Problems with Nutrition Research

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Appearances to the mind are of four kinds.
Things either are what they appear to be;
Or they neither are, nor appear to be;
Or they are, and do not appear to be;
Or they are not, and yet appear to be.
Rightly to aim in all these cases
Is the wise man’s task.
Epictetus, 2nd century AD

If you pay attention to the news then you don’t go a day without hearing about nutrition research. Alcohol, chocolate, meat, fat, carbs, protein, fiber, sugar, this diet, that diet, and a galaxy of supplements are under constant scrutiny. You may also notice that studies seem to frequently contradict one another. (The health effects of alcohol are a notable example.) It’s easy to become confused and frustrated as you search for accurate information. (And that’s just with the valid research out there. Throw in the junk “research” behind bogus supplements and snake oil and you may simply want to give up being informed.)

I’m neither a researcher nor a statistician but I respect the need for solid research into health, fitness, nutrition, and the like. I understand that valid research requires a large number of study subjects. The best studies are designed as double-blind placebos. Finally, research results must be replicated several times over in order to be seen as valid and worth taking seriously. Beyond that, I don’t have a good grasp of statistical methods so I can’t always tell if the conclusions drawn from the research are accurate. Thus I’m often confused by what I see and hear around nutrition research.

If you consider yourself a well-informed, educated, healthy person who finds yourself confused by conflicting nutritional studies then an article in the New York Times, More Evidence That Nutrition Studies Don’t Add Up, may help you understand your frustration. The story discusses the shoddy research practices of Cornell University researcher Dr. Brian Wansink.

The article goes beyond Dr. Wansink’s malpractice to discuss general, widespread nutrition research problems:

“Dr. Wansink’s lab was known for data dredging, or p-hacking, the process of running exhaustive analyses on data sets to tease out subtle signals that might otherwise be unremarkable. Critics say it is tantamount to casting a wide net and then creating a hypothesis to support whatever cherry-picked findings seem interesting — the opposite of the scientific method. For example, emails obtained by BuzzFeed News showed that Dr. Wansink prodded researchers in his lab to mine their data sets for results that would “’go virally big time.’”

“’P-hacking is a really serious problem,’” said Dr. Ivan Oransky, a co-founder of Retraction Watch, who teaches medical journalism at New York University. “’Not to be overly dramatic, but in some ways it throws into question the very statistical basis of what we’re reading as science journalists and as the public.’”

“Data dredging is fairly common in health research, and especially in studies involving food. It is one reason contradictory nutrition headlines seem to be the norm: One week coffee, cheese and red wine are found to be protective against heart disease and cancer, and the next week a new crop of studies pronounce that they cause it. Marion Nestle, a professor of nutrition, food studies and public health at New York University, said that many researchers are under enormous pressure to churn out papers. One recent analysis found that thousands of scientists publish a paper every five days.”

Further:

“In 2012, Dr. John Ioannidis, the chairman of disease prevention at Stanford, published a study titled “’Is Everything We Eat Associated With Cancer?’” He and a co-author randomly selected 50 recipes from a cookbook and discovered that 80 percent of the ingredients — mushrooms, peppers, olives, lobster, mustard, lemons — had been linked to either an increased or a decreased risk of cancer in numerous studies. In many cases a single ingredient was found to be the subject of questionable cancer claims in more than 10 studies, a vast majority of which “’were based on weak statistical evidence,’” the paper concluded.

Nutrition epidemiology is notorious for this. Scientists routinely scour data sets on large populations looking for links between specific foods or diets and health outcomes like chronic disease and life span. These studies can generate important findings and hypotheses. But they also have serious limitations. They cannot prove cause and effect, for example, and collecting dietary data from people is like trying to catch a moving target: Many people cannot recall precisely what they ate last month, last week or even in the past 48 hours. Plenty of other factors that influence health can also blur the impact of diet, such as exercise, socioeconomic status, sleep, genetics and environment. All of this makes the most popular food and health studies problematic and frequently contradictory.

