Stephen Paea breaking the NFL Combine Benching Record with 49 reps

Rep Speed for Bench Press to Optimize Output

If you workout there is a very good chance that at some point during your week, you are performing a bench press.

In this Italian journal, authors have looked at effects of velocity on strength training during a supine barbell chest press.

Taken from: http://www.nfl.com/combine/story?confirm=true&id=09000d5d806ceaab&template=with-video

20 subjects were separated randomly into two groups where the average age was around 40, height about 5'8" (remember Italians like me are not the tallest!) and with similar training history (averaging to 20 years). The first group was the fixed pushing group (pushing at 80-100% max speed) and the second group performed at a self-selected speed (whatever I feel like!!).

At the beginning of the study, each of the subject's single repetition maximum was determined through what was referred to a "touch-and-go" technique:

"(A) a warm-up including 5-10 repetitions at 40-60% of the estimated 1 RM, (B) 1-min rest with light stretching followed by 3-5 repetitions at 60-80% of the estimated 1 RM, (C) 3-5 attempts to reach the 1RM with 5-min rest intervals between each new lift. The maximum weight that was successfully lifted was recorded.... After 3 and 5 days, all subjects were tested in a bench press exercise at 85% and 100% of 1RM in the same manner as on the first day in order to ascertain their specific maximal speed"

Once the 1RM was determined, the strength training would begin. Training took place over 3 weeks, and with only 2 training sessions per week (subjects were told that no high intensity endurance activity could be performed outside of this study).

The fixed speed group performed 85% 1RM and stopped when the speed dropped by 20%. Recovery between sets was 2 minutes, and the subjects stopped the session when they could not arrive at the base calculated speed.

The self-selected speed group would perform 85% 1RM until failure, with a 2 minute break between sets until they could not do another push.

Taken from: http://www.coreperformance.com/daily/play-better/nfl-combine-secret--1-boost-your-bench-press.html

The results are in: maintaining that fast speed is more important than pumping out all those reps! Both strength and velocity measures had significant changes in the fixed speed group as the self-selected speed group had minimal changes (non-significant).

Specifically, this study showed that high velocity training can make an >10% strength increase in only 3 weeks! This is even more incredible seeing as the fixed speed group had less overall reps thus less overall pushed weight.

Lets just take one step back for a second though: these individuals had an average training history of about 20 years. These athletes had no current history of muscular or tendinous injuries, and had a good grasp of how a bench press should be done. Do not be surprised that when you go to see your physiotherapist for a shoulder injury that you will be working with a much smaller load, and without that high-velocity approach as this could disrupt healing.

Also a heads up if you haven't been watching it's the season of of NFL COMBINE! Check it out on nfl.com if you want more information. One of the events is the bench press: how many times can you bench 225? The season may be over, but the hype is still there!

Padulo, J. et. al. (2012). Effect of Different Pushing Speeds on Bench Press. International Journal of Sports Medicine, volume(?)(2), pp?.

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Anatomy of the Shoulder

To be able to fully understand your condition, you have to know the anatomy of the area of injury. I have been very lucky for a couple reasons: I have a father that lectures in the Department of Anatomy at the School of Medicine and I worked as a prosector for the School of Medicine for 3 years (the former helped put a good word in for the latter... thanks dad!). Being able to see under the skin and appreciate the depth and nuances of human anatomy has been extremely helpful in my career as a physiotherapist.

The shoulder is not only one of the more complicated joints of the body, it is also very complicated. We will start at the deepest level (the bones and joints) and make our way more and more superficially until we are at the skin level.

FIRST LAYER

The shoulder complex (depending on how you see it) is made up by three bones: the humerus (arm bone), the scapula (the shoulder blade), and the clavicle (collarbone). These bones will link together in what is called a joint, and in the shoulder there are 4 joints (with one pseudo-joint). The obvious first joint is the glenohumeral joint (GHJt), this is the ball-in-socket joint made by the humerus (ball) and the scapula's glenoid fossa (socket). The other joints are the acromioclavicular joint (ACJt), the sternoclavicular joint (SCJt), and the scapulothoracic joint (ScTJt - not really a joint). The GHJt, ACJt, and SCJt have a wrapping around the surfaces of the joint - called the joint capsule.

 

Taken from: http://www.activemotionphysio.ca/Injuries-Conditions/Shoulder/Surgery/Artificial-Joint-Replacement-of-the-Shoulder/a~374/article.html

Taken from: http://www.shoulderdoc.co.uk/patient_info/shoulder-anatomy.asp.

