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Data Source: Zamparo P, Bonifazi M (2013). Bioenergetics of cycling sports activities in water.

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Weekly Round-up

  1. How sleep helps brain learn motor task.
  2. Fatigue shifts and scatters heart rate variability in elite endurance athletes. - by Dr. Schmitt
  3. The development of peripheral fatigue and short-term recovery during self-paced high-intensity exercise. - by Dr. Froyd
  4. Postural control and low back pain in elite athletes comparison of static balance in elite athletes with and without low back pain. - by Dr. Oyarzo
  5. Virtual swimming--breaststroke body movements facilitate vection. - by Dr. Seno
  6. Symmetry of support scull and vertical position stability in synchronized swimming. - by Dr. Winiarski
  7. Is bone tissue really affected by swimming? A systematic review.- by Gómez-Bruton
  8. Effect of gene polymorphisms on the mechanical properties of human tendon structures. - by Dr. Kubo
  9. Relation between efficiency and energy cost with coordination in aquatic locomotion. - by Dr. Figueiredo
  10. Is There a Minimum Intensity Threshold for Resistance Training-Induced Hypertrophic Adaptations? - by Brad Schoenfeld
  11. The Temporal Profile of Postactivation Potentiation is related to Strength Level. - by Dr. Seitz
  12. Athletes and novices are differently capable to recognize feint and non-feint actions. - by Dr. Güldenpenning 
  13. Effects of betaine on body composition, performance, and homocysteine thiolactone. - by Dr. Cholewa
  14. Fructose-Maltodextrin Ratio Governs Exogenous and Other CHO Oxidation and Performance. - by Dr. O'Brien
  15. Sports drink consumption and diet of children involved in organized sport. - by Dr. Tomlin
  16. Which exercises target the gluteal muscles while minimizing activation of the tensor fascia lata? Electromyographic assessment using fine-wire electrodes. - by Dr. Selkowitz
  17. Scapular Kinematics and Shoulder Elevation in a Traditional Push-Up. - by Dr. Suprak

Abnormal MRIs in Tennis Players


The association between diagnostic imaging abnormalities and pain has been discussed before. However, more research on this subject continues to surmount. Remember, structural abnormalties do not equal pain! Now, this doesn't suggest an acute rotator cuff tear will not cause pain, instead it means overuse of any joint (from sport or life) will result in structural defects, but not necessarily pain.

A recent study by Alyas (2013) analyzed magnetic resonance imaging (MRI) in the lumbar spines of elite adolescent tennis players who did not have pain. This study took MRIs of 33 players (mean age 17.3) and found only five of the players showed no structural abnormalities! This small sample implies a mere 15% adolescent tennis players without pain had no structural abnormalities. The most common structural change were facet joint arthopathy in 23 of the 33 players. Synovial cyst formation was seen in 10 of the subjects. Thirteen of the subjects showed disc degeneration. Pars injuries occurred in nine of the subjects.

This high rate of abnormalities suggest the high stresses of the low back with tennis result in structural changes. Alyas (2013) implies in their study that these structural changes may be predictors of pain later in an athletes career, but as we've discussed if you have proper surrounding muscular support and muscle length, strength, and timing the body can adapt and handle the stress and work with the structural changes. 

Summary
It is clear every sport has excess stress at one joint or another. These stresses often damage structures in even youth athletes. However, if an athlete has proper length, strength, and timing they are likely able to handle the demands of the sport and have a healthy career. Make sure you are taking care of your body and understanding the importance of muscle length, strength, and timing, even in your young swimmers!


Reference

  1. Alyas F, Turner M, Connell D. MRI findings in the lumbar spines of asymptomatic, adolescent, elite tennis players. Br J Sports Med. 2007 Nov;41(11):836-41; discussion 841. Epub 2007 Jul 19.
By Dr. G. John Mullen received his Doctorate in Physical Therapy from the University of Southern California and a Bachelor of Science of Health from Purdue University. He is the founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Dryland Mistake: Medicine Ball Training for Swimming

Go to practically any swim club and you are virtually guaranteed to find medicine balls somewhere on the premises.  Despite years of technology infusing the sport, the simple medicine ball remains a trusted piece of equipment.  There’s good reason for this as the medicine ball is generally safe, easy to learn, versatile, cost effective, and efficient for large groups.

