Injury, Re-injury & the Brain

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Many of us have experienced recurring injuries.  From Achilles tendon pain, low-back pain and whatever else-type of pain, we often feel great only to have the maddening issue return–often for no clear reason.  Anyone who’s experienced this pattern knows how crushingly disheartening it can be when after a layoff,  you feel good and with great joy you’re able to return to your chosen activity… only to fall back into the same injury pattern as before.  It’s more than just physical pain.  It’s a highly emotional and psychologically challenging obstacle to overcome.

To this point, the Peak Performance newsletter features an excellent article called Once Injured, Twice Fearful.  (Peak Performance is an great resource.  You can register for free and access many well-researched and well-written fitness and performance-related articles.  For a fee you can access more of Peak Performance.)  The main issue is how our brain is affected by an injury.  We may reach a point where our tissues are healed yet mentally we aren’t yet prepared to return to our sport.

Most interesting to me is the discussion on the pain neuromatrix.  What is the pain neuromatrix?  Well, there is no easy answer.  This is a theoretical construct that sort of consists of our perception of a threat and whether or not the brain decides that the threat is sufficient to create pain.  For instance, we sprain an ankle.  The damaged ankle is literally a potential threat to our survival (Not so much in 2010 but for most of human existence a sprained ankle may indeed have led to our starvation or death from the elements or predators.)  The nerves in the ankle send a status update to the brain, the brain then interprets this information as damage and thus gives us pain.  Why?  Pain gets our attention.  Pain will cause us to alter our activity so that we don’t further damage that ankle, thus we should survive longer.  (In contrast, if we sprain an ankle while we’re running away from an erupting volcano, the brain may say “That volcano is a far bigger threat, so no pain for you–KEEP RUNNING!!!“)  This is a fairly complex thing.  Here’s a brief explanation.  For further information, read Ronald Melzak’s paper on the topic.

Once injured, our brain pays particularly close attention to the damaged area.  The neuromatrix keeps close watch so that we don’t re-injure ourselves.  If all goes well, the tissue heals, we start moving normally and pain free, the neuromatrix senses no threat and the pain is gone.  However, this close scrutiny by the neuromatrix may sort of get stuck in the “on” position.  The tissue may heal but the athlete may still feel pain and anxiety at the prospect of re-injury.  This often results in poor performance because the brain is focused on monitoring the area of injury and thus can’t devote full attention to sport skills.

So what’s the solution?  First, simply explaining this psychological model to the athlete can be quite helpful in calming anxiety.  His or her knowing that pain doesn’t necessarily equal injury can be very reassuring.

Next, we must modulate the threat as it’s perceived by the neuromatrix.  If for instance a soccer player sustained a major injury on the field, simply returning to the field in soccer cleats may be perceived as a threat and pain and/or anxiety may be the result.  Certainly then running, cutting, dribbling, etc.–playing soccer in other words–may be a huge threat.

(A more overt example of this type of situation can be seen in war vets suffering from post-traumatic stress disorder.  Though the person may be safe and the actual threat long gone, any number of minor events may trigger extreme reactions such as panic attacks or violent behavior.  The sound of a book dropped on the floor or trash bag in a yard may cause the sufferer to react in a way that’s vastly inappropriate relative to the actual threat posed by the event or object.)

The player must be gradually re-introduced to the movements and environment of soccer.  Brief, easy jogging on the field; simple ball handling drills, and slow- to moderate-speed agility drills may be introduced as a way to ease the player back into the sport.  Variables may be added as the player feels more confident.  Speed, duration and predictability of drills may be adjusted.  Opponents may be introduced.  Playing surfaces may be changed.

A key part of this process is movement reeducation.  An injury doesn’t only include tissue damage.  The connection between the brain and the injured region (let’s say it’s the ankle) is also disrupted.  Such a disruption means the ankle tissue may heal but control of the ankle may remain deficient.  This sort of thing may cause pain–but it may not be ankle pain!  A poorly moving ankle may cause pain at the knee, hip, back, anywhere along the spine, shoulder, even the jaw.  Such is the nature of this highly interconnected system we live in called the body.

The Z-Health system has by far helped me more than anything in addressing my own pain as well as my clients’ pain.  R-Phase is the introduction to Z-Health.  With R-Phase we start to relearn the ABCs of movement.  We reestablish control over every joint in the body: feet, ankles, knees, hips, spine, shoulders, elbows, wrists, hands, fingers, jaws and even the eyes.    Through methodical, mindful movements we can very effectively reduce pain and increase performance very quickly.  Here we recreate and reinforce the foundation for all our more complex movements such as running, stair climbing, shooting baskets, swinging a golf club, etc.  We can then safely reintroduce our favorite sporting movements and activities.  It’s a very powerful and exciting system.

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Zone-based training is a key component for competitive cyclists looking to perform better.  Determining the proper zones typically requires lab tests such as lactate threshold testing.  A graduate student at the University of New Hampshire has developed an inexpensive way of determining

“Power is a very unbiased way of measuring your exercise ability, compared to speed, heart rate, or perceived exertion,”



The Bad News on Fruits & Vegetables

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It may not be a huge surprise that most of us in this country don’t eat a healthy diet.  Now the data is in and according to the U.S. Centers for Disease Control and Prevention, in 2009, 67.5 percent of adults ate fruit less than two times daily and 73.7 percent ate vegetables less than three times per day.  This information comes from an article in Business Week.

These numbers are in contrast to the goals of Healthy People 2010, a comprehensive set of health objectives set by the government.  The goals of Healthy People 2010 were for 75 percent of people to eat at least two servings of fruit and 50 percent to eat at least three servings of vegetables every day.  Despite these noble efforts, over the past decade there has been a two percent decrease in fruit consumption and no change in the vegetable consumption, researchers found.  This program is failing.  Why?