Injuries that may occur at this level of anatomy consist of fractures of the bone (commonly humeral head fractures and clavicular fractures), as well as joint capsule tears (AC joint separation - aka separated shoulder or shoulder dislocations). Usually only traumatic mechanisms of injury result in these pathologies.

One thing I would like to highlight is a structure that lies within the GHJt, the labrum. As I noted above, the GHJt is a ball-in-socket style joint and this design allows you amazing mobility about the shoulder to move in all directions. The problem is that in gaining mobility, we lose stability and this is why the shoulder is such a common area of injury. The socket of the GHJt is actually very shallow, but this is where the labrum helps out. The labrum deepens the socket in order to gain more passive joint stability. This being a soft tissue, this structure is prone to injuries such as tearing.

Taken from : http://www.wikidoc.org/index.php/Glenoid_labrum

The above image shows a side view of the shoulder looking directly into the glenoid fossa or socket of the GHJt. The labrum is tagged as the GLENOID LIG. You can also see here that one of the bicep tendons is attached to the labrum. The labrum is damaged often with anterior shoulder dislocations (where the ball pops out in a forward direction) - these pathologies can sometimes be termed Hill-Sach's lesions or Bankart lesions.

SECOND LAYER

The next layer would be the ligaments of the shoulder. Ligaments cross over joints to help stabilize them from excessive movement and are made up of strong collagen fibers. These too usually are damaged only with strong impact forces or high velocity forces.

Image taken from http://www.blog.sportstrap.com.au/how-to-strap-a-shoulder/

These ligaments create what we call Passive Stability, where there is no physical expenditure of energy to maintain this stability. But what happens if you damage some of your passive stability structures? Well that's what the next layer is for!

THIRD LAYER

This is the level where the rotator-cuff muscles and deeper muscles of the shoulder sit. Lets go over the rotator-cuff muscles first.

Just as it sounds, these muscles make a muscle cuff around the shoulder in order to help with rotary movements at the joint surface. It is comprised of four small muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. You can see by this great image by ADAM, where these muscles sit.  

FYI anterior (latin: ante - before) means looking from the front and posterior (latin post - after) means looking from the back.

 

This image taken from: http://health.allrefer.com/pictures-images/rotator-cuff-muscles.html

The rotator-cuff muscles create Active Stability. You may be required by your physiotherapist to train the rotator-cuff muscles in order to gain active stability to make up from the lack passive stability caused by an injury. Sometimes muscle imbalances or postural changes can lead to positional changes of the humerus in the glenoid fossa. This, over time, can manifest in internal or external shoulder impingement syndromes, and may follow with a non-traumatic rotator-cuff partial or full-thickness tear. The most common muscle being injured is the supraspinatus tendon that (with poor posture and muscle imbalances) can be irritated in the sub-acromial space.

Taken from: http://optimumsportsperformance.com/blog/?p=638

At this same deep level, there is also the long head of the biceps tendon (there are two tendons, this bi. Latin = 2). There is a groove on the humerus that this tendon makes its way through and attaches itself to the aforementioned superior (latin: top) of the labrum. You can see in the image above where this tendon runs. After the supraspinatus, this is the 2nd most common tendon to become irritates and become strained (aka: bicipital tendonosis).

FOURTH LAYER

POSTERIORLY:

In the back, there are a number of larger, superficial muscles that can control the movement of the scapula on the thoracic wall and movement of the humerus on the scapula. Both groups of muscles must work in concert to be able to have full and pain-free range of motion (creating a scapulo-humeral rhythm). To have full arm elevation, we require the arm to lift, but also the shoulder blade to turn upwards (in fact, we even need the upper part of our thoracic spine to extend, but that will be for another post!).

Lets take a look at some of the muscles on the posterior surface of the back that affect the shoulder:

 

Taken from: http://strengthconditioning1.blogspot.com/2010/05/musculature-of-shoulder.html

This image shows the three sections of the trapezius muscle (all of which do completely different activities), the latissimus dorsi (the pull-up muscle), teres major, rhomboid major and minor (the rowing muscles), levator scapulae (latin: shoulder blade lifter) and the deltoid. Each of these muscles create different movements to the shoulder, which I will leave out for another posting. An unmentioned muscle here would be the triceps muscle.