In one recent example, an observational study of thousands of people published in The Lancet last year made headlines with its findings that high-carb diets were linked to increased mortality rates and that eating saturated fat and meat was protective. Then in August, a separate team of researchers published an observational study of thousands of people in a related journal, The Lancet Public Health, with contrasting findings: Low-carb diets that were high in meat increased mortality rates.

“’You can analyze observational studies in very different ways and, depending on what your belief is — and there are very strong nutrition beliefs out there — you can get some very dramatic patterns,’ Dr. Ioannidis said.”

Read the article to learn more.

If this topic interests you then you should also read Congratulations. Your Study Went Nowhere, also from the New York Times. Among other things, it discusses an interesting problem with research publication. That is research with positive findings gets published far more than research with negative findings.

For instance, let’s say my study finds evidence that eating peanut butter increases IQ. Meanwhile, six other studies find no relationship between peanut butter and IQ: “Nothing to see here folks!” My positive study is more likely to be published than the negative studies. This is a type of publication bias. Positive studies are thus more likely to be mentioned in the news even if they’re outnumbered by negative studies. The article describes two types of biases:

Publication bias refers to the decision on whether to publish results based on the outcomes found. With the 105 studies on antidepressants, half were considered “positive” by the F.D.A., and half were considered “negative.” Ninety-eight percent of the positive trials were published; only 48 percent of the negative ones were.

Outcome reporting bias refers to writing up only the results in a trial that appear positive while failing to report those that appear negative. In 10 of the 25 negative studies, studies that were considered negative by the F.D.A. were reported as positive by the researchers, by switching a secondary outcome with a primary one, and reporting it as if it were the original intent of the researchers, or just by not reporting negative results.

We never hear a TV news reporter say, “Nine studies found absolutely no relationship between food X and cancer.” In other words, we only hear the bell that’s rung, not all the other bells that aren’t rung. The obvious problem is that if shoddy research findings are reported (vaccines linked to autism is a prominent example) and we may hear reports from multiple credible sources, then we start to believe false information. There are serious consequences to this problem.

 

 

An Abrupt End to the Racing Season :-(

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It is with a snarling, frustrated, heavy relieved, accepting, grateful heart that I must call an abrupt end to my 2018 trail racing season. I’ll miss both the Pikes Peak Ascent and my main event, the Grand Traverse. It’s all due to a gimpy left calf and a bad decision on my part.

Good decisions

The calf strain came a few weeks ago while climbing during a race. I did the right thing. I quit the race and avoided further injury. I took two weeks off from running. I saw Dr. Nick Studholme who taped my foot and calf and helped me understand the injury. We decided on a collection of exercises to help the area heal and get stronger. I did calf and lower-leg strength work to my level of tolerance.

Last Monday I did an easy road run for the first time and I felt good. Great! Then I had a decision to make: Do I continue a slow, gradual return to running protocol? Or do I jump quickly back into hard training?

A bad decision

I chose option two, a seven-mile trail run with intervals. Everything felt fine until about mile three. I took a big step off a rock, landed on my left foot, and felt some pain low in the calf, the same area that was hurt in the race. I didn’t crumple in agony but there was noticeable discomfort. I kept running. I hoped the pain might fade out or simply be a minor annoyance. It hurt more as I ran and hurt less when I walked. That is a clear-cut indication of an acute injury that must be unloaded and allowed to rest. I made the wrong decision.

The Pikes Peak Ascent is two weeks away. Uphill running will put my calf under massive stress. I was running uphill when I hurt it the first time. Two weeks is probably enough time to start running again, but by god isn’t nearly enough time to prepare for an 8000 ft. ascent.

Madness

The 40+ mile Grand Traverse is four weeks away. Four weeks… That’s not much time… Is it enough time…? If you’re an endurance athlete then you may recognize the following line of “reasoning.” The conversation I had with myself went something like this:

“I’ve heard of athletic miracles, of players coming back from near-disastrous injuries and illness with incredible performances. Can that be me?”

“Can I replace running with mega-miles on the bike, rehab the calf, and get to the start line of the Grand Traverse?”

“Are there miracle drugs? Can steroids help? If so, should I attempt to use them?”

(I’ve never considered steroids but I did learn a few things about them. The good news is that several significant factors including ugly/weird other effects put me off this route.)

