Sleep: Think You Can Do Without It?

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This is the cutting edge of health!

A recent TED Talk has grabbed my attention. The topic is sleep. (I’ve written before about this vastly under-appreciated component of health here and here.) The presenter is Dr. Kirk Parsley. Dr. Parsley is a former Navy Seal. He’s been a member of the American Academy of Sleep Medicine since 2006 and served as Naval Special Warfare’s expert on sleep medicine. In other words, he’s familiar with lack of sleep and its effects.

Among other things, he discusses our cultural view of sleep which is one that I’ve observed as well. It seems that a lot of us recognize the necessity of good eating and vigorous exercise as part of getting in top-notch shape but sleep seems to be a footnote. It’s often dismissed without much thought. We look at sleep as an obstacle to productivity. It’s like a leisure activity done only by babies and the weak. The productive go-getters hardly sleep–they work!

I’ve had a lot of people say something along the line of, “Oh well, I can’t ever get to bed that early,” or “Yeah… I know… I just wind up staying up late.” Some people seem to think they don’t need sleep. “I feel fine with five hours of sleep,” or something like that. Here, from the National Institutes of Health, are a few of the negative health effects of lack of sleep:

In the past 10 or more years, research has overturned the dogma that sleep loss has no health effects, apart from daytime sleepiness. The studies discussed in this section suggest that sleep loss (less than 7 hours per night) may have wide-ranging effects on the cardiovascular, endocrine, immune, and nervous systems, including the following:

Obesity in adults and children
Diabetes and impaired glucose tolerance
Cardiovascular disease and hypertension
Anxiety symptoms
Depressed mood
Alcohol use

The evidence suggests strongly that if you’re not sleeping enough then you’re not performing as well as you’d like and your health is suffering. In my totally anecdotal experience, the days when I get to bed early and sleep in for a little while results in my feeling phenomenal. I’m going to try and do that more often. Here’s the TED talk:

Techniques to Help You Run Pain Free

I’ve used a few simple techniques to help a few of my clients with their running technique. These ideas have also helped me overcome a long-term bout of heel and Achilles trouble.

My clients often hurt when they ran so if nothing else, I figured they needed to run differently somehow. There was no guarantee that what I would show them would solve their problems but clearly the way they were running wasn’t quite working.

The following are drills and cues that I’ve used. Effective cueing can be challenging. I have in my mind a movement a feeling and an experience that I’d like you to have. I have to translate what I feel into English and transmit that message to you. My words may hit the mark or you may have absolutely no idea what I’m talking about!

Hop up and down.

Hop up and down. How do you land? On your heels? Most people land on their toes and to some degree their heels settle to the ground. It happens naturally. Your probably don’t need to think about it too much. In this way, we effectively dissipate the impact forces and avoid too much jarring and banging into the ground.

Run in place.

Now run in place–quickly! Again, how do you land? I think most people land similar to the way described above. It’s a light landing on the toes, not heels first. This is pretty much one-footed hopping.

Where do your feet land? Directly under your hips. That’s about where we want the feet to land. In contrast, what we don’t want is for your feet to fling out in front and slam into the ground. To that point…

Quick Pace

Overstriding is a frequent issue in injured runners. By overstriding the foot lands out in front of the runner and he or she slams hard into the ground with every foot fall. This can cause lots of stress to various tissues and joints and it’s likely a cause of pain.

This is a good contrast in foot placement. The guy in back is overstriding.

By running at a quick(er) pace we facilitate the feet landing under us, not out in front. We create shorter loading times of the bones and joints and thus reduce the stress that may be causing our pain. It’s difficult to overstride with a quick cadence.

For a most runners this means consciously picking up the pace. This can feel awkward at first and may feel inefficient. One way to start to adjust your cadence is by using a metronome when you run. Start at your normal pace and sync the metronome to your pace. From there you can up the beat and match your pace to the metronome. This takes time and practice. If it’s important then you’ll do it.

Again, this all may feel very strange–and it should. After all, if our current chosen running technique is causing pain, then it stands to reason that a new and better running technique should feel weird. As with any new skill, it won’t feel strange forever.

Lean forward from the ankles.

Learning to lean from the ankles–not the hips!–is important. By leaning from the ankles we sort of fall forward. We keep the hips under us, not poked out behind. When leaning from the ankles it’s difficult to overstride and slam the foot into the ground. Here’s a drill to learn how to lean from the ankles.

Run tall. Keep eyes on the horizon.

The simple cue to “run tall” seems to work well for a lot of runners. I’ll keep it simple and leave that phrase as is.

Keep your eyes on the horizon. This works well to help keep you tall. Your body tends to go where your eyes go. If you stare at the ground then you’re likely to slump forward. You won’t be running tall. Learn to use your peripheral vision to see the ground. The guys below are running tall and gazing out.

These guys are RUNNING REALLY TALL!! You should do it too!

These guys are RUNNING REALLY TALL!! You should try it!

Run lightly. Quick pace. Lean from the ankles. Run tall. Eyes on the horizon.

Here’s a good graphic.

I’m not going to say a lot more other than I like the information presented here:

Skipping

Finally, here’s a skipping drill that may help you get a feel for running tall, running lightly and not pounding your heel into the ground. My hope is that this drill will transfer to your actual running. Skipping involves an exaggerated running gait and you don’t actually want to bound and prance to an extreme degree.