But do we know why the medicine ball works or even if it does work?   This post will not be a library of “Best Medicine Ball Moves” but rather a reflection on current practices.  There’s minimal formal literature suggesting that swimming would benefit directly from medicine ball work.  In fact, some would suggest that dryland training is at best irrelevant.  But if we accept that general athleticism and movement proficiency are at least tangentially related to swimming performance, it’s worth investigating deeper due to the medicine ball’s popularity.

As with any tool, what’s important is not the tool itself but what you choose to do with the tool.  With the medicine ball, there is evidence to confirm that the medicine ball can help as an adjunct to other routines (Symanski 2007: medicine ball group of high school baseball players improved greater in rotational power than the resistance-only group).  Further, for those indulging in dryland power testing, medicine ball throws have been validated as a reliable method (Stockbrugger 2001).   

Unfortunately, studies isolating medicine ball training in swimmers are hard to find.  Garrido (2010) noted improvements following a dryland protocol that included medicine ball work, but this program was multivariate in including several other exercises.  How do we know if it was the medicine ball that helped or the other exercises?  Even beyond the specific literature measuring power output, medicine ball is also useful for developing general athletic skills: throwing, catching, rotating, and stabilizing. 

COMMON MISTAKES
But despite these benefits, there are caveats.  The safety conferred by the medicine ball’s lightness can also be a detriment.  Heavier weights can be feedback to the lifter: there are fewer incorrect ways to lift a heavy weight than a light one.  Because we can perform many repetitions with a medicine ball it’s easy to allow form to lapse if not carefully monitored.

Perhaps the most common programming error is performing high repetition, moderate paced movements that mimic swimming activities.  

“The many hours of long distance swimming which is a necessary part of training has a tendency to stifle quick and powerful movements. Auxiliary training programs can be used to counteract this suppression. Activities should be either explosive and powerful, as in sprint swimming, or static, as in holding postures and stabilizing movement bases.” (Rushall 1993)

The two most common technique flaws are excess flexion during seated exercise and excess extension during standing exercise.  For example, the Russian twist and other variants are popular moves seen on many pool decks (and questionable moves to begin with), but are most commonly performed sloppily with swimmers either beginning in flexion or deteriorating into flexion with fatigue. 





While standing, many swimmers hyperextend the back to throw the ball overhead or to slam it into the ground.  Some extension is natural for such movements, but must remain within controlled ranges and appropriate training volumes. 



PRACTICAL APPLICATION
Greatest benefit of the medicine ball is its practicality.  Many teams must combine dryland and swimming into one practice block due to schedule limitations.  As Dr. John has written recently, exhaustive resistance training performed at certain times may lead to adverse effects of in-water performance if not scheduled appropriately [Exhaustive Resistance Training Alters Joint Biomechanics].   However, “[m]edicine balls and static exercises may produce fatigue but not to the extent that the conduct of exercises later in the program will be compromised” (Rushall 1993).  The medicine ball may allow the best of both worlds as a dryland tool that does not detract from subsequent in-water activity. 

REFERENCES
  1. Garrido, N, Marinho, D, Reis, V, van den Tillar, R, Costa, A, Silva, A, Marques, M.  Does Combined Dryland Strength and Aerobic Training Inhibit Performance of Young Competitive Swimmers .  Journal of Sport Science and Medicine.  2010 (9) 300-310.
  2. Szymanski DJ, Szymanski JM, Bradford TJ, Schade RL, Pascoe DD.  Effect of twelve weeks of medicine ball training on high school baseball players.  J Strength Cond Res. 2007 Aug;21(3):894-901.
  3. Stockbrugger BA, Haennel RG.  Validity and reliability of a medicine ball explosive power test.  J Strength Cond Res. 2001 Nov;15(4):431-8.
  4. Rushall, B. S., Marsden, J., & Young, C. (1993). A suggested program of foundational conditioning exercises for age-group swimmers: A manual for coaches. NSWIMMING Coaching Science Bulletin, 2(1), 1-23. 
By Allan Phillips. Allan and his wife Katherine are heavily involved in the strength and conditioning community, for more information refer to Pike Athletics.