It’s hard to imagine that ignorance is driving our avoidance of produce.  Who among us doesn’t know that fruits and vegetables are good for us?  One issue is that low-income Americans are less likely to have access to fresh fruits and vegetables at affordable prices compared to affluent Americans.  (For more on this issue, read about food deserts.)

Connie Diekman, director of university nutrition at Washington University in St Louis discusses the affordability of fresh produce:

“Another factor that seems to impact purchasing fresh produce that is not clear in this report is the cost of fresh produce,” Diekman said. “With economic changes the last several years, the slight differences in consumption based on household income might be an important factor for health-care providers to address.”

(I find it tragically laughable that fresh produce–food that’s plucked right off a tree or a vine; or pulled right out of the ground–can cost more per calorie than a highly complex, laboratory engineered food such as a Twinkie, frozen pizza, or a sugary soda.  This is what our farm subsidies are doing to us.)

Most interesting to me are the neurological factors behind what we eat, and why even though we know what’s healthy and unhealthy we still make unhealthy choices.  Samantha Heller, a dietitian, nutritionist, exercise physiologist and clinical nutrition coordinator at the Center for Cancer Care at Griffin Hospital in Derby, Connecticut says the following:

“It is easy to fill up on fast food, junk foods, sweets and sugar-sweetened beverages. In addition, by eating these highly palatable foods — those high in fat, sugar and sodium — we alter our taste and mental expectations about how a food is ‘supposed’ to taste.”

“We end up craving these foods and the healthier fare is ignored. Thus, a sweet ripe peach does not taste very sweet to someone who just chugged a 20-ounce soda or ate a bowl of ice cream. The same with vegetables. The delicious taste of many vegetable pales in comparison with high-fat, high-sodium cheese burgers and french fries.”

This is a tremendous uphill battle we face as a nation.  It’s this very issue that’s at the heart and core of our health care system.  We’ve had heated debate on what form of health care we’ll have and how to fund the system.  Yet we avoid the most significant factor in our health care, that is what we chose to eat or not eat.  It’s too tough an issue for politicians to discuss as pointing out our failings at personal responsibility tend to anger voters.  (In contrast, Michelle Obama has done a very admirable job of bringing attention to the issue of nutrition and obesity.)  No number of doctors, drugs, or high-tech medical devices can offset our personal habits.  I’m not sure that there’s a light at the end of this tunnel.

More News & Questions on Stretching

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Stretching–and whether or not to do it–is one of the most debated issues in health and fitness.  What’s the final verdict?  (I’ve given my opinions a few times already here, here, and here.)  Does Stretching Before Running Prevent Injuries comes from the New York Times and it’s the latest comment on the issue.  The article discusses a study from USA Track & Field that involved about 3000 runners over the course of three months.  These subjects were split into two groups: one group followed a pre-run stretching routine, the other group did not stretch.  (From the description, the stretching group engaged in static isolated stretching, or what many of us would recognize as stretching: bend over and stretch the hamstrings for 20-30 seconds for example.)  Both groups followed the same running program.  The result?  Both groups experienced the same injury rate.  Thus, pre-run static stretching does not appear to help guard against injuries.  There is an exception though.

The study states:

“If runners who normally stretch prior to running were assigned to stretch, they had a low risk of injury but if they were assigned not to stretch, the injury risk was double those who kept stretching. It’s this result that most startlingly exhibits why people consider stretching to prevent injury. This study shows that those who are comfortable with their pre-run stretching routine should maintain it. They risk injury if they discontinue their pre-run stretching. For runners comfortable without pre-run stretching, they don’t necessarily improve their injury protection by starting a pre-run stretching routine.”

As I see it, the broad point to take from this observation is that any changes to your program should be undertaken slowly.  That goes for adding speed work, hill work, more mileage or engaging in barefoot running.  Sudden dramatic changes may leave you sidelined.

Music, Exercise & the Nervous System

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Four laps around this radio equals a mile.

Many of us listen to music while we exercise.  (Some of us even proceed to sing and dance too.)  Do you think it makes you stronger?  Faster?  Is it easier for you to grind through your workout with music?  The New York Times Health Section tells us more about why we like music and how it affects our performance.

The Times piece describes research done at Research Institute for Sport and Exercise Sciences in Liverpool, England.  Twelve male cyclists listened to music set to three different tempos.  Popular music was played either at the regular tempo, increased by 10 percent, or decreased by 10 percent.  Researchers tracked heart rate, power output, pedal cadence, enjoyment of the music and perception of exertion.

Participants rode faster, produced more power, had higher heart rates and enjoyed the faster music more.  In contrast, slower music brought on slowe rides, less power, lower heart rates and less enjoyment of the music which stayed the same.  Interestingly, participants perception of their effort didn’t drop with the increased music but rather it went up.  Seems the music motivated them to ride harder. 

There may be an upper limit to the effect of music on our performance though.  Research shows the following:

“While running on a treadmill at 85% of aerobic capacity (VO2max), listening to music will not make the task seem easier in terms of information that the muscles and vital organs send the brain. Nevertheless, the runner is likely to find the experience more pleasurable. The bottom line is that during a hard session, music has limited power to influence what the athlete feels, but it does have considerable leverage on how the athlete feels.”

What we’ve got here is a nice thorough intermingling of auditory input, psychological motivation, and physiological performance.  It’s fascinating that though we may very much feel the effect of exhaustive work, we can through music actually perceive the work differently.  Does anyone still think there’s some sort of difference between the “body” and the “mind?”