Panic

I screeched into a blistering panic for about 48 hours. I came up with all sorts of irrational, desperate thoughts. It was agonizing and depressing. The emotional part of my brain had a flailed and reeled as the rational part held up the facts about my injury and the reality of running a 40-mile race in four weeks.

Waaah! The poor privileged white man may not get to run recreationally through the woods! 

In the context of the wider world, of suffering, of true hardship, this was not an actual problem… but sometimes things bother me.

Sanity and calm

I spoke with my coach, Andrew Simmons of Lifelong Endurance. He helped me. He did what a good coach should do: Tell the truth. We both agreed that Pikes was out. As for the GT, he said there was a far outside possibility that I could jog/hike the race, stagger across the finish line in misery,  damage my calf severely, and destroy my ability to run for 60-90 days. These were the facts. My decision was crystal clear. No more racing. Heal up. Get ready for next year.

We agreed to reconnect again in several weeks. He recommended I be able to run 20-25 miles per week with 10-12 mile long runs before I commit to serious training.

To be very clear, I place no blame on Andrew or the running plan for my injury. I was making solid progress and I have been entirely satisfied with Andrew’s coaching. I fully intend to enlist his help again on future races.

The upside

Adverse events are guaranteed to happen. Any athletic endeavor comes with risk. Trail running is risky. Ultra-distance running even more so. There are innumerable variables that must align for a successful race and a successful season. It’s entirely likely that something or several somethings can go wrong. How does one react? To me, that’s a crucial issue. Does one wallow in self-pity and self-criticism or is there a better way? I choose to observe several positive details:

First and most importantly, my mind is right. I love the training: running in the mountains, preparing to race. My motivation is sky high—I love the process! — and I am deeply grateful for my time on the trail in the mountains. I have every intention of running the races I missed this year. I carry no negative emotions around trail running.

Second, I try to be resilient in these circumstances. I’m not Mr. Spock, I have emotions and I definitely experience the intense anguish familiar to any athlete who’s hobbled by an injury. Once the teeth gnashing and the freakout is over though I try to move forward in a positive way. Ruminating and stewing over past events is wasted energy, it won’t heal my calf faster, and unless you have a time machine I can borrow so I can go back and fix my mistake, I’ll never be able to change the past. Move forward.

Third, I recognize the significance of my weak link. My left lower-leg/ankle/foot/calf is a continual problem. I do just enough rehab/strength work to push the problem away, then I ignore the weak link and the problems return. I believe the recent hard running I’ve done has exposed the weak link again. Calf work is boring for me. I don’t like it so it’s easy to avoid it. The problem is that it’s critical for my running success. (I’ve discussed this in the past.) It stares me in the face. I have a choice: I can continue to follow the same process and thus I should expect the same problem to return. Or I can devote significant energy to build up my lower leg, armor it, make it strong and resilient, and expect to perform better. I have a chance to make a better choice going forward and address my calf strength the way I should.

Finally, I had a great experience working with my coach. We moved my running in the right direction. Specifically, we worked on tempo runs. I got faster over longer distances. The hard runs felt good and I made progress. My final long run of 20 miles felt superb. I fully believe that I’ll return to a high level of performance with Andrew’s guidance.

There is always an upside to a regrettable situation. Always. Now I get to spend a lot of time on the mountain bike!

The Left Calf Strikes Again. No Running for A While.

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Damnit.

Two weekends ago, I was looking forward with much enthusiasm to the 25k Under Armor race at Copper Mountain. I’d completed a strong 20-mile run the previous weekend to cap off several weeks of hard training. I felt good and everything seemed in proper working order. So it was a surprise to me that I had to quit the race at mile two due to calf/Achilles pain.

The race started immediately with a long climb. It wasn’t terribly difficult, nothing for which I didn’t feel prepared. I was warmed up, had done some running-specific joint mobility drills, and I felt 100% ready to go. Temperatures were in the 60s and the sky was clear. Everything seemed in place for a good performance.

Noticeable calf pain started about 30-minutes into the race. It got worse with every step. Nothing snapped or gave way but the pain came on within several minutes and it quickly slowed my pace.