Friday Intervew: Dr. Malachy McHugh

1. Please introduce yourself to the readers (how you started in the profession, education, credentials, experience, etc.).
Malachy McHugh PhD, director of research at the Nicholas Institute of sports medicine and athletic trauma at Lenox Hill hospital in NYC. I have been working in sports medicine and exercise science for 25 years.

2. You recently published an article on the role of the neural tension and strength, could you please explain the study and the results?
Over the last 15 or so years there has been a lot of research showing an acute loss of muscle strength after a bout of stretching. While i am still unsure about the functional significance of these effects in the practical on-field setting it is clear that stretching muscles can affect the subsequent contractile force production. In this study we sought to find out if stretch-induced strength loss was in part due to excessive tension on the neural structures that are in parallel to the muscle tendon units. There was marked strength loss after a bout of stretching that was performed with excessive neural tension. The neural tension was achieved by having subject maintain a "slump" posture during passive hamstring stretches (flexed cervical and thoracic spine in seated position). By contrast when the stretches were performed in a spinal neutral position (cervical and thoracic spine in neutral while seated) there was no subsequent strength loss, rather a shift to strength loss at short muscle lengths and strength gain at long muscle lengths. This effect was attributed to a more compliant (less stiff) muscle tendon unit after stretching.

3. Based on the findings how do you neural mobility should be incorporated with low flexibility?
Possibly doing some neural flossing techniques before stretching might help but that is pure conjecture. Maintaining a spinal neutral position during hamstring stretching is the one practical take home message from the study.

4. How should neural mobility be used in those with back pain?
if the individual presents with a positive neural tension sign then that should be addressed. Flossing techniques are indicated (i think the pts still refer to these as flossing techniques.

5. What still needs to be understood about neural tensioning/mobility?
Positive neural tension has been noted in athletes with previous hamstring strains but the practical and clinical significance of that has not been determined - does it increase risk of reinjury (which is very high for hamstring strains).

6. How much do you think the feeling of "tightness" is from poor neural mobility?
Not much, possibly only is a select group of individuals

7. Who is doing the most interesting research on neural mobility? What are they doing? What do you think about it?
To be honest I have not seen much in this area recently - though i have not specifically searched the topic on a regular basis. Since we are aware of the potential problem few of our patients with hamstring problems develop neural tension issues since we are proactive in avoiding them.

8. What research or projects are you currently working on or should we look from you in the future?
We are looking at whether the shift in the length-tension curve after stretching (decreased strength at short muscle lengths and increased strength at long muscle lengths) can reduce subsequent exercise-induced muscle damage. We have previously shown this not to be the case but the shift in the curve may have been insufficient. So now we are looking at different stretching techniques that may cause a greater shift. This research is moving away from the neural tension effects and more to the mechanical effects of muscle stretching.



Thanks Dr. McHugh

Low Back Pain is Not Stereotypical!

Legendary researcher Dr. Paul Hodges recently published a new article on the role of spinal pain and stability. This has been repeatedly discussed on Swimming Science (Abdominal Drawing-in Myth, Low Back Instability in Swimmers) as pain is believed to impair stability and alter motor control. Dr. Hodges confirmed this once again with his groups latest research, but unfortunately found no stereotypical pattern of stability. This adds more evidence to the individualization principle, indicating each person responds differently to the similar, different, and even the same stimuli. This makes a systematic, individualized approach on rehabilitation necessary for improvement. Keep this in mind, with every swimmer who exhibits pain secondary to soreness or injury.

