Chronic Pain Lecture at Cherry Creek Athletic Club, Denver

For anyone who’s interested in learning more about chronic pain and how to use the Z-Health Performance System to start overcoming chronic pain, I’m giving two lectures next week at the Cherry Creek Athletic Club in Denver. Both members and non-members are welcome. The lecture is free. Dates and times are:

5:45 pm, Tuesday, December 6th
9:30 am, Thursday, December 8th

This is an interactive lecture so you will be moving around. It’s not a full-on workout by any means but please wear clothing that will allow you to move comfortably.

For more information call the Cherry Creek Club at 303-399-3050 or you may email me at DenverFitnessJournal@Gmail.com.

Questions About Supplements

Dietary supplements are huge business in this country. Over half of Americans take some sort of supplement such as a multivitamin, calcium, Vitamin D, Vitamin E, chromium, iron, zinc, and/or any number of various such nutrients. Consumers spent $26.7 billion on supplements in 2009. We take supplements for weight loss, bone health, cardiovascular health, athletic performance; and we may take them in order to avoid prescription medicine. Recent research may make you reevaluate your view of supplements.

Vitamin E and prostate cancer

First, some information from an article in the Atlantic called Are Supplements Killing You? The article looks at two studies. The SELECT study is the first one discussed. The results of the trial were recently published in the Journal of the American Medical Association. The aim of the study was to see if Vitamin E and/or selenium supplementation offered a protective effect from prostate cancer. The study followed 35,000 men aged 50 and up split into three groups: one group took Vitamin E, one group took selenium, one group took both. Participants were tracked from 2001 to 2008. The study was stopped in 2008 because rather than finding a protective effect, there were indications that cancer risks were going up. The pertinent details are these; emphasis is mine:

“The recently published article included results as of July 2011. It found an increase in new prostate cancers among all three groups taking supplements, with the increase only significant in the vitamin E group. That group showed a 17 percent increase in the rate of prostate cancer compared to the placebo group.“

An unclear picture for women and supplements

The Atlantic article also discusses the Iowa Women’s Health Study, which has generated some controversy. This study looked at the effect of taking vitamin and mineral supplements on mortality on nearly 39,000 U.S. women aged 55 to 69 and used information collected from 1986 through 2008

At the start of the study, 66% of the study subjects reported using at least one supplement. This increased to 85% in 2004, with 27 percent reporting use of four or more supplements.

The study examined the effect of taking 14 individual supplements and also a multivitamin. The researchers concluded that women who took any of six supplements or a multivitamin had a slightly higher risk of death over the study period:

Multivitamins were associated with a 2.4 percent higher risk of earlier death
Vitamin B6 gave a 4.1 percent higher risk
Folic acid gave a 5.9 percent higher risk
Iron gave a 3.9 percent higher risk
Magnesium gave a 3.6 percent higher risk
Zinc gave a 3 percent higher risk
Copper gave an 18 percent higher risk
Calcium gave a 3.8 percent lower risk of death

Do the results surprise you? They surprised a lot of other scientists as well. The controversy centers around the statistical methods used to analyze the data. Though I would love to be able to explain the fine details of this issue to you, I definitely cannot do it. (Sometimes I need a calculator to count my fingers and toes.) Read the Atlantic article to learn more or you can hop over to the Perfect Health Diet site and see a very detailed breakdown and critique of the study. If you scroll down just past the picture of the duckling trying to eat a fly, you’ll find it. (The Perfect Health Diet is a pretty interesting concept. Learn more about it here.)

One of the key elements here is that it’s an observational study, not an intervention study. That means the researchers simply observed the subjects. They didn’t try to change their behavior. So while the data may seem to suggest that taking these supplements caused early death, it would be a mistake to draw that conclusion. (One possibility is that some of the women were ill and they started taking supplements; they then died from the illness.) The article also states, “In general, when an effect is present in some statistical models and absent in others, it means that if the effect actually exists, it’s a small one.”