It’s not uncommon to have some odd ache or pain that fades out after a few minutes of activity. Not this time. Every step was more painful than the last. I stopped a few times, wiggled my foot, stretched the calf a little, tried to do anything at all to fix the issue and no luck. I was limping. One of the rules of pain to which I adhere is that if the pain is enough to alter my mechanics then it’s time to stop the activity.

This felt like an acute injury with pain brought on due to tissue damage. This pain wasn’t behaving like chronic pain. A light-speed PowerPoint presentation of possible outcomes flashed through my mind as several race-related questions materialized:

  • Could I limp and hobble my way to the finish? I had about 13 miles and a lot of climbing left to do. At best it would take all day and I would limp painfully across the finish line. At worst I would have a seriously injured calf and wouldn’t be walking for weeks.
  • What about my other races??? I have two other races, including the main event, the Grand Traverse on Sept 1. That’s the goal and the primary focus for this season. Anything that derails that race is to be avoided. This was a strong argument to quit.
  • My ego sprang to life, the ego that identifies as a runner, a personal trainer, a very fit person, and someone who knows how to guard against injury. For good or ill, this ego needs others to know all these things, and see me as I want to see myself. To tell others that I quit a race could be a serious blow to Mr. Ego. This emotional, irrational dude pleaded to find a way to push on.
  • Some 43-year-old part of my being chimed in. This individual seemed educated, experienced, emotionally balanced, and most importantly, honest. This voice evaluated the evidence and stated clearly, “Stop now! You’re done. Don’t be stupid. Not only is it the right decision, it’s the only decision.”

I quit the race, earning myself my first DNF (Did Not Finish) and limped down the mountain to the base. Boo hoo. It was a drag. It was frustrating. I was angry. All normal emotions in this circumstance. That said, I didn’t flush myself too far down the toilet of despair.

I’m not the first runner to quit a race. In fact, my bet is everyone who races in any serious way quits a race due to injury. No one can guard against every potential obstacle. I did the best I could to prepare but I’m not perfect. Further, it’s not like I did anything stupid. I didn’t get drunk the night before. I didn’t forget my shoes at home. I didn’t sabotage myself. (Continuing the race would definitely have been an act of self-sabotage.) Beating myself up ad nauseam would’ve been wasted energy, it wouldn’t have helped me heal faster, and it wouldn’t help me on my next race.

The good news is I made the right decision. I quit when it should have and I avoided a bad injury. I got some crucial information too: I must strengthen the left calf. I must be more thorough than I’ve been in the past. (Here’s a rundown of what I’ve written about the subject.) Here’s what I know:

  • First and foremost I must let this injury heal. It would be a massive mistake to let it partially heal then go run and injure it again. This may take two weeks or more.
  • My left lower leg strength (as measured by single-leg heel raise ability) is significantly weaker than my right.
  • I’ve paid lip service in the past to my left lower leg. I must devote more time and effort to making it strong and keeping it strong.
  • Once my calf heals and once I’m able to load it, I must worship at the altar of calf raises and other lower-leg exercises.

In an effort to maintain my conditioning I will replace running with cycling. Is cycling a good replacement for running? Not really. Considering various kinematic differences in turning a crank with my legs vs running (lack of eccentric loading in cycling, connective tissue contribution in running, joint angles, body position) cycling is noticeably different from running. Is there a better alternative? No.

A 20-Mile Confidence Boost & a Race This Weekend

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I’m in the thick of training for several races, the big one being the 40-mile Grand Traverse on September 1. Yesterday, 7/8, I completed my first 20-mile run for this project. I started with two miles out and back along the Burning Bear Trail then ran out and back on the Abyss Lake Trail for about 16 miles. Both trails are located along Guanella Pass between Georgetown and Grant, CO.

It was a pristine morning, cool and quiet. Rain fell sometime in the night. There were no crowds, just a few people at the start and a few more when I finished.

At this point in my training, I’ve accumulated a lot of miles and fatigue. I’m often sore (not injured, sore). My mood and enthusiasm for running are low some days. This isn’t a surprise. I’ve gone through it before.