Tiger Woods’ Back Pain Mythology

For effective management of persistent pain, provide a clear understanding of the factors that drive pain, develop graduated strategies to normalise and optimise movement patterns while controlling pain, and couple these steps by prescribing sports specific conditioning and a graduated return to sport. Addressing psycho-social stressors and unhealthy lifestyle factors is part of this process, especially where ‘central’ pain features are dominant. Magic bullets don’t exist, so don’t promise them.
– Dr Peter O’Sullivan, Curtin University, West Australia

Tiger Woods received a lot of coverage earlier this month for withdrawing from a golf tournament due to back pain. Tiger mentioned back spasms in interviews and made the following statement:

“It was a different pain than what I had been experiencing, so I knew it wasn’t the site of the surgery. It was different and obviously it was just the sacrum,” Woods said. “The treatments have been fantastic. Once the bone was put back in the spasms went away, and from there I started getting some range of motion. My physio is here. If it does go out (again), he’s able to fix it.”

So the implication here is that the sacrum can in fact pop out and be put back in place. And that once the sacrum is back where it belongs–presto!–the pain was gone. This is the type of statement that perks up the ears of numerous therapists, coaches and trainers. This is also the type of information that grabs the attention of multitudes of back-pain sufferers. There’s hope! A magic treatment is at hand!

First, can a sacrum pop out? For that question, I like these words from UK physiotherapist Adam Meakins aka the Sports Physio:

“The notion of anyone’s sacrum just ‘popping out’ is complete and utter nonsense, let alone the sacrum of a fit athletic professional male golfer without any past risk factors or history of significant trauma…

SACRUMS DONT JUST POP IN AND OUT…

All that white webbing-type stuff are ligaments. Very strong stuff. The sacrum is underneath it between the hip bones at the bottom of the spine.

For starters the pelvis is an incredibly strong and stable structure with many, many strong ligaments and muscles across it. The sacroiliac joint does have some small amount of movement, and yes some have more or less than others, but the variation is minimal and the ridiculous belief that many therapists have in thinking that they can 1) feel this joint move 2) decide if it’s in the right or wrong position and 3) adjust it with manipulations is just again complete and utter nonsense based in pseudo science and nothing more than palpation pareidolia as I have discussed before in my previous blog here and on the assessment of the painful SIJ here and its management here.”

So why did Tiger think his sacrum had ‘popped out’ well there are two possible reasons.”

One very competent and observant trainer is Boulder’s Mike Terborg. He sent me an informative article from the British Medical Journal Blogs called Common misconceptions about back pain in sport: Tiger Woods’ case brings 5 fundamental questions into sharp focus. It was written by physiotherapist Dr. Peter O’Sullivan. I won’t go into every detail of the article but I’ll summarize the big pieces. (Emphasis is mine.) O’Sullivan lists five quotes related to Tiger’s pain and then asks questions of those observations. He cites research to support his answers. Go to the article to read the whole shebangabang.

“Tiger has a pinched nerve in his back causing his pain.”
What is the role of imaging for the diagnosis of back pain?

O’Sullivan: “Disc degeneration, disc bulges, annular tears and prolapses are highly prevalent in pain free populations, are not strongly predictive of future low back pain and correlate poorly with levels of pain and disability. (Deyo 2002, Jarvik JG 2005).”
“Tiger had a micro-discectomy for a pinched nerve which had lasted for several months.”
What is the role of microdiscectomy for the management of back pain?

O’Sullivan: “The role of decompressive surgery (micro-discectomy) should be limited to nerve root pain associated with progressive neurological loss (e.g., leg weakness)… (O’Sullivan and Lin 2014). Micro-discectomy is not a treatment for back pain.”
“My sacrum was out of place and was put back in by the physio.”
What role do manual therapies play to treat back pain?

O’Sullivan: “Passive manual therapies can provide short-term pain relief. Beliefs such as ‘your sacrum, pelvis or back is out place’ are common among many clinicians.

These beliefs can increase fear, anxiety and hypervigilance that the person has something structurally wrong that they have no control over, resulting in dependence on passive therapies for pain relief (possibly good for business, but not for health). These clinical beliefs are often based on highly complex clinical algorithms associated with the use of poorly validated and unreliable clinical tests (O’Sullivan and Beales 2007). Apparent ‘asymmetries’ and associated clinical signs relate to motor control changes secondary to sensitised lumbo-pelvic structures, not to bones being out of place (Palsson, Hirata et al. 2014). In contrast, there is strong evidence that movements of the sacroiliac joint is associated with minute movements, which are barely measurable with the best imaging techniques let alone manual palpation (Kibsgård, Røise et al. 2014).”
“I need to strengthen my core to get back to playing golf again.”
What is the role of core stability training?

O’Sullivan: “’Working the core’” has become a huge focus of rehabilitation of athletes and non athletes in recent years.

Recent studies have also demonstrated that positive outcomes associated with stabilisation training are best predicted by reductions in catastrophising rather than changes in muscle patterning (Mannion, Caporaso et al. 2012), highlighting that non-specific factors such as therapeutic alliance and therapist confidence may be the active ingredient in the treatment – rather than the desired change in muscle.“
What should clinicians do? The paradigm shift required for managing a complex multidimensional problem like back pain.

O’Sullivan: “Firstly, clinicians need to realise that back pain does not mean that spinal structures are damaged – it means that the structures are sensitised…There is growing evidence that low back pain is associated with a combination of genetic, pathoanatomical, physical, neurophysiological, lifestyle, cognitive and psychosocial factors for each domain. The presence and dominance of these factors varies for each person, leading to a vicious cycle of tissue sensitisation, abnormal movement patterns, distress and disability (O’Sullivan 2012, Rabey, Beales et al. 2014).”

O’Sullivan makes these recommendations to clinicians:

To adopt this new approach clinicians require at least two things:

Change of mindset: Abandon old unhelpful biomedical beliefs, and embrace the evidence to change the narrative to help people with pain understand the underlying mechanisms linked to their disorder.
New and broader skills for examining the multiple dimensions known to drive pain, disability and distress. These assessment skills need to be complemented by the skill of developing innovative interventions that enhance self management, allow the patient to engage in relaxed normal movement. The clinician also needs to encourage the patient to adopt healthy lifestyles and positive thinking about backs (O’Sullivan 2012).

