Sunday, August 12, 2018

I'm a Physical Therapist Now!

And so I've expanded the areas covered by my blogging to reflect that. Most of my blogging will now be over at stevenhirschpt.com.

This new blog will reflect my increased training, education and interests. In addition to continuing material on Strength & Conditioning training for HEMA, fencing, martial arts and other combat sports, I will also be writing about:
  • Physical Therapy – these posts will fall into to categories:
    • Patient oriented articles
    • Therapist oriented articles, that is content intended for fellow physical therapists and related professionals
  • General Fitness – while I had a few of these over at my old blog I will get more into this topic here given my expanding work
  • Strength & Conditioning  – for non-athletes and those in sports other than combat sports, as well as strength & conditioning for non-traditional athletics like dance, rock-climbing, circus etc.
  • Nutrition – now part of my formal certifications as a Certified Strength & Conditioning Specialist (CSCS)
  • Science, Skepticism and Science-Based Medicine – my true love/obsession, which underpins everything else I do.  Based in large part on what I’ve learned over at SBM and Neurologica.
Thanks for joining me.

Bad News Everybody!

or

On How I Continued Strength Training with a Broken Finger

About a month ago I broke a finger. My right index finger, proximal phalanx. Yes, I'm  right-handed.
I broke it sword-fighting. (For those who don't know I do Historical Fencing at Athena School of Arms.) My opponent's sword hit a gap in my protective gear. The hit split my skin all the way down to the tendon. There was a visible, longitudinal defect in the tendon - that I got to see in the ER. And there is a diagonal fracture along the length the bone. Minor as far as fractures go - not displaced or open.
And so I was put into a heavy duty splint. It immobilized me from the tip of the index finger down to the carpal bones. With the middle finger included in the finger splint, almost like buddy taping the fingers. And it wrapped around the base of my thumb. I could barely get my thumb and pinky finger to grip.

But I Did Strength Training Anyways

I'm not convinced the OT who created my splint would have really approved of my exercise routine, but . . .
There was no chance I was going to stop unless it was impossible.

Lower Body Strength Training

Squats, and variants thereof, were alright, it was just harder to grip the bar solidly to stabilize it. I've just been concerned with the fail state - if I had to ditch the weight I can't move my hand out of the way as easily as usual.
Deadlifts are right out because I can't generate the grip strength necessary. So I replaced them with barbell hip thrusts. It's possible to move a surprising amount of weight with this. I'm up to almost 300 pounds with this. Single-leg deadlifts were still doable because the weight was light enough to grip.

Upper Body Strength Training

This is where it got interesting. I couldn't do any pushing exercises because the splint came down across the heel of my palm by the thumb. And of course I had trouble gripping for pulling exercises!
I solved this with a lifting hook. This is like the more common lifting straps, but I went for something more intense, these: Lifting Lab Weightlifting Hooks. These put almost all the pull into the strap around my wrist letting me do pulling exercises pretty close to normal. I even reached a point where I could do pullups!
The other workaround I used was to put an ankle strap around  my wrist and use a cable column machine for flyes, reverse flyes and front raises. This allowed me to target both the pecs with the flyes and the deltoids with the raises. Thereby covering the same muscles I would work with typical pushing exercises. This preserves the muscle performance.
When I got back to bench press last week my plan had worked and I had maintained nearly 100% of what I was at when I broke my finger (5 pounds away from finally benching 2 plates!)
And the reverse flyes hit the mid-back muscles until I was able to return to doing rows instead.

Olympic Lifts

. . . were right out. Boo. But I continued with box jumps to keep up my lower body explosive power.

Progress

At my follow-up appointment last week the splint got reduced to just a finger splint, freeing up most of my hand and allowing me to go back to doing regular pushing exercises. Hooray!
Finger splint
After a few weeks like that and now I can even take the splint off and type normally.