Reference:
  1. Hodges PW, Coppieters MW, Macdonald D, Cholewicki J. New insight into motor adaptation to pain revealed by a combination of modelling and empirical approaches. Eur J Pain. 2013 Jan 25. doi: 10.1002/j.1532-2149.2013.00286.x. [Epub ahead of print]
By G. John Mullen founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Abdominal Drawing-in Myth

A while back I posted an in-depth article about spinal stability on Sports Rehab Expert (Flexion bias essentials, by the way sign-up for their free annual telecast, great information!). In this piece, I picked apart core stability. One area which I discussed was the abdominal-drawing in method (ADIM). This motion is theoretically believed to increase core stability by recruiting the transverse abdominus (TA), a commonly weak muscle in those recovering from low back pain. In the past, the ADIM method has been repeatedly shown to not increase spinal stability (Vera-Garcia 2007). More interestingly, recent research suggests the ADIM method also doesn't increase contraction of the beloved TA (Grooms 2012). Unfortunately, the Groomers study concluded the lack of TA contraction was due to poor exercise selection. In this study they picked the common hook lying ADIM with a blood pressure bladder under the spine to ensure minimal compression. 


This reviewer is not a advocate of the ADIM method for swimmers (and most general population) as this method does not promote stability compared to other methods (I prefer flexion-bias abdominal bracing) and it seems it does not greatly (if at all) contract the TA. For swimming, this position likely prevents the diaphragm from contracting, as the drawing-in may prevent the diaphragm from contracting (descending). 

Bottom Line: These new results require a re-evaluation for anyone performing this method for prevention, rehabilitation, or swimming enhancement. Instead, consider performing abdominal bracing which increases spinal stiffness and abdominal contraction (Vera-Garcia 2007; McGill 2009).

References:
  1. McGill SM, Karpowicz A.Exercises for spine stabilization: motion/motor patterns, stability progressions, and clinical technique. Arch Phys Med Rehabil. 2009 Jan;90(1):118-26.
  2. Grooms DR, Grindstaff TL, Croy T, Hart JM, Saliba SA. Clinimetric Analysis of Pressure Biofeedback and Transversus Abdominis Function in Individuals With Stabilization Classification Low Back Pain. J Orthop Sports Phys Ther. 2012 Nov 16. [Epub ahead of print] Vera-Garcia FJ, Elvira JL, Brown SH, McGill SM. Effects of abdominal stabilization maneuvers on the control of spine motion and stability against sudden trunk perturbations. J Electromyogr Kinesiol. 2007 Oct;17(5):556-67. Epub 2006 Sep 22.
G. John Mullen received his Doctorate in Physical Therapy from the University of Southern California and a Bachelor of Science of Health from Purdue University. He is the founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Resolution of Pain is Not the End Game!

In any sport, injuries come and they go. This is the nature of placing high levels of stress on your body. Swimming places the most stress on the shoulders and low back, both frequent sites of pain in swimmers. If you search swim decks, you'll find a plethora of swimmers with a long history of low back or shoulder injuries. Most of the time, these symptoms are in remission and all is perceived as fine. However, resolution of pain is not the end game! In fact, after any injury (no matter the severity) current research is demonstrating a residual effect of muscle coordination. Unlike popular belief, this dysfunctional muscle timing during the injury does not resolve once pain is resolved. Also, the literature suggests previous injury is universally recognized as one of the most predictive factors of future injury.

This phenomenon has been demonstrated most recently in a study by Butler (2012) in the low back, but as rehabilitation specialist, I can assure you this occurs at all joints. Just think of the last time you hurt yourself, for example if you stubbed your toe on the way to get a drink at night (read about the importance of hydration on cognitive-motor skills). When you stub your toe, you likely scream a few obscenities (this may also improve the pain), then you hobble around the house like Frankenstein until the pain resolves. This hobbling is altering your normal motor control to mitigate the pain in your toe. Now, if this pain resolves and you return to normal walking in a few minutes, then the amount of time spent altering this motor control is minimal, a little harm is done. However, most injuries don't last a few days, as they frequently last days, weeks, years, or even decades. This extended alteration in motor control is damaging and likely causing the results in Butler's study when she compared a few movements in those in remission of low back pain compared to those without low back pain. In fact, the low back pain remission group had higher muscle activation during the activity. However, the posterior fibers of the external oblique had decreased activation. This altered motor programming leads to some muscles being over active and some being under active. Moreover, this leads to stroke compensations which are repeated thousands of times every day, even if not perceptible to the naked eye; all of which leads to risk of reinjury or at least can impair performance if the swimmer is subconsciously using excess tension to maintain normal biomechanics. For a full resolution of an injury, improvement in symptoms, imbalances (muscle length and strength), and motor control (muscle timing) are key! Unless you improve all these facets, your injury is likely to return. In swimming, if you have a history of shoulder injury, you're at a higher risk of reoccurrence, unless the proper precautions and rehabilitation is received. Make sure you seek and demand full improvement of the injury, not simply resolution of pain, as this is far from the end game!