The change he advocates for is sloooowly happening in some areas of health care. The strictly biomechanical model (pain = injury) is still king.

The Goblet Squat

Nearly all of my clients squat. Sometimes instructing the squat can be a challenge. Though it’s essentially just sitting down, the squat can become complicated and difficult. It’s easy to over-coach the squat. That’s where the goblet squat comes in very handy.

Big-time strength coach Mike Boyle has done a great job telling us about the goblet squat. I find his instruction to be succinct and easy to follow. Here’s the video. Watch it and squat away!

Breaking Plateaus: the MilitaryPress

I’m a big fan of the military press (aka the press, the standing press, the overhead press). I like putting the weight overhead. It’s a challenging total-body exercise that in my mind probably delivers more useful strength and skill than something like a bench press. I’d like to press 200 lbs. which is my body weight. For that reason, I tend to lift heavy and I typically don’t go above five reps per set. My progress stalled for a while so I went on the hunt for ways to move it along. This led me to read up on all kinds of interesting ways to break through plateaus. (Admittedly, a torn ACL didn’t help my pressing. My press was slowing down though prior to the tear.)

To get stronger we generally need to add weight to whatever it is that we’re lifting. This is the simplest, most obvious way to get stronger. It’s inevitable though that at some point our progress will slow and we’ll have to find other ways to move forward in our strength training. Here are a few methods I’ve used to improve my press:

Weight: A lot of people tend to lift in the same rep range. I often see people in commercial gyms lifting in the 10-15 rep neighborhood. A good way to make progress is to add weight and move down in reps. The 5-rep and below range is good for getting stronger. In contrast, if we’ve been lifting in the low-rep range, there might be a benefit to reducing weight and adding reps.
Speed: We can subtract weight and move faster. To get fast we need to move fast. If we reduce the weight (40%-60% of your 1-rep max) and move very fast then we get a very different type of powerful stimulus to the muscles. I’ll talk about this more below.
Different exercises and movement patterns: If progress stalls on the barbell military press then we might want to switch to an incline barbell press, or a dumbbell military press, or a seated military press, or a behind-the-neck press. You see my point? Choosing an exercise that’s the “same but different” can help us make progress in our main lift.
Bring up weak points: I’m not much of a fan of bodybuilding-type training in which individual muscles are emphasized. That’s not to say there isn’t a place for this approach. If we look at the particular muscles involved in a given lift then we might use exercises to isolate those muscles and make them stronger and/or add mass. For instance, we could use tricep extensions in order to strengthen that piece of our press. Similarly, we might look at supporting musculature–the upper back for instance–and target those muscles to a stronger foundation from which to press.

Here’s some more on my experience with dynamic effort, “same but different” and some bodybuilding work.

Dynamic Effort

Speed and strength live in the same house. They are very close acquaintances. They have a lot of physiological similarities. Training one tends to help the other. Fast twitch muscle fibers are our strong and fast fibers. They should be trained with heavy weights as well as high velocities.

As we add weight to the bar, the bar slows down. We create more force but we don’t create speed. If we want to train speed then we need to lighten the load considerably and move a lot faster. The Westside Conjugate Method addresses both strength and speed during the week. Max Effort (ME) day has lifters lifting very heavy weights and generating a lot of force but at a slow velocity. Dynamic Effort (DE) day has the lifter using much lighter loads moved at a high velocity. This creates explosion.

Incorporating a dynamic effort day into your lifting may help you break through any current plateaus you may be experiencing. If you’ve never employed the DE method, then you probably have a nice well of untapped potential and you’ll likely see impressive results fairly quickly.

I’ve from pressing 135 lbs. for 2 reps to 145 lbs. for 3 reps in about four weeks since incorporating the DE method. Cool! As advocated by Louie, the DE day came 72 hours after the ME day. I typically did 10 sets of 2 reps, adding 5 lbs. each week.

At no time did I become anything like exhausted by the DE work. That isn’t the point. Speed is the point. If you get tired then you’ll slow down. Don’t expect to experience a typical workout feeling with DE work.

Louie wrote an article titled Westside Military Press Training for Mike Mahler’s Aggressive Strength site. Here are the tips:

Do the seated press with dumbbells. Choose three weights for example 100 lbs, 75 lbs, and 50 lbs. Work on setting a repetition record with one dumbbell weight. the reps should range from 10 to 25 reps.
Do dumbbell extensions or barbell extensions for special work along with rear, side and front raises.
Do barbell pressing in the following manner. Ten sets of three reps in a three- week wave. 70% the 1st week 75% the second week and 80% the third week. Pendulum back to 70% and start over. Second day 72 hours later do max effort work.
Use chains on the bar or JUMPSTRETCH bands to accommodate resistance. (Editor’s note: Usually as the bar gets close to lockout you will naturally slow the bar down. The bands keep the resistance on all the way to the end).
Work up to new PR in the incline press.
Do rack lockout work on the high pin where 10%-15% highest weight can be done.

Developing the Overhead Press is another good article on Mahler’s site. If you like to press then read it!

The Conjugate System can get a little complicated and hard to understand. For a very good and concise explanation of the system, check out Jordan Syatt’s article The Westside Conjugate System: A User’s Guide.

Other ways to train speed (either lower or upper body) include the following:

jumping
medicine ball throws
plyometric pushups
power pull-ups: Do these explosively for 1-3 reps.

Same but different

I’ve varied the way I press–but I’ve kept pressing. In the book Easy Strength, Pavel Tsatsouline talkes about the “same but different” concept. With this concept, we take the main lift we’re working on–the press–and find some way to change it just a little. We offer a little variety to the nervous system, we learn a slightly new skill, and we can improve our main lift.