ANTERIORLY:

Here lies the pectoral muscles (major and minor), biceps, coracobrachialis, serratus anterior (latin: saw-like) and subclavius

 Taken from: http://virtual.yosemite.cc.ca.us/rdroual/Lecture%20Notes/Unit%203/muscles%20with%20figures.htm

Taken from: http://puckthathurts.wordpress.com/2011/07/13/torn-pectoral-gross-dude/

OTHER STRUCTURES:

Although unmentioned, there are other structures than just the bones, joints and muscles in the shoulder.

There are nerves that supply each of the muscles, the joint capsules, the ligaments, and even the bones themselves. Compression, torsion, adhesion, or tension can irritate these nerves and lead to manifestations in the shoulder. Often a component of shoulder complaints stem from issues going on in the neck, possibly irritation on a nerve root. Irritation can appear as numbness or tingling down the arm, weakness, or simply pain.

Taken from: http://www.nlm.nih.gov/medlineplus/ency/imagepages/9129.htm

There are a number of bursae (fluid filled sacks) that sit between muscles to stop too much friction from occurring. These structures can be irritated with continual overhead motion that occurs with swimmers, pitchers, and even drywallers or electricians.

Taken from: http://www.uk-muscle.co.uk/shoulders/17110-subacromial-bursa.html

There are also blood vessels (arteries and veins) and lymphatic drainage areas. Compression to an artery can lead to a numbness type of feeling (can be distinguished from nerve numbness). Compression or damage to the veins or lymphatic system can create edema (swelling) to the arm and hand.

 Taken from: http://anatomyhq.org/wp-content/uploads/2011/10/Superficial-Arm-Veins1.gif

Taken from: http://www.rci.rutgers.edu/~uzwiak/AnatPhys/Blood_Vessels_files/image028.jpg

 

Taken from: http://year2.comyr.com/6_files/C6FF13.png

SUMMARY

This is not the complete anatomy of the shoulder, as there are a number of items that we did not go into much depth about, with specific movements of the shoulder being one of those topics. I hope to go into further depth at another time. We will use this posting as a guide to further topics about the shoulder.

If you have been diagnosed with any of the previously mentioned conditions, there is much a physiotherapist can do for you. Your orthopaedic physiotherapist is a specialist in human anatomy and body movement. If you have pain in your shoulder or arm and do not know what is causing your pain or loss of function, contact your physiotherapist for an assessment; you do not require a referral from a physician.

I hope that this opened deeper thought and possible discussion about the shoulder and its injuries. Please post any feedback or questions below!

As if it wasn't cold enough already!

We are well into February, and we are finally getting the winter that forgot to freeze us in January. Regardless of the temperature outside, sometimes we are required to ice our injuries.

In my experience, I apply ice for acute injuries that have a component of active swelling. My goal is to cause vasoconstriction of the local blood vessels so that they do not allow too much exudate (fluid) into the damaged area (possibly allowing early mobilization and rehab of the tissue).

 This is an image of Maria Sharapova getting her shoulder iced after a practice at Edgbaston in 2007. The image was taken from www.birminghampost.net/news/news-gallery/2009/05/18/maria-sharapova-at-edgbaston-2007-65233-23653722/

Ice can only penetrate the body's skin so deep and so in some instances (although there may be swelling and an acute trauma) there is no valid reason to ice simply because there is no cooling effect to the deep structure in question.

This topic does bring up the question of when to use ice and when to use heat, and what pathologies it can be helpful with. Today, I am more interested in the question arises when you are told by your therapist/doctor to ice your injury, what is the best method to do this: well it seems that Joseph Dyskra, MA, ATC from Western Michigan University has answered this very question.

Dyskra found that previous studies outlined how ice cubes/flakes and crushed ice performed better overall with cooling than a bag of peas or a cryogenic gel pack. He then realized there was no comparison between types of actual ice application. This study contrasts the use of cubed ice (2000ml) vs. crushed ice (2000ml) vs. wet ice (2000ml of cubed ice, plus 300ml of room temperature water). All were placed in a polyethylene bag.

Image removed from www.runnersworld.co.za/injury-prevention/the-right-way-to-ice-an-injury/   Thank-you.

The ice was applied to 12 study participants on the back of their calf, and temperature was measured on the surface of the skin, as well as two centimeters below the subcutaneous level (i.e. plus half the skin fold).