I was intimidated going into this run. Last week I ran 17 miles and it was a nasty slog. (Forest fire smoke was a significant factor last week, not this week.) Twenty miles is a genuinely long run, even if I’ve been hovering near that distance for a while.

I finished surprisingly strong on this run. I wasn’t beat up, beat down, or overly brutalized. Tired, yes but not dead. This was a breakthrough run for me. This was a huge confidence boost for me as I head into the Under Armor Copper Mt. 25k.

I believe one of the reasons I felt so good is that I took three acetaminophen tablets at Abyss Lake, a little further than halfway through the excursion. I’ve used acetaminophen on several long runs after I read about the performance-enhancing effects of the drug discussed in Endure by Alex Hutchinson and in this Runner’s World post by Amby Burfoot. (Yes, it’s a drug. Yes, I took it. Call the cops if you want.) I’ve taken two tablets in the past. I’m big, about 200 lbs., so I thought I’d take a little more and observe the effects. I don’t intend to take more. I will continue the acetaminophen consumption on my long runs.

Competitor Running Article: Benefits of the Single-leg Tube Squat

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One version of the 1-leg tube squat.

The Benefits of the Single-leg Tubing Squat is for runners who want to build leg and hip strength that will transfer to running. This exercise may help you overcome knee and hip pain as well whether you’re a runner or not. There are three variations on this exercise and all are discussed in the article. This is my second article for Competitor Running. (Those pretty pictures were taken by my wife with her fancy new camera.)

Pain Science for Runners

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This post is mostly the same as my recent article in CompetitorRunning.com. I discuss several exercises in the article designed to help runners overcome common painful issues related to running. For this post, I include pics and videos of the exercises. Here it is.

Pain Science for Runners

Acute vs Chronic Pain

Chronic pain is frustrating. Painful feet, ankles, knees, hips, and low-backs are common in runners. Chronic pain may bring fear that you’re broken, weak, and fragile. Thus you avoid many meaningful activities. You may obsess over your pain. This is the fear-avoidance cycle and it fuels itself.

Chronic pain is different from the pain of an acute injury such as a bone fracture; dislocation; or a cut, scrape, burn, or puncture. Chronic pain lasts long after an acute injury has healed.

Pain serves a valuable purpose but with chronic pain, the pain remains after it has served its purpose. Chronic pain comes from a “broken pain system,” akin to a car alarm that goes off for no reason. Fortunately, you can overcome chronic pain and start running again.

Pain science reveals several important points regarding chronic pain. Most important is that pain rarely equals harm or damage. You can be hurt and strong at the same time. (You can also have damage with no pain. Ever find a bruise but have no memory of how it got there?) Chronic pain is the result of a sensitized nervous system aka central sensitization (http://www.instituteforchronicpain.org/understanding-chronic-pain/what-is-chronic-pain/central-sensitization). Contributors to sensitization include:

  • Beliefs such as you’re broken and further activity (running) will break you more.
  • Lifestyle factors: job stress, relationship stress, lack of sleep, poor diet, lack of exercise
  • Coping strategies: Avoiding running out of fear which drives you deeper into despair and further sensitization.
  • Emotions: catastrophizing, fear, anxiety, anger, rumination
  • Tissue stress: Tissue stress can definitely contribute to pain. Remember though, tissue damage is typically a minor contributor to sensitization.

All of the above factors may be kindling for a pain fire. One too many stressors may spark the fire. You feel pain when the accumulation of stress exceeds your brain’s perceived ability to cope. There are two ways to tackle pain. One way is to decrease the stress that contributes to pain. Another way is to increase your resilience and get strong.

Confront your pain

You can lower nervous system sensitization in several ways:

    • General physical activity
    • Talk with a counselor
    • Various therapeutic techniques: massage, foam rolling, manual therapy, hot, cold
    • Consistent sleep schedule
    • Improve your diet
    • Load and strengthen the place that hurts.
    • Resume running

Your bones, connective tissue, joints, and muscles are very strong and they respond well to loading. If you’ve been guarding and resting part of your body then it gets weaker. Structures like the Achilles and patellar tendons need strength, not more rest. Physiotherapist, chiropractor and pain expert Greg Lehman favors gradual strengthening as one of the best ways to reduce pain.