A similar process is proposed by Bill Starr in the book the Strongest Shall Survive. This system employs a heavy/light/medium approach to lifting where the exercises are changed slightly between each workout. For example, the back squat is used on the heavy and medium days and the front squat is used on the light day. Presses alternate from the bench press to the military press to the behind-the-neck press. Read the book to learn more.

In my case, I’ve incorporated the standing behind-the-neck press as well as seated dumbbell or kettlebell presses in which I sit on the floor with my legs straight out in front. I do these for reps.
Here are some examples “same but different” changes we could incorporate into our press routine

military press to behind-the-neck press to incline press
standing press to seated press
handstand or incline pushups
dumbbells and/or kettlebells in place of the barbell

Other things

I’ve also incorporated back-off sets after my heavy pressing days. I reduce the weight considerably and press for 10-12 reps. I expect this to help build some mass.

I’ve used dumbbell rear delt flyes to help build my upper back. I do these for 8-15 reps typically and I vary the weight each workout. This is the type of bodybuilding isolation work that I haven’t done in years.

Finally

I’ve just scratched the surface with this stuff so I anticipate continued progress. As my ACL heals I expect progress to accelerate quite a bit. This has been a very interesting process. I’ve enjoyed learning about and applying these concepts, particularly the dynamic effort work. I just recently started a little bit of jumping. I expect this to help my squat and deadlift. I plan to keep a speed day as part of my workout plans.

Coaching Movement: Internal vs. External Cues

I recently listened to an interview with Todd Hargrove of BetterMovement.org at the Well Rounded Athlete. At about 21:30 in the interview, Todd discusses the idea of internal cues vs external cues as they pertain to learning new movement skills. I found it to be a fascinating concept and one that pertains very strongly to my current study of the FASTER Global curriculum.

What are internal and external cues?

Internal cue: The athlete focuses on his/her body parts and how they move.
External cue: The athlete focuses on affecting something in his/her environment. He/she focuses on the outcome of his/her movement.

Below are some examples of internal and external cues from an NSCA article titled What We Say Matters, Part I.

(What We Say Matters, Part II is also very interesting. I won’t discuss the whole thing but it goes into feedback frequency, or how much information coaches should give athletes while they’re learning a new skill. Turns out a good bit less feedback is better than giving feedback 100% of the time. Coaches and trainers should definitely read it. On to the internal/external cues.)

Table 1provides examples of internal versus external focus cues for different movements and note that analogies can be considered external cues.

	Internal Cue	External Cue
Sprinting: Acceleration	Extend your hip (knee) Activate your quad (glute) Stomach tight	Drive the ground away Explode off the ground Brace up
Change of Direction	Hips down Feet wide Drive through big toe	Roof over head Train tracks or wide base Push the ground away
Jumping	Explode through hips Snap through ankles Drive hips through head	Touch the sky Snap the ground away Drive belt buckle up
Olympic Lifting: Snatch	Drive feet through ground Drive chest to ceiling Snap hips through the bar Drive feet through ground Drive chest to ceiling Snap hips through the bar	Push the ground away Drive/jump vertical Snap bar to ceiling Snap and drop under bar

Which is best? Internal or External?

The article cites research that demonstrates internal cues to be more effective than external cues. More evidence comes in an article from Strength and Conditioning Research (a great resource) titled How Much Difference Do External Cues Make? The following studies are cited and they’re summarized:

Marchant (2009) – the researchers found that an external attentional focus led to greater force and torque during isokinetic elbow flexion movements while simultaneously decreasing muscle activation as measured by EMG.
Porter (2010) – the researchers found that directing attention toward jumping as far past the starting line as possible had a much greater effect at increasing broad jump distance compared to focusing attention on extending the knees as fast as possible.
Wulf (2010) – the researchers found that an external focus led to increased jump height with simultaneously lower EMG activity compared to an internal focus of attention.
Wu (2012) – the researchers found that an external attentional focus let to increased broad jump distances despite not affecting peak force production compared to an internal attentional focus.
Makaruk (2012) – the researchers found that 9 weeks of plyometric training with an external focus led to greater standing long jump and countermovement jump (but not drop jump) performance compared to training with an internal focus.
Porter (2012) – the researchers found that an external focus far away from the body led to greater results than an internal focus or an external focus near the body in terms of standing long jump performance.

“So in general, the main factor that is associated with external focus is an increase in performance. Also, there may be a tendency for reduced EMG activity at the same time. This is interesting, as it may be a mirror image of what happens with internal focus.”

The reference to reduced EMG means that with an external focus, more muscles are actually relaxed during the movement. The benefit to that is that the muscles acting in opposition to the movement are more relaxed, thus allowing for better movement. If too many muscles are contracted then we may move slow.

How does an external rather than internal focus result in superior outcomes? The NSCA article cites work by Dr. Gabrielle Wulf, Director, Motor Performance and Learning Laboratory at UNLV:

“Wulf et al. (17) defined the hypothesis, stating that focusing on body movements (i.e. internal) increases consciousness and ‘constrains the motor system by interfering with automatic motor control process that would ‘normally’ regulate the movement,’ and therefore by focusing on the movement outcome (i.e., external) allows the ‘motor system to more naturally self-organize, unconstrained by the interference caused by conscious control attempts.’”

From other research by Wulf in another article:

“Wulf et al. (2001) explained this benefit of an external focus of attention by postulating the ‘constrained action hypothesis’. According to this view, individuals who utilize an internal focus constrain or ‘freeze”’their motor system by consciously attempting to control it. This also seems to occur when individuals are not given attentional focus instructions (2). In contrast, an external focus promotes the use of more automatic control processes, thereby enhancing performance and learning (3,5).”

