The Nuchal Ligament

The what? That's what probably many think when they here that. The nuchal ligament is a ligament that runs from the base of your external occipital protuberance (the bump on the back of your head) to the spinous process of the 7th cervical vertebrae. (the last bone of your neck). For a long time, it was thought that it wasn't a major player in restraining cervical flexion. New studies have shown that it is a primary restrainer of flexion, so it's role was vastly underestimated! Not only this but there is now evidence that there is continuity between the nuchal ligament and the dura at the atlanto-occipital interspace. In laymens terms this suggests that the nuchal ligament has a role of some sort in cervicogenic headaches. It is also important for keeping the proper curve of the neck.

Recent theories have even surfaced that it is one of the reasons human being have the ability to run. How cool is that! Glute max, the achillies tendon and the nuchal ligament are what many scientist believe we need to propel our bodies across the world and not just slowly walk.

So we know that the nuchal ligament is important, we also know it's obviously a ligament. With this knowledge what do we do with it? Ligaments are passive, which means they are active without our control. Ligaments and bones are passive restraints. Muscles would be active. If a passive structure hurts, it would hurt when someone moved it for us. If an active structure hurts, it would hurt when we move it, but not when someone moves it for us. So we must look at what active structures limit cervical flexion, if we get those stronger, it will in turn ensure the nuchal ligament stays strong and healthy and able to function.

Over the next few weeks we'll look more closely at these muscles and some exercises you can do to strengthen them.

Book Review of the Month

I know it's been awhile since I've last done a book review, I've been reading, but mostly some awesome textbooks. This past few weeks I've been travelling though, and because of that, have had the chance to do more leasurily stuff.
First up, Steroid Nation, by Shaun Assael. I found this to be a highly entertaining and informative book. It gets into how the supplement industry exploded in the early nineties when now Vice President Joe Biden, made it his mission to get steroids up there with the same penalites as cocain and heroin. It tells the story of Dan Duchaine, Victor Conte of Balco Labs, and a few of the scientist probably responsible for the formulas used in baseball today. If you ever wonder how sports got to be the way they are, this is a good read.

Second up, Born to Run by Christopher Mcdougall. I have to say, this is one of the best books I've read since Omnivores Dillemma. It touches on quite a few themes. At it's heart is a true story of a man set to learn to run pain free. Woven throughout the text though are human evolution, training, culture, sports, the shoe industry, ultra running and much more. I highly recommend it for anyone that runs or is interested in sub culture at it's finest. It's well written and has a great story, you won't be dissapointed.

Sleep and Growth Hormone: Tips for success

So you now want to keep those Growth Hormone levels high and appreciate a great nights sleep. So here are a few helpful tips.

1. Keep your room as dark as possible. Think back to the caveman.

2. Keep your room cool. 66-68 degrees has been shown to be pretty optimal.

3. If you wake up for any reason, keep the lights off. Only in darkness will your body produce melatonin. Melatonin is a hormone that is released by the pineal gland, it produces healthy sleep cycles (along with a lot of other healthy stuff!).

4. Keep the electromagnetic levels to a minimum. Keep your bed at least 3 ft from alarm clocks, tv's, radios. In the perfect environment, leave this stuff out of the bedroom.

5. Get on a regular schedule. Go to bed and get up at the same time every day....even the weekends. According to Ayurdevic medicine 10 pm to 6 am is the optimal cycle. I think it depends on the person....I know personally that 1 am to 9 am is great from me.

6. According to feng shui, you should sleep with your head to the North.

7. Avoid caffeine in the late afternoon and night. Hopefully that's a no brainer.

8. For men, a zinc/magnesium supplement will often times help. Try taking it an hour before bed.

So there are 8 tips to help achieve peaceful slumber and get those GH levels back up. Do you have any tips that you have found work great for you?

Sleep and Growth Hormone: Thats when the magic happens!

"We don't sleep to dream"
"We sleep to build stamina,"
"Energy to do our thing"
"Grab your camera!"
lyrics from FORT MINOR

Sleep is the most important tool you will ever have when it comes to recovery and regeneration. You know you don't get stronger lifting weights right? Lifting actually destroys your body, it's the recovery your body throws at the process that makes you stronger. The number one reason is Growth Hormone.

Growth Hormone is a hormone your body produces. Its effects include but aren't limited to: decreased body fat, increased muscle mass, supports a strong immune system, increased energy, healthy skin, increased bone density, just to name a few.....sound great right? Well your body produces a little over half of this when you sleep, so when you start cutting hours, your cutting out growth hormone and those hours start to add up. Having trouble losing that last little bit of belly fat and your eating and exercising right? Check your sleep patterns. Not getting stronger in the gym? Again, check your sleep patterns.