Summary
Do not be content with the resolution of pain. Seek further improvement of the injury and improve the underlying issues of muscle length, strength, and timing. For the shoulder, consider purchasing the Swimmer’s Shoulder System.


Reference:
  1. Butler HL, Hubley-Kozey CL, Kozey JW. Changes in electromyographic activity of trunk muscles within the sub-acute phase for individuals deemed recovered from a low back injury. J Electromyogr Kinesiol. 2012 Nov 28. doi:pii: S1050-6411(12)00195-2. 10.1016/j.jelekin.2012.10.012. [Epub ahead of print]
By G. John Mullen founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

More on Squatting

Last week Dr. Mullen’s squat article (Dryland Mistake: Squat) raised some compelling discussion. Although written from an anecdotal voice, the recommendation is based on science, even if not expressly stated. In this follow up, I’ll address literature supporting that article’s conclusions and discuss more on squatting.

To be clear, there is no study saying “squats are more dangerous than other exercises.”  Yet science does not mean we exclude logic.  Personal observation carries less reliability than the various research layers, but research is particularly limited to test whether something causes injury.  Its one thing if there’s a large population that voluntarily injures themselves (distance runners are one example).  Quite different with predicting whether a particular exercise is harmfu
l, which gets into thorny ethical territory. 

One point overlooked is screening.  Check someone’s squat mechanics before loading up with a bar (and if their mechanics are suboptimal, don’t automatically run for the leg press machine, but that’s a whole ‘nuther discussion!)  If someone has good squat mechanics, a bilateral squat becomes a safer choice, subject to intelligent weight progressions and sound movement patterns under stress.  However, if someone squats poorly without weight, putting a weight on their back is unlikely to improve things.  Much better to find out what someone’s squat looks like with an unweighted squat than with a bar and some giant wheels on their back.  (See the COR Movement Screen for more on swim specific screening).
 

Butler (2010) explored biomechanical differences in lower extremity joints between different Functional Movement Screen deep squat classifications. A “3” in the FMS scoring is a pristine squat, “2” is satisfactory, and “1” is a faulty squat (“0” is pain, but not included in this study).  You don’t have to use the FMS scoring system or the FMS itself, but for sake of this research it does offer a mechanism to differentiate experimental groups.  Authors noted significant differences at the ankle, knee, and hip comparing each squat category, particularly when comparing 3’s to 1’s. 

A fundamentally sound squat requires particular ranges of motion at the key joints.  If mobility and stability don’t occur within those joints, those movements will come from someplace else, placing the body at risk.  But if joint doesn’t move properly in saggital plane, where is that movement coming from?  Your conscious mind doesn’t always get to choose where stress will be distributed, but certain compensations are predictable.  The picture below is revealing.      
If movement is not available in the saggital plane at the hip and ankle, the body may choose excess mobility in the frontal plane via knee valgus.  It may also lose control of the saggital plane with the knees moving forward or the back rounding.  

Macrum (2012) studied 30 healthy individuals in a bilateral (two legged) squat.  One group performed a squat as normal, the other group used a wedge under each foot to restrict ankle dorsiflexion.  Adding the wedge increased both peak knee valgus and median knee displacement.  Authors noted, “Altering ankle-dorsiflexion starting position during a double-leg squat resulted in increased knee valgus and MKD, as well as decreased quadriceps activation and increased soleus activation. These changes are similar to those seen in people with patellofemoral pain.”

One reason to sometimes prefer single leg work for squatting-type movements is that you simply can’t put as much weight on your back.  Even though you have two limbs to support a heavy weight, your body doesn’t always get to decide where the stress is distributed.  Asymmetries are well supported by the literature as a reliable predictor of injury.  They are more easily addressed in single leg environment. 