To me this suggests that the external cueing allows us to tap into reflexes, reactions and movements controlled by the autonomic nervous system. I think any athlete has experienced the situation where we think too much and our performance falters. We think very hard about the individual components of what we’re trying to do and the result is we don’t ski well, we don’t drive a golf ball well, we miss an Olympic lift. In contrast, we’ve been in that “zone” where things just happen. We don’t think, we do. Everything is coordinated and we’re barely aware of what we’re doing. It seems that the external cues are the best way to get to our ideal way of moving.

Is there a place for internal cues?

So the research tells us that external cues are superior to internal cues. Does that mean we should do away with all internal cues? That issue has been discussed in an article by Bret Contreras titled What Types of Cues Should Trainers and Coaches Provide? and an article by Sam Lahey titled the Science and Applications of Coaching Cues. They’re both in agreement that internal cues are sometimes the best way to go when coaching. As often happens, the coaches in the field have some disagreement with researchers.

Contreras does a very good job in discussing his observations of when internal cues might be superior to external cues, particularly when it comes to getting an athlete or client to feel his or her glutes. This is from his article:

“When I train beginner clients, it takes me considerable time to get their lumbpelvic-hip complex working ideally during squats, deadlifts, back extensions, and glute bridges. In my opinion, external cueing is not ideal for improving form in the most rapid manner possible. My belief is that internal cueing will get the individual to where you want them to be in a much more efficient manner.

This applies to preventing lumbar flexion in a deadlift, preventing valgus collapse in a squat, or preventing lumbar hyperextension and anterior pelvic tilt in a back extension or hip thrust.

1) Palpating different regions of their body to make them aware of the various parts involved and what those parts are doing,

3) Having them stop approximately 3/4 the way up on a hip thrust and practicing anterior and posterior pelvic tilt so they can understand how to prevent anterior tilt from occuring,

5) Being ‘hands-on’ during their performance and manually helping place their pelvis in proper position, manually setting the core in neutral, manually pushing the hips upward to ensure full ROM is reached, and poking the glutes to make sure they’re on and the hammies to make sure they’re not overly activated, and

I don’t believe that this heavily ‘internal’ approach can be improved-upon by a purely external cueing approach.”

I tend to agree with Contreras. I’ve often found that I need to bring awareness to one piece of the overall movement puzzle (glutes are the best example). I want clients particularly aware of glute contraction at the very top of a squat, deadlift or kettlebell swing. Contracting the glutes tightly at the top of these movements is important for keeping the pelvis and lumbar spine in good, safe position and for getting the most “oomph” into the lift. Before I teach these exercises, I want the client to know what it feels like to squeeze their glutes. I simply want them to know what the glute contracting feels like. I don’t need them to move fast or lift heavy. In this case, an internal cue seems to be the best way to go. I’m not sure of a more effective cue than saying “Squeeze your butt as tight as possible,” when I want to make someone aware of their glutes.

(Though now that I think about it, “Squeeze a quarter between your butt cheeks as tight as possible” might actually be an external cue that would work very well.)

Contreras also cites the cues “chest up” and “knees out” during the squat as simple, effective and commonly used internal cues that often work well during the squat. Again, I agree with him that phrases like this are usually effective enough that we don’t necessarily need to construct similar type phrases with an external focus.

Finally, Contreras says that he typically uses more internal cues with beginners during the initial instruction period. As the athlete gains experience and expertise, he moves on to more external cues with the idea of getting maximum performance. That process matches what I’ve seen and experienced with my own clients and athletes.

Thoughts

The task for coaches and trainers is to use language to express to an athlete how he or she should move. We may use a description that makes perfect sense to us, yet is completely confusing to the athlete. If that’s the case then we need to pick another description of that movement. Further, a description that’s crystal clear to one athlete may make no sense at all to another. From what the research says, using these external cues is probably the best way to get our athletes and clients to move the way we want them to. We may however need several different external cues to paint the best picture in the athlete’s head. If an internal cue works best then we should use it.

What I’ve learned from reading these articles is that:

Less is more. Too much coaching confuses the athlete. Fewer/simpler cues are best.
Directing the athlete’s mind outward will by-and-large get the best performance out of him or her.
Some degree of internal cueing may be necessary from time to time. We don’t want to throw the baby out with all the internal cueing bathwater.

I think we coaches would do well to think of several ways of describing exercises. A good time to do this is during our own workouts. How many ways can we describe moving a barbell or kettlebell? What is important during a push-up and how can we verbalize those points? What are some external cues to describe good running technique? Or weightlifting techniques?

This whole concept of cues is another example example of that the real target with exercise is from the neck up. The brain is the real target here, not the muscles, joints or bones.

Science, Belief, Psychology and Nonsense

“The good thing about science is that it’s true whether or not you believe in it.” ― Neil deGrasse Tyson

I want very much to be on the side of science. The scientific method is perhaps the most powerful and influential tool in all of human existence. A long line of dedicated scientists have blessed us with electric light, the eradication of smallpox and polio, a steady food supply, clean water, air conditioning, and every bit of computer technology ever known just to name a very few things. That said, I will admit my own confusion and I will admit adherence to various practices and ideas that don’t hold up to vigorous scrutiny. (I’m trying to do better.)

Mention the word “science” to some people and they’ll take it as a dirty word. Some don’t like the pointy-headed image of scientists telling us certain unfortunate truths (climate change is man-made for instance.) Others among us have been scared by genetically modified food (GMOs) and vaccines. This is unfortunate for a lot of reasons. Many of us walk around in needless fear for instance. More specifically, fear of vaccines has led to needless outbreaks of disease. Famously, Steve Jobs delayed rejected science-based cancer treatment for complimentary/alternative medicine (CAM.) According to his biographer, Jobs regretted this decision.