A closing comment was made by Robert M. Russell, M.D., special expert to the Office of Dietary Supplements (ODS) at NIH and former senior scientist and director of the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University:

“In general, what we have learned from an accumulating database from both observational epidemiology and interventional studies is that the vitamin and minerals are safe to take in RDA amounts (as are contained in most over the counter multivitamin-multimineral preparations). Further, we have learned that taking large amounts of single nutrients or nutrient combinations often lead to chronic undesirable toxic effects with implications for chronic disease such as cancer. We have seen this with beta-carotene with a stimulation of lung cancer at high doses, and now we are seeing a similar picture with high dose vitamin E vis-a-vis prostate cancer.”

“So what is the best advice for the public? Stick to a varied diet, if you want to take supplements, take a multivitamin-multimineral that has RDA amounts. Don’t jump on the silver bullet of the day single nutrient band-wagon until there is enough evidence for both efficacy as well as long term safety. That said, in order to get RDA amounts of calcium and vitamin D, a single nutrient supplement may be necessary for some people. Following the nutrient guidance of our National Academies of Science is my best advice.”

So it seems that optimal health can be had largely by eating the right foods. Focusing on the individual nutrients doesn’t seem wise. There certainly doesn’t seem to be any miracle supplement out there. The miracle is the interaction between the thousands of compounds found in our food. If we go beyond our needs and add more of a particular nutrient then we may have trouble.

The Limited Value of MRIs

The pitchers were not injured and had no pain. But the M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent. “If you want an excuse to operate on a pitcher’s throwing shoulder, just get an M.R.I.,” Dr. James Andrews, sports medicine orthopedist from Gulf Breeze Florida says.

Sports Medicine Said to Overuse M.R.I.s is a very valuable article from the New York Times Health section. It deals with the widespread use and misuse of magnetic resonance imaging (MRI). As you may know, these images can reveal all sorts of interesting information from inside our bodies. Fractures, frayed tendons, fluid around a joint and tumors are just a few things that can we can see via an MRI scan. The thing is, these images don’t always tell us why we’re in pain.

The quote at the top is from a study by Dr. Andrews in which he scanned the shoulders of a bunch of uninjured baseball pitchers. Though they weren’t in pain, nearly all the scans revealed “abnormalities.” The results are similar to a similar study of hockey players in which MRIs showed that 70% of the subjects show “abnormalities” in their hips. The thing is none of the hockey players were injured or in pain.

The Times article discusses the profit motive behind both MRI scans:

“The price, which medical facilities are reluctant to reveal, depends on where the scan is done and what is being scanned. One academic medical center charges $1,721 for an M.R.I. of the knee to look for a torn ligament. The doctor who interprets the scan gets $244. Doctors who own their own M.R.I. machines — and many do — can pocket both fees. Insurers pay less than the charges — an average of $150 to the doctor and $960 to the facility.”

The article goes on to discuss a skier who was prescribed surgery for a torn knee ligament. This prescription was based on an MRI and the tear was confirmed by a second opinion. It was a third opinion and MRI however that showed that the ligament was not torn and surgery was not needed. In this case, the third doctor noticed that the first and second assessments of the torn ligament did not match the symptoms of the man’s injury. It seems the prior opinions relied only on what the MRI showed and not on a carefully considered history of the injury.

The overall message here is that MRIs can give us a lot of information but they may not tell us the whole story. An MRI is not a perfect, magic tool that tells us exactly how to address our pain. It seems the best doctors recognize this and are very careful to order MRIs only when truly needed. Don’t be afraid to get multiple opinions on your injury. If your doctor seems to be relying only on an MRI, keep looking around for more help.

Stuff to Read: Weightlifiting vs. Powerlifting, Hormones & Weight Loss

Powerlifting vs. Weightlifting

To a lot of people the terms “weightlifting” and “powerlifting” may sound synonymous. I assure you they are quite different activities. Both sports require the lifting of barbells with lots of weight attached, but the similarities stop there. (As an example, we can start with the highly ironic term “powerlifting.” In fact, powerlifting features almost no power whatsoever. Weightlifting on the other hand features lots of power. You had no idea did you?) For a very thorough and informative look at the two different activities–and to figure out which best enhances athletic performance–check out this article from TNation.com titled Weightlifting vs. Powerlifting: Which is Right for You?