Get strong – Load it!

Loading strengthens muscles and connective tissue while and provides an analgesic effect. Physical activity boosts your mood, builds self-efficacy, and shows that you’re not broken. By engaging in exercise you break the fear-avoidance cycle. Here are several exercises to help with several conditions. A comprehensive guide is beyond the scope of this article.

Isometrics:

Isometrics work well to calm pain. Contract and hold with no motion for 30-60 seconds. Perform isometrics frequently throughout the day.

  • Right: Heel raise loaded with a kettlebell for Achilles and plantar

    Heel raise

    fascia pain. Use a bent or straight knee.

  • Below: Wall sit for patellar pain. Progress from two to one leg.

    Wall sit

     

 

 

 

 

 

 

 

  • Below: Straight-leg bridge for glute/hamstring pain. Progress from two to one leg.

Straight-leg bridge

HSR (Heavy Slow Resistance) training:

Exercises should be exhausting in 5-10 slow, deliberate reps. (Most of these can also be done as isometrics too.) Start with bodyweight then add weight via barbells, dumbbells, kettlebells, weight vests, machines, or rubber tubing/bands. Persist into pain no higher than a 4 on a 1-10 scale.

Heel raises for Achilles tendonitis can be done with a straight or bent knee.

Loading the knee and hip reduces knee pain.

Band knee & hip extension

Band walks

Side bridges target abs and hip

Band leg press (A squat can be done in a similar way.)

IT Band syndrome

1-leg squat

1-leg bridge

Band leg press (A squat can be done in a similar way.)

Resume activity

Exercise is medicine. If you’ve avoided running for a while then it’s time to run! A little bit of running will help you understand that you’re not broken and the physical activity will help calm your nervous system. You’ll use the process of graded exposure. Add work gradually, keep pain at a minimum, and you’ll increase your capacity for activity.

Try a run/walk protocol like this:

  • Week 1: 1 min. run/3 min. walk, repeat 10x
  • Week 2: 2 min. run/2 min. walk, repeat 10x
  • Week 3: 3 min. run/1 min. walk, repeat 10x
  • Week 4: 40 min. run

Perform each workout twice per week on non-consecutive days. Pain should be no higher than a 4 on a 10-scale (1 = no pain, 10 =  very painful) and pain should not alter your running form. Don’t push through severe pain.

Flare-ups

It’s not uncommon for pain to flare up after activity. Don’t be alarmed. You haven’t done more damage. You’ve pushed a boundary and your nervous system has overreacted. Reduce your activity level a little bit next time you exercise.

Finally

You may need more information beyond this article. A physical therapist or other medical professionals can help guide you through recovery. Injuries such as stress fractures definitely need to be unloaded and rested. If your pain gets worse with activity then seek medical care.

 

Here’s What’s Right With You.

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We typically visit a doctor, physical therapist, chiropractor or some other medical professional because we hurt. We go to be fixed. As part of the diagnostic process, he or she may tell us what’s wrong. Similarly, many personal training assessment protocols have the trainer take clients through some sort of movement assessment and we get to tell our new client where they’re tight, where they’re immobile, and what movement skills they lack. (Often the movements that make up these assessments are highly unusual to most people and they have little resemblance to anything we do in real life. No wonder so many people don’t score well.)

By framing the discussion in terms of “what’s wrong,” we enter into a negative state of mind. We may have walked in feeling fear, hesitation, shame, and pessimism about our inability to get out of pain and get in shape. When we’re labeled as “dysfunctional” then we will only feel worse — yet we came in seeking help! There’s a better way to discuss patent and client health.

Movement optimism

Physiotherapist, chiropractor, and strength coach Greg Lehman advocates for being a “movement optimist.” In his seminar Reconciling Biomechanics with Pain Science, he suggests a better way to help our clients and patients is to start by telling them what they can do rather than what they can’t. People come to health and fitness professionals to feel good, get out of pain, and be strong. Our words matter. We can have a tremendous impact by setting the stage for success.