With 20 minutes of application, it was found that the wet ice was more effective at cooling the surface tissue, as well as the intramuscular tissue.

If you are directed that you may benefit from the application of ice/cold to your injury, grab a large ziplock bag and fill it with at least an entire tray of ice (2 litres is the same a 11.2 cups) and a small amount of luke-warm tap water. Apply for 20 minutes, and reap the benefits!

Dykstra, J. et. al. (2009). Comparisons of Cubed Ice, Crushed Ice, and Wetted Ice on Intramuscular and Surface Temperature Changes. Journal of Athletic Training, 44(2), 136-141.

Suffering from Headaches?

It's the end of the work day and you can feel it coming on: the pounding starting at the back of your skull and reaching over your head into your eyes and temples. You try to stretch your neck out side to side with no avail, the headache stays. In an article published in the journal Cephalagia, Stovnern et. al. found that upwards of two-thirds of the world's population suffers from headaches.

There are many different types of headache, and may be caused from a number of different issues. Some of the more common headaches are migraines, tension headaches, and cervicogenic headaches (CGH).

I'd like to write about the latter of that group today, as this is a kind of headache that physiotherapy can have the greatest impact on (although tension headaches, we can also help with!).

Cervicogenic put simply means that the pain originates in the neck, typically the area from the bottom of the occiput (skull) to the third cervical spine. The actual definition of a cervicogenic headache is published by the International Headache Society (IHS) and is explained as pain, referred from a source in the neck and perceived in 1 or more regions of the head and/or face.

Diagnosis of cervicogenic headaches can be done by your physiotherapist through an assessment method known as the flexion-rotation test, or FRT. This test checks for rotational mobility between the first (atlas) and second (axis) cervical vertebrae - the atlanto-axis joint or AA joint (the motion at these joints contribute almost half of our total neck rotation). If there is marked loss of rotation to one side, it there is a very good probably of having restriction in the  AA joint that is leading to your headaches. The restriction is often on only one side, and thus headaches are also predominantly on that same side.

Okay, great. My physiotherapist has given me a diagnosis of having a restriction in my AA joint leading to headaches, now what the heck can I do about it??

With proper diagnosis, we can give a very specific exercise to help mobility of this joint. The exercise can then be used when you have your headaches, and diminish or abolish your symptoms!

This image was taken from the research article of Hall et. al. in JOSPT (see reference below).

The image above shows the patient working on a restriction on the left side of her neck. She is using a custom strap, but this can also be done with a towel. Pressure is applied by the right hand on the left atlas (C/1) while looking forward. Pressure is maintained on the atlas as you rotate as far to the right you can without pain. End-range is then held for a few seconds, and then you return to the start position, while again maintaining the forward pressure on the atlas.

 

This is an image of Jack Miller performing a Mulligan technique in one of their DVDs. 

This technique was first shown to me by Jack Miller (PT, FCAMPT), who is a great physiotherapist based out of London, during a lecture of CANZED seminars: Mulligan Concept - Upper Quadrant Procedures. This exercise takes the name of a self-SNAG aka self-sustained natural apophyseal glide, meaning we are maintaining pressure on the joint through normal pain-free motion.

A study published by Toby Call, MSc. in 2007 show the efficacy of this self-SNAG technique with those clients that have AA joint restriction leading to headaches. The study took 32 subjects with CGH and FRT limitation. The study was double-blinded and placebo controlled (aka: a wonderful study!). After the first visit, those in the self-SNAG group already had marked improvement in range of motion (mean: 15 degrees), and had a lower self-reported headache index questionnaire than their control counterparts at 4 weeks and at 12 months.

If you are suffering from headaches, and you are not sure where the pain may be coming from, or you are certain it is coming from the neck, I suggest that you go for an assessment of your neck by an orthopaedic physiotherapist. We will be able to properly assess your condition to see if you may benefit from physiotherapy, and whether this technique may be ideal to help you self-manage your pain. Call in for an appointment today at 204-421-9177!

Hall, T. et. al. (2008). Clinical Evaluation of Cervicogenic Headache: A Clinical Perspective. The Journal of Manual and Manipulative Therapy. 16(2), 73-80.

Hall, T. et. al. (2007). Efficacy of a C1-C2 Self-sustained Natural Apophyseal Glide (SNAG) in the Management of Cervicogenic Headache. Journal of Orthopaedic & Sports Physical Therapy. 37(3), 100-107