The Physical Therapy Attitude

I didn't let my injury stop me anymore than absolutely necessary. I kept up with every exercise I could and adapted those that were not doable in the usual manner. A big part of what I see physical therapy as being good for is this concept of maintaining function and adapting instead of stopping activity. We keep people moving. No matter what (almost).

Tuesday, March 29, 2016

Part 2: FALSE: "If you can't do it slow, you can't do it fast."

As expected this particular post created some immediate responses from people who disagree. And some of them were quite predictable. Such as:
  1. Well not for me or not in my art.
  2. Not in this entirely different scenario or type of training.
  3. Not when it's used for this unrelated purposes.
The reason I'm putting these objections in generic is to show how this post can be generalized. These types of responses should be called out for what they are whenever they show up.

HADOUKEN!
 (Image included again for my own amusement)

Well it worked for me - Nope


We've seen this before. In this particular type of situation we have the common error of attributing a satisfactory level of success to a training method that may not have anything to do with it.

  1. That a given level of success is reached does not prove that this method produced the highest level of success attainable.
  2. That a given amount of time was necessary does not prove that this method was the most time efficient method of achieving that.
  3. That a given result occurred when multiple methods were employed does not prove that all methods were necessary for that result.
  4. That a given volume of a method was employed does not prove that this was the optimal quantity of that training mode.
The last element is important because I acknowledge the value of slow training when utilized an appropriate amount.

What the person is actually saying when they say, "it worked for me" is that it produced a result they are satisfied with, in a time frame they are satisfied with, and as part of the set of things they did. They can't actually, logically at least, assert that it was the optimal method because no controlled experiment was performed.

And the controlled experiments clearly contradict this assertion.

Well it works in my art


This is an alternate version of the same excuse. The reply I got was that it works for "internal" martial arts. But unless "internal" means you just imagine the fight, then this it's just not true. To block, dodge and hit against, a resisting opponent you have to move fast. To move fast you have to train fast and you have to keep your slow training to an appropriately small amount.

The general logical fallacy term for this argument is Special Pleading.

Not in this different thing


Another reply I got was about situation awareness training. Well, that's not motor programming, so it was neither the original topic nor what I was talking about. Irrelevant.

There was also the reply about how it's good for balance. But that's not the same thing either but in a different way. Being balanced while moving slowly is not the same as maintaining balance while moving fast. It requires more power to stay balance at speed and this requires fast muscle movements as well. It requires fast reaction times and those are not trained at slow speeds either.

Not when it's used for this unrelated purpose


Yet another was that slow training is good for stretching. So what if slow actions are good for stretching? That's not relevant to martial arts application. That's not what we are talking about.

They are plenty of ways of stretching a muscle or joint besides using a specific technique from your art. And I don't want to interfere with the technique training by using it for this unrelated purpose.

Additionally, while I'm all for dynamic stretching this does not increase range of motion (the suggested benefit) and slow actions are not good dynamic stretching because it won't warm you up.

Not even slow training


One response was about how holding stances for a long time was good for conditioning. That's not even slow training. You've wandered off topic to grasp at straws to prove me wrong. Nope.

Conclusion


Turns out you weren't going to contradict my professional education and depth of knowledge regarding the decades of research with a quick sentence. Nope.

Certified Strength & Conditioning Specialist

I passed my Certified Strength & Conditioning Specialist examination yesterday! And I'll have a nice fancy piece of paper to put on the wall in about a month.

This is National Strength & Conditioning Association certification and they describe it like this:
Certified Strength and Conditioning Specialists (CSCSs) are professionals who apply scientific knowledge to train athletes for the primary goal of improving athletic performance.
They conduct sport-specific testing sessions, design and implement safe and effective strength training and conditioning programs and provide guidance regarding nutrition and injury prevention.
Recognizing that their area of expertise is separate and distinct, CSCSs consult with and refer athletes to other professionals when appropriate.

I am proud to have earned this qualification and I enjoyed going back and doing the necessary study to pass the exam. I am amused that the test included a variety of Administration and Organization questions that are really geared towards heading a large facility. I did worst on this part of the test. So I'm not qualified to head a large facility yet. So it's good that I don't. But all the things expected of a facility like my own I am doing correctly.

The certification also covers nutrition guidance. Between the studying for this and other recent reading I've done on the topic I will be formally adding this to the set of services that I provide.

Now I'm going to see how many entries for the blog I can bang out in a week.

Tuesday, March 22, 2016

Small Break for CSCS Exam

Hello all,

The reason I haven't been posting for a bit now is that I am studying up for my Certified Strength and Conditioning Specialist (CSCS) certification from the National Strength and Conditioning Association (NSCA).

As such I am spending all of my "free time" studying. This is great. It is an opportunity for me to review and be reminded of little things that I have forgotten over time. Humans cannot just remember everything. Our brains do not work like computer hard drives. Periodic re-testing and continuous learning are both necessary simply to avoid sliding backwards.

See you sometime after the 28th.

Cheers,

Friday, March 4, 2016

The Role of Accessory Exercises

In the exercise plans that I put together for Longpoint I categorize the exercises as being either, Power, Primary or Accessory. The role of the power and primary exercises I assume are clear, but I think that elaborating on the accessory exercise concept will be helpful.

Why Are There Accessory Exercises at All?


I could, and I have, put together programs where all of the exercises are done at the same intensity. And for a general purpose, full body program that's perfectly fine. Though you will want to program the bigger exercises first so that you aren't fatigued when doing your deadlifts or squats.

However, for sport specific and advanced programs there is a level of focus on specific exercises that creates better benefits. If all the exercises in a day were at the 5RM intensity then the later exercises would suffer, you just wouldn't be able to actually provide max effort.

Programming Accessory Exercises


Accessory exercises will follow a couple of basic guidelines for how they are incorporated into the program.

  1. Later in the workout. Do the big, complex, multi-joint, power and primary exercises first.
  2. Lower intensity. Accessory exercises should not be more intense than 8RM. In some cases I won't do more than 10 or 12 RM, for exercises that use a small number of muscles.
  3. Cover the movement patterns that aren't under the primary exercises. The objective is a balanced full-body program, but not all the muscles need the same intensity each day.


Progressing Accessory Exercises


With our major exercises it's important to see progress. If you're not seeing progress it means that there is a problem that needs to be fixed. With the accessory exercises there should be some progress over time, but it does not need to be fast. If I do the same weight for an entire month that doesn't worry me.

And some of the more minor exercises are really about factors like balance and stability rather than strength. In these cases it's sufficient to just keep doing them, rather than to push them to be substantially harder. These are exercises like the mini-bands that I've described before.

Conclusion


Don't confuse the purpose of primary and accessory exercises. They are both necessary parts of a complete program but the primary exercises are the ones that will have the biggest effect on performance, injury prevention and health. The accessory exercises round out the program and complete it.

Saturday, February 27, 2016

Knees Over Toes Lunges

There exists a common piece of wisdom in fencing training that the knee should not extend in front of the toes while lunging. My friend Max asked about this recently. One part of the question is that both a limited lunge and lunge with the knee more flexed show up in historical manuals.

A "perfect" lunge with the knee behind the toes.

A lunge with the knee well past the toes.
And both kinds of lunge can also be seen in high-level competitors in modern sport fencing.

The Principles


The concern is generally phrased that letting the knee go past the toes will damage the knee in the long run. Others will argue instead that as long as the knee is strong enough that it shouldn't matter.

From a technical terminology standpoint we are talking about the amount of flexion at the knee joint. The top picture shows about 110° of knee flexion (0° is the knee straight). The bottom picture would be closer to 130° if the thigh were parallel to the ground - as it is the angle looks similar but this fencer has their hips higher than the other.