Muscle activation also differs between single leg versus bilateral work.  McCurdy (2010) studied female division I athletes and found higher muscle activation in the gluteus medius and hamstring in the single leg versus two legged squat, the latter of which showed more quadriceps activation. 

No one is suggesting you don’t squat.  As noted in the previous comment section, the squat is a fundamental movement pattern that all healthy individuals should train.  Its more about using the data to select the proper squat, whether it’s a single leg squat variation, split squat, Bulgarian squat, or a counterbalance squat (CBS) (weight held in front…a goblet squat is one example of a counterbalance squat).  Lynn (2012) compared the counterbalance squat to the regular squat and found the “CBS produces a more hip-dominant and less knee-dominant squat movement pattern and could be used in exercise programs aimed at producing more hip-dominant movement patterns.”

This latter study also raises the importance of understanding corrections.  Some coaches may know what a good squat looks like, but do they know how to fix it.  Thinking about good technique is a start but often an inadequate strategy.  Better to have a library of drill progressions to facilitate the learning process.   

Summary
The words of caution are not based on opinion alone.  Yes, it requires some extrapolation from related data, but there is scientific basis why a bilateral squat can be a provocateur for dryland injuries.  We can reach this conclusion via a research trail if not with a single study.  Most importantly, screen and assess mechanics first, correct any problems, and then place load on the system. 

References
  1. Macrum E, Bell DR, Boling M, Lewek M, Padua D.  Effect of limiting ankle-dorsiflexion range of motion on lower extremity kinematics and muscle-activation patterns during a squatJ Sport Rehabil. 2012 May;21(2):144-50.
  2. Lynn SK, Noffal GJ.  Lower extremity biomechanics during a regular and counterbalanced squat.  J Strength Cond Res. 2012 Sep;26(9):2417-25.
  3. McCurdy K, O'Kelley E, Kutz M, Langford G, Ernest J, Torres M.  Comparison of lower extremity EMG between the 2-leg squat and modified single-leg squat in female athletes.  J Sport Rehabil. 2010 Feb;19(1):57-70.
  4. Butler RJ, Plisky PJ, Southers C, Scoma C, Kiesel KB.  Biomechanical analysis of the different classifications of the Functional Movement Screen deep squat test. Sports Biomech. 2010 Nov;9(4):270-9.
By Allan Phillips. Allan and his wife Katherine are heavily involved in the strength and conditioning community, for more information refer to Pike Athletics.

Dryland Mistake: Squat


If you’re a frequent reader of this website, the headline “Dryland Mistake: Squat” may make you scratch your head. In the past, we have discussed teaching a squat and the front squats application to the backstroke start

The role of strength and conditioning in swimming is highly controversial, as it seems out-of-water strength doesn’t translate to swimming improvement in most events. However, a recent study from Portugal suggests handgrip strength correlated with 100-meter freestyle success in female age-group swimmers. This brings up a whole separate debate, as dry-land and swimming is highly complex. 

However, whether you agree athletes should perform heavy strength training is irrelevant as it is widely accepted general strength and exercise variation is key for youth development of motor control and strength, no matter what sport.

However, the squat poses a few problems despite its common use in sports and resistance training program, a question sparked by strength coach Mike Boyle and was further discussed in the “Strength of Evidence” podcast.

The main issue with squats (specifically heavy loaded squats) is the accompanied risk of injury. Now let’s be honest, all exercises have their associated injury risk, but when someone gets hurt in the weight room squats, deadlifts, and bench press are the common injurious exercises. For swimmers (and all athletes) the first priority of the strength coach is to keep the athletes healthy. This puts this exercise under scrutiny as injuries MUST NOT OCCUR IN DRY-LAND! Remember is the reward worth the risk?

This makes squatting (heavy loaded) a potential dry-land mistake, as it potentially increases injury risk. Moreover, alternative exercises exist which are potentially just, if not more, beneficial. The main exercise Mr. Boyle discussed was the Bulgarian Deadlift (BDL) also known as the rear foot elevated squat. This exercise is unilateral and likely puts less stress on the low back.  Moreover, the BDL increases the emphasis on the legs, which likely stresses the glutes and quads more than squats, but most importantly it may decrease the risk of injury as the spine remains vertical, even with heavy weights. It also uses reciprocal hip activation (front of one leg and back of the other), similar to long axis swimming kicking.  