Hormones and the Difficulty of Weight Loss

Losing weight and keeping it off is typically a very difficult task for a lot of people. The idea that it’s simply an issue of willpower is simply false nonsense. (Look here, here, here, here and here for previous posts on the issue.) Now there’s another study and another article to add to the pile of knowledge on obesity and weight loss. Why Dieters Can’t Keep the Weight Off is an article from Time Magazine that discusses recently published research from the New England Journal of Medicine. It goes into the issue of various hormones that essentially tell us we’re hungry. The levels of these hormones rise in people who are losing weight. Further, these same hormones tend to stay elevated post weight loss. The practical effect is that weight loss is difficult to achieve and maintain. It’s definitely not just an issue of willpower. Read the article for more detail.

Z-Health S-Phase: Athletic Vision Skills

Last weekend I finished the third of four basic courses (R, I, S, T) that make up Z-Health. S-Phase (Sport, Skill, Strategy Phase) deals with two things: vision training and sport specific mobility. There was a lot of learning but there was also a lot of real fun. We spent a good bit of time out on a grass ball field working on all sorts of sport movements from sprints to catching to changing direction and accelerating. This is a breakdown of the athletic visual skill portion of S-Phase.

The Power of Vision

I think it’s probably obvious to you that vision is important. Very important. As humans it’s our most valuable sense. (If we were dogs, we’d be talking about our noses. If we were bats, it would be our hearing that’s the big topic.) The loss of any of our other senses (hearing, taste, touch, smell) would make life quite difficult but loss of vision would likely make life nearly impossible for most of us. (This is taking nothing away from blind people who are able to live a full, rich life. My point is to say that we rely on vision more than the other senses.)

Thus, our visual skills impact every part of us. We know if we have a bad prescription for lenses then we can experience pain often in the form of headaches. Similarly, visual impairment may throw off our balance or make us nauseous. We may be scared or extremely cautious of driving or walking stairs if our eyes don’t function correctly. In the other direction, we can enhance our balance, mobility, speed and strength if we enhance our visual skills.

Visual Skills

When I speak of vision skills, I’m not really talking about eyesight. Eyesight is what your optometrist measures in his or her office. That’s simple stuff. You’re seated. They eye chart isn’t moving at all and neither your balance nor any type of coordination is tested along with your vision. In other words, there’s very little real-world stress or stimulation that’s used in an eyesight test. When we discuss vision skills, we’re talking about a skill set made up of the abilities:

Dynamic visual acuity: This skill allows you to see objects clearly while either they or you are in motion. In very nearly every sport (and in non-sport activities such as driving) we must have exceptionally good vision anywhere from a few inches out to 300 feet.
Eye tracking: This refers to your ability to move your eyes and track an object in motion. It pertains to “keeping your eye on the ball.”
Focusing/Accomodation: This is the ability to change focus quickly and accurately from near to far and back again.
Peripheral vision: This skill is well described by the phrase, “how well you can see what you’re not looking at.” These are the things you should be able to see “out of the corner of your eye.”
Vergence flexiblity and stamina: This is the skill to keep both eyes working together in unison under high speed, physically stresfful situations and differing environments.
Depth perception: This skill allows you to quickly and accurately judge the distance and speed of objects moving towards and away from you.
Imagery: This is the ability to picture events with your “mind’s eye.”
Sequencing: This refers to the skill to correctly see and put together a series of movements in order. It’s sort of a Simon-says type of thing. We see this particularly when learning sports movements: “First do this, then do that, then do this….”
Eye-hand & Food-hand coordination: These interactions are the ultimate basis of athletic skill. Here we use our ability to take in visual information and translate it into the necessary body movements. (It’s also how we live a big part of our non-athletic lives.)