Some people think that “science” equates to “Western medicine,” or “pharmaceuticals.” Not true. There’s plenty of non-scientific practices and methods employed by modern medicine and the pill companies. In fact, good, thorough, rigorous science can expose the ineffective or dangerous aspects of medicine and drugs. In Bad Science and Bad Pharma, Ben Goldacre has done a great job discussing the misuse and abuse of science by both complimentary/alternative medicine and the pharmaceutical industry.

Skepticism

Skepticism is useful. This is a questioning point of view. A skeptic requires solid evidence before he or she believes something. Being skeptical means you’ve set a high bar for your beliefs. You don’t accept information at face value. Nor do you accept anecdotal evidence or information gained from an “experiment of one.” Healthy skepticism can save us money and may save our health. Here are some things that I understand about skepticism: When we hear about a “miracle cure,” “secret trick to whatever-it-is-you’re-dreaming-about,” “startling breakthrough” or “what the doctors don’t want you to know,” the skeptic in us should come to life and pay close attention to what we’re being told. It’s probably nonsense!

(BTW, skepticism doesn’t equal cynicism. Skepticism is not a negative thing. A skeptic simply asks for valid evidence to be shown.)

Correlation and Causation

Today I wore green shorts. I didn’t throw up. Green shorts prevent nausea! They protect against throwing up! I know it to be true because I was there and I witnessed it. That’s proof enough for me. “I know what works for me.”

Does this sound familiar? Does this line of thinking make sense?

Here’s another example: Someone gets acupuncture for seasonal allergies (or any other ailment you care to think of) and some time soon after they feel better. Someone could see this as “proof” that acupuncture “works” to cure allergies. So every time this person feels their allergies come on, he or she gets acupuncture and soon the symptoms are gone. This could be fairly convincing to a lot of people that acupuncture works very well at curing an illness.

Acupuncture correlates to the resolution of the illness. But did acupuncture cause the illness to go away? Here are some things to think about: Why do we seek treatment for an illness? Typically people seek help because the symptoms are too tough to deal with. Guess what usually comes on the heels of our bad symptoms whether or not we seek treatment or not: We feel better! There’s a normal course that most illnesses take and it doesn’t usually end with us in the grave. Rather, our immune system fights off the illness and we feel fine, acupuncture or no acupuncture. Chiropractic adjustment or no adjustment. Homeopathy or no homeopathy. So what would we say if someone got acupuncture and they felt worse? What if someone did not receive acupuncture and he or she felt better soon anyway? All of these are possible outcomes. We might think that acupuncture doesn’t have much relationship to illness at all.

Fitness

“I consider corrective exercise to be the alternative medicine of the fitness field.”
– Coach Nick Tumminello

That statement has given me a lot to chew on, and I am coming around to agree with him. The fitness universe abounds in various systems and methods that promise better movement and less pain. All of them are sold by people with impressive credentials who use technical and scientific-sounding terminology. I have absolutely fell under the spell of some of these systems.

Now I look back and realize that either a) I should’ve been more skeptical towards some of the claims I’ve heard or b) because I was searching desperately for a solution to my 10-year-long chronic back pain, I was ready to believe many things told to me by those who spoke with certainty–even though I tiny voice in the back of my head may have been questioning those claims.

Tumminello has written a series of posts on his blog that discusses the psychological factors that make us susceptible to faulty thinking. He’s aimed this series at the fitness community but he really discusses psychological tendencies that all humans seem to share–no matter how smart or well-informed we are. Why Smart Trainers Believe Stupid Things: Part 1 discusses bias toward positive evidence. In Part 2 we learn how “authorities” can use jargon and inflated language to sway us. Part 3 goes into regression to the mean (discussed previously) and why it’s easy to believe a given treatment may “work” when in fact the thing the treatment was meant to fix has simply run its natural course. Psychological reasons why coaches will never stop arguing; training debates are a waste of time; and the fitness industry will never be united (long title) is very similar in tone and content to the previous articles.

These articles were very illuminating to me. If you’re a critically thinking fitness professional, they may help sharpen your thinking quite a bit.

New Thinking

As I’ve said, I’ve swallowed some nonsense and falsely ascribed amazing results to methods that simply didn’t do what I believed. The health & fitness field is perhaps more awash in phony gurus and foolish hocus pocus than almost any discipline on earth. (Religion may take 1st place.) From medicine to food to exercise–especially corrective exercise–there are numerous minefields out there. Misinformation and half-baked nonsense is widespread on the Internet so I must be careful what to believe.

The best snake-oil salesmen blend truth with bull$hit. (Dr. Oz comes to mind.) I need to examine each statement and claim from the person making it. I shouldn’t give the benefit of the doubt to anyone based on their credentials, popularity or status.

Rather than seek out information that confirms my beliefs, I need to look for evidence that actually disproves what I believe. (That’s a tough one!) I should be prepared to set aside my beliefs when solid evidence contradicts those beliefs.

There are a lot of cases where making leaps in thinking leads to inaccuracies. Nutrition is rife with this type of thing. The fat-causes-heart-disease idea seems to be in this category. A researcher may expect that A causes B–animal fat consumption causes heart disease for example–but this conclusion may be based on animal studies or educated guesses. What should happen isn’t necessarily what actually happens, yet many of our Federal dietary guidelines have been based on assumptions, not evidence.

I need to be (more) aware of my biases and my emotions. I should be aware of my herd mentality and I shouldn’t be afraid to ask questions. If a proponent of something wonderful can’t or won’t answer my questions, or uses excessively big and complex language in their explanation, I should beware.