To summarize, squats alone are not a dry-land mistake if performed properly, but heavy loaded squats are potentially more injurious than other, similarly effective exercises like the BDL. Heavy squats are an advanced strength training exercise, yet most swimmers (even elites) are actually novices on dry-land. Heavy squats are fine if you have worked your way through the progression, which actually takes years of daily practice and which most swimmers have not achieved, nor should they, spend the time in the pool!

We wouldn't have a novice swimmer do sets of 200 flys...its obvious to any swimmer and swim coach that getting there takes years of progression and daily training. So why would we take swimmers who are relative beginners in the gym and give them exercises (heavy squats) that are equivalent to giving novice swimmers 200 fly sets? Before any exercises are prescribed a systematic screen is necessary for finding weak areas, then these should be addressed for swimmers of all ages. Just remember, keep the exercises safe, effective, and efficient, not matter the deviation found.


By G. John Mullen founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.
 

Pain and Swimming Part II


If you missed part I, read Pain and Swimming Part I.

Hodges proposed a newer and more complicated theory on pain:

“The new theory proposes that pain is associated with an adaptation in motor behavior that: 
  1. Involves redistribution of activity  within and between muscles (rather than inhibition or excitation of muscles in a stereotypical manner) .
  2. Changes the mechanical behavior such as modified movement and stiffnes.
  3. Leads to ‘‘protection’’ from further pain or injury, or threatened pain or injury (as a result of a variety of changes such as decreased activity to reduce voluntary movement, increased activity to splint a body region, or change distribution of activity to modify the distribution of load on a structure). 
  4. Is not explained by simple changes in excitability, but involves changes at multiple levels of the motor system and these changes may be complementary, additive or competitive (rather than isolated effects of nociceptor afferent input at the spinal cord). 
  5. Has short-term benefit, but with potential long-term consequences due to factors such as increased load, decreased movement, and decreased variability (Hodges 2011).”
This new model helps guide pain intervention suggesting motor control or neuromuscular rehabilitation exercises, psychological intervention, and physical modalities (Hodges, 2011).
 
Muscle Length and Strength Compensations
Hodges’ model is a bit more complex, but necessary for total improvement. However, his theory combines a lot of the two older theories. Vladamir Janda discussed alterations in muscle length in the 1970s and it’s unlikely he was the first. In fact, this occurs in many animals as a means of protection from further injury.

Hodges states:

“A variety of options are available to meet the overall objective of protection. In some cases this may involve reduced activity (such as the inhibition of masseter muscles during painful jaw movement (Svensson et al., 1997) consistent with the pain adaptation theory), increased activity (such as increased activity of sternocleidomastoid in neck pain (Johnston et al., 2008) consistent with the vicious cycle theory) or a combination of both (such as increased and decreased abdominal muscle activity with slow trunk movements during experimental pain (Hodges et al., 2006, 2011)”

It appears this compensation has short-term benefit, but with long-term consequences.
Therefore, resolving the muscle length and strength are essential for improvement in pain and preventing further dysfunction. Luckily, these two typically go together as one improves the other in most cases.

Muscle Timing Disruptions
Muscle timing has many aliases, but simply means an alteration in motor programming. These alterations are not beneficial, as they disrupt motor planning. These disruptions result in:
 
“Delayed and reduced activation of the transverse abdominis is common in low back pain, it exist between pain episodes (Hodges and Richardson, 1996; Ferreira et al., 2004), and can be induced by experimental pain (Hodges et al., 2003). Delayed and reduced activation of transversus abdominis can be restored with motor relearning strategies (Tsao and Hodges, 2007). These changes persist after cessation of training (Tsao and Hodges, 2008), are related to the magnitude of improvement in pain/disability (Ferreira et al., 2010), and baseline values can indicate individuals who will respond to the intervention (Ferreira et al., 2010). These interventions also change the organisation of the motor cortical networks (assessed with transcranial magnetic stimulation of the motor cortex) that have input to this muscle (Tsao et al., 2010b) and the amplitude of change in timing is related to the magnitude of cortical reorganization (Tsao et al., 2010b). Current data do not clarify whether symptom improvement is due to improved activation of transversus abdominis or the resolution of other aspects of the adaptation, such as more optimal control of other trunk muscles or movement and/posture. Regardless, the activation of transversus abdominis serves as a useful marker of the motor recovery (Hodges, 2011)”.