If any of these skills are deficient, then we won’t perform as well as we should be able, whether it’s on the playing field or in every day life. Conversely, if we spend a little time training these skills, then we can expect progress in any number of areas from sport skill to pain reduction. Most recently I’ve been using some visual drills to help a client overcome hip pain. It’s quite interesting stuff.

The S-Phase course taught us tests and exercises to evaluate these visual skills. The video below is an example of one of the drills we learned. It’s called the Pencil Pushup.

For further information on what’s behind visual skills, how to assess them and how to improve your visual skills, the Z-Health site offers an article titled, The Eyes Have It. Another article, Reflexive Lifting, discusses ways to modify your eye position and posture in order to increase your performance in the deadlift and the kettlebell swing.

Finally, this video illustrates (among other things) the role of the eyes in the chin-up. Watch the whole video to learn more about Z-Health in general. At about the eight minute mark Dr. Cobb demonstrates what happens when we change eye position during a chin-up. Try it out on your own and see what you discover.

It’s the Cycling Stupid?

Despite what I said in my last post about feeling great, a number of my years-old aches and pains have returned–and it frustrates the hell out of me!! I can spend several weeks feeling great. I can run, lift and bike however much I want and everything feels top-notch. Then the symptoms come back. My left heel and Achilles starts to ache. My left glute feels weak. Parts of my left hamstring often hurt. (Maybe I should amputate my left side?) And I’m right back where I’ve been for way too long. It’s all of these things that have led me to continue to investigate pain, injury, nervous system dysfunction, and how to overcome these issues.

Giving up is not an option!

Cycling-related issues

Bicycling has been one of the constants over the course of my pain. It’s been one activity that I’ve largely been able to do pain free. But now I’m wondering if the bicycling is setting me up for the pain and dysfunction I’ve been experiencing. Beyond that, it may be sitting in general that’s an issue for me.

It’s probably no surprise to you that spending a lot of time on a bike saddle isn’t always the healthiest thing a man can do. Various nerves and blood vessels can be mashed which can result in a variety of problems including erectile dysfunction, numbness, prostate issues. Here’s a decent rundown of potential men’s health issues related to cycling.

Cycling may also have implications beyond that most sensitive of areas. If we look at the hip flexion and extension in cycling vs. hip flexion/extension in running, then we see that that cycling keeps the hips in a very closed type of position. We go from lots of flexion to slightly less flexion as we pedal. We never get full hip extension. Thus we may create glutes that are overly stretched out and weak while simultaneously restricting various other nerves in the low back and pelvis. Add this to the fact that we all wind up sitting a lot during the day no matter how active we are, and you might see how we can quickly create problems in the hips that may filter out to other areas of the body.

Nerve flossing

This is your wiring.

Something else I’ve started recently is a bit of nerve flossing. “What?!” you say? If you look at the chart on right, you’ll notice that the nerves run out from the spinal cord and out through the limbs all the way out to the fingers and toes. Along the way they travel through various passages. As we move our nerves must move too–at least they should move. They should slide back and forth smoothly as we bend, reach, sit, stand, twist, etc. But sometimes these nerves sort of become stuck. As you might guess, nerves are somewhat sensitive. They don’t much like being stuck, squished, pinched or otherwise messed with. We can end up with what’s known as nerve impingement or nerve entrapment. Nerve entrapment can cause pain, numbness, weakness and/or pins-and-needles in any number of places. Someone can have an entrapped nerve for instance in their knee and they may feel symptoms down in the ankle or up in the hip. Fortunately we can mobilize these nerves though and un-stick them. Watch the nerve flossing videos to see how.

(These are drills which we’re taught in Z-Health T-Phase. I haven’t attended T-Phase yet but I’m dying to go. Nerve flossing isn’t exclusive to Z-Health. It comes from the world of neurodynamics. Good resources for neurodynamics are the NOI Group and Neurodynamic Solutions.)

I started doing some of these last week and felt better immediately. I’m doing a lot of them every day and I’m sort of playing around with different angles and different amounts of tension as I do them. My theory is that if I free up the nerves several good things should happen. First, I expect reduced pain right off the bat. Second, I expect better movement as the nerves should conduct impulses from the brain out to my working parts and back again. Better movement should help resolve any deformities in soft or hard tissue. (For more on this concept read about Wolff’s Law and Davis’ Law. These laws describe how tissue remodels along the lines of stress. Further, these laws govern such things such as bone density, arthritis, and callouses. Arthritis is reversible by the way! Don’t let a doctor tell you otherwise.)

So the plan is this: As much as it “pains” me, I’m laying off the bike for several weeks. How long? I’m not sure. It’s the one part of the equation that I really haven’t changed so I need to investigate it. Further, I’m going to continue with the nerve flossing and lots of to see what happens.

Further, my idea is that running is something humans have done since before the start of forever. Bicycling meanwhile is quite a different activity from anything our ancient ancestors did, and it’s a very new activity relative to how long homo sapiens have been on earth. Thus it may be the sort of activity that causes some weird stuff to happen to us–or me specifically. So my hope and my expectation is by reducing the cycling I’ll resolve some of these issues, and this will allow me to run. I will eventually return to cycling and see how I feel. This whole process, should it work, should enhance my cycling ability as well.

Goals & Motivation

Choices to make: strength or endurance?

I feel fantastic these days. My varied lingering aches and pains are dwindling to fleeting annoyances. I actually feel like some sort of athlete! And now my mind turns to various athletic goals. I have strength goals–pulling 500 lbs. on the deadlift, mastering the barbell snatch, and cleaning and jerking my body weight (at the very least) for instance. I also have endurance goals such as running a marathon and doing the Epic Single Track mountain bike race series at Winter Park next year. I want to do it all! But as I’ve mentioned before (here and here) it’s not realistic to pursue both high-end strength and endurance goals at the same time. If you work hard enough in one direction, then your abilities at the other end will suffer. From the injury and burnout perspective, doing a lot of endurance work plus heavy strength/power work will very likely put you in a bad spot very quickly. So I’ve got to choose, and it’s a tough call.

Short-term reward vs. long-term benefit

I mentioned previously that getting stronger helps one’s endurance abilities but it doesn’t work the other way. Increasing one’s endurance work tends to make one weaker. Further, dropping weight via dropping muscle mass makes running and biking much easier. Hauling around extra weight never helps. The whole idea of losing strength and mass is sort of tough to swallow. But if I continue to lift to the degree that I’ve enjoyed–then I’ll impede to my endurance abilities.

As I’ve thought about all this, I realize I’m facing the sort of dilemma faced by many of us who want to get in better shape. The issue boils down to a short-term reward vs. a long-term goal. We know in some part of our brain what we should do, but in some other part we desire something else in the here-and-now. We’d like to be thin some day for example but a bowl of ice cream is looking mighty good right now. Or maybe I’d like to have more muscle mass and better bone density, but I really feel like watching TV right now. Does this sound familiar? In most cases, the short-term reward wins out. This can be a titanic struggle at times. It’s you vs. your brain!

Add weight to be strong.

One of the most respected and knowledgeable strength coaches in the country is Mark Rippetoe, owner of the Wichita Falls Athletic Club, and co-author of the books Starting Strength and Practical Programming for Strength Training. (If you want to get stronger, stop reading right now and order both books. They are superb.) If he’s talking, I’m listening. Recently, I watched a video from his site about tall athletes. (I’m 6’3″ and that qualifies as reasonably tall.) It’s a forum discussion with Rippetoe, former Olympic weight lifting champion Tommy Suggs, big time powerlifter Jim Windler, and strong man/nutritionist John “Johnny Pain” Shaffer. An audience member asks about training concerns for tall athletes. (See, tall people have long limbs or levers. Long levers can’t move as much weight as short levers. Thus we tall people have a few questions sometimes on what we should do to get stronger.) The discussion moves to eating and body weight. Shaffer recommends one weigh 3 lbs. per inch of height–as a starting place— in order to be able to use your levers effectively. For me that’s 225 lbs. Right now, I’m just about 200 lbs. Here’s the video in case you’re interested:

Roundtable: Tall Athletes from stef bradford on Vimeo.

Weigh more. Go slow.

So, to be strong–really strong–I should eat to get big. But the creator of the universe is a comedian and he or she has dictated that if I’m big I’ll also have a really hard time running very far or biking up through the beautiful Rocky Mountains of Colorado. It’s obvious: As body mass goes up, endurance performance goes down and vice versa.

I’ve had personal and dramatic experience with this sort of thing. Back in college I went to Europe for four weeks to take “classes.” (It was a vacation disguised as school. Had a wonderful time!) At the time I was riding bikes with a group from a local bike shop in Denton, TX. I didn’t touch a bike while overseas. I ran a lot. I lifted a very few times and I walked constantly. I dropped about 1o or 15 lbs without thinking about it. I got back to TX and the next time I rode I smoked everyone but the very fastest rider in the group. So I became a much better cyclist without improving my cycling skills. The weight made the difference, and this shouldn’t surprise anyone. Here’s some more evidence.

An article on Peak Performance Online cites a study from the University of Georgia that compared run times of men vs women. Part of the study had the subjects perform a 12-minute run test. Here’s a discussion of the results:

“Males did significantly better on the test, running an average of almost 3300 metres in 12 minutes, while females covered just 2750 metres. Although male performances were about 20 per cent better, males didn’t run more economically than the females, and male V02max values were only slightly (5 per cent) higher. What caused the big difference in performance?”

“As it turned out, percent body fat averaged 20 per cent in the females but only 11 per cent in the males. When Sparling analysed the data, he found that 74 per cent of the variation between male and female performances could be accounted for by the difference in body fatness, while a much smaller amount (20 per cent) of the difference was determined by the males’ higher V02max values. The higher amounts of body fat in the female runners acted as ‘dead weight’, increasing the energy cost of running and making quality running paces seem more strenuous.”

Now, clearly fat and muscle are different types of tissue, but too much muscle will still count as “dead weight” during a ride or a run. So the debate in my head continues. Fortunately, as I’ve eluded to before, strength work does help endurance athletes. So as it stands, I can still get a lot stronger and improve my endurance performance. The downside is that I will not reach my genetic potential in strength so long as I continue the endurance activity. I’m also going to focus on reducing my body fat. I don’t carry too terribly much body fat but I also don’t work much to reduce it, and I probably should.

the Pencil Pushup

What is Z-Health?

The big question that I and just about every other Z-Health practitioner must answer is “What is Z-Health?” It takes more than one or two sentences to explain this system that I’m involved with. Key points that I mention in my explanation are:

Z-Health is a performance system designed to take someone from an injured, painful, or inhibited state to the highest level of performance he or she wants to achieve.
The nervous system is in charge. Neither the muscles nor the bones nor the joints make decisions. The nervous system decides whether or not you’re in pain. The nervous system decides whether or not your muscles are tight. Your nervous system dictates how fast, strong or agile you are.
The aim of Z-Health is better movement. Period. If you want to lose weight, you need to move better so you can exercise vigorously. Chronic pain is often a result of poor movement patterns. The solution? Move better. If you’re an athlete and you want to perform better–then you need to move better.

How to Swing

Big thanks to my very studious client Marilyn Munsterman who sent me a three-part video series on the kettlebell swing. The series comes from Franz Sniderman, an RKC (Russian Kettlebell Certified) instructor based in San Diego. The swing is more than just a swing. If you know how to swing a bell then you’ve got a very powerful exercise on your hands. If you only know how to do something that only looks like a swing, then you’ve got a waste of time and a potential injury on your hands.. Sniderman does a superb job of dissecting the signature kettlebell exercise and highlighting the essentials. Watch and learn.

Denver Fitness Journal

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