I don't know of any hard training athletes that don't get 7.5-9 hours a night. In fact, most even sneak in a nap to add sleep to their routine. If your not reaching your athletic goals or aren't recovering from your workouts, look at your sleep, it may hold the answer. In the next post I'll show some practical ways to improve the sleep your getting.

Homocysteine, B12 and Folate

Homocysteine is an amino acid found in the blood. It's a very important marker for long term health. Lets back step for a second. Methionine is an essential amino acid obtained from protein. Some methionine is turned into homocysteine. The body turns much of the homocysteine in the body back to methionine with the help of B12. If B12 is lacking the homocysteine levels gradually increase.
Homocysteine can be a nerve toxin promoting cardivascular disease, stroke and Alzheimer's. Keeping the homocysteine levels low is associated with lower disease rates, but this requires adequate levels of b12 and folate. For non vegetarians, folate is more important for keeping homocysteine levels down, for vegetarians B12 is more important. So if your non vegetarian a folate supplement is advised or eating a lot of foods such as beans, lentils, lettuce, black eyed peas, okra and banannas. If your a vegetarian it's advised to take a B12 supplement as it's hard to get the required amount of B12, there are fortified foods out there, but in reality it is advised to be on a B12 supplement for optimal health. Remember, optimal is what were after.

Iliotibial band exercies

So in the last post we talked about one of the more common causes of IT band problems. So in this post we will get into some actual steps to dealing with it.

Step one: Activate the glute med.
Step two: Strengthen the glute med.
Step three: Work the tissue quality of the IT band

Activation, the name of the game. Get what you got firing! The clam shell. Lie on your side, knees bent, feet together. Slowly and consciously raise your knee up while keeping your feet together. With one hand feel the muscles on the side of your hip working. This will allow a better mind body connection. 2 sets of 20 reps.
Side shuffle. Upper body erect, slight knee bend. Slowly step straight sideways. Repeat 10x in each direction. As this gets easier you can add a theraband around your ankles for increased resistance.

Strengthening. You get muscles stronger to cement the motion. Single leg lunges. Take a long lunge step forward. Really work to stabilize and keep your balance. Stay errect. Single leg deadlift. Standing on one leg. Reach down with a dumbell in the opposite hand, slowly lower it and raise back up again.
Pretty much anything done on a single leg will recruit the glute med.

Tissue quality is of utmost importance. I really like foam rolling the IT band. You can choose how much of your bodyweight you want to put on it, I recommend as much as you can, that doesn't lead to wincing pain. Slight uncomfortableness is expected though. Look to do around 2-4 minutes 2-3x a day.

So there is a prescription for fighting the IT band syndrome. Let me know if you have had success and what other strategies you've used.

Iliotibial band problems

At first it starts as just an annoying ache on the outside of your knee, but slowly it becomes something painful and sometimes downright stops you from training and competing. Welcome to the IT Band issue.

It is a classic example of a repetitive tissue injury. As the IT band slides over the lateral trochanter of the knee, it becomes inflamed and painful. Lets looks at the causes of this. Primarily what were dealing with is the bodies attempt at stabilizing the pelvis. When certain muscles, mainly the glute medius, don't have the strength or endurance to stabilize the pelvis, then the body feels it must recruit others (IT band) to help out with this job. Well the IT band wasn't designed for this, so over time, it gets really tight and shortens causing the friction over the lateral knee and ultimately pain.

So you must attack this issue from a few angles. First we have to do some glute med activation exercises, followed by glute med strengthening excercises and soft tissue work on the shorted IT band. The next post we'll get into the actual details of the exercises.

Congratulations to Ingrid Marcum National Champion

A big shout out of congratulations goes out to Ingrid Marcum, National Champion in the 75K olympic weightlifting class. Last Saturday she won her division with 91K in the snatch and 103 in the clean and jerk. Ingrid will compete in the world championships in August. I know Ingrid from bobsled as she competes for the US in the winter and goes back to weightlifting in the summer. Congratulations and good luck at Worlds in a few months! You can read more about Ingrid at her website. http://ingridmarcum.typepad.com/

Enter the Psoas: Fixing Low Back Pain

The stats don’t lie; low back pain is a problem. Eighty percent will have some severe low back pain in their life, with the majority experiencing repeat episodes. Not coincidentally, more and more people work at a desk for a living. Does this scenario sound familiar? One drives to work, sits all day, drives home, watches T.V. and hits the repeat cycle. Over the years, gain a little weight, so one hits the gym, warm up on the bike, sit at machine after machine, and wonder why ones low back is always sore. Enter the psoas muscle.
The what? The psoas, it’s the bodies major hip flexor. It originates on the last thoracic vertebrae and the first four lumbar vertebrae where it courses down and inserts into the hip. The ability to raise your bent leg past ninety degrees towards your chest is its major action. Lately, research is pointing that its major role is actually that of a lumbar stabilizer. Put plainly, when healthy, it keeps your low back stable. The problem is, all this sitting has shortened the muscle. Tightness equals weakness.
Run these examples. Ever get uncomfortable back pain after standing still for a few minutes, like you have pressure building right around the belt line? How about a little bit of sharp jabbing pain after getting up from a sitting position? How many have been out for the count after stooping to pick up something as small as a pencil? If any of these scenarios sound familiar, the psoas is tight!