Other non-BS resources

I’ve found some useful resources for evidence-based information. There must be many more out there. Here are a few:

Genetic Literacy Project: Lots of good information on GMOs.
Science Based Medicine: A wide range of medical information. From vaccines to chiropractic to acupuncture, nutrition, evolution, veterinary medicine and a lot more.
Soma Simple: This for manual therapists, physical therapists, pain management people and coaches. It’s a very high bar to cross if you want to put out your ideas. The group here demands evidence. I’ve learned a ton about pain science here and I’ve been made aware of a lot of the exercise baloney that’s out there.
Evidence Based Fitness: Bryan Chung does a great job of discussing and laying out the research facts on the latest fitness research.
Exercise Biology: Similar to Evidence Based Fitness. Anoop T. Balachandran discusses the evidence pertaining to strength training, pain, nutrition, supplements and more. His post on pain should be required reading by all trainers and coaches.
How to Detect Bullshit: My article wouldn’t be complete without a link to this fine piece of writing from Scott Berkun. I might need to read it several times.

Size Matters Not: A Case for Strength Part III

Who should be strong and why?

Clearly athletes benefit from more strength, but what about someone who doesn’t label him or herself an “athlete?” Well, strength is like money in the bank: No one ever complained about having too much. No matter who you are, you will benefit from more strength. Here’s a list of who can benefit from strength and why:

Endurance athletes
Paula Radcliffe holds the women’s world record in the marathon. That looks to be about 150-160 lbs. that she’s squatting.

Plenty of research exists showing that the ability to put more force into the ground, into the pedals or into the water will make you faster. For runners, heavy strength work enhances the spring-like qualities of the Achilles tendon and other connective tissue that aids in running. More strength can help the endurance athlete maintain good form as he or she tires during an event.

No one is too old to be strong! This image is from a Tampa-area senior powerlifting meet.
Senior citizens
I mentioned previously that proper strength work creates stronger bones. That’s good for anyone with bone density issues. Beyond that, strength goes hand-in-hand with balance. Strength enables you to better keep yourself from falling and it will help you get up if you fall.
Martial arts champ Gina Carano is strong enough to beat you up.

Do you want to look good?
It’s interesting, when you get strong, you tend to look strong. Posture often improves as part of the process. For a lot of people, heavy strength work works nicely to stimulate the metabolism, especially if they’re new to heavy lifting. Further, multi-joint exercises like squats, push-ups and the like do a great job of creating impressive arms, shoulders, legs and all the rest.
Do you do any manual labor?
Any kind of yard work, house work, moving and carrying stuff, putting stuff overhead, shoveling snow, going up and down stairs etc. will be a lot easier if you’re stronger. The work you do in the gym should enhance your life outside the gym. Exercises like squats, presses and deadlifts loaded with enough weight will definitely help with manual labor.

Do you like to feel good?
Strength training carries some impressive and interesting psychological effects. A review of literature from the University of Georgia found the following psychological benefits from weight training:

“The weight of the available evidence supported the conclusion that strength training is associated with reductions in anxiety symptoms among healthy adults (5 trials); reductions in pain intensity among patients with low back pain (5 trials), osteoarthritis (8 trials), and fibromyalgia (4 trials); improvements in cognition among older adults (7 trials); improvements in sleep quality among depressed older adults (2 trials); reductions in symptoms of depression among patients with diagnosed depression (4 trials) and fibromyalgia (2 trials); reductions in fatigue symptoms (10 trials); and improvements in self-esteem (6 trials). “

(From my observations: For some magical reason, deadlifting a new 3-rep max has a much more powerful and positive effect on the mind and emotions than does curling 2 lb. periwinkle dumbbells for 30 reps.)

How to get strong

Reps and sets:
In a nutshell, the way to get stronger is to lift heavy. How heavy? Look at the chart. If the training objective is strength then we’re looking at lifting something for fewer than six reps. The weights used are 85% of your 1-rep max (1RM) or greater.

Effective set/rep schemes include: 2-5 sets of 5 reps, 3 sets of 3 reps, 5 sets of 2 reps and 6 sets of 1 rep.

Exercises:
The best strength-building exercises are multi-joint exercises. They include but aren’t limited to the following:
- squats
- deadlifts
- overhead press
- bench press
- rows
- cleans
- snatches
- push-ups
- pull-ups
Olympic silver medalist Allyson Felix can deadlift 270 lbs.

A solid strength workout can be built around one or two, maybe three of these exercises (squat, overhead press, row for example). There’s no need to do them all in one workout.

In contrast, single-joint exercises like bicep curls, tricep extensions, leg extensions/curls and calf raises aren’t as well suited to enhancing strength. They have their place and they can be included in your strength workout but never at the expense of the big lifts.

Most of these exercises except for push-ups and pull-ups should be done with a barbell. Other implements like dumbbells and kettlebells can certainly be used but a barbell is the ideal tool for this type of work. As push-ups and pull-ups become easy, weight can be added.

Remember, the idea here is to increase your strength. That means weight should be added to the exercises from week to week. You can also add reps to the already-challenging weight you’re lifting. Accordingly, you should track your weights, sets and reps. You should strive for progress.

Finally, good form is vital! Heavy lifting is quite safe when done properly. If you’re hesitant then you should seek out a good strength coach or personal trainer. It’s difficult to learn how to do these exercises without good coaching. Reading a magazine article or watching other people in the gym probably won’t quite cut it.

To wrap up

I hope I’ve convinced you of the value of strength. When we’re strong we tend to look and feel strong. Through strength training we can build a strong healthy, useful body without any worry of looking overly muscular. Remember, you can get very strong with virtually no risk of looking “too big.” Sorry, I’m wrong. It’s impossible for you to get “too big.”

Seeing progress in the gym builds confidence and enthusiasm and gives purpose to our workouts. We should expect progress from exercise. Watching the weights go up is a great way to quantify our work in the gym.