Lehman’s optimistic outlook mirrors some ideas from physical therapist Gary Gray. He advocates that in working with clients we start where he or she is successful. That means we find a movement with which they’re comfortable. We start where it’s easy. Then we progress gradually toward more challenging or painful movements.

For instance, if someone can’t balance well on one foot, we allow him or her to hold on to something or use their other foot to help with balance while he or she performs a movement task. Or, if someone feels knee pain with a forward lunge, but has no knee pain in a lateral lunge, then we start with lateral lunging and gradually progress to the forward lunge. If we start with success then we build confidence. If we allow the nervous system to move without pain then we help calm fears about pain and we facilitate more pain-free movement.

Research: Positive self-talk works.

Movement optimism isn’t just for clinicians and trainers. Patients, clients, and athletes have the power to help themselves. Research on positive self-talk shows that it has a measurable positive effect on strength and endurance.

Greg Nuckols of Stronger by Science discusses the effects of positive self-talk on strength athletes in this edition of his newsletter, MASS. Scroll down to page 75 to read the details. Greg writes:

“Adding mental training to your current program will likely boost your strength gains and may even decrease markers of physiological stress. Positive self-talk and first-person kinesthetic mental imagery absolutely don’t replace slinging around heavy iron, obviously, but they can help you get larger gains from your training program.”

Positive self-talk also helps endurance athletes. Alex Hutchinson has discussed research on cyclists:

“Take 24 volunteers and have them do a cycling test to exhaustion; give half of them a two-week self-talk intervention; and then do another cycling test to exhaustion and see if they’ve improved relative to controls. In this case, the answer was yes: the self-talk group lasted 18% longer (637 to 750 seconds) while the control group stayed the same. The rating of perceived exertion (RPE) on a 10-point scale also climbed more slowly in the self-talk group; in other words, they were able to convince themselves that the exercise felt easier.”

Hutchinson also discusses the effect of smiling (yes smiling!) while running:

“A new study in the journal Psychology of Sport and Exercise from Noel Brick and his colleagues at Ulster University explores precisely this question. They had 24 runners complete a series of four six-minute runs and measured their running economy (an efficiency metric based on how much oxygen you consume at a given pace), as well as perceptual outcomes, like effort. During the runs, the volunteers were instructed to smile, frown, relax their hands and upper body (by imagining, for example, that they were carrying potato chips between their thumb and forefingers without breaking them), or just think their usual thoughts.

“The results more or less supported the benefits of smiling. Running economy was a little more than 2 percent better when smiling—an improvement that’s comparable to what you see in studies of weeks or months of plyometrics or heavy weight training.”

(A note to curmudgeons: Your act is tired and childish. It’s a cry for attention that helps no one. Enough with the nonsense! Try something new! Do something that works. Or don’t…)

The brain is central to everything I’ve discussed. Pain science tells us that we are less apt to hurt if we feel relaxed, confident, and safe. In contrast, we’re more likely to feel pain if we’re stressed, anxious, and fearful. Clinicians and coaches have a huge opportunity to help people if we communicate in a positive way. Patients, clients, and athletes have the same opportunity when they communicate with themselves.

 

 

Biomechanics and Pain Science Seminar with Greg Lehman

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Poke the bear. (But don’t hump the s%it out of the bear.

I’ll get to the above statement in a moment. (Mom, I apologize but blame Greg for it. I’m just quoting what he said.)

I recently attended Reconciling Biomechanics with Pain Science, a two-day seminar with chiropractor and physiotherapist. Greg Lehman. (There aren’t too many people schooled in both disciplines.) The course was superb! I recommend the course to anyone involved in helping people move and get out of pain, whether you’re a trainer, coach, massage therapist, chiropractor, physical therapist, etc.

This is the cutting edge of pain science. The information may challenge what you hold near and dear as pain gospel, most importantly, pain doesn’t always equal damage. Nor should painful movements always be avoided. In fact, engaging in painful movement is part of getting past the pain and back to living.