The forces on the various structures of the knee change throughout the range of motion. The ligaments are tightest around 90°, so the lunge differences we are discussing won't matter since both options flex the knee past 90°.

Compressive forces on the  cartilage and articular surfaces increase with knee flexion. Forces between the underside of the patella and the femur are larger than the forces between the femur and the tibia and menisci. Theoretically this means the kneecap would be at greater risk, but really there are enough differences between the ways an injury can occur that a simple comparison of the numbers is not compelling.

The Research


Well, I couldn't find any published research on this question. But since all the peer-reviewed research on fencing could fit on a 3.5" floppy disk, that isn't surprising. The closest research I could find was on squat depth, such as, "Are Deep Squats a Safe and Viable Exercise?"[1] This is a commentary article where a for and against position are presented by different exercise scientists. The article summarizes a large number of relevant studies. I'm going to extrapolate from this to our question about lunges - any time conclusions are extrapolated or generalized from separate research we should be aware that we could easily be wrong. There could be any number of unaccounted for factors in our lunge question that just don't show up in squat research.

There is ambiguity in the research regarding the risk of injury from deep squats. Overall it would seem that there is no clear correlation in population studies between injury and squat depth. But this could be explained by self-selection. That is, those individuals who continue and/or do well with deep squat exercises are those whose knees would not have been injured - for whatever reason, perhaps some natural advantage of their joint architecture. While those who refrain from deep squats, even for unconscious reasons, may  be more susceptible.

Biomechanics studies clearly show greater compressive forces from deep squats. And greater forces do mean greater likelihood of both acute and chronic injury. So the concern is certainly plausible.

The above is for healthy individuals. In those with known knee problems we can be confident that limiting squat depth, and by extension the knee position in lunges, will reduce pain. The safe generalization is that the motion - squat or lunge - should remain within a pain free range. Whether that is sudden pain during the motion or the ache afterwards doesn't matter, pain is our indication to avoid that extreme.

Tactically


There is also, of course, the tactical considerations of lunge length. The more the knee is flexed the longer the lunge that can be obtained. A longer reach is it's own tactical advantage. However, a longer lunge is also a longer recovery. So there is a trade-off - higher risk of getting hit by the riposte or afterblow. As a technical coach I would counsel a more conservative lunge, but that is based on my study of Hope's system.

As a fencer I will sometimes take much longer lunges, when I feel the opportunity is right. Sometimes I am wrong and my opponent gets the afterblow. Sometimes I still fall short, but don't get hit either, in which case I was still wrong, just not as wrong. And sometimes I hit where otherwise I would not have and do so safely.

The ability to recover quickly from a long lunge is dependent on the strength of the lead leg, and I think this is where the biggest component of strength actually plays into our question. A strong leg is less likely to suffer many kinds of injuries, but not really the kinds of injuries that occur from deep knee flexion. There are legitimate exceptions though. One of the fencers I train has healthy knees that can withstand a long lunge, but her strength in balance is lacking and she falls too often. I'd tell her to limit her lunge length to reduce injury and falls (but she's 14 so I don't expect it to take).

On the other hand one of my frequent opponents has a nice technically perfect lunge length and knee angle, but her strength-to-weight ratio isn't as good so she has a slow recovery. Which I can exploit when we fence.

Conclusion


If the historical system you study shows a deep lunge then I would feel free suggesting a person train that, as long as it's pain free.  In general, I will always counsel a conservative approach; it is easy for young, healthy athletes, or simply highly competitive adults, to overtax themselves in ways that they will regret years later.

And there is a component of individualization, rather than a one size fits all answer. This is the responsibility of the coach and requires time, observation, experience and thought to answer


Bibliography
1. Schoenfeld, B., & Williams, M. (2012). Are Deep Squats a Safe and Viable Exercise?: Strength and Conditioning Journal, 34(2), 34–36. http://doi.org/10.1519/SSC.0b013e31824695a3