Strength has real-world use. It enhances athletic performance and allows us to better take on life’s daily challenges. Strength can keep us safe too, especially from falls and injuries.

Finally, for you to get strong you must lift heavy!

More resources

I didn’t invent any of this information presented here. If you’re interested in learning more, here are some books and online resources for you. There are lot more resources out there. Don’t get confused though: To get strong, pick up something heavy! (Have I said something like that already?)
- Books
  - Power to the People, Pavel Tsatsouline
  - Starting Strength, Mark Rippetoe & Lon Kilgore
  - Practical Programming for Strength Training, Mark Rippetoe & Lon Kilgore
  - Easy Strength, Dan John & Pavel Tsatsouline
- Online

Size Matters Not: A Case for Strength Part II

In Part I of this series I suggested that you should see progress in your exercise routine. Further, I broached the idea that muscular strength and muscular size are not necessarily the same. Finally, I argued that getting “too big” is nearly impossible for you to do. This is Part II of the conversation.

Big vs. strong. What’s the difference?

Muscle bulk is what a lot of men (especially young guys) want from their exercise program. For many of you though, your fitness goals don’t include bulking up. Most women I encounter want to get leaner and essentially smaller. Obesity is a big problem in America so many of us definitely don’t need to consider enlarging ourselves. Endurance athletes don’t need to haul around extra muscle as it can hinder performance. Because of all this we see a lot of people lifting rather light weights for very high reps (15-20 or more). The problem is, you can’t actually get stronger this way.

Let me offer this thought to you: You can get stronger–without getting bigger! You can learn to create more force with your muscles without much if any additional muscle growth. The two circumstances are not the same. Strictly speaking, bigger muscles can be stronger than smaller muscles, but strength is much more than that. Strength is also very much the result of changes within the central nervous system (CNS). Here’s more on that.

Neurology of strength

Zoe Smith is a record-setting British Olympic weightlifter.

It’s helpful to understand a little bit about processes by which we get stronger. Besides some potential muscle growth, what happens when we strength train? Without getting overly science-y, here’s a description:

Better intramuscular coordination:
This is learning to use more of an individual muscle. Muscles are made up of muscle fibers. Those muscle fibers are innervated (“fired”) by nerves. The nerve plus the muscle fibers it innervates is known as a motor unit. Untrained individuals can recruit only so many motor units for a given task. Effective strength training enables us to recruit more motor units within an individual muscle.

Strength training also changes the rate at which our motor units fire. Untrained people fire their motor units more slowly than trained people. Proper strength training can enable us to fire our motor units very quickly. The result is we can be stronger and/or faster and muscle growth is unaffected.

At the same time, strength training also teaches us to synchronize these motor units to fire together. All of this is skill, and it has nothing to do with muscle growth.

Better intermuscular coordination:
This is better coordination of muscle groups. In looking at almost any common human movement (sitting to standing, running, reaching, pushing, pulling, lifting something off the ground, climbing stairs, etc.) multiple body parts move together. Proper exercise selection (multi-joint exercises like squats, lunges, rows, presses, etc.) plus appropriate loading of these exercises enable us to develop stronger movement patterns rather than just a stronger quad, calf, bicep, etc. This again is a way of becoming stronger without enlarging the muscles.
What else?
Effective strength training gives us stronger connective tissue. Ligaments and tendons become stronger just like the muscles. Our bones also get stronger if we load them effectively. A good strength program is a very effective way to protect against injury and increase bone density in people of all ages and abilities.

Examples of Stronger, Not Bigger

The majority of sports actually don’t require athletes to be particularly big. American football linemen need to be big in order to

Greek weightlifting legend Pyrros Dimas. Incredibly strong but not stereotypically massive.

shove opponents out of the way. It’s a similar situation with sumo wrestlers. Shot putters need to be big so they can put a lot of mass against the shot. Beyond that, very large athletes are often at a disadvantage. They can’t generate as much power relative to their body weight. They can’t endure as well. Thus, for many athletes, some degree of increased muscle mass may be a good thing, but being “too big” is not an advantage. Strength however is always in demand.

German Olympic weightlifter Julia Rohde. Strong–not huge.

Most sports involve sprinting of some sort. More strength helps an athlete sprint faster. Does more bulk help? Only up to a point. A massively muscle-bound body doesn’t help.

Weight class athletes such as boxers, weightlifters, martial artists, and wrestlers must stay within a certain weight range to compete. Now, we’ve all seen the stereotypical massive superheavyweight weightlifter or powerlifter. Look at the lighter weight classes of these sports though and you won’t see such hulking physiques. You’ll see lean, strong athletic physiques. These people are always looking to get stronger and more powerful without getting bigger.

Gymnasts are excellent examples of athletes who must be very strong and

US Gymnast Danell Leyva is very strong but not overly bulky.

powerful yet clearly don’t benefit much at all from enormous amounts of muscle bulk. Have you ever seen a gymnast that was “too big?”

So there are numerous examples of people who require great strength but have no need of excessive muscle. How exactly do they get there? I’m glad you asked! Stay tuned for Part III of this series.

Size Matters Not: Part I

I’m very grateful to Jamie Atlas of Bonza Bodies for giving me the opportunity to write a guest post for his blog. He runs one of the big group bootcamps at Red Rocks. He’s been featured in 5280 and has been voted one of the top trainers on Denver’s A-List. Jamie also contributes a fitness column to the Denver Post. So, he’s a fairly big-time presence in the Denver health & fitness scene. He’s also been very generous to me with his time and his sharing of information. So head over to his blog for my post titled Size Matters Not. A Case for Strength Part I. Parts II and III will appear on my blog.

Denver Fitness Journal

All Things Health and Fitness by Kyle Norman, MS, CSCS, FMS, RRCA Running Coach