This was another big dose of information with which I was familiar. Much like reading a book for the second, third, or 19th time, it’s always useful to revisit and re-examine important information. I came away with a deeper understanding of how pain works and how to work with it.

I’ll discuss what I learned and how I’ll apply this information to over the next several blog posts. Here’s my first takeaway:

You’re free to poke into pain

One of the best ways to overcome pain, regain function, and have fun doing what you love is to load the affected area. Does something hurt when you move it? If so, do the movement slowly and safely to the edge of your ability. Add a little more work over time. Work to the level of pain that you can tolerate. Load the movement to your tolerance. The idea and the expectation is that your tolerance will increase, your pain will decrease, and your life will improve. It may take time, but it’ll happen. This is called graded exposure. Pain is the bear that was mentioned at the top of the post. The concept is that you are free to gradually work to a tolerable level of pain but don’t grind and bash your way into severe pain. You shouldn’t limp, flinch, or recoil from the pain. No white knuckles, please.

If it’s a sore knee, then we’re going to use those parts and make them work. We may do squats, lunges, one-leg squats, hopping—whatever is tolerable. By poking into pain you can habituate to it and decrease the severity. Same with a sore ankle, shoulder, back, etc. Some other examples of pain that diminishes upon exposure:

  • You sprain your ankle and you “walk it off.” It hurts but you move it, load it, and resume activity to a tolerable level and you’re fine. The ankle might be sore so take it easy but don’t just rest it for days or weeks without using it.
  • You step into a hot shower and—Wow! It’s hot!—but it feels fine in a few moments. You accomodate. Similarly…
  • You get into a swimming pool and—Whoooo! It’s chilly!—and you’re fine in a few minutes. You adapt. (Strangely, the same process happens when you step out…)
  • You start a bike ride or a run and you knee bugs you a little. The pain vanishes in a few minutes. Did you suffer an injury that suddenly healed? No, but you had pain and your nervous system changed and then there was no pain. You’re fine.

Movement is a great way to desensitize the nervous system! Anyone who’s gone through post-surgical rehab for something like an ACL tear (me) has gone through this process. We’ve had to work through a certain amount of pain and discomfort as we progressed out of the injury and back into normal living. The crucial point is this: PAIN DOESN’T EQUAL DAMAGE. You’re not broken.

*****IMPORTANT DISCLAIMER***** I’m not talking about loading an acute, severe injury. If a bone is fractured, if you have a dislocation, if you suspect organ damage or if you’re bleeding then please don’t load it. In this case, you ARE damaged and you need medical help, not a trip to the gym. These conditions should be obvious.

I have vanquished the foe!

In my case, I’ve had some foot and heel pain which has been severe at times. I’ve curtailed my running and I’ve had to face the prospect of missing several big races this year. I’ve spiraled down a drain of negative thoughts and dread.  Most runners have faced this overflowing toilet of fear, self-hate, and psychological nastiness. All that stress has only contributed to my pain. What will I do with this crisis? Can life go on???

On the first day of the lecture, I started loading those hurt areas. I sought out the sore spots and made them work. I did both isometric contractions and heel raises with bent and straight knees. I worked various angles and speeds. I worked to the point of local fatigue. My pain started to recede before the lecture was over. My nervous system was changing and my pain was retreating. My hurt spots hurt less.

The next day before the second lecture I went for an easy run. I continued with heel raises and toe work and I added weight to the exercises. My symptoms have only improved. Two days later I did a hard hill workout, a workout that would’ve been seriously painful and nearly unthinkable prior to my new hopeful mindset.  I’m not broken! In fact, wouldn’t be surprised if I was made of vibranium… Maybe adamantium. You probably are too!

 

 

 

The War On Metatarsalgia

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If there’s a foot problem then I’ve either had it or I’m going to get it. Currently, I’m battling a tasty little bit of metatarsophalangeal joint pain in my left foot. My symptoms are described to a T in this article from Merck.

I am frustrated but I can overcome it. I’ve overcome a host of other frustrating aches and pains. On that note, I’ve found a series of strength and mobility drills that I’m going to play with and see what happens. It’s from the innovative people at GMB.io. The full article is here. There are three videos in the article. I’m exploring this one now: