– Derek M. Hansen –
On March 7, 2009, I hosted a conference with the theme of “Recovery, Regeneration and Rehabilitation.” I felt that the theme was fitting, considering that we are all faced with the issues of a struggling economy that needs to recover and regenerate, as well as a financial system that requires rehabilitation. Additionally, when I was asking one of our presenters, Dr. Donald Chu, about how the economy was affecting his practice, he said that while demand for elective services – such as sports training – has fallen off a degree, there hasn’t been a similar impact on rehabilitation services. “People are still getting injured,” replied Dr. Chu. This is something to consider for those picking a recession-proof business plan.
I also like the topic of recovery, regeneration and rehabilitation because it makes me think of big picture issues. We live in a society now that fixates on details. In the exercise and rehabilitation fields, there is a significant fixation on exercises, drills and protocols. The “exercise of the week” concept litters web sites and magazines, with the expectation that one exercise will solve your fitness problems… at least this month. When we think of issues of recovery and rehabilitation, I believe it makes us think of the bigger picture of the overall training program design, the interplay of volume and intensity, the suitability of the stressors that are applied, and the duration and frequency of rest periods. If you consider the importance of recovery, regeneration and rehabilitation when planning and implementing workouts, chances are you will have a lower incidence of injury and a greater probability of success.
Provided below is a brief review of the information presented at the conference.
Dr. Donald Chu – Recovery and Regeneration: The Missing Part of the Equation
Our first presenter, Donald Chu, provided a broad overview of the importance and application of recovery, regeneration and rehabilitation. In selecting conference presenters, I was looking for someone who had a wealth of experience in many different areas. In addition to providing some of the foundational texts on plyometrics and power training in North America, Dr. Chu also has a significant professional and academic career in physical therapy, having received his PhD in physical education and physical therapy from Stanford University. He also served as the Director of Athletic Training and Rehabilitation at Stanford. Dr. Chu also currently serves as the President of the California State Board of Physical Therapy.
Dr. Chu began his presentation by recounting his experiences as a track and field coach at California State University and highlighting his work with his high jumpers (see the embedded video for his introduction). He conveyed what he had learned in regards to workloads, quality of work and recovery in his efforts to get his high jumpers over the magical barrier of seven feet. What he found to be of most importance, was the need to maintain an optimal equilibrium between training, social life and recovery. The purpose, in his words, was to avoid acute exhaustion and overtraining.
Dr. Chu outlined the factors that influence recovery, including age, experience, gender and several environmental factors. He followed these descriptions up with a review of three main means of restoration, including physical, medical and psychological modalities – which he maintained must be used in combination. Dr. Chu continued his presentation on the specifics of recovery durations, particularly for explosive training methods such as plyometrics. He concluded by highlighting the fact that “recovery” is often the most overlooked variable in a training program.
Chad Brenzikofer – Neurodynamics in the Evaluation and Treatment of Hamstring Injuries
Working out of Denver, Colorado at Muscle Management Therapies Inc., Chad Brenzikofer came recommended to me by Al Vermeil. His presentation, based largely on the work of Dr. Alf Breig and Michael Shacklock, covered the management and prevention of hamstring injuries through the application of Neurodynamics. The clinical definition of Neurodynamics is, “the clinical application of mechanics and physiology of the nervous system as they relate to each other and are integrated with the musculoskeletal function.” In a quick survey of the audience, when asked who had incurred at least one hamstring injury in their athletic careers, over half the audience raised their hand. This high incidence of hamstring problems highlighted the importance of identifying the key causes and treatment options for these types of injuries.
Brenzikofer spent a good deal of time in his presentation addressing issues around stretching and tension. Although stretching can be used to alleviate tension, in many cases inappropriate methods of stretching have been employed that only exacerbate the problem. He presented the idea that application of Neurodynamics can help facilitate movement of nerves within the musculoskeletal structures without stretching and irritating the nerves themselves. In cases where soft-tissue hamstring injuries exhibit tingling, numbness and pain-free muscle weakness, caregivers must be able to differentiate between specific soft-tissue injuries and nerve-related issues. Treatment of the nervous system without moving the musculoskeletal structures can allow for enhanced sliding of the nerves without nerve stretching, further irritation and continued dysfunction.
This presentation provided me with a different perspective when evaluating and managing musculoskeletal injuries that do not respond to conventional means of recovery and rehabilitation. A greater understanding of functional anatomy and nerve movement can go a long way to determining the cause of injury and the potential path to full recovery.
Lyle McDonald – Nutrition for Recovery and Regeneration
Lyle provided what could best be described as a fact-filled flurry of information regarding nutrition and recovery. While his website and books have provided me with lots of good information in the past year, there is nothing quite like hearing Lyle talk in person about the topic of nutrition. There was so much information flying past my brain during the 90 minute presentation that it felt like an advanced level of “Guitar Hero: The Nutrition Edition.”
Lyle’s presentation highlighted where nutrition can influence recovery, including overall health and wellness, immune function, connective tissue health, acid-base balance, sufficient sleep and workout recovery. He also pointed out that different sports have different nutritional requirements. “One size fits all nutrition doesn’t fit anybody,” according to Lyle. While some endurance athletes may respond well to high-fat diets, others may be more partial to high-carbohydrate diets.
He also spent a good deal of time on caloric requirements, nutrient recommendations and the role of dietary protein. Some key points included:
– Fiber – most athletes don’t eat enough.
– Fluids – five clear urinations per day, two after training
– Fats – fish oils required – 6 to 10 one gram capsules daily, flax oil is not ideal
– Iron – men should be aware of iron overload, while women need to choose multivitamins with significant iron content
– Antioxidants – excessive amounts may impair adaptations to training
– Common micronutrient deficiencies – iron, zinc, B12, calcium, magnesium
Lyle then got into a discussion of the timing of nutrition. He recommended that athletes consume nutrients at least 1-4 hours before training to ensure appropriate blood glucose levels, hydration and amino acid intake. Immediately prior to training, fat and fiber should be avoided, while liquid forms of carbohydrates work well. During workouts, consumption of carbohydrates and protein can improve performance and decrease fatigue. Following workout, Lyle discussed the need to resynthesize glycogen, improve long-term adaptations to training and enhance recovery prior to the next training session. He identified the one to two hour window following training as appropriate for consumption of required nutrients.
Other topics covered by Lyle included immune system function, connective tissue and bone health, sleep quality, acid-base balance and special populations. All in all, it was an extremely informative 90 minutes.
John Gray – Spine Stability and Movement Retraining in Recovery from Back Injury
John Gray’s presentation focused mainly on identifying the key causes of back injury (i.e. instability versus postural issues), as well as the primary means of retraining the muscles in question. Having seen some of John’s previous presentation, I know he is always dealing with the definition of “instability” and “core” training. He always points out that too many people are focusing on the “core” and not looking more comprehensively at all movement patterns and the body as a whole. Although many people focus on addressing spinal instability, other peripheral sources of weakness and instability can lead to back injury (i.e. hip muscle imbalance). If overall movement patterns and coordination is improved, the incidence of back injury and re-injury can be reduced significantly.
John then got into some exercise progressions for movement training (see embedded video clip) and emphasized the need to progress gradually through the exercise program. He identified some daily exercises that should take no more than 10 minutes to improve your motor coordination and movement efficiency for back health. We went over the following exercises:
– Lower abs sustained contraction
– Bent-knee leg lifts
– Side-lying leg lifts
While none of these exercises are dynamic or sexy, they do provide an effective means of re-training the required muscles, particularly for non-athletic individuals who may not have fabulous motor coordination to begin with.
Some key points that John left the audience with included:
– Train the trunk and don’t worry about “deep” muscles being activated
– Train the trunk dynamically – isometric holds do not improve core performance
– Don’t train the tests that are used to evaluate core stability
– You can train unilaterally (i.e. single leg), but bilateral training is a must, especially for heavy loads (i.e. squats)
– Movement awareness is the key to progress
– Focus on lower extremity proprioception and peripheral sources that can complicate back injury
Denis Thompson – Innovations in the Application of Electrotherapy for Recovery, Regeneration and Rehabilitation
Our original presenter, Giuseppe Gueli, had to cancel his trip to Vancouver due to contractual obligations to one of his key clients. However, Denis Thompson from the Accelerated Recovery Performance (ARP) company was gracious enough to fill in for Giuseppe on short notice.
Denis began his presentation with an exuberant introduction of how the ARP program relaxes muscles, eliminates conventional stretching and increases the ability of the body to absorb force. We had a football athlete in attendance that has had chronic patellar tendonitis in both knees to a point where he has not been able to play a game in his two years at our university. Denis promptly ran him through some quick muscle tests which drew the ire of a few of our therapists in attendance. The rest of us were unsure as to what actually was being tested. Long story short – the tests didn’t really contribute to the assessment of the problem, but only highlighted the questionable nature of certain muscle testing protocols and the intent behind them.
The next phase in the treatment of the football athlete was searching for the muscles that were causing his knee tendon pain. Denis hooked the athlete up to the ARP unit, placing one pad on the knee and the other on the opposite quadriceps. After a few minutes of the “search and destroy” process (see embedded video clip), Denis found that the vastus medialis was the culprit muscle and began to treat the athletes right quadriceps with a pad on the vastus medialis and another pad on the vastus lateralis. The treatment consisted of turning up the ARP muscle stimulator to a point where the athlete could no longer tolerate any further current (i.e. a 10 out of 10 on the discomfort scale) and then have him perform a set of assisted squats. The discomfort subsided after each set and Denis continued to dial up the current. More sets of squats were performed and eventually the athlete was feeling no pain in his patellar tendon. I check in with the athlete a few days later and he informed me that he was pain free for two days, and then the knee pain returned to normal levels. However, he was encouraged by the results and felt it merited further investigation.
A number of audience members were still skeptical about the process and asked Denis about peer reviewed research on the protocols used by ARP. We discovered that all of the information published on the ARP website is anecdotal, with a peer reviewed article due for publishing in August of 2009. There was also a question about the ARP unit itself and whether or not it was FDA approved. Denis responded by saying that the unit was approved back in 1989 under the name Therastim.
It was an interesting presentation and demonstration that created a lot of controversy and heated discussion. It will be interesting to see where the ARP goes from here. They have a significant following amongst NFL players and have been making inroads in other professional sports. It is obvious that the unit and the protocols are working on some level. Even after Denis Thompson’s presentation, it is quite unclear as to what is happening on a physiological level. I will be watching for more peer reviewed studies on this technology in the future.
Books By Donald Chu
Books By Lyle McDonald