Worst of all, these flaws in muscle timing remain after the painful stimulus is removed! Janda termed this a functional lesion and leads to many muscular imbalances, increasing risk for further injury. A functional lesion is the result of movement alteration and:

“This is seen as many compensatory strategies exist after the painful stimulus is removed: If the motor adaptation was simply due to input from nociceptive afferents on motoneurons (Kniffki et al., 1979) or due to reflex inhibition (Spencer et al., 1984) it could be assumed that the most appropriate treatment should be application of techniques to reduce pain (e.g. analgesic agents) or techniques that may increase motoneuron excitability (e.g. peripheral electrical stimulation). Treatment of pain is unlikely to be sufficient to restore motor control as it has been shown that many aspects of the motor adaptation persist between episodes, despite resolution of pain (Hodges and Richardson, 1996; MacDonald et al., 2009; Hodges 2011).”

Therefore finding methods to feed the nervous system raw, correct data is essential to reset the clock and improve muscle timing.

Next week, this series will tackle exercising with pain.

By G. John Mullen founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.

Pain and Swimming Part I

Missing time from the pool is detrimental for swimming success as swimming is the best mode for swimming improvement. As much as I love dry-land, swimmers benefit more from being in the pool. It's the SAID (Specific Adaptation to Imposed Demands) principle at work- the more related your training is to your competition activity, the better your competitive performance will be!

Unfortunately, pain prevents many swimmers from training. Pain is a complex topic as many swimmers do not know how to differentiate pain from soreness. Often times acute pain is a signal of a possible injury, where soreness is the result of delayed onset muscle soreness (DOMS). The lack in feeling makes distinction difficult and being precautions is essential for many reasons most noted by Paul Hodges, a renowned pain researcher.

Pain typically accompanies an injury. This could be micro or macro damage; nonetheless the result is still the same, only the magnitude differs.


Stub toe -> Inflammation to foot -> repair to injured tissue -> modeling to injured tissue. This is discussed in more detail in Tips to Improve Shoulder Inflammation and Inflammation and Anti-inflammatory Medication.

This piece will discuss theoretical events which occur during pain, typical compensations in muscle length and strength, disruptions in muscle timing, training and pain, and a guide to improve pain while maintaining feel.

Leading pain researcher Paul Hodges released a review article titled: Pain and motor control: From the Laboratory to rehabilitation in 2011. Another excellent article is Reconceptualising Pain According to Modern Pain Science by Lorimer Moseley. A lot of these ideas are taken from this excellent resource and I suggest getting a copy of this article for further understanding.

Theories
There are two theoretical models for this motor adaptation to pain:
  1. Vicious Cycle: proposes an increase in muscle activity that is painful or move in the painful region. This increase in muscle pain is theorized to cause ischemia from vascular compromise and accumulate pain metabolites.
  2. Pain Adaptation: argues activity of a muscle that is painful or produces a painful movement is uniformly inhibited, while the opposite muscle (antagonist) is facilitated.

Of the two theories, the pain adaptation model has more data in its corner, as muscles have been shown to be overactive and weakened in the leg (Graven-Nielsen 1997). However, both of these theories are far from proven, since just as much research opposes as confirms each theory.

Moseley argues pain is much more complex and the biology of pain is never really straight-forward. This series will discuss the complexity of pain and how to handle pain secondary to injury, readily returning the swimmer to the pool.

By G. John Mullen founder of the Center of Optimal Restoration, head strength coach at Santa Clara Swim Club, creator of the Swimmer's Shoulder System, and chief editor of the Swimming Science Research Review.