6-12)
The thoracic cavity gets larger as mentioned earlier. This allows the lungs to expand to take up the now available space.

So now hopefully you can picture what takes place when you take a nice deep breath! The next post I'll cover what happens when proper breathing goes awry, what to look for and the dysfunction it can create in your body.