Even if none of these scenarios sound like you, you’re not off the hook yet. Athletically, it is a huge component to performance. When tight, even without low back pain, they act as brakes. It will keep you from jumping your highest, running your fastest, and lifting your heaviest. They shut down the most powerful muscle you have, the glute maximus. It inhibits their force production. That simply stated means you’re not as powerful as you could be.

So lets fix this. The first is a combo exercise. With the right knee down on the floor, the left leg in front in a lunge position, lean forward through the hips so that the back leg is now at an angle, the upper body is still upright. Raise up your right arm toward the ceiling and bring it across your body. The stretch should run from the front of the right hip into the right abdominal area. Hold for a count of fifteen and switch sides. Immediately stand up, feet shoulder width apart, stand tall, squeeze your fists and then squeeze your glutes together and hold for a count of five. You should feel your pelvis tip up as you first squeeze the glutes together. This isometric contraction activates the glutes. This is a simple combo exercise to restore the length. It also has a magical effect of boosting your vertical leap!

After being tight for so long the psoas may need to be strengthened. To find out, stand tall with your right leg bent parallel to the floor resting on a box or bench, left leg held straight. Raise the right leg so that it is now above ninety degrees. Hold for thirty seconds. The right leg should remain above ninety degrees, if it drops, you feel a cramping sensation or you find yourself bending forward at the waist, you have a weakness. This drill will also strengthen them. Test both legs. Add this to your strength routine. Don’t let low back pain decrease your quality of life. So release the psoas and reap the rewards of new athletic movement and a pain free back to boot.

Bobsled Training Update

This past week I had 4 bobsled athletes fly in or make the trip up to Grand Rapids for some one on one training. It was good to be able to see some of the progress being made first hand heading into the Olympic year. Two of the athletes broke there previous PR's in the trap bar deadlift. So the maximal strength for this time of year is excellent. Some pushing technique ques were developed that should pay dividends down the road.

The bobsled season is unique in that there is a pretty long offseason in which to build up for the season. The season is somewhat like football where every weekend you must peak for a race and then hopefully if all goes well plan on being in the big show, the Olympic games. For the athletes, they must also plan on peaking for the push championships before the season even starts, for some athletes this must be followed by being in top shape for the National Championships, also before the season starts. So it becomes a chess match with the different strength, speed, technique qualities that must be juggled from what you gain in the offseason to peaking for the important events and not losing your offseason gains.

Weekend Quote

Think about your last big decision. Think of all the reasons you thought about and told yourself. Now think of your decision in relation to this following quote.

“A decision is a conclusion based on everything you believe about yourself.”

Think over that one! Have a great weekend!

Don't throw out that egg yolk!

Don't throw out that egg yolk! Egg yolks are loaded with vital vitamins, one being choline. Choline is essential in the formation of acetyl choline a neurotransmitter. It's also vital for pregnant women as it helps with the development of the child. It cuts down on neural tube defects. It's also important for cell membrane health. It has been shown to be a breast cancer preventative as well as improve cardiovascular health and improve memory. It has been estimated that one in ten Americans currently reach the RDA for choline which is 550 milligrams. It's not that far of a reach to say that the RDA for most things is notoriously low. Two egg yolks provide around 250 milligrams. Other good sources are broccoli, beef liver and cod. So say goodbye to that all white omelet. Keep the yolk!

Traction for low back pain: Good or Bad?

Low back pain is always an interesting topic and a topic that every athlete and weekend warrior should know a little about. Needless to say, every clinician should know A LOT about this topic. One thing that many clinicians use and many athletes have undergone is the tool of mechanical traction.

Mechanical traction is the use of a table or instrument to elongate the tissue at a particular level. Usually the basis is to open up the disc space and take pressure off a particular nerve root. So is this a good thing? Well like all "tools" it depends!

Usually there will be one side that you will find painful. If it feels better to lean away from the painful side, this is usually indicative that the injured rootlet is above the protrusion. This scenario traction is not recommended and will make your situation worse. On the other hand If you lean towards the painful side, this usually means your injured rootlet is below the protrusion and traction may very well help.

So before you seek or use traction, test yourself or your patient, with these simple steps and you may be able to really help or at least keep from